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Kremer J. SP0169 JAK inhibition in patients with rheumatoid arthritis. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.1644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Kremer J, Genovese MC, Keystone E, Taylor P, Zuckerman SH, Schlichting DE, Beattie SD, Macias WL. THU0226 Baricitinib Effects on Serum Cholesterol and Circulating Lipid Particles in a Phase 2B Study in Patients with Rheumatoid Arthritis. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Tak PP, Mease PJ, Genovese MC, Kremer J, Haraoui B, Tanaka Y, Bingham CO, Ashrafzadeh A, Travers H, Safa-Leathers S, Kumar S, Dummer W. Safety and efficacy of ocrelizumab in patients with rheumatoid arthritis and an inadequate response to at least one tumor necrosis factor inhibitor: results of a forty-eight–week randomized, double-blind, placebo-controlled, parallel-group phase III trial. ACTA ACUST UNITED AC 2012; 64:360-70. [PMID: 22389919 DOI: 10.1002/art.33353] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate the safety and efficacy of ocrelizumab plus methotrexate (MTX) or leflunomide (LEF) in patients with active rheumatoid arthritis (RA) and an inadequate response to tumor necrosis factor α inhibitors. METHODS This was a multicenter randomized, double-blind, placebo-controlled, parallel-group study that continued over 48 weeks. Patients receiving stable doses of MTX or LEF were randomized to receive 2 infusions of placebo (n = 277), ocrelizumab 200 mg (n = 278), or ocrelizumab 500 mg (n = 285) on days 1 and 15 as well as at weeks 24 and 26. Coprimary end points were the proportion of patients with response according to the American College of Rheumatology 20% improvement criteria (ACR20) at weeks 24 and 48. Secondary end points included the change from baseline in the modified Sharp/van der Heijde score (SHS) and the ACR50/70 responses. RESULTS ACR20 responses were 22.0% in the placebo group, 42.2% in the ocrelizumab 200 mg group, and 47.9% in the ocrelizumab 500 mg group at 24 weeks and 19.5%, 48.7%, and 50.7%, respectively, at 48 weeks (P < 0.0001 versus placebo for each comparison at each time point). At 48 weeks, patients receiving both doses of ocrelizumab showed significantly improved ACR50 and ACR70 responses of ~3-fold versus placebo. Only those in the ocrelizumab 500 mg group showed statistically significant (P = 0.0017) inhibition of joint damage progression (mean change in the SHS) relative to placebo (61% inhibition) at 48 weeks. Overall adverse events and infections during the 48 weeks of study were comparable in all treatment groups. Serious infections were observed more frequently in patients taking ocrelizumab (5.1% and 4.3%) than in those taking placebo (2.5%). CONCLUSION Patients in both of the ocrelizumab groups met the clinical primary efficacy end points. Inhibition of change in the SHS was statistically significant at 48 weeks for those in the ocrelizumab 500 mg group. The rate of serious infections in this trial was higher for both ocrelizumab doses as compared with placebo.
