Variants of the IL23R gene are associated with ankylosing spondylitis but not with Sjögren syndrome in Hungarian population samples

Recently, associations were found between several autoimmune diseases and functional variants of interleukin-23 receptor (IL23R) gene; here, we studied the possible association of nine polymorphisms of IL23R with ankylosing spondylitis (AS) and with Sjögren syndrome (SS). In our study, we genotyped groups of patients with AS (n = 206), SS (n = 156) and healthy controls (n = 235) for rs11805303, rs10889677, rs1004819, rs2201841, rs11209032, rs11209026, rs10489629, rs7517847 and rs7530511 variants using PCR-RFLP methods. We observed significant increase in the carriage of the T allele of rs11805303 and the A allele of rs1004189 in the AS group compared with the controls. For the rs10889677 variant, the prevalence of the AA genotype and for the rs2201841, the CC genotype showed a more than two-fold increase in the AS group compared with the controls. By contrast, the GA heterozygous genotype of rs11209026 variant showed a significant decrease in AS patients compared with controls. Haplotype analysis revealed association of four IL23R haplotypes with AS. There was no difference in the distribution of any of the examined IL23R variants between controls and SS patients. In conclusion, we confirmed the susceptibility or protective associations of IL23R polymorphisms with AS in a Hungarian population and first demonstrated the involvement of the rs11805303 intronic single nucleotide polymorphisms, which was tested so far only for other autoimmune diseases.

[Megacolon and arthritis]

In the present report the authors describe four cases with megacolon and arthritis. The etiology of these unique associations is known in only one case. The musculoskeletal pictures belong to the group of seronegative spondyloarthritis. A huge resistance with great scibalas was detected in the left iliac region by physical examination in all cases. Surgical procedures of the colon resulted in complete remission of arthritis in one case, in the others, chronic obstipation with intermittent relapse of arthritis persisted.

Structural polymorphisms in the mannose-binding lectin gene are associated with juvenile idiopathic arthritis

OBJECTIVE

To investigate the possible association between polymorphisms of the mannose-binding lectin gene (MBL2) and susceptibility to juvenile idiopathic arthritis (JIA).

METHODS

We performed a case-control association study including 118 Hungarian patients with JIA and 118 sex-matched healthy controls. MBL genotyping for the 3 mutant structural alleles at codons 54 (B), 57 (C), and 52 (D) in exon 1 and the promoter polymorphisms at position -550 (HL) and -221 (YX) were carried out by real-time PCR allelic discrimination. Serum level of MBL was determined by ELISA.

RESULTS

Variant allele frequencies of both codon 52 and 57 polymorphisms in the MBL2 gene were significantly overrepresented in JIA (p=0.001 and p=0.004, respectively). The frequency of low MBL genotypes (XA/XA, YA/YO, XA/YO, and YO/YO) in JIA was higher than that in healthy controls (p=0.001). Serum MBL concentrations were found to be significantly lower in JIA patients versus control subjects (p=0.001). The 2 promoter polymorphisms and codon 54 SNP of the MBL2 gene were not associated with JIA.

CONCLUSION

Our findings suggest that genetically determined low MBL levels may predispose children to JIA in a Hungarian population. These data warrant further research to investigate the role of the lectin-dependent complement system in the pathogenesis of JIA.

Role of HLA-DRB1 and PTPN22 genes in susceptibility to juvenile idiopathic arthritis in Hungarian patients

OBJECTIVE

Juvenile idiopathic arthritis (JIA) is a complex immune-mediated disease characterized by environmental influences along with several predisposing genes in the pathogenesis. The present study was undertaken to investigate the association of polymorphisms in two candidate genes for autoimmunity, human leukocyte antigen (HLA) DRB1 and protein tyrosine phosphatase N22 (PTPN22) with JIA in Hungarian patients.

METHODS

A case-control study including 150 Hungarian JIA patients and 200 sex and ethnically matched healthy controls was conducted. Genotyping for HLA-DRB1 and PTPN22 C1858T single nucleotide polymorphism (SNP) (rs2476601) was carried out by group-specific PCR amplification and by real-time PCR allelic discrimination, respectively.

