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Hudson M, Dell'Aniello S, Shen S, Simon TA, Ernst P, Suissa S. Comparative safety of biologic versus conventional synthetic DMARDs in rheumatoid arthritis with COPD: a real-world population study. Rheumatology (Oxford) 2020; 59:820-827. [PMID: 31504972 DOI: 10.1093/rheumatology/kez359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 07/05/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Abatacept, a biologic DMARD, was associated with respiratory adverse events in a small subgroup of RA patients with chronic obstructive pulmonary disease (COPD) in a trial. Whether this potential risk is specific to abatacept or extends to all biologics and targeted synthetic DMARDs (tsDMARDs) is unclear. We assessed the risk of adverse respiratory events associated with biologic and tsDMARDs compared with conventional synthetic DMARDs (csDMARDs) among RA patients with concomitant COPD in a large, real-world cohort. METHODS We used a prevalent new-user design to study RA patients with COPD in the US-based MarketScan databases. New users of biologic DMARDs and/or tsDMARDs were matched on time-conditional propensity scores to new users of csDMARDs. Adverse respiratory events were estimated using Cox models comparing current use of biologic/tsDMARDs with csDMARDs. RESULTS The cohort included 7424 patients initiating biologic/tsDMARDs and 7424 matched patients initiating csDMARDs. The adjusted hazard ratio of hospitalized COPD exacerbation comparing biologic/tsDMARD vs csDMARD was 0.76 (95% CI: 0.55, 1.06), while it was 1.02 (95% CI: 0.82, 1.27) for bronchitis, 1.21 (95% CI: 0.92, 1.58) for hospitalized pneumonia or influenza and 0.99 (95% CI: 0.87, 1.12) for outpatient pneumonia or influenza. The hazard ratio of the combined end point of COPD exacerbation, bronchitis and hospitalized pneumonia or influenza was 1.04 (95% CI: 0.89, 1.21). CONCLUSION In this large, real-world comparative safety study, biologic and tsDMARDs, including abatacept, were not associated with an increased risk of adverse respiratory events when compared with csDMARDs in patients with RA and COPD.
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Affiliation(s)
- Marie Hudson
- Centre for Clinical Epidemiology, Lady Davis Institute-Jewish General Hospital, Canada.,Division of Rheumatology, Jewish General Hospital, Montreal, Québec, Canada
| | - Sophie Dell'Aniello
- Centre for Clinical Epidemiology, Lady Davis Institute-Jewish General Hospital, Canada
| | - Sophie Shen
- Global Pharmacovigilance and Epidemiology, Bristol Myers Squibb, Hopewell, NJ, USA, Canada
| | - Teresa A Simon
- Global Pharmacovigilance and Epidemiology, Bristol Myers Squibb, Hopewell, NJ, USA, Canada
| | - Pierre Ernst
- Centre for Clinical Epidemiology, Lady Davis Institute-Jewish General Hospital, Canada.,Division of Respiratory Medicine, Jewish General Hospital, Canada
| | - Samy Suissa
- Centre for Clinical Epidemiology, Lady Davis Institute-Jewish General Hospital, Canada.,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Québec, Canada
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Cecconi M, Ranza R, Titton DC, Moraes JCB, Bertolo M, Bianchi W, Brenol C, Carvalho HM, de Castro GRW, Costa IP, Cunha MFL, Duarte Â, Fernandes V, Freire M, Louzada-Junior P, Macieira JC, Miranda JRS, Pereira IA, Pinheiro GRC, Stadler B, Toledo RA, Valim V, Descalzo MA, Pinto RMC, Laurindo I. Incidence of Infectious Adverse Events in Patients With Rheumatoid Arthritis and Spondyloarthritis on Biologic Drugs-Data From the Brazilian Registry for Biologics Monitoring. J Clin Rheumatol 2020; 26:73-78. [PMID: 32073519 PMCID: PMC7034387 DOI: 10.1097/rhu.0000000000000935] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The safety profile of biologic drugs might present substantial regional differences. Since 2009, the Brazilian Society of Rheumatology has maintained BIOBADABRASIL (Brazilian Registry for Biologic Drugs), a registry for monitoring of biologic therapies in rheumatic diseases. OBJECTIVES The aim of this study was to verify the incidence rate (IR) of serious infections in rheumatoid arthritis (RA) and spondyloarthritis (SpA) patients on biologic drugs. METHODS BIOBADABRASIL prospectively included patients with rheumatic diseases who started the first biologic drug or a synthetic disease-modifying antirheumatic drug as a parallel control group. This study focuses on serious infectious adverse events (SIAEs) in RA and SpA patients on biologic drugs compared with controls, from January 2009 to June 2015. Time of exposure was set from initiation of the drug to the date of last administration or censorship. Serious infectious adverse events IR was calculated per 1000 patient/years with 95% confidence interval (CI). RESULTS A total of 1698 patients (RA, 1121; SpA, 577) were included, 7119 patient/years. Serious infectious adverse events were more common among patients on tumor necrosis factor inhibitors (TNFi's) than controls (adjusted IR ratio, 2.96 [95% CI, 2.01-4.36]; p < 0.001). Subsequent TNFi was associated with a higher SIAEs incidence when compared with first TNFI (adjusted IR ratio, 1.55 [95% CI, 1.15-2.08]; p = 0.004). Serious infectious adverse events were associated with age and corticosteroids intake. Serious infectious adverse events were more frequent in the respiratory tract in all subgroups. CONCLUSIONS In BIOBADABRASIL, biologic drugs, especially the subsequent TNFi, were associated with a higher risk of serious infections compared with synthetic DMARDs. Corticosteroid intake and age represented risk factors for SIAEs. Constant monitoring is required to follow the safety profile of drugs in the clinical setting of rheumatic conditions in Brazil.
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Affiliation(s)
| | - Roberto Ranza
- From the Universidade Federal de Uberlândia, Uberlândia
| | | | | | | | | | - Claiton Brenol
- Universidade Federal do Rio Grande do Sul/Hospital de Clínicas de Porto Alegre, Porto Alegre
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Roberto A. Toledo
- Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto
| | | | | | | | - Ieda Laurindo
- Faculdade de Medicina da Universidade Nove de Julho, São Paulo, Brazil
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Safety results of ixekizumab with 1822.2 patient-years of exposure: an integrated analysis of 3 clinical trials in adult patients with psoriatic arthritis. Arthritis Res Ther 2020; 22:14. [PMID: 31964419 PMCID: PMC6975022 DOI: 10.1186/s13075-020-2099-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 01/09/2020] [Indexed: 02/08/2023] Open
Abstract
Background The long-term safety was assessed in patients with psoriatic arthritis who were treated with ixekizumab in three clinical trials (SPIRIT-P1/-P2/-P3). Methods Integrated safety data from three trials (controlled and uncontrolled), including two pivotal phase 3, randomized, double-blind clinical trials: SPIRIT-P1 and SPIRIT-P2, were assessed. Safety data were integrated from the all ixekizumab exposure safety population (defined as all patients receiving ≥ 1 dose of ixekizumab). We report exposure-adjusted incidence rates (IRs) per 100 patient-years (PY) at 1-year intervals up to 3 years for adverse events. Results Total exposure to IXE reached 1822.2 PY (1118 patients). The IRs/100 PY for the following treatment discontinuations were as follows: adverse events (5.3); serious infections (1.3); injection-site reactions (12.7); infections (34.2); and deaths (0.3). The IRs for treatment-emergent adverse events decreased or remained stable over time, the most common being upper respiratory tract infection, nasopharyngitis, and injection-site reactions. The IRs for serious adverse events and serious infections remained stable over time, whereas for injection-site reactions and general infections, IRs decreased with longer ixekizumab exposure. Opportunistic infections were limited to oral and esophageal candida and localized herpes zoster. No suicide or self-injury-related behaviors were reported. The IRs/100 PY for safety topics of special interest included inflammatory bowel disease (adjudicated; 0.1), depression (1.6), malignancies (0.7), and major adverse cardiovascular events (0.6). Conclusions The findings of this integrated safety analysis in patients with psoriatic arthritis are consistent with the known safety profile of ixekizumab. No unexpected safety signals were observed with ixekizumab treatment in patients with psoriatic arthritis. Trial registration SPIRIT-P1 (NCT01695239; Registered August 08, 2012), SPIRIT-P2 (NCT02349295; September 23, 2014), and SPIRIT-P3 (NCT02584855; August 04, 2015).