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Dzilic E, Kreibich M, Santer D, Moser P, Nagel F, Kremer J, Baumgartner A, Hasun M, Podesser B, Trescher K. New NO Donor S-NO-HSA improves cardioplegic solutions. Thorac Cardiovasc Surg 2012. [DOI: 10.1055/s-0031-1297417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Nishikawa M, Owaki H, Fuji T, Soliman MM, Ashcroft DM, Watson KD, Lunt M, Symmons D, Hyrich KL, Atkinson F, Malik S, Heycock C, Saravanan V, Rynne M, Hamilton J, Kelly C, Burmester G, Kary S, Unnebrink K, Guerette B, Oezer U, Kupper H, Dennison E, Jameson K, Hyrich K, Watson K, Landewe R, Keystone E, Smolen J, Goldring M, Guerette B, Patra K, Cifaldi M, van der Heijde D, Lloyd LA, Owen C, Breslin A, Ahmad Y, Emery P, Matteson EL, Genovese M, Sague S, Hsia EC, Doyle MK, Fan H, Elashoff M, Kirkham B, Wasco MC, Bathon J, Hsia EC, Fleischmann R, Genovese MC, Matteson EL, Liu H, Fleischmann R, Goldman J, Leirisalo-Repo M, Zanetakis E, El-Kadi H, Kellner H, Bolce R, Wang J, Dehoratius R, Decktor D, Kremer J, Taylor P, Mendelsohn A, Baker D, Kim L, Ritchlin C, Taylor P, Mariette X, Matucci Cerenic M, Pavelka K, van Vollenhoven R, Heatley R, Walsh C, Lawson R, Reynolds A, Emery P, Iaremenko O, Mikitenko G, Smolen J, van Vollenhoven R, Kavanaugh A, Luijtens K, van der Heijde D, Curtis J, van der Heijde D, Schiff M, Keystone E, Landewe R, Kvien T, Curtis J, Khanna D, Luijtens K, Furst D, Behrens F, Koehm M, Scharbatke EC, Kleinert S, Weyer G, Tony HP, Burkhardt H, Blunn KJ, Williams RB, Young A, McDowell J, Keystone E, Weinblatt M, Haraoui B, Guerette B, Mozaffarian N, Patra K, Kavanaugh A, Khraishi M, Alten R, Gomez-Reino J, Rizzo W, Schechtman J, Kahan A, Vernon E, Taylor M, Smolen J, Hogan V, Holweg C, Kummerfeld S, Teng O, Townsend M, van Laar JM, Gullick NJ, De Silva C, Kirkham BW, van der Heijde D, Landewe R, Guerette B, Roy S, Patra K, Keystone E, Emery P, Fleischmann R, van der Heijde D, Keystone E, Genovese MC, Conaghan PG, Hsia EC, Xu W, Baratelle A, Beutler A, Rahman MU, Nikiphorou E, Kiely P, Walsh DA, Williams R, Young A, Shah D, Knight GD, Hutchinson DG, Dass S, Atzeni F, Vital EM, Bingham SJ, Buch M, Beirne P, Emery P, Keystone E, Fleischmann R, Emery P, Dougados M, Williams S, Reynard M, Blackler L, Gullick NJ, Zain A, Oakley S, Rees J, Jones T, Mistlin A, Panayi G, Kirkham BW, Westhovens R, Durez P, Genant H, Robles M, Becker JC, Covucci A, Bathon J, Genovese MC, Schiff M, Luggen M, Le Bars M, Becker JC, Aranda R, Li T, Elegbe A, Dougados M, Smolen J, van Vollenhoven R, Kavanaugh A, Fichtner A, Strand V, Vencovsky J, van der Heijde D, Davies R, Galloway J, Watson KD, Lunt M, Hochberg M, Westhovens R, Aranda R, Kelly S, Khan N, Qi K, Pappu R, Delaet I, Luo A, Torbeyns A, Moreland L, Cohen R, Gujrathi S, Weinblatt M, Bykerk VP, Alvaro-Gracia J, Andres Roman Ivorra J, Nurmohamed MT, Pavelka K, Bernasconi C, Stancati A, Sibilia J, Ostor A, Strangfeld A, Eveslage M, Listing J, Herzer P, Liebhaber A, Krummel-Lorenz B, Zink A, Haraoui B, Emery P, Mozaffarian N, Guerette B, Kupper H, Patra K, Keystone E, Genovese MC, Breedveld FC, Emery P, Cohen SB, Keystone E, Matteson EL, Burke L, Chai A, Reiss W, Sweetser M, Shaw T, Ellis SD, Ehrenstein MR, Notley CA, Yazici Y, Curtis J, Ince A, Baraf H, Malamet R, Chung CY, Kavanaugh A, Hughes C, Faurholm B, Dell'Accio F, Manzo A, Seed M, Eltawil N, Marrelli A, Gould D, Subang C, Al-Kashi A, De Bari C, Winyard P, Chernajovsky Y, Nissim A, van Vollenhoven R, Emery P, Bingham C, Keystone E, Fleischmann RM, Furst DE, Macey KM, Sweetser MT, Lehane P, Farmer P, Long SG, Kremer JM, Furst DE, Burgos-Vargas R, Dudler J, Mela CM, Vernon E, Fleischmann RM, Wegner N, Lugli H, Quirke AM, Guo Y, Potempa J, Venables P. Rheumatoid arthritis - treatment: 180. Utility of Body Weight Classified Low-Dose Leflunomide in Japanese Rheumatoid Arthritis. Rheumatology (Oxford) 2011. [DOI: 10.1093/rheumatology/ker031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Daly I, Lampic C, Skoog Svanberg A, Sydsjo G, Fryk N, Shyshak