RESULTS

In Hungarian patients JIA was associated with HLA-DRB1*01, DRB1*08, DRB1*13 (p=0.048, p=0.002, p=0.019, respectively) with marked differences between the disease subtypes classified according to the ILAR criteria. There was no association of the PTPN22 C1858T SNP with JIA (p=0.66). No correlation was found between the presence of this PTPN22 SNP and HLA-DRB1 alleles.

CONCLUSIONS

Our results confirm that certain HLA-DRB1 alleles reported previously as susceptibility factors are strongly associated with JIA in a Hungarian population. However, C1858T polymorphism of PTPN22, another candidate gene of autoimmunity seems to be independent of JIA in Hungarian patients. Our data taken together with various findings in different populations suggest that associations related to PTPN22 seem to be more ethnicity-specific in contrast to the general and less population-dependent role of HLA-DRB1 in JIA.

Natural autoantibodies reactive with glycosaminoglycans in rheumatoid arthritis

Introduction

Although natural autoantibodies make up the majority of circulating immunoglobulins and are also present in high numbers in therapeutically used intravenous immunoglobulin preparations, they have received little attention and their precise role remains largely unknown. An increasing awareness of the importance of posttranslational autoantigen modifications and glycobiology led us to explore carbohydrate-reactive natural autoantibodies in patients with rheumatoid arthritis. This study examined systematic antibodies reactive to glycosaminoglycans (GAGs), the carbohydrate components of proteoglycans that are released in large amounts from degrading cartilage.

Methods

To measure antibodies reactive to six different types of GAGs, a specialised ELISA was used in which the carbohydrates were covalently linked to the plastic surface through a 2 nm spacer. Sera from rheumatoid arthritis patients (n = 66), umbilical cord serum samples (n = 11) and adult controls (n = 54) were studied. In order to explore cross-reactivity with microbial antigens, bacterial peptidoglycans and fungal polysaccharides were used. Sera and synovial fluid samples were also tested using a GlycoChip carbohydrate array to characterise individual carbohydrate recognition patterns. We followed a multistep statistical screening strategy for screening GAG-reactive antibodies as predictive disease markers.

Results

While anti-GAG antibodies were absent in the umbilical cord sera, they were readily detectable in adult controls and were significantly elevated in patients with rheumatoid arthritis (p < 0.001). Anti-GAG antibodies showed significant cross-reactivity among different types of GAGs. They also reacted with bacterial peptidoglycans and fungal polysaccharides. Interestingly, anti-chondroitin sulphate C IgM antibody levels showed inverse correlation both with the Disease Activity Score (DAS) 28 scores and C-reactive protein (CRP) levels in rheumatoid arthritis.

Conclusion

The highly abundant and cross-reactive, GAG-specific natural autoantibodies in serum may serve as novel disease-state markers in patients with rheumatoid arthritis.

Impact of disease progression on health status, quality of life and costs in rheumatoid arthritis in Hungary