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Chiu YM, Chen DY. Infection risk in patients undergoing treatment for inflammatory arthritis: non-biologics versus biologics. Expert Rev Clin Immunol 2020; 16:207-228. [PMID: 31852268 DOI: 10.1080/1744666x.2019.1705785] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction: Despite the therapeutic effectiveness of biologics targeting immune cells or cytokines in patients with inflammatory arthritis, which reflects their pathogenic roles, an increased infection risk is observed in those undergoing biological treatment. However, there are limited data regarding the comparison of infection risks in inflammatory arthritis patients treated with non-biologics (csDMARDs), biologics (bDMARDs), including tumor necrosis factor (TNF) inhibitors and non-TNF inhibitors, or targeted synthetic (ts)DMARDs.Areas covered: Through a review of English-language literature as of 30 June 2019, we focus on the existing evidence on the risk of infections caused by bacteria, Mycobacterium tuberculosis, and hepatitis virus in inflammatory arthritis patients undergoing treatment with csDMARDs, bDMARDs, or tsDMARDs.Expert opinion: While the risks of bacterial and mycobacterial infection are increased in arthritis patients treated with csDMARDs, the risks are further higher in those receiving bDMARDs therapy, particularly TNF inhibitors. Regarding HBV infection, antiviral therapy may effectively prevent HBV reactivation in patients receiving bDMARDs, especially rituximab. However, more data are needed to establish effective preventive strategies for HBsAg-negative/HBcAb-positive patients. It seems safe to use cyclosporine and TNF inhibitors in patients with HCV infection, while those undergoing rituximab therapies should be frequently monitored for HCV activity.Abbreviations: ABT: abatacept; ADA: adalimumab; AS: ankylosing spondylitis; bDMARDs: biologic disease-modifying anti-rheumatic drugs; CKD: chronic kidney disease; COPD: chronic obstructive pulmonary disease; CS: corticosteroids; CsA: cyclosporine A; csDMARDs: conventional synthetic disease-modifying anti-rheumatic drugs; CZP: certolizumab; DAAs: direct-acting antiviral agents; DM: diabetes mellitus; DOT: directly observed therapy; EIN: Emerging Infections Network; ETN: etanercept; GOL: golimumab; GPRD: General Practice Research Database; HBV: hepatitis B virus; HBVr: HBV reactivation; HBsAg+: HBsAg-positive; HBsAg-/anti-HBc+: HBsAg-negative anti-HBc antibodies-positive; HCV: hepatitis C virus; HCQ: hydroxychloroquine: IFX: infliximab; IL-6: interleukin-6; JAK: Janus kinase; LEF: leflunomide; LTBI: latent tuberculosis infection; mAb: monoclonal antibody; MTX: methotrexate; OR: odds ratio; PsA: psoriatic arthritis; PMS: post-marketing surveillance; RA: rheumatoid arthritis; TNF: tumor necrosis factor; TNFi: tumor necrosis factor inhibitor; SCK: secukinumab; SSZ: sulfasalazine; TOZ: tocilizumab; RCT: randomized controlled trial; RR: relative risk; RTX: rituximab; 3HP: 3-month once-weekly isoniazid plus rifapentine; TB: tuberculosis; tsDMARDs: targeted synthetic disease-modifying anti-rheumatic drugs; UTK: ustekinumab; WHO: World Health Organization.
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Affiliation(s)
- Ying-Ming Chiu
- Rheumatology and Immunology Center, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - Der-Yuan Chen
- Rheumatology and Immunology Center, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan.,Translational Medicine Laboratory, Rheumatic Diseases Research Center, China Medical University Hospital, Taichung, Taiwan.,Program in Translational Medicine and Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan.,Institute of Biochemistry, Microbiology and Immunology, Chung Shan Medical University, Taichung, Taiwan
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Ehrenstein B. [Acute exacerbation of the underlying disease or infection : Which diagnostics are warranted in patients with immunosuppressive treatment for inflammatory rheumatic diseases?]. Z Rheumatol 2019; 78:932-939. [PMID: 31511978 DOI: 10.1007/s00393-019-00705-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Infectious diseases always have to be considered in the differential diagnosis of new symptoms in patients with immunosuppressive treatment for established inflammatory rheumatic diseases. Knowledge about the specific frequency and type of infections that can be expected under immunosuppressive treatment of inflammatory rheumatic diseases as well as the diagnostic value of laboratory tests and imaging results can facilitate the often difficult differential diagnosis.
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Affiliation(s)
- Boris Ehrenstein
- Klinik und Poliklinik für Rheumatologie/Klinische Immunologie, Asklepios Klinikum Bad Abbach, 93077, Bad Abbach, Deutschland.
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Suissa S, Hudson M, Dell'Aniello S, Shen S, Simon TA, Ernst P. Comparative safety of abatacept in rheumatoid arthritis with COPD: A real-world population-based observational study. Semin Arthritis Rheum 2019; 49:366-372. [DOI: 10.1016/j.semarthrit.2019.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/25/2019] [Accepted: 03/14/2019] [Indexed: 12/31/2022]
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Chen SK, Liao KP, Liu J, Kim SC. Risk of Hospitalized Infection and Initiation of Abatacept Versus Tumor Necrosis Factor Inhibitors Among Patients With Rheumatoid Arthritis: A Propensity Score-Matched Cohort Study. Arthritis Care Res (Hoboken) 2019; 72:9-17. [PMID: 30570833 DOI: 10.1002/acr.23824] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 12/04/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE We aimed to evaluate the comparative risk of hospitalized infection among patients with rheumatoid arthritis (RA) who initiated abatacept versus a tumor necrosis factor inhibitor (TNFi). METHODS Using claims data from Truven MarketScan database (2006-2015), we identified patients with RA ages ≥18 years with ≥2 RA diagnoses who initiated treatment with abatacept or a TNFi. The primary outcome was a composite end point of any hospitalized infection. Secondary outcomes included bacterial infection, herpes zoster, and infections affecting different organ systems. We performed 1:1 propensity score (PS) matching between the groups in order to control for baseline confounders. We estimated incidence rates (IRs) and hazard ratios (HRs) with 95% confidence intervals (95% CIs) for hospitalized infection. RESULTS We identified 11,248 PS-matched pairs of patients who initiated treatment with abatacept and TNFi with a median age of 56 years (83% were women). The IR per 1,000 person-years for any hospitalized infection was 37 among patients who initiated treatment with abatacept and 47 in those who initiated treatment with TNFi. The HR for the risk of any hospitalized infection associated with abatacept versus TNFi was 0.78 (95% CI 0.64-0.95) and remained lower when compared to infliximab (HR 0.63 [95% CI 0.47-0.85]), while no significant difference was seen when compared to adalimumab and etanercept. The risk of secondary outcomes was lower for abatacept for pulmonary infections, and similar to TNFi for the remaining outcomes. CONCLUSION In this large cohort of patients with RA who initiated treatment with abatacept or TNFi as a first- or second-line biologic agent, we found a lower risk of hospitalized infection after initiating abatacept versus TNFi, which was driven mostly by infliximab.