O, Donarelli Z, Lo Coco G, Gullo S, Marino A, Volpes A, Allegra A, Hinton L, Kurinczuk JJ, Ziebland S, Frederiksen Y, Zachariae R, Schmidt L, Ingerslev HJ, Vercammen L, Stoop D, De Vos M, Polyzos NP, Nekkebroeck J, Devroey P, Graham S, Jadva V, Morrissette M, Golombok S, Hamilton J, Behan H, Venables R, Maher B, Moorhead C, Hughes C, Mocanu E, Smeenk JMJ, Verhaak CM, Valladolid N, Guijarro JA, Brod M, Simone Crespi MPH, Hein Fennema P, Jadva V, Blake L, Readings J, Casey P, Golombok S, Jordan C, Broderick P, Winter C, Belva F, Nekkebroeck J, Bondulle M, Van den Broeck U, Vandermeeren M, Vanderschueren D, Enzlin P, Demyttenaere K, D'Hooghe TM, Harrison C, Bunting L, Tsibulsky I, Boivin J, Overbeek A, van den Berg MH, Louwe L, Hilders C, Veening MA, Lambalk CB, Stiggelbout AM, van Dulmen-den Broeder E, Ter Kuile MM, Indekeu A, D'Hooghe T, De Sutter P, Demyttenaere K, Vanderschueren D, Vanderschot B, Welkenhuysen M, Rober P, Colpin H, Riedel P, Baeckert-Sifedine IT, Iversen C. V, Ludwig O, Ludwig S, Kentenich H, Skoog Svanberg A, Lampic C, Brandstrom S, Geijervall AL, Gudmundsson J, Karlstrom PO, Solensten NG, Sydsjo G, Van Dongen AJCM, Kremer JAM, Van Sluisveld PHJ, Verhaak CM, Nelen WLDM, Galhardo A, Cunha M, Pinto-Gouveia J, Huppelschoten DA, Aarts JWM, van Empel IWH, Nelen WL, Kremer JAM, Ockhuysen H, Boivin J, Hoogen A, Macklon NS, Aarts A, van den Haak P, Nelen W, Tuil W, Faber M, Kremer J, Bak CW, Seok HH, Song SH, Yoo SW, Lee WS, Yoon TK. POSTER VIEWING SESSION - PSYCHOLOGY AND COUNSELLING. Hum Reprod 2011. [DOI: 10.1093/humrep/26.s1.87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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de Medeiros K, Robert P, Gauthier S, Stella F, Politis A, Leoutsakos J, Taragano F, Kremer J, Brugnolo A, Porsteinsson AP, Geda YE, Brodaty H, Gazdag G, Cummings J, Lyketsos C. The Neuropsychiatric Inventory-Clinician rating scale (NPI-C): reliability and validity of a revised assessment of neuropsychiatric symptoms in dementia. Int Psychogeriatr 2010; 22:984-94. [PMID: 20594384 PMCID: PMC3314709 DOI: 10.1017/s1041610210000876] [Citation(s) in RCA: 158] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS) affect almost all patients with dementia and are a major focus of study and treatment. Accurate assessment of NPS through valid, sensitive and reliable measures is crucial. Although current NPS measures have many strengths, they also have some limitations (e.g. acquisition of data is limited to informants or caregivers as respondents, limited depth of items specific to moderate dementia). Therefore, we developed a revised version of the NPI, known as the NPI-C. The NPI-C includes expanded domains and items, and a clinician-rating methodology. This study evaluated the reliability and convergent validity of the NPI-C at ten international sites (seven languages). METHODS Face validity for 78 new items was obtained through a Delphi panel. A total of 128 dyads (caregivers/patients) from three severity categories of dementia (mild = 58, moderate = 49, severe = 21) were interviewed separately by two trained raters using two rating methods: the original NPI interview and a clinician-rated method. Rater 1 also administered four additional, established measures: the Apathy Evaluation Scale, the Brief Psychiatric Rating Scale, the Cohen-Mansfield Agitation Index, and the Cornell Scale for Depression in Dementia. Intraclass correlations were used to determine inter-rater reliability. Pearson correlations between the four relevant NPI-C domains and their corresponding outside measures were used for convergent validity. RESULTS Inter-rater reliability was strong for most items. Convergent validity was moderate (apathy and agitation) to strong (hallucinations and delusions; agitation and aberrant vocalization; and depression) for clinician ratings in NPI-C domains. CONCLUSION Overall, the NPI-C shows promise as a versatile tool which can accurately measure NPS and which uses a uniform scale system to facilitate data comparisons across studies.