A rheumatoid arthritis (RA) krónikus, progresszív, szimmetrikus sokízületi gyulladás. A betegek hosszú távú gondozásához és a költséghatékonysági modellekhez alapvető ismerni és standardizáltan mérni a betegség lefolyását és annak következményeit. Célkitűzés: A betegségprogresszió és az egészségi állapot, életminőség és költségek kapcsolatainak vizsgálata magyarországi RA-s betegeken. Módszer: 2004. április–augusztus között keresztmetszeti kérdőíves vizsgálatot végeztek RA-s betegek bevonásával hat fekvőbeteg-osztályos háttérrel rendelkező járóbeteg-szakambulancián. Standardizált kérdőívekkel vizsgálták a betegség progresszióját kifejező funkcionális állapotot (HAQ), az egészségi állapotot (EQ-5D), a betegségspecifikus életminőséget (RAQoL), felmérték a betegségaktivitást (DAS) és a betegséggel összefüggő költségeket, elemezték e paraméterek kapcsolatát. Eredmények: 255 beteg adatait elemezték [átlagos életkor: 55,5 ± 12,3 év; a betegség fennállása: 9,0 ± 9,3 év; HAQ: 1,38 ± 0,76; EQ-5D: 0,46 ± 0,33; RAQoL: 16,2 ± 8,1; DAS: 5,09 ± 1,42; költség: 1 043 163 (± 844 750) Ft/beteg/év]. Szignifikáns korrelációt találtak az összes esetben ( p < 0,01), függvénykapcsolat volt kimutatható: EQ-5D index = 1,014–0,25 × HAQ–0,041 × DAS és HAQ = 0,314 + 0,065 × RAQoL. Betegségsúlyossági csoportonként (0,5 HAQ-léptékkel) vizsgálva, az egészségi állapot átlaga rosszabbodott (EQ-5D: 0,784; 0,576; 0,504; 0,367; 0,211; 0,022), és az átlagos költség emelkedett (628 280; 888 187; 953 759; 1 291 218; 1 346 112; 1 371 674 Ft/beteg/év) a betegség előrehaladásával. Minimális klinikailag szignifikáns funkciócsökkenés (0,25 HAQ-változás) 0,0705 EQ-5D-csökkenésnek és 1,884 RAQoL-emelkedésnek felelt meg, nem súlyosan aktív (DAS < 5,1) esetekben kisebb a változás (EQ-5D: 0,05725). Következtetések: A betegségprogresszió és az általános egészségi állapot, életminőség és a költségek kapcsolata nem tér el jelentősen a nemzetközi eredményektől. A betegségköltségek nagysága azonban jelentősen kisebb Magyarországon, mint a fejlett országokban. A vizsgálat adatokkal szolgál a hazai egészség-gazdaságtani elemzésekhez.

Physiological up-regulation of inhibitory receptors Fc gamma RII and CR1 on memory B cells is lacking in SLE patients

Under physiological conditions immune complexes (IC) are efficiently cleared from the circulation and meanwhile provide important feedback signals for the immune system via Fc gamma Rs and complement receptors. Dysregulation of these mechanisms have been implicated in conditions where IC concentrations reach pathological levels and inflict diseases, like systemic lupus erythematosus (SLE). Our aim was to compare distinct sub-populations of CD19(+) B cells of healthy individuals and SLE patients with regard to their expression of Fc gamma R type II (Fc gamma RII, CD32), complement receptor type 1 (CR1, CD35) and complement receptor type 2 (CR2, CD21) and sIgG/IgM. The following four groups of peripheral CD19(+) B cells were investigated: IgM(+)/CD27(-) naive, IgM(+)/CD27(+) and IgM(-)/CD27(+) memory cells and CD27(high) plasmablasts. We demonstrate that the expression of the inhibitory receptors Fc gamma RII and CR1 is up-regulated on peripheral memory B cells of healthy controls, whereas this up-regulation is considerably impaired on the memory B cells of SLE patients. This reduction affects both the IgM(+) and switched memory B cells. We found a striking difference between the expression of complement receptors CD21 and CD35; namely, no up-regulation of CD21 occurred on the memory B cells of healthy donors, and its decreased expression in SLE patients was characteristic for both the CD27(-) naive and the CD27(+) memory B-cell populations. Our results clearly demonstrate that the previously reported reduced expression of IC-binding receptors is mainly due to the disturbed memory compartment; however, the higher frequency of CD19(+)/CD27(high)/sIg(low) plasmablasts expressing minimal levels of these receptors also contributes to this diminution.

Genetic background of anticyclic citrullinated peptide autoantibody production in Hungarian patients with rheumatoid arthritis