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Affiliation(s)
- Sarah K Chen
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Katherine P Liao
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jun Liu
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Seoyoung C Kim
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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58
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Adverse Cutaneous Reactions of Common Biologic Medications for Rheumatic Diseases. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2019. [DOI: 10.1007/s40674-019-00129-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Simon TA, Boers M, Hochberg M, Baker N, Skovron ML, Ray N, Singhal S, Suissa S, Gomez-Caminero A. Comparative risk of malignancies and infections in patients with rheumatoid arthritis initiating abatacept versus other biologics: a multi-database real-world study. Arthritis Res Ther 2019; 21:228. [PMID: 31703717 PMCID: PMC6839238 DOI: 10.1186/s13075-019-1992-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 09/05/2019] [Indexed: 01/12/2023] Open
Abstract
Background Patients with rheumatoid arthritis (RA) are at an increased risk of developing certain cancers and infections compared with the general population. Biologic and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) are effective treatment options for RA, but limited evidence is available on the comparative risks among b/tsDMARDs. We assessed the risk of malignancies and infections in patients with RA who initiated abatacept versus other b/tsDMARDs in a real-world setting. Methods This retrospective, observational study used administrative data from three large US healthcare databases (MarketScan, PharMetrics, and Optum) to identify patients treated with abatacept or other b/tsDMARDs. In both groups, age-stratified incidence rates (IRs) with 95% confidence intervals (CIs) were calculated for total malignancy and hospitalized infections; propensity score matching and Cox proportional hazards regression models were used to estimate hazard ratios (HRs) with 95% CIs for total malignancy, lung cancer, lymphoma, breast cancer, non-melanoma skin cancer (NMSC), hospitalized infections, opportunistic infections, and tuberculosis (TB), both within individual databases and in meta-analyses across the three databases. Results A rounded total of 19.2, 13.6, and 4.2 thousand patients initiating abatacept and 55.3, 40.8, and 13.8 thousand initiating other b/tsDMARDs were identified in the MarketScan, PharMetrics, and Optum databases, respectively. The IRs for total malignancy and hospitalized infections were similar between the two groups in each age stratum. In meta-analyses, total malignancy risk (HR [95% CI] 1.09 [1.02–1.16]) of abatacept versus other b/tsDMARDs was slightly but statistically significantly increased; small, but not statistically significant, increases were seen for lung cancer (1.10 [0.62–1.96]), lymphoma (1.27 [0.94–1.72]), breast cancer (1.15 [0.92–1.45]), and NMSC (1.10 [0.93–1.30]). No significant increase in hospitalized infections (0.96 [0.84–1.09]) or opportunistic infections (1.06 [0.96–1.17]) was seen. For TB, low event counts precluded meta-analysis. Conclusions In this real-world multi-database study, the risks for specific cancers and infections did not differ significantly between patients in the abatacept and other b/tsDMARDs groups. The slight increase in total malignancy risk associated with abatacept needs further investigation. These results are consistent with the established safety profile of abatacept.
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Affiliation(s)
| | - Maarten Boers
- Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
| | - Marc Hochberg
- University of Maryland School of Medicine, Baltimore, MD, USA
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Pombo-Suarez M, Gomez-Reino J. The role of registries in the treatment of rheumatoid arthritis with biologic disease-modifying anti-rheumatic drugs. Pharmacol Res 2019; 148:104410. [PMID: 31461667 DOI: 10.1016/j.phrs.2019.104410] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 08/22/2019] [Accepted: 08/22/2019] [Indexed: 12/21/2022]
Abstract
Registries characterize the effectiveness and safety of therapeutic interventions in daily clinical practice. Data from registries enable mining the records of tens of thousands of patients towards determining the effectiveness, safety, and cost-benefit of any given therapeutic. The strengths of registries include real-life settings, greater power than clinical trials to detect rare events, and the study of multiple outcomes and several research questions. Registries also have their weaknesses. They are expensive, less accurate than clinical trials, affected by channelling bias, often require links to external sources or use historic and selected control cohorts or combine datasets to increase power, and have the risk of multiple confounders. Since the beginning of biological era, registries were developed to profile emerging treatments. This article reviews the role of registries in the treatment of rheumatoid arthritis with biologic disease-modifying anti-rheumatic drugs.
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Affiliation(s)
- Manuel Pombo-Suarez
- Rheumatology Service, Hospital Clinico Universitario, Santiago de Compostela, Spain
| | - Juan Gomez-Reino
- Fundacion Ramon Dominguez, Hospital Clinico Universitario, Santiago de Compostela, Spain.
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61
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Ozen G, Pedro S, England BR, Mehta B, Wolfe F, Michaud K. Risk of Serious Infection in Patients With Rheumatoid Arthritis Treated With Biologic Versus Nonbiologic Disease-Modifying Antirheumatic Drugs. ACR Open Rheumatol 2019; 1:424-432. [PMID: 31777822 PMCID: PMC6858027 DOI: 10.1002/acr2.11064] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 07/08/2019] [Indexed: 12/19/2022] Open
Abstract
Objective The objective of this study is to examine the risk of serious infections (SIs) associated with biological disease‐modifying antirheumatic drugs (bDMARDs) compared with conventional synthetic disease‐modifying antirheumatic drugs (csDMARDs) in patients with rheumatoid arthritis (RA). Methods We studied patients with RA who initiated bDMARDs or csDMARDs from 2001 to 2016 in FORWARD–The National Databank for Rheumatic Diseases. Disease‐modifying antirheumatic drugs (DMARDs) were categorized into three groups: (1) csDMARDs (bDMARD‐naïve; reference), (2) tumor necrosis factor α inhibitors (TNFis), and (3) non‐TNFi biologics (abatacept, rituximab, tocilizumab, and anakinra). SIs were defined as those requiring intravenous antibiotics or hospitalization or those resulting in death. We calculated the propensity score (PS), which reflected the probability of receiving a specific DMARD group, and estimated the hazard ratio (HR) (with the 95% confidence interval [CI]) for SI from multivariable Cox models, adjusting for PS and time‐varying confounders. Results A total of 694 (5.9%) first SIs were identified in 11 623 patients with RA during 27 552 patient‐years of follow‐up. The SI incidence rate per 1000 patient‐years was 22.4 (95% CI 19.2‐26.1) for csDMARDs, 26.9 (95% CI 24.5‐29.6) for TNFis, and 23.3 (95% CI 19.0‐28.5) for non‐TNFi bDMARDs. Adjusted HRs for SIs were 1.33 (95% CI 1.05‐1.68) for TNFis and 1.48 (95% CI 1.02‐2.16) for non‐TNFi bDMARDs, compared with csDMARDs. The SI risk with non‐TNFi bDMARDs versus TNFis was not different. Other risk factors for SI were older age, higher comorbidity burden (particularly pulmonary disease), higher weighted cumulative prednisone dose, disability and disease activity, and number of prior csDMARD failures. Conclusion TNFis and non‐TNFi bDMARDs were associated with an increased SI risk compared with csDMARDs in RA, even after accounting for risk‐associated patient characteristics.