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Gerritse R, Peek R, Sweep F, Thomas C, Braat D, Kremer J, Westphal JR, Beerendonk C. In vitro 17ß-oestradiol release as a marker for follicular survival in cryopreserved intact bovine ovaries. CRYO LETTERS 2010; 31:318-328. [PMID: 20818460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Transplantation of cryopreserved intact ovaries from cancer patients is a technically challenging option for restoring fertility after sterilizing cancer therapy. In this paper we describe an assay based on 17ß-oestradiol (oestradiol) production, to monitor the functional damage sustained by the ovarian tissue during the freeze/thawing procedure. To this end, fresh bovine ovarian cortical biopsies were cultured in vitro for 7 days. As a control, the oestradiol release of biopsies that had sustained maximal cryodamage was analyzed. In addition the oestradiol release by cortical biopsies from two ME2SO perfused and cryopreserved intact ovaries was analyzed. Oestradiol production could be measured in culture supernatants, while oestradiol release of maximal cryo-damaged biopsies was at background levels. In vitro oestradiol release by cortical biopsies can be used as a functional marker for cryo-damage and indicates that our assay is suitable to optimize the cryopreservation procedure of intact ovaries.
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Fleischmann R, Burgos-Vargas R, Ambs P, Alecock E, Kremer J, Soliman MM, Ashcroft DM, Watson KD, Lunt M, Symmons DP, Hyrich KL, Tak PP, Rigby W, Rubbert A, Peterfy C, van Vollenhoven RF, Stohl W, Hessey E, Chen A, Tyrrell H, Shaw T, Genovese MC, Breedveld FC, Emery P, Cohen SB, Keystone EC, Matteson EL, Burke LS, Chai A, Reiss WG, Sweetser MT, Shaw TM, Owen SA, Eyre S, Martin P, Hider S, Bruce IN, Barton A, Thomson W, Jones G, Gomez-Reino JJ, Lowenstein MB, Tornero J, Sebba A, Alecock E, Guarin E, Genovese M. Concurrent Oral 1 - Rheumatoid Arthritis: Treatment [OP4-OP9]: OP4. Inhibition of Radiographic Progression and Improvements in Physical Function at 2 Years, with Increasing Clinical Efficacy Over Time, in Rheumatoid Arthritis (Ra) Patients Treated with Tocilizumab (Tcz): The Lithe Study. Rheumatology (Oxford) 2010. [DOI: 10.1093/rheumatology/keq701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Macaraeg G, Genant K, Peterfy C, Westhovens R, Becker JC, Vratsanos G, Zhou X, Kremer J. P31 Abatacept increases the proportion of patients who remain free from structural damage progression through 5 years in methotrexate inadequate responders with RA. INDIAN JOURNAL OF RHEUMATOLOGY 2009. [DOI: 10.1016/s0973-3698(09)60049-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Greenberg JD, Fisher MC, Kremer J, Chang H, Rosenstein ED, Kishimoto M, Lee S, Yazici Y, Kavanaugh A, Abramson SB. The COX-2 inhibitor market withdrawals and prescribing patterns by rheumatologists in patients with gastrointestinal and cardiovascular risk. Clin Exp Rheumatol 2009; 27:395-401. [PMID: 19604430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To examine effects of the COX-2 inhibitor market withdrawals on NSAID utilization among patients at increased risk of gastrointestinal (GI) and cardiovascular (CV) toxicities. METHODS A prospective cohort study was conducted using patients enrolled in the Consortium of Rheumatology Researchers of North America (CORRONA) Registry. The study population included rheumatoid arthritis (RA) and psoriatic arthritis (PsA) patients prescribed NSAIDs by rheumatologists from 1/1/2003 to 12/31/2005. Three cohorts were defined based on calendar year. The primary outcome assessed whether or not an NSAID gastroprotective strategy was prescribed. Secondary outcomes included rates of COX-2 inhibitor utilization and gastroprotective co-therapy utilization, stratified by the presence of cardiac and GI risk factors. RESULTS NSAID gastroprotection