Polymorphisms of the peptidylarginine deiminase 4 (PADI4) gene encoding for the isoenzyme that converts arginyl into citrullyl residues have been shown to contribute to susceptibility to rheumatoid arthritis (RA), depending on the population studied. We aimed at determining whether PADI4 single nucleotide polymorphisms (SNPs) are associated with RA in a Hungarian population. The relationship between anticyclic citrullinated peptide (anti-CCP) production and HLA-DRB1 alleles encoding the shared epitope (SE) was also investigated. DNA samples were obtained from RA (n = 261) patients and from control donors (n = 120). HLA-DRB1 genotyping was carried out by polymerase chain reaction (PCR) with sequence-specific priming. PAD4_92 G/C and PAD4_104 T/C SNPs were genotyped using real-time PCR allele discrimination. Autoantibodies against CCP were detected by ELISA. All healthy controls tested anti-CCP negative, whereas 171 (66%) RA patients were anti-CCP positive. No significant difference in allele or genotype frequencies were found between RA patients and controls for any of the PADI4 SNPs. Anti-CCP seropositivity was unrelated to these two SNPs. No association was found between any of the PADI4 SNPs and HLA-DRB1 subtypes. Presence of the HLA-RB1 SE alleles was significantly associated with anti-CCP seropositivity; HLA-DRB1*0401 and HLA-DRB1*1001 carriers showed the strongest association. In conclusion, our data suggest that polymorphisms of the PADI4 gene are not associated with rheumatoid arthritis and are unlikely to be responsible for the presence of anti-CCP autoantibodies in a white Hungarian population. HLA-DRB1 SE alleles, however, may significantly contribute to the genetic determination of anti-CCP production in Hungarian patients with RA.

[New ways in the management of rheumatoid arthritis in Hungary]

Rheumatoid arthritis is an autoimmune rheumatic condition of unknown origin. Due to its high prevalence, incompletely solved therapy, significant impact on mortality and morbidity, and the psychological and economic burden it puts on the patient, family and society, rheumatoid arthritis has a major public health significance. Although its importance is still underestimated both by the public and the medical community, today an improving tendency can be observed. The past decade has seen important breakthroughs in terms of increased recognition of the significance of the disease, as well as in its pathogenesis, diagnosis and therapy. The introduction of new diagnostic and prognostic markers and early aggressive treatment, the establishment of early arthritis clinics, and, most importantly, the successful use of biological therapy have revolutionized the management of rheumatoid arthritis. The paper reviews the modern therapy of the disease, touching on the options available in Hungary.

Rituximab in patients with rheumatoid arthritis: systematic review

A rheumatoid arthritis terápiájában legújabban alkalmazott gyógyszerek a biológiai szerek. Legutóbb a B-lymphocyta-gátló rituximabot törzskönyvezték rheumatoid arthritis indikációjában. A rituximabot eddig a non-Hodgkin-lymphoma kezelésében alkalmazták. Európai és a magyar reumatológusok ajánlása szerint a rituximab rheumatoid arthritisben azoknak a betegeknek javasolható, akiknél a kórtörténetben eredménytelenség vagy toxicitás miatt sikertelen TNF-α-gátló kezelés szerepel. Célkitűzés: A rituximabkezelés klinikai hatásosságáról rheumatoid arthritisben rendelkezésre álló szakirodalom áttekintése. A rituximabkezelés hatásosságának és biztonságának értékelése. Módszer: A szerzők a MEDLINE- és Cochrane-adatbázisokban megkeresték az összes randomizált, kontrollált rituximabvizsgálatot rheumatoid arthritisben. Elvégezték az adatok metaanalízisét. Eredmények: Az irodalomkeresés során 3 randomizált kontrollált klinikai vizsgálatot azonosítottak a szerzők, amelyekben összesen 1145 beteget követtek. A TNF-α-gátló kezelésre nem reagáló, súlyos gyulladásos tüneteket mutató betegeknél rituximabkezelés mellett 33%-kal több betegnek (95%; KI: 25–41%) javulnak a tünetei az American College of Rheumatology 20 kritérium szerint, mint ha nem kezelnék őket. Majdnem 5-ször nagyobb (relatív kockázat = 4,77; 95%; KI, 3,12–7,31) esélyük van a javulásra, mint kezelés nélkül. A funkcionális állapotot jelző Health Assessment Questionnaire pontszám is szignifikánsan nagyobb mértékben ( p < 0,001) javult a rituximabcsoportban (–0,4 pont), mint a kontrollcsoportban (–0,1 pont). Rituximabkezelés hatására a mérsékelt vagy jó választ adó betegek aránya 38%-kal nagyobb (95% KI, 32–44%) a rituximabkezelési ágon, mint a kontrollcsoportban, a különbség szignifikáns ( p < 0,00001). A rituximab a radiológiai progressziót is javítja a TNF-α-gátló kezelésre nem reagáló betegek között. Következtetések: A rituximab új, hatásos terápiás lehetőség a rheumatoid arthritis terápiájában. A TNF-α-gátló kezelésre nem reagáló vagy azt nem toleráló betegeknél is javulás érhető el.