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Affiliation(s)
| | - Sofia Pedro
- FORWARD-The National Databank for Rheumatic Diseases Wichita Kansas
| | - Bryant R England
- University of Nebraska Medical Center and VA Nebraska-Western Iowa Health Care System Omaha
| | - Bella Mehta
- Hospital for Special Surgery New York New York
| | - Frederick Wolfe
- FORWARD-The National Databank for Rheumatic Diseases Wichita Kansas
| | - Kaleb Michaud
- University of Nebraska Medical Center, Omaha, and FORWARD-The National Databank for Rheumatic Diseases Wichita Kansas
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62
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Chen C, Borrego ME, Roberts MH, Raisch DW. Comparison of post-marketing surveillance approaches regarding infections related to tumor necrosis factor inhibitors (TNFi’s) used in treatment of autoimmune diseases. Expert Opin Drug Saf 2019; 18:733-744. [DOI: 10.1080/14740338.2019.1630063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- C. Chen
- College of Pharmacy, University of New Mexico, Albuquerque, NM, USA
| | - M. E. Borrego
- College of Pharmacy, University of New Mexico, Albuquerque, NM, USA
| | - M. H. Roberts
- College of Pharmacy, University of New Mexico, Albuquerque, NM, USA
| | - D. W. Raisch
- College of Pharmacy, University of New Mexico, Albuquerque, NM, USA
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63
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Mehta B, Pedro S, Ozen G, Kalil A, Wolfe F, Mikuls T, Michaud K. Serious infection risk in rheumatoid arthritis compared with non-inflammatory rheumatic and musculoskeletal diseases: a US national cohort study. RMD Open 2019; 5:e000935. [PMID: 31245055 PMCID: PMC6560658 DOI: 10.1136/rmdopen-2019-000935] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 04/23/2019] [Accepted: 05/15/2019] [Indexed: 11/04/2022] Open
Abstract
Objectives To identify serious infection (SI) risk by aetiology and site in patients with rheumatoid arthritis (RA) compared with those with non-inflammatory rheumatic and musculoskeletal diseases (NIRMD). Methods Patients participating in FORWARD from 2001 to 2016 were assessed for SIs; defined by infections requiring hospitalisation, intravenous antibiotics or followed by death. SIs were categorised by aetiology and site. SI risk was assessed through Cox proportional hazards models. Best models were selected using machine learning Least Absolute Shrinkage and Selection Operator (LASSO) methodology. Results Among 20 361 patients with RA and 6176 patients with NIRMD, 1600 and 276 first SIs were identified, respectively. Incidence of SIs was higher in RA compared with NIRMD (IRR = 1.5; 95% CI 1.2 to 1.5). The risk persisted after adjusting using the LASSO model (HR 1.7; 95% CI 1.5 to 1.8), but attenuated when additionally adjusted for glucocorticoid use (HR 1.3; 95% CI 1.2 to 1.5). SI risk was significantly higher in RA versus NIRMD for bacterial infections as well as for respiratory, skin, bone, joint, bloodstream infections and sepsis irrespective of glucocorticoid use. Compared with NIRMD, SI risk was significantly increased in patients with RA who were in moderate and high disease activity but was similar to those in low disease activity/remission (p trend < 0.001). Conclusions The risk of all SIs, particularly bacterial, respiratory, bloodstream, sepsis, skin, bone and joint infections are significantly increased in patients with RA compared with patients with NIRMD. This infection risk appears to be greatest in those with higher RA disease activity.
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Affiliation(s)
- Bella Mehta
- Department of Medicine, Hospital for Special Surgery, New York, New York, USA
| | - Sofia Pedro
- Forward, The National Databank for Rheumatic Diseases, Wichita, Kansas, USA
| | - Gulsen Ozen
- Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Andre Kalil
- Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Frederick Wolfe
- Forward, The National Databank for Rheumatic Diseases, Wichita, Kansas, USA
| | - Ted Mikuls
- Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Kaleb Michaud
- Forward, The National Databank for Rheumatic Diseases, Wichita, Kansas, USA.,Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Prevalence, Safety and Long-Term Retention Rates of Biologics in Hong Kong from 2001 to 2015. Drug Saf 2019; 42:1091-1102. [PMID: 31168709 DOI: 10.1007/s40264-019-00844-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Biologic agents were initially introduced as treatment for rheumatoid arthritis (RA) but have since been used for other medical conditions. As new biologics become increasingly widespread in treatment regimens, it is important to understand their safety and utilization in the post-marketing context. PURPOSE The aim of this study was to investigate long-term prescribing patterns and the safety of biologics in real clinical settings in Hong Kong. METHODS This was a population-based drug utilization study in Hong Kong using a territory-wide electronic medical database Clinical Data Analysis and Reporting System (CDARS). Patients who received biologic treatments from 2001 to 2015 were identified and their corresponding demographic and clinical details retrieved from CDARS. The annual prevalence of biologic prescriptions, the long-term retention rates and incidence rates of infections associated with biologic treatments were evaluated. RESULTS A total of 30,298 patients (male: 44%) prescribed biologic treatments were identified from CDARS from 2001 to 2015. The annual prevalence of biologic prescriptions increased from 0.1 to 16.1 per 100 persons for both sexes. Infliximab had the highest first-year retention rate of 95.6% among all biologics and continuously attained the highest retention rate from second to fifth year. The overall incidence rate of serious infections was less than five per 100 person-years. Specifically, the incidence rates of tuberculosis, upper and lower respiratory infections and herpes zoster were 0.52, 3.24, 4.99 and 1.01 per 100 person-years, respectively. CONCLUSION This population-based study revealed an increasing prevalence of biologic prescribing. Results from the study described the long-term retention rates and incidence rates of serious infections of biologic treatments for all indications, and confirmed the safety of biologic treatments. Since this study provides an overview of all biologic utilization, further studies on cost effectiveness, safety and compliance of treatment in different patient groups are still warranted.
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Shalom G, Naldi L, Lebwohl M, Nikkels A, de Jong EMGJ, Fakharzadeh S, Goyal KG, Srivastava B, Langholff W, Galindo C, Cohen AD. Biological treatment for psoriasis and the risk of herpes zoster: results from the Psoriasis Longitudinal Assessment and Registry (PSOLAR). J DERMATOL TREAT 2019; 30:534-539. [DOI: 10.1080/09546634.2018.1445193] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Guy Shalom
- Department of Dermatology and Venereology, Soroka Medical Center, Beer-Sheva, Israel
| | - Luigi Naldi
- Department of Dermatology, Azienda Ospedaliera Papa Giovanni XXIII, Study Center of the Italian Group for Epidemiologic Research in Dermatology (GISED), Bergamo, Italy
| | - Mark Lebwohl
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Elke M. G. J. de Jong
- Radboud University Medical Centre, and Radboud University Nijmegen, Nijmegen, The Netherlands
| | | | | | | | | | | | - Arnon D. Cohen
- Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
- Clalit Health Services, Tel Aviv, Israel
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66
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Kim H, Cho S, Lee J, Bae S, Sung Y. Increased risk of opportunistic infection in early rheumatoid arthritis. Int J Rheum Dis 2019; 22:1239-1246. [DOI: 10.1111/1756-185x.13585] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 02/13/2019] [Accepted: 03/18/2019] [Indexed: 01/05/2023]
Affiliation(s)
- Hyoungyoung Kim
- Department of Rheumatology Hanyang University Hospital for Rheumatic Diseases Seoul Korea
| | - Soo‐Kyung Cho
- Department of Rheumatology Hanyang University Hospital for Rheumatic Diseases Seoul Korea
- Clinical Research Center for Rheumatoid Arthritis (CRCRA) Hanyang University Seoul Korea
| | - Jiyoung Lee
- Clinical Research Center for Rheumatoid Arthritis (CRCRA) Hanyang University Seoul Korea
| | - Sang‐Cheol Bae
- Department of Rheumatology Hanyang University Hospital for Rheumatic Diseases Seoul Korea
- Clinical Research Center for Rheumatoid Arthritis (CRCRA) Hanyang University Seoul Korea
| | - Yoon‐Kyoung Sung