utilization decreased from 65.1% in 2003 to 47.7% (p<0.001) in 2005. COX-2 inhibitor use decreased from 55.1% to 29.2% (p<0.001), whereas nonselective NSAIDs (nsNSAIDs) use increased from 50.2% to 73.9% (p=<0.01). Among patients with two or more risk factors for NSAID related GI bleeding, gastroprotection decreased from 74.4% in 2003 to 60.9% (p<0.01). For patients with two or more CV risk factors from 2003 to 2005, COX-2 inhibitor utilization decreased significantly, whereas nsNSAID utilization increased significantly. CONCLUSIONS The COX-2 inhibitor withdrawals resulted in a rapid decline in NSAID gastroprotection prescribed by participating U.S. rheumatologists despite the availability of other gastroprotective options. Channeling toward nsNSAID use was widespread, including among patients at increased CV risk. Longer term follow-up is required to determine the clinical significance of these changes in NSAID prescribing, particularly for NSAID-related GI and CV-related toxicities.
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Dungl A, Kremer J, Brunner A, Sagmeister T, Rheinheimer B, Riss P. Anforderungsprofil an einen Palliativen Konsiliardienst in der gynäkologischen Onkologie. Geburtshilfe Frauenheilkd 2009. [DOI: 10.1055/s-0029-1225173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Brunner A, Kremer J, Sagmeister T, Brustmann H. Gefrierschnittuntersuchung bei der ambulant durchgeführten ultraschall-gezielten core needle biopsy bei suspekten Brusttumoren. Geburtshilfe Frauenheilkd 2009. [DOI: 10.1055/s-0029-1220272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Keystone E, Burmester GR, Furie R, Loveless JE, Emery P, Kremer J, Tak PP, Broder MS, Yu E, Cravets M, Magrini F, Jost F. Improvement in patient-reported outcomes in a rituximab trial in patients with severe rheumatoid arthritis refractory to anti-tumor necrosis factor therapy. ACTA ACUST UNITED AC 2008; 59:785-93. [PMID: 18512710 DOI: 10.1002/art.23715] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To assess the effects of treatment with rituximab plus methotrexate on patient-reported outcomes in patients with active rheumatoid arthritis (RA) who experienced inadequate response to anti-tumor necrosis factor therapy. METHODS Patients with active RA were randomly assigned to rituximab (1,000 mg on days 1 and 15) or placebo. The primary end point was the proportion of patients with an American College of Rheumatology 20% response at week 24. Additional goals were to assess treatment effects on pain, fatigue, functional disability, health-related quality of life, and disease activity by comparing mean changes between groups. The analysis was conducted in the intent-to-treat population. The proportion of patients who achieved the minimum clinically important difference on the Health Assessment Questionnaire (HAQ) disability index (DI), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), and Short Form 36 (SF-36) was determined. RESULTS Rituximab patients had statistically significantly greater pain relief. The FACIT-F showed significantly greater improvement in rituximab patients than placebo patients from weeks 12 through 24. Mean improvement from baseline in functional disability (measured by the HAQ DI) was significantly greater in rituximab patients from weeks 8 to 24. The mean +/- SD change from baseline for the SF-36 Physical Component Score was 6.64 +/- 8.74 for rituximab patients and 1.48 +/- 7.32 for placebo patients (P < 0.0001). The mean change from baseline for the SF-36 Mental Component Score was 5.32 +/- 12.41 for rituximab patients and 2.25 +/- 12.23 for placebo patients (P = 0.0269). CONCLUSION Rituximab produced rapid, clinically meaningful, and statistically significant improvements in patient-reported pain, fatigue, functional disability, health-related quality of life, and disease activity. These effects were sustained throughout the study.