Multiplex site-directed mutagenesis strategy including high-efficiency selection of the mutant PCR products

Site-directed mutagenesis is of great importance for probing the structure/function relationship of proteins. Developing our previous method (Nagy et al. Anal Biochem 324:301-303, 2004), here we report a multiplex strategy for site-directed mutagenesis using PCR in one tube to introduce a single mutation into three or more genes at the same time. DNA fragments carrying the desired mutation can be distinguished from each other in a standard antibiotic selection step of the transformed bacteria. Due to this strategy the mutagenesis procedure for several genes can be accelerated.

Altered Expression of Fc and Complement Receptors on B Cells in Systemic Lupus Erythematosus

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by B cell hyper-reactivity, autoantibody production, immune complex (IC) deposition, and multiple organ damage. The contribution of IC and B cell-mediated changes in the pathogenesis of SLE is well established, however, the exact role of IC-binding receptors expressed on B cells, Fcgamma receptors, and complement receptors CR1 and CR2 in these pathological processes is unclear. Development of lupus-like symptoms in mice defective for the inhibitory Fc-gammaRIIb and genetic association of certain FcgammaR genes with SLE demonstrate a significant role for these receptors but reports indicating alterations of Fcgamma or complement receptor-mediated B cell functions in human SLE are relatively few. The present review highlights a selected set of data including our own discussing the significance of animal models, genetics, and functional alterations of these IC-binding receptors in the etiopathogenesis of SLE.

[When does an autoimmune disease begin? Importance of the early diagnosis]

In autoimmune diseases, such as type I diabetes mellitus, systemic autoimmune diseases and the early phase of rheumatoid arthritis, before the development of a definitive disease, clinical and laboratory alterations can be observed. Being aware of these symptoms is crucial both for family practitioners and specialists, handling autoimmune and early arthritis patients. The early recognition and prognosticating of the disease and sending the patient immediately to a specialist will lead to the exponential improvement of the patient's life expectancies and will also help to avoid complications. The need for special diagnostics, care and treatment made the development of national immunological and rheumatological centers imperative, where sufficient experience and professional knowledge helps the proper medical attendance.

Possible pathogenic nature of the recently discovered TT virus: Does it play a role in autoimmune rheumatic diseases?

Pathogenesis of viral origin has long been suggested in autoimmune rheumatic diseases. Beside the well-defined virus induced transient or chronic rheumatic diseases often resembling systemic autoimmune disorders such as rheumatoid arthritis, viruses can contribute to disease pathogenesis by several different pathomechanisms. TT virus is a recently discovered virus of extremely high genetic diversity which commonly infects humans. Despite accumulated evidence on the biological characteristics of TTV, its pathogenicity is still in question; many consider TTV as a harmless endosymbiont. The recent paper overviews the biology of TT virus and investigates the hypothesis that TTV might have a causative role in human diseases with special attention to the possibility that TTV might trigger autoimmunity in rheumatic disorders.

Epidemiology of Paget's disease in Europe: the prevalence is decreasing

This study estimated changes in the age- and sex-specific prevalence of Paget's disease of bone in six European towns over a 20-year period. Declines in prevalence were observed in this disorder, occurring among both men and women.

INTRODUCTION

To estimate secular changes in the age-and sex-specific prevalence of Paget's disease of bone in Europe, we conducted a second radiographic survey using identical sampling and methods in six European towns where a baseline study was performed in 1978-1979. In addition to these towns, the survey was carried out in two Hungarian centers not included in the initial study.