- Department of Rheumatology Hanyang University Hospital for Rheumatic Diseases Seoul Korea
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Ranza R, de la Vega MC, Laurindo IMM, Gómez MG, Titton DC, Kakehasi AM, Brigante A, Benitez A, Ranzolin A, Granel A, Cappuccio AM, Quinteros A, Hayata ALS, Smichowski A, Duarte ÂLBP, Kahlow BS, Andia CS, Brenol CV, Velozo E, Mussano E, Soriano ER, Christopoulos GB, da Rocha Castelar Pinheiro G, de Castro GRW, Casado G, da Silveira Carvalho HM, Exeni IE, da Silveira IG, Petkovic I, Pereira IA, da Costa IP, Rosa JE, Miranda JRS, de Moraes JCB, Bertolo MB, Buhl M, Lázaro MA, da Sauma MDFLC, de Medeiros Pinheiro M, Díaz M, de Vechi MVSS, Cerda OL, Astesana P, Curi PF, Louzada-Jr P, Teodoro RB, Toledo RA, Papasidero S, Valim V, Fernandes V, Saurit V, Bianchi WA, de Melo Costa Pinto R, Descalzo MA, Gomez-Reino JJ. Changing rate of serious infections in biologic-exposed rheumatoid arthritis patients. Data from South American registries BIOBADABRASIL and BIOBADASAR. Clin Rheumatol 2019; 38:2129-2139. [DOI: 10.1007/s10067-019-04516-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 03/02/2019] [Accepted: 03/13/2019] [Indexed: 12/21/2022]
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68
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Toxoplasma gondii seroprevalence in rheumatoid arthritis patients treated with biological agents. JOURNAL OF SURGERY AND MEDICINE 2019. [DOI: 10.28982/josam.523350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Loloi J, Saadi R, Williams N, McGinn J. Cutaneous Angioinvasive Fungal Infection of the Auricle. EAR, NOSE & THROAT JOURNAL 2019; 99:173-174. [PMID: 32180447 DOI: 10.1177/0145561319831663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Justin Loloi
- The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Robert Saadi
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Nicole Williams
- Department of Pathology, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Johnathan McGinn
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
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Cerda OL, de los Angeles Correa M, Granel A, Marcos AI, Giraldo C, Rillo O, Schneeberger EE, Citera G. Tuberculin test conversion in patients with chronic inflammatory arthritis receiving biological therapy. Eur J Rheumatol 2019; 6:19-22. [PMID: 30407165 PMCID: PMC6459330 DOI: 10.5152/eurjrheum.2018.18096] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 09/15/2018] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The blockade of inflammatory mediators produced by biological therapies is associated with an increased risk of opportunistic infections, as for example Mycobacterium tuberculosis (MT). Given the endemic situation of tuberculosis (TB) in some countries and immunosuppression/anergy of patients with chronic inflammatory arthritis, we wonder whether it is necessary to monitor the MT infection after starting the biological treatment. To evaluate the frequency of the tuberculin skin test (TST) conversion and its association with an active TB infection and other disease variables. METHODS Patients with rheumatoid arthritis (RA), juvenile idiopathic arthritis (JIA), and spondyloarthritis (SpA) receiving treatment with anti-TNF, tocilizumab, and/or abatacept agents were included into the study. Patients had to have a negative TST (<5 mm) at the baseline, and a second TST was performed 2-22 months after the initiation of biologic therapy. The TST conversion was considered as a variation ≥5 mm between the two TSTs performed within an interval between 2 months and 2 years. RESULTS A total of 85 patients were included into the study, and 78.8% were women, with a median schooling duration of 12 years. A total of 74.1% of patients had RA, 16.5% psoriatic arthritis, and 4.7% AIJ and ankylosing spondylitis. Regarding treatment, 75.3% received anti-TNF therapy (31.8% etanercept, 21.2% adalimumab, 17.6% infliximab, 3.5% golimumab, and 1.2% certolizumab), 15.3% tocilizumab, and 9.4% abatacept. Eight patients (9.4%) developed a TST conversion. The shift was more frequent in men (62.5%) than in women (37.5%) (p=0.009), and in those with a prolonged disease duration (X 226±109 vs X130±105 [p=0.017]). This association remained after adjusting for other variables. All patients who developed a TST conversion received prophylactic isoniazid, and only one patient with other risk factors developed active TB. CONCLUSION The frequency of a TST conversion in patients with chronic inflammatory arthritis was low and was associated with male gender and longer disease duration.
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Affiliation(s)
| | | | | | | | - Claudia Giraldo
- Hospital General de Agudos Dr. Ignacio Pirovano, Buenos Aires Argentina
| | - Oscar Rillo
- Hospital General de Agudos Dr. Ignacio Pirovano, Buenos Aires Argentina
| | | | - Gustavo Citera
- Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina
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71
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Seca S, Patrício M, Kirch S, Franconi G, Cabrita AS, Greten HJ. Effectiveness of Acupuncture on Pain, Functional Disability, and Quality of Life in Rheumatoid Arthritis of the Hand: Results of a Double-Blind Randomized Clinical Trial. J Altern Complement Med 2019; 25:86-97. [DOI: 10.1089/acm.2018.0297] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Susana Seca
- Heidelberg School of Chinese Medicine, Heidelberg, Germany
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
| | - Miguel Patrício
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Sebastian Kirch
- Heidelberg School of Chinese Medicine, Heidelberg, Germany
- Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
| | - Giovanna Franconi
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | | | - Henry J. Greten
- Heidelberg School of Chinese Medicine, Heidelberg, Germany
- Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
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Yoshida S, Kotani T, Kimura Y, Matsumura Y, Yoshikawa A, Tokai N, Ozaki T, Nagai K, Takeuchi T, Makino S, Arawaka S. Efficacy of abatacept tapering therapy for sustained remission in patients with rheumatoid arthritis: Prospective single-center study. Int J Rheum Dis 2019; 22:81-89. [DOI: 10.1111/1756-185x.13384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 07/12/2018] [Accepted: 08/09/2018] [Indexed: 12/29/2022]
Affiliation(s)
- Shuzo Yoshida
- Department of Internal Medicine (IV); Osaka Medical College; Osaka Japan
| | - Takuya Kotani
- Department of Internal Medicine (IV); Osaka Medical College; Osaka Japan
| | - Yuko Kimura
- Department of Internal Medicine (IV); Osaka Medical College; Osaka Japan
| | - Yoko Matsumura
- Department of Internal Medicine (IV); Osaka Medical College; Osaka Japan
| | - Ayaka Yoshikawa
- Department of Internal Medicine (IV); Osaka Medical College; Osaka Japan
| | - Nao Tokai
- Department of Internal Medicine (IV); Osaka Medical College; Osaka Japan
| | - Takuro Ozaki
- Department of Internal Medicine (IV); Osaka Medical College; Osaka Japan
| | - Koji Nagai
- Department of Internal Medicine (IV); Osaka Medical College; Osaka Japan
| | - Toru Takeuchi
- Department of Internal Medicine (IV); Osaka Medical College; Osaka Japan
| | - Shigeki Makino
- Department of Internal Medicine (IV); Osaka Medical College; Osaka Japan
| | - Shigeki Arawaka
- Department of Internal Medicine (IV); Osaka Medical College; Osaka Japan
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Clinical Utility of Neutrophil CD64 to Detect Extrapulmonary Tuberculosis in Three Patients with Rheumatoid Arthritis Undergoing Treatment with Biologics. Case Rep Rheumatol 2018; 2018:2856546. [PMID: 30631629 PMCID: PMC6304869 DOI: 10.1155/2018/2856546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 11/02/2018] [Accepted: 11/18/2018] [Indexed: 11/21/2022] Open
Abstract
Biologics play a key role in the treatment of rheumatoid arthritis (RA), while RA-related serious infection remains an unsettled clinical problem. Detection of tuberculosis (TB) is challenging due to the difficulty in distinguishing symptoms such as fever and elevation of inflammatory markers from other infections or a disease flare of RA. The expression of the CD64 molecule on neutrophils (neutrophil CD64) was upregulated by various infections including TB. However, it was not affected by disease activity of RA or by any therapy against RA. The present article reports three cases of extrapulmonary TB which occurred in patients with RA undergoing treatment with biologics. The marked increase in the levels of neutrophil CD64 may provide important insight into the diagnosis of TB.