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Emery P, Keystone E, Tony HP, Cantagrel A, van Vollenhoven R, Sanchez A, Alecock E, Lee J, Kremer J. IL-6 receptor inhibition with tocilizumab improves treatment outcomes in patients with rheumatoid arthritis refractory to anti-tumour necrosis factor biologicals: results from a 24-week multicentre randomised placebo-controlled trial. Ann Rheum Dis 2008; 67:1516-23. [PMID: 18625622 PMCID: PMC3811149 DOI: 10.1136/ard.2008.092932] [Citation(s) in RCA: 797] [Impact Index Per Article: 49.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objectives: The phase III RADIATE study examined the efficacy and safety of tocilizumab, an anti-IL-6 receptor monoclonal antibody in patients with rheumatoid arthritis (RA) refractory to tumour necrosis factor (TNF) antagonist therapy. Methods: 499 patients with inadequate response to one or more TNF antagonists were randomly assigned to receive 8 mg/kg or 4 mg/kg tocilizumab or placebo (control) intravenously every 4 weeks with stable methotrexate for 24 weeks. ACR20 responses, secondary efficacy and safety endpoints were assessed. Results: ACR20 was achieved at 24 weeks by 50.0%, 30.4% and 10.1% of patients in the 8 mg/kg, 4 mg/kg and control groups, respectively (less than p<0.001 both tocilizumab groups versus control). At week 4 more patients achieved ACR20 in 8 mg/kg tocilizumab versus controls (less than p = 0.001). Patients responded regardless of most recently failed anti-TNF or the number of failed treatments. DAS28 remission (DAS28 <2.6) rates at week 24 were clearly dose related, being achieved by 30.1%, 7.6% and 1.6% of 8 mg/kg, 4 mg/kg and control groups (less than p = 0.001 for 8 mg/kg and p = 0.053 for 4 mg/kg versus control). Most adverse events were mild or moderate with overall incidences of 84.0%, 87.1% and 80.6%, respectively. The most common adverse events with higher incidence in tocilizumab groups were infections, gastrointestinal symptoms, rash and headache. The incidence of serious adverse events was higher in controls (11.3%) than in the 8 mg/kg (6.3%) and 4 mg/kg (7.4%) groups. Conclusion: Tocilizumab plus methotrexate is effective in achieving rapid and sustained improvements in signs and symptoms of RA in patients with inadequate response to TNF antagonists and has a manageable safety profile. Trial registration number: NCT00106522.
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Kramer A, Kremer J, Assadian O, Schneider I, Dähne H, Schwemmer J, Müller G, Siegmund W, Jäkel C. The classification of antiseptic products to be administered to wounds--another borderline case between medicinal products and medical devices? Int J Clin Pharmacol Ther 2007; 44:677-92. [PMID: 17190379 DOI: 10.5414/cpp44677] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The importance of a correct demarcation between a Medicinal Product (MP) and a Medical Device (MD) is undisputedly one of the major topics related to the development and launch of a new healthcare product. However, for some products the correct demarcation between MPs and MDs can turn out to be somewhat complicated. This article aims to provide an overview on the existing legislation and its adequate application based on a suitable example at hand. Article 2 (2) of the European Directive 2001/83/EC as amended by Directive 2004/27/EC on the Community code relating to medicinal products for human use stipulates that the respective Medicinal Products Legislation must be applied whenever a product can be covered by both the definitions for MPs and for products regulated by other legal provisions enacted by the European Community, e.g. Cosmetic Products (CPs) or MDs. This basic principle implies that the decision to base the risk-benefit assessment of the product in question on the Medical Device Directive (MDD) would contradict the aforementioned constitutional principle, pursuant to which the stricter of the regulatory procedures theoretically possible is to apply in cases of doubt. In contrast to the approval procedure established for MPs, the MDD requires a Conformity Assessment Procedure to be performed by the manufacturer himself and a "Notified Body". Thus, in the majority of cases the responsibility for the risk assessment of MDs lies solely with the manufacturer and is prior to launch not subject to further scrutiny by regulators. Only in specific cases, i.e. for the Conformity Assessment Procedure of Class III MDs which contain an Active Pharmaceutical Ingredient one of the Member States competent authorities designated in accordance with Directive 65/ 65/EEC has to be involved before taking a decision. It is therefore important that the classification of the product is carried out carefully in full compliance with existing legal provisions, also taking into account the related guidance documents issued by the European Commission. The adequate application of these rules is explained using the example of the antiseptic compound polihexanide, which is used both in approved medicinal products (wound antiseptics) and wound irrigation solutions labelled as medical devices.