MATERIALS AND METHODS

In each center, a sample of abdominal radiographs of people >or=55 years of age was taken from stored films within the radiology department of the principal general hospital. Radiographs showing the entire pelvis, sacrum, femoral heads, and lumbar vertebrae were studied for the period of 2000-2001. The films were evaluated by a trained observer and a consultant radiologist.

RESULTS

A total of 6935 radiographs (3512 women and 3423 men) were assessed in the eight towns. The overall age- and sex-standardized prevalence rate of Paget's disease was 0.3% with a male/female ratio of 1.5. Prevalence increased with age among men and women rising to 0.8% of men and 0.9% of women >/=85 years of age. The differences in prevalence rate among the European centers were relatively small, especially in women. There was a decline in rates between 1978/79 and 2000/01.

CONCLUSIONS

These European data confirm the decrease in frequency of Paget's disease observed in Britain. These declines favor an environmental contribution to the causation of the disease that requires further research.

Coexistent Marfan's syndrome and ankylosing spondylitis

We describe a 22-year-old woman with coexisting Marfan's syndrome (MFS) and ankylosing spondylitis (AS). A change of fibrillin-1 due to mutation of the FBN1 gene (MFS) or a cell-mediated autoimmune response in AS could account for a common pathology.

Lack of genetic association of the Toll-like receptor 4 (TLR4) Asp299Gly and Thr399Ile polymorphisms with spondylarthropathies in a Hungarian population

OBJECTIVES

Bacteria have long been suggested as aetiological factors in the genetically susceptible host in spondylarthropathies, including ankylosing spondylitis (AS) and reactive arthritis (ReA). Variability of the Toll-like receptor 4 (TLR4) gene has been shown to play a role in the inflammatory response to certain bacterial infections. We investigated whether TLR4 Asp299Gly and Thr399Ile polymorphisms contribute to the genetic background of spondylarthropathies in a cohort of Hungarian patients with AS and ReA.

METHODS

DNA was obtained from patients with AS (n=138), ReA (n=91) and ethnically matched healthy controls (n=140). Genotyping was carried out by polymerase chain reaction-restriction fragment length polymorphism analysis and the results were confirmed by direct sequencing.

RESULTS

No significant differences in allele or genotype frequencies were observed between controls and either the AS patients or the ReA patients. Clinical characteristics of these groups were unrelated to the presence of any of these polymorphisms.

CONCLUSIONS

Toll-like receptor 4 Asp299Gly and Thr399Ile polymorphisms do not contribute to disease susceptibility in either AS or ReA. Functional abnormalities of the TLR4 signalling pathway suggested in spondylarthropathies seem not to be genetically determined by these two common polymorphisms.

Detection of TT Virus in Patients with Idiopathic Inflammatory Myopathies

The TT virus, a recently identified single-stranded DNA virus with unknown pathogenicity, has been shown to commonly infect humans. Viruses have been considered to contribute to disease pathogenesis in autoimmune disorders including idiopathic inflammatory myopathies (IIMs) and rheumatoid arthritis (RA). We assessed the prevalence of TTV infection in IIM compared with that in patients with RA and healthy blood donors. Detection of TTV was conducted by nested PCR and real-time PCR in the sera of 94 patients with IIM, 95 RA patients. and 95 age- and sex-matched healthy blood donors. Identity of the PCR products was confirmed by sequencing. TTV DNA was detected in 61 of 94 (64.9%) patients with IIM, in 64 of 95 (67.4%) patients with RA, and in 62 of 95 (65.3%; P > 0.05) healthy individuals. Age, sex, activity, or duration of disease had no influence on TTV positivity in either group. However, patients with severe IIM (n = 36) had a significantly higher rate of TTV infection (31/36, 86.1%) than patients with mild disease (30/58, 51.7%, P < 0.05, chi(2) = 10.0). Disease was considered severe in IIM when immunosuppressive treatment was necessary because of continuous high activity and/or serious inner-organ involvement despite corticosteroid treatment. In conclusion, although we found the detection rate of TTV similar in patients with idiopathic inflammatory myopathies and rheumatoid arthritis and comparable to that in healthy controls, our data suggest that infection with TT virus may result in a more severe disease in patients with idiopathic inflammatory myopathies.