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74
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Arleevskaya MI, Albina S, Larionova RV, Gabdoulkhakova AG, Lemerle J, Renaudineau Y. Prevalence and Incidence of Upper Respiratory Tract Infection Events Are Elevated Prior to the Development of Rheumatoid Arthritis in First-Degree Relatives. Front Immunol 2018; 9:2771. [PMID: 30555464 PMCID: PMC6281887 DOI: 10.3389/fimmu.2018.02771] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 11/12/2018] [Indexed: 12/21/2022] Open
Abstract
Introduction: The aim of this study was to characterize infection events in a longitudinal cohort of first-degree relatives (FDR) of probands with rheumatoid arthritis (RA) and explore their associations with RA development. To this end, newly diagnosed RA patients (n = 283), unaffected related FDR and age-matched healthy women were ascertained from the Caucasian triple women prospective Tatarstan cohort. Methods: In this cohort initiated in 1997, 26/283 (9.2%) FDR developed RA (incidence: 9.1 cases/1,000/year). At baseline and during the follow-up, information regarding infectious events (prevalence) and their incidence and duration per year were collected from all individuals. Results: Results reveal in the unaffected FDR developing RA subgroup: (i) a higher prevalence and/or incidence at baseline of upper respiratory infections (URI), otitis, tonsillitis, herpes reactivation, and skin infections; (ii) Mycoplasma sp detection was increased during pregnancy; (iii) a peak of infections started in the 3 years preceding RA onset, and thereafter decreased following RA diagnosis and treatment initiation with disease-modifying anti-rheumatic drugs (DMARDs) when considering URI, and acute tonsillitis; (iv) herpes virus reactivation, at baseline, was associated with a higher report of morning stiffness and arthralgia while independent from rheumatoid factors and anti-citrullinated peptide (CCP)2 Ab positivity; and (v) infection events represent an independent environmental factor associated with RA development. Conclusion: In conclusion, an annual increase of respiratory tract infections was found at the pre-clinical stage of RA. This could be due to alterations in the immune system that result in susceptibility to infection, controlled by DMARDs, or that the infectious events predispose to RA.
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Affiliation(s)
| | | | | | | | - Julie Lemerle
- Laboratory of Immunology and Immunotherapy, INSERM U1227, Hôpital Morvan, Centre Hospitalier Regional Universitaire de Brest, Brest, France
| | - Yves Renaudineau
- Central Research Laboratory, State Medical Academy, Kazan, Russia.,Laboratory of Immunology and Immunotherapy, INSERM U1227, Hôpital Morvan, Centre Hospitalier Regional Universitaire de Brest, Brest, France
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Galindo T, Reyna J, Weyer A. Evidence for Transient Receptor Potential (TRP) Channel Contribution to Arthritis Pain and Pathogenesis. Pharmaceuticals (Basel) 2018; 11:E105. [PMID: 30326593 PMCID: PMC6315622 DOI: 10.3390/ph11040105] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 10/08/2018] [Accepted: 10/12/2018] [Indexed: 02/07/2023] Open
Abstract
Based on clinical and preclinical evidence, Transient Receptor Potential (TRP) channels have emerged as potential drug targets for the treatment of osteoarthritis, rheumatoid arthritis, and gout. This review summarizes the relevant data supporting a role for various TRP channels in arthritis pain and pathogenesis, as well as the current state of pharmacological efforts to ameliorate arthritis symptoms in patient populations.
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Affiliation(s)
- Tabitha Galindo
- School of Physical Therapy and Athletic Training, Pacific University, Hillsboro, OR 97116, USA.
| | - Jose Reyna
- School of Physical Therapy and Athletic Training, Pacific University, Hillsboro, OR 97116, USA.
| | - Andy Weyer
- Biological Sciences Department, City College of San Francisco, San Francisco, CA 94112, USA.
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Caporali R, Crepaldi G, Codullo V, Benaglio F, Monti S, Todoerti M, Montecucco C. 20 years of experience with tumour necrosis factor inhibitors: what have we learned? Rheumatology (Oxford) 2018; 57:vii5-vii10. [DOI: 10.1093/rheumatology/key059] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Indexed: 12/17/2022] Open
Affiliation(s)
- Roberto Caporali
- Division of Rheumatology, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia
| | | | - Veronica Codullo
- Division of Rheumatology, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia
| | - Francesca Benaglio
- Division of Rheumatology, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia
| | - Sara Monti
- Division of Rheumatology, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia
| | - Monica Todoerti
- Division of Rheumatology, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia
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Ramírez J, Cañete JD. Anakinra for the treatment of rheumatoid arthritis: a safety evaluation. Expert Opin Drug Saf 2018; 17:727-732. [PMID: 29883212 DOI: 10.1080/14740338.2018.1486819] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
INTRODUCTION The anti-interleukin-1 receptor antagonist, anakinra, was approved for the treatment of rheumatoid arthritis (RA) more than 12 years ago. However, its adverse effects are not well known. Areas covered: We review the safety profile of anakinra, analyzing clinical trials, observational studies, and registry data. Expert opinion: Due to its lower efficacy compared with other biological therapies approved for RA and its daily subcutaneous administration, anakinra is used only marginally for the treatment of RA. This has limited the experience with this drug in RA, with a lack of data from long-term observational studies or registries. From the five clinical trials performed, and given the unfeasibility of developing new studies of anakinra in RA, it may be concluded that site injection reactions, infections at higher doses (>100 mg), and immunogenicity are the most frequent adverse events related to anakinra administration.
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Affiliation(s)
- Julio Ramírez
- a Arthritis Unit, Rheumatology Department , Hospital Clinic, and IDIBAPs , Barcelona , Spain
| | - Juan D Cañete
- a Arthritis Unit, Rheumatology Department , Hospital Clinic, and IDIBAPs , Barcelona , Spain
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78
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Goletti D, Petrone L, Ippolito G, Niccoli L, Nannini C, Cantini F. Preventive therapy for tuberculosis in rheumatological patients undergoing therapy with biological drugs. Expert Rev Anti Infect Ther 2018; 16:501-512. [PMID: 29848120 DOI: 10.1080/14787210.2018.1483238] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Latent tuberculosis infection (LTBI) accounts for almost a quarter of the world population, and, in 5-10% of the subjects with impaired immune-response against M. tuberculosis growth, it may progress to active tuberculosis (TB). In this review, we focus on the need to propose a screening for LTBI including preventive therapy offer in rheumatic patients undergoing therapy with biological drugs. Areas covered: We report on evidence that biologics are associated with an increased risk of active TB reactivation. This effect seems to be mainly limited to treatment with anti-tumor necrosis factor (TNF) agents, while non-anti-TNF-targeted biologics are not likely associated to any increased risk. We introduce the concept that the patients' coexisting host-related risk factors, such as comorbidities, are crucial to identify those at higher risk to reactivate TB. We report that preventive TB therapy is well tolerated in patients treated with biological drugs. Expert commentary: Availability of non-anti-TNF targeted biologics, that are not associated with an increased risk of TB reactivation, offers a great opportunity to tailor a therapeutic intervention at low/absent TB risk. After proper LTBI screening investigations, preventive TB therapy has been demonstrated to be effective and well-tolerated to reduce the risk of TB reactivation in rheumatic patients requiring biological drugs.