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Breslin G, Hodges NJ, Williams AM, Kremer J, Curran W. A comparison of intra- and inter-limb relative motion information in modelling a novel motor skill. Hum Mov Sci 2006; 25:753-66. [PMID: 16879888 DOI: 10.1016/j.humov.2006.04.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2005] [Revised: 04/07/2006] [Accepted: 04/08/2006] [Indexed: 11/16/2022]
Abstract
The importance of intra- and inter-limb relative motion in modelling a whole body coordination skill was examined. Participants were assigned to one of four groups: Full-Body point light model of a cricket bowler, INTRA-LIMB relative motion of the bowling arm, INTER-LIMB relative motions of the right and left wrists or NO-Relative motion, showing only the motions of the right wrist. During 60 acquisition trials, participants viewed the model five times before each 10-trial block. Retention was examined the following day. Although all groups improved on intra-limb coordination of the bowling arm, the INTRA-LIMB and FULL-BODY groups were more accurate than the INTER-LIMB group in acquisition, although these groups did not differ in retention. For inter-limb coordination, the three groups who received relative motion information performed more like the model than the NO-Relative motion group (even though the INTRA-LIMB group did not see the other limb). The amount of information within a display plays a constraining role on acquisition, perhaps more so than the type of information, such that the acquisition of coordination is more an emergent feature of observational learning, rather than a direct approximation of the model.
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Tutuncu Z, Reed G, Kremer J, Kavanaugh A. Do patients with older-onset rheumatoid arthritis receive less aggressive treatment? Ann Rheum Dis 2006; 65:1226-9. [PMID: 16414968 PMCID: PMC1798297 DOI: 10.1136/ard.2005.051144] [Citation(s) in RCA: 129] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2006] [Indexed: 11/03/2022]
Abstract
Rheumatoid arthritis among elderly people is an increasingly important health concern. Despite several cross-sectional studies, it has not been clearly established whether there are important clinical differences between elderly-onset rheumatoid arthritis (EORA) and younger-onset rheumatoid arthritis (YORA). The aim of this study was to compare disease activity and treatment in EORA and YORA, using the Consortium of Rheumatology Researchers of North America (CORRONA) registry, a database generated by rheumatologist investigators across the USA. From the CORRONA registry database of 9381 patients with rheumatoid arthritis, 2101 patients with disease onset after the age of 60 years (EORA) were matched, on the basis of disease duration, with 2101 patients with disease onset between the ages of 40 and 60 years (YORA). The primary outcome measures were the proportion of patients on methotrexate, multiple disease-modifying antirheumatic drugs (DMARD) and biological agents (etanercept, infliximab, adalimumab and kineret) in each group. Disease activity and severity differed slightly between the EORA and YORA groups: Disability Index of the Health Assessment Questionnaire: 0.30 v 0.35; tender joint count: 3.7 v 4.7; swollen joint count: 5.3 v 5.2; Disease Activity Score 28: 3.8 v 3.6; patient global assessment: 29.1 v 30.9; physician global assessment: 24.9 v 26.3; patient pain assessment: 31.4 v 34.9. Regarding treatment, the use of methotrexate use was slightly more common among patients with EORA (63.9%) than among those with YORA (59.6%), although the mean methotrexate dose among the YORA group was higher than that in the EORA group. The percentage of patients with EORA who were on multiple DMARD treatment (30.9%) or on biological agents (25%) was considerably lower than that of patients with YORA (40.5% and 33.1%, respectively; p<0.0001). Toxicity related to treatment was very minimal in both groups, whereas toxicities related to methotrexate were more common in the YORA group. Patients with EORA receive biological treatment and combination DMARD treatment less frequently than those with YORA, despite identical disease duration and comparable disease severity and activity.