Relapsing polychondritis

Relapsing polychondritis (RP) is a rare multisystem autoimmune disease of unknown origin characterized by recurrent episodes of inflammation and progressive destruction of cartilaginous tissues. Elastic cartilage of the ears and nose, hyaline cartilage of peripheral joints, vertebral fibrocartilage and tracheobronchial cartilage, as well as proteoglycan-rich structures of the eye, heart, blood vessels or inner ear may all be affected. In most patients RP manifests in a fluctuating but progressive course which eventually results in a significant shortening of life expectancy. The relatively uncommon occurrence, the unknown etiopathogenesis, the ambiguous clinical pattern, as well as the variety in its course and response to therapy may all contribute to the difficulties the physician must overcome when managing RP. Beside describing the main features of RP and seven clinical cases of our own, in the present review we focus on recent findings in the etiopathogenesis and novel treatment options.

Efficacy and safety of four doses of lumiracoxib versus diclofenac in patients with knee or hip primary osteoarthritis: a phase II, four-week, multicenter, randomized, double-blind, placebo-controlled trial

OBJECTIVE

To compare the efficacy and tolerability of the novel cyclooxygenase 2-selective inhibitor lumiracoxib with placebo and diclofenac in osteoarthritis (OA).

METHODS

Adults (n=583) with knee or hip OA were randomized to receive for 4 weeks lumiracoxib 50, 100, or 200 mg twice daily or 400 mg once daily; placebo; or diclofenac 75 mg twice daily. Efficacy assessments included overall joint pain intensity and Western Ontario and McMaster Universities Osteoarthritis Index subscales; tolerability was evaluated by adverse event and physician reporting.

RESULTS

All lumiracoxib doses were superior to placebo in relieving pain, improving stiffness, and improving physical function after 4 weeks. At study endpoint, pain relief was comparable among all lumiracoxib dosages and similar to diclofenac. Lumiracoxib tolerability was superior to diclofenac and comparable to placebo.

CONCLUSION

Lumiracoxib provides predictable and sustained relief from pain, stiffness, and impaired physical function in OA. Lumiracoxib shows clinically comparable efficacy and superior tolerability to diclofenac.

Efficacy and safety of leflunomide 10 mg versus 20 mg once daily in patients with active rheumatoid arthritis: multinational double-blind, randomized trial

OBJECTIVE

To compare the efficacy and safety profile of two daily maintenance doses of leflunomide, 10 mg and 20 mg, for the treatment of active rheumatoid arthritis (RA).

METHODS

In this multinational, randomized, double-blind, parallel-group study, 402 RA patients were randomized equally to receive daily doses of 10 mg leflunomide (n = 202; loading dose on day 3, 100 mg) or 20 mg leflunomide (n = 200; loading dose on day 1-3, 100 mg) for 24 weeks. The study was designed to demonstrate non-inferiority of the efficacy of 10 mg compared with 20 mg by calculating 95% confidence intervals for differences in changes in tender joint count (TJC), swollen joint count (SJC) and Health Assessment Questionnaire Disability Index (HAQ DI), comparing these confidence intervals with predefined bounds.

RESULTS

In the intent-to-treat population, mean improvements at the end-point in the 10 and 20 mg groups respectively were: TJC, -7.57 and -8.89 (P = 0.061); SJC, -6.38 and -6.96 (P = 0.304); and HAQ DI, 0-0.37 and 0-0.49 (P = 0.095). By American College of Rheumatology (ACR) > or =20% criteria, response rates were 49.8 and 56.6% respectively (P = 0.1724). Adverse events (AEs) resulting in treatment withdrawal were higher in the 10 mg (15.3%) than in the 20 mg treatment group (12.0%), as were serious adverse events (SAEs): 12.9 vs 10.0%.

CONCLUSIONS

This study rejected the hypothesis of non-inferiority of 10 mg compared with 20 mg daily maintenance doses of leflunomide. More AEs resulting in treatment discontinuation and SAEs in patients receiving 10 mg leflunomide daily also support a better efficacy profile for the 20 mg daily dose.