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Affiliation(s)
- Delia Goletti
- a Translational Research Unit, Department of Epidemiology and Preclinical Research , "L. Spallanzani" National Institute for Infectious Diseases (INMI), IRCCS , Rome , Italy
| | - Linda Petrone
- a Translational Research Unit, Department of Epidemiology and Preclinical Research , "L. Spallanzani" National Institute for Infectious Diseases (INMI), IRCCS , Rome , Italy
| | - Giuseppe Ippolito
- b Scientific Direction, "L. Spallanzani" National Institute for Infectious Diseases (INMI), IRCCS , Rome , Italy
| | - Laura Niccoli
- c Department of Rheumatology , Hospital of Prato , Prato , Italy
| | - Carlotta Nannini
- c Department of Rheumatology , Hospital of Prato , Prato , Italy
| | - Fabrizio Cantini
- c Department of Rheumatology , Hospital of Prato , Prato , Italy
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ESCMID Study Group for Infections in Compromised Hosts (ESGICH) Consensus Document on the safety of targeted and biological therapies: an infectious diseases perspective (Soluble immune effector molecules [I]: anti-tumor necrosis factor-α agents). Clin Microbiol Infect 2018; 24 Suppl 2:S10-S20. [DOI: 10.1016/j.cmi.2017.12.025] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 12/25/2017] [Accepted: 12/30/2017] [Indexed: 12/14/2022]
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Subesinghe S, Rutherford AI, Byng-Maddick R, Leanne Hyrich K, Benjamin Galloway J. Recurrent serious infections in patients with rheumatoid arthritis-results from the British Society for Rheumatology Biologics Register. Rheumatology (Oxford) 2018; 57:651-655. [PMID: 29340619 DOI: 10.1093/rheumatology/kex469] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Indexed: 12/17/2022] Open
Abstract
Objectives To establish the rate of recurrent infection in RA patients recruited to the British Society for Rheumatology Biologics Register - Rheumatoid Arthritis. Secondary objectives were to establish whether the organ class of index infection predicted future serious infection (SI). Methods Using data from the British Society for Rheumatology Biologics Register - Rheumatoid Arthritis, a prospective observational cohort, we identified patients with at least one episode of SI. Incidence rates of SI, recurrent SI within the same organ class as the index infection and recurrent SI (of any class) were calculated. A Cox proportional hazards model was used to identify predictors of SI. Results In total, 5289 subjects with at least one SI contributing 19 431 patient-years follow-up were studied. The baseline annual rate of first SI was 4.6% (95% CI: 4.5, 4.7), increasing to 14.1% (95% CI: 13.5, 14.8) following an index infection. Respiratory infections were the most frequent (44% of all events). Recurrent infections mirrored the organ class of the index infection. Sepsis, increasing age and polypharmacy were significant predictors of infection recurrence in a fully adjusted model. The system class of index infection was associated with the risk of a recurrent event; subjects who experienced sepsis had the highest risk of subsequent SI within 12 months, 19.7% (95% CI: 15.1, 25.7). Conclusion Recurrent infections in RA are common. Understanding patterns and predictors of recurrent infection together with the differential infection risk associated with immunosuppressive agents will help personalize RA care, tailor treatment choices better and mitigate against episodes of SI.
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Affiliation(s)
- Sujith Subesinghe
- Academic Department of Rheumatology, Weston Education Centre, King's College London, London, UK.,Department of Rheumatology, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, London, UK
| | - Andrew Ian Rutherford
- Academic Department of Rheumatology, Weston Education Centre, King's College London, London, UK.,Department of Rheumatology, King's College Hospital NHS Foundation Trust, London, UK
| | | | - Kimme Leanne Hyrich
- Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,NIHR Manchester Musculoskeletal Biomedical Research Centre, Central Manchester University Hospitals NHS Foundation Trust and University of Manchester Partnership, Manchester, UK
| | - James Benjamin Galloway
- Academic Department of Rheumatology, Weston Education Centre, King's College London, London, UK.,Department of Rheumatology, King's College Hospital NHS Foundation Trust, London, UK
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McCarthy EM, Sutton E, Nesbit S, White J, Parker B, Jayne D, Griffiths B, Isenberg DA, Rahman A, Gordon C, D'Cruz DP, Rhodes B, Lanyon P, Vital EM, Yee CS, Edwards CJ, Teh LS, Akil M, McHugh NJ, Zoma A, Bruce IN. Short-term efficacy and safety of rituximab therapy in refractory systemic lupus erythematosus: results from the British Isles Lupus Assessment Group Biologics Register. Rheumatology (Oxford) 2018; 57:470-479. [PMID: 29216396 PMCID: PMC5850287 DOI: 10.1093/rheumatology/kex395] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Indexed: 01/17/2023] Open
Abstract
Objectives To describe the baseline characteristics of SLE patients requiring biologic therapy in the UK and to explore short term efficacy and infection rates associated with rituximab (RTX) use. Methods Patients commencing biologic therapy for refractory SLE and who consented to join BILAG-BR were analysed. Baseline characteristics, disease activity (BILAG 2004/SLEDAI-2K) and rates of infection over follow-up were analysed. Response was defined as loss of all A and B BILAG scores to ⩽ 1 B score with no new A/B scores in other organ systems at 6 months. Results Two hundred and seventy SLE patients commenced biologic therapy from September 2010 to September 2015, most commonly RTX (n = 261). Two hundred and fifty (93%) patients were taking glucocorticoids at baseline at a median [interquartile range (IQR)] oral dose of 10 mg (5–20 mg) daily. Response rates at 6 months were available for 68% of patients. The median (IQR) BILAG score was 15 (10–23) at baseline and 3 (2–12) at 6 months (P < 0.0001). The median (IQR) SLEDAI-2K reduced from 8 (5–12) to 4 (0–7) (P < 0.001). Response was achieved in 49% of patients. There was also a reduction in glucocorticoid use to a median (IQR) dose of 7.5 mg (5–12 mg) at 6 months (P < 0.001). Serious infections occurred in 26 (10%) patients, being more frequent in the first 3 months post-RTX therapy. A higher proportion of early infections were non-respiratory (odds ratio = 1.98, 95% CI: 0.99, 3.9; P = 0.049). Conclusion RTX is safe and is associated with improvement in disease activity in refractory SLE patients with concomitant reductions in glucocorticoid use. Early vigilance for infection post-infusion is important to further improve treatment risks and benefits.