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Bingham CO, Sebba AI, Rubin BR, Ruoff GE, Kremer J, Bird S, Smugar SS, Fitzgerald BJ, O'Brien K, Tershakovec AM. Efficacy and safety of etoricoxib 30 mg and celecoxib 200 mg in the treatment of osteoarthritis in two identically designed, randomized, placebo-controlled, non-inferiority studies. Rheumatology (Oxford) 2006; 46:496-507. [PMID: 16936327 DOI: 10.1093/rheumatology/kel296] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To compare the efficacy of etoricoxib 30 mg with the generally maximum recommended dose of celecoxib, 200 mg, in the treatment of osteoarthritis (OA) in two identically designed studies. METHODS Two multi-centre, 26-week, double-blind, placebo-controlled, non-inferiority studies were conducted, enrolling patients who were prior non-steroidal anti-inflammatory drug (NSAID) or acetaminophen users. There were 599 patients in study 1 and 608 patients in study 2 randomized 4:4:1:1 to etoricoxib 30 mg qd, celecoxib 200 mg qd or one of two placebo groups for 12 weeks. After 12 weeks, placebo patients were evenly distributed to etoricoxib or celecoxib based on their initial enrollment randomization schedule. The primary hypothesis was that etoricoxib 30 mg would be at least as effective as celecoxib 200 mg for the time-weighted average change from baseline over 12 weeks for Western Ontario and McMaster (WOMAC) Pain Subscale, WOMAC Physical Function Subscale and Patient Global Assessment of Disease Status. Active treatments were also assessed over the full 26 weeks. Adverse experiences were collected for safety assessment. RESULTS In both studies, etoricoxib was non-inferior to celecoxib for all three efficacy outcomes over 12 and 26 weeks; both were superior to placebo (P < 0.001) for all three outcomes in each study over 12 weeks. The safety and tolerability of etoricoxib 30 mg qd and celecoxib 200 mg qd were similar over 12 and 26 weeks. CONCLUSIONS Etoricoxib 30 mg qd was at least as effective as celecoxib 200 mg qd and had similar safety in the treatment of knee and hip OA; both were superior to placebo. ClinicalTrials.gov Identifiers: NCT00092768; NCT00092791.
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Kremer J. [Lifestyle intervention for the prevention of cardiovascular disease]. NEDERLANDS TIJDSCHRIFT VOOR GENEESKUNDE 2006; 150:583; author reply 583. [PMID: 16566426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
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Kremer J. [Hendrikje van Andel-Schipper and other remarkable developments in the life expectancy of the Dutch population]. NEDERLANDS TIJDSCHRIFT VOOR GENEESKUNDE 2006; 150:461-2; author reply 462. [PMID: 16538852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
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73
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Grob U, Puy H, Jacob K, Deybach JC, Kremer J, Doss MO. Biochemical compared to molecular diagnosis in acute intermittent porphyria. J Inherit Metab Dis 2006; 29:157-61. [PMID: 16601882 DOI: 10.1007/s10545-006-0155-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2005] [Accepted: 10/10/2005] [Indexed: 10/24/2022]
Abstract
The biochemical and the molecular diagnoses of an inherited porphyria require experience. False positive or negative screening tests and the low penetrance of the disease make a correct diagnosis difficult.The biochemical and the molecular procedures for the diagnosis of acute intermittent porphyria were applied to five unrelated patients suffering from acute intermittent porphyria. All patients were shown to be gene carriers of acute intermittent porphyria by both methods. The two different possibilities of the diagnosis corresponded well. In a family definitively identified by molecular diagnosis of one of the patients and his relatives, the patient's two children were asymptomatic. His son was shown to be a gene carrier of the father's deficiency by biochemical as well as molecular analysis, whereas his daughter was not affected by acute intermittent porphyria.
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Kremer J. [Van Leeuwenhoek's discovery of bacteria: a look too far ahead]. NEDERLANDS TIJDSCHRIFT VOOR GENEESKUNDE 2005; 149:495; author reply 495-6. [PMID: 15771347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
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