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Affiliation(s)
- Eoghan M McCarthy
- The Kellgren Centre for Rheumatology, NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester
| | - Emily Sutton
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester Academic Health Science Centre, Manchester
| | - Stephanie Nesbit
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester Academic Health Science Centre, Manchester
| | - James White
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester Academic Health Science Centre, Manchester
| | - Ben Parker
- The Kellgren Centre for Rheumatology, NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester.,Division of Musculoskeletal & Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester
| | - David Jayne
- Department of Medicine, Addenbooke's Hospital, Cambridge
| | | | - David A Isenberg
- Division of Rheumatology, University College London, Rayne Institute, London
| | - Anisur Rahman
- Division of Rheumatology, University College London, Rayne Institute, London
| | - Caroline Gordon
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham.,Rheumatology Department, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham
| | | | - Benjamin Rhodes
- Rheumatology Department, University Hospitals Birmingham NHS Foundation Trust, Old Queen Elizabeth Hospital, Birmingham
| | - Peter Lanyon
- Rheumatology Department, Nottingham University Hospitals NHS Trust, Nottingham
| | - Edward M Vital
- Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds.,NIHR Leeds Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds
| | - Chee-Seng Yee
- Department of Rheumatology, Doncaster and Bassetlaw Hospitals NHS Foundation Trust, Doncaster
| | - Christopher J Edwards
- Musculoskeletal Research Unit, NIHR Wellcome Trust Clinical Research facility, The University of Southampton.,Department of Rheumatology, University Hospital Southampton NHS Foundation Trust, Southampton
| | - Lee-Suan Teh
- Department of Rheumatology, Royal Blackburn Hospital, Blackburn
| | - Mohammed Akil
- Rheumatology Department, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust
| | - Neil J McHugh
- Department of Rheumatology, Royal National Hospital for Rheumatic Diseases and Royal United Hospitals Bath NHS Foundation Trust, Bath, UK.,Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - Asad Zoma
- Rheumatology Department, Hairmyres Hospital, Lanarkshire, UK
| | - Ian N Bruce
- The Kellgren Centre for Rheumatology, NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester.,Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester Academic Health Science Centre, Manchester
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82
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Lee WJ, Lee TA, Suda KJ, Calip GS, Briars L, Schumock GT. Risk of serious bacterial infection associated with tumour necrosis factor-alpha inhibitors in children with juvenile idiopathic arthritis. Rheumatology (Oxford) 2018; 57:273-282. [PMID: 28431162 DOI: 10.1093/rheumatology/kex049] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Indexed: 01/29/2023] Open
Abstract
Objectives TNF-α inhibitors (TNFIs) have a black box warning for increased risk of serious infection that was based on evidence from studies of adults. Evidence of the association is lacking for children. We aimed to examine the risk of infection posed by TNFIs compared with DMARDs in children with JIA. Methods We conducted a cohort study using the 2009-13 Truven MarketScan Commercial Claims and Encounters database. Children <16 years old with JIA who initiated monotherapy with TNFIs or DMARDs were identified and followed for occurrence of serious bacterial infection requiring hospitalization. Cox proportional hazard models were used to estimate hazard ratios for infection associated with TNFIs compared with DMARDs, adjusting for potential confounders with high-dimensional propensity scores and time-varying CS use. Results We identified 2013 DMARD initiators and 482 TNFI initiators with a mean follow-up of 255 and 307 days, respectively. We identified 18 and 11 patients with a serious infection in the DMARD and TNFI groups, resulting in crude rates of 1.28 (95% CI 0.76-2.02) and 2.72 (95%CI 1.36-4.86) per 100 person-years, respectively. In adjusted models, TNFIs were associated with an increased risk of serious bacterial infection compared with DMARDs (adjusted hazard ratio 2.72, 95% CI: 1.08, 6.86). Conclusion Use of TNFIs poses a higher risk of serious infection compared with DMARDs in children with JIA. Our analysis confirms the US Food and Drug Administration warning about TNFI-associated infection in children with JIA.
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Affiliation(s)
- Wan-Ju Lee
- Department of Pharmacy Systems, Outcomes and Policy, Chicago, IL, USA
| | - Todd A Lee
- Department of Pharmacy Systems, Outcomes and Policy, Chicago, IL, USA.,Center of Pharmacoepidemiology and Pharmacoeconomic Research, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
| | - Katie J Suda
- Department of Pharmacy Systems, Outcomes and Policy, Chicago, IL, USA.,Center of Pharmacoepidemiology and Pharmacoeconomic Research, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA.,Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, Chicago, IL, USA
| | - Gregory S Calip
- Department of Pharmacy Systems, Outcomes and Policy, Chicago, IL, USA.,Center of Pharmacoepidemiology and Pharmacoeconomic Research, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
| | - Leslie Briars
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
| | - Glen T Schumock
- Department of Pharmacy Systems, Outcomes and Policy, Chicago, IL, USA.,Center of Pharmacoepidemiology and Pharmacoeconomic Research, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
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83
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Rutherford AI, Subesinghe S, Hyrich KL, Galloway JB. Serious infection across biologic-treated patients with rheumatoid arthritis: results from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis. Ann Rheum Dis 2018; 77:905-910. [PMID: 29592917 DOI: 10.1136/annrheumdis-2017-212825] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 03/16/2018] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To compare the incidence of serious infection (SI) across biologic drugs used to treat rheumatoid arthritis (RA) using data from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis (BSRBR-RA). METHODS The BSRBR-RA is a prospective observational cohort study. This analysis included patients with RA starting a new biologic. The primary outcome was SI defined as an infectious event requiring admission to hospital, intravenous antibiotics or resulting in death. Event rates were calculated and compared across biologics using Cox proportional hazards with adjustment for potential confounders. Secondary outcomes were the rate of infection by organ class and 30-day mortality following infection. RESULTS This analysis included 19 282 patients with 46 771 years of follow-up. The incidence of SI was 5.51 cases per 100 patient years for the entire cohort (95% CI 5.29 to 5.71). Compared with etanercept, tocilizumab had a higher risk of SI (HR 1.22, 95% CI 1.02 to 1.47) and certolizumab pegol a lower risk of SI (HR 0.75, 95% CI 0.58 to 0.97) in the fully adjusted model. The 30-day mortality following SI was 10.4% (95% CI 9.2% to 11.6%). CONCLUSIONS The rate of SI was lower with certolizumab pegol than etanercept in the primary analysis but the result was no longer significant in several sensitivity analyses performed suggesting residual confounding may account for the observed difference. From these results, it would be wrong to conclude that certolizumab pegol has a lower rate of SI than other biologics; however, the risk does not appear to be significantly higher as has previously been suggested.
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Affiliation(s)
- Andrew I Rutherford
- Academic Rheumatology Department, King's College London, London, UK.,Rheumatology Department, King's College Hospital NHS Foundation Trust, London, UK
| | | | - Kimme L Hyrich
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Manchester University, Manchester, UK.,NIHR Manchester Musculoskeletal Biomedical Research Centre, Central Manchester Foundation Trust, Manchester, UK
| | - James B Galloway
- Academic Rheumatology Department, King's College London, London, UK.,Rheumatology Department, King's College Hospital NHS Foundation Trust, London, UK
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84
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Anti-Tumor Necrosis Factor-α-Induced Dermatological Complications in a Large Cohort of Inflammatory Bowel Disease Patients. Dig Dis Sci 2018; 63:746-754. [PMID: 29349693 DOI: 10.1007/s10620-018-4921-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 01/07/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND/AIMS The broader use of anti-tumor necrosis factor (TNF) agents in inflammatory bowel disease (IBD) has been associated with a high rate of adverse reactions. Dermatological complications are among the most common adverse events. We assessed the incidence, risk factors, management, and outcome of anti-TNF-induced dermatological complications in a large cohort of IBD patients. METHODS This was an observational retrospective study at a single tertiary referral center. All consecutive adult IBD patients treated with anti-TNF agents between 2005 and 2015 were identified. Patients who developed at least one dermatological complication while on anti-TNF therapy were included. RESULTS From the 732 patients treated with anti-TNF agents, 211 (29%) developed at least one dermatological complication: 52% women (mean age of 42 ± 13 years), 85% with Crohn's disease, 67% were under infliximab. Median follow-up time under anti-TNF therapy was 53 (27-77) months. Dermatological complications recorded were: infections (13.5%), psoriasiform lesions (5.3%), injection/infusion reactions (3.8%), skin cancer (0.5%), and miscellaneous (5.6%). Overall, female gender (OR = 1.658, p = 0.029), smoking (OR = 2.021, p = 0.003), and treatment with an infliximab dose of 10 mg/kg (OR = 2.012, p = 0.007) were independent risk factors for dermatological complications in multivariable analysis. Female gender (OR = 3.63, p = 0.017), smoking (OR = 2.846, p = 0.041), and treatment with adalimumab (OR = 8.894, p < 0.001) were independently associated with development of psoriasiform lesions. Three (3%) patients with infectious complications and 12 (31%) patients with psoriasiform lesions discontinued anti-TNF therapy definitively. CONCLUSIONS Dermatological manifestations occurred in almost one-third of our population. Infections were the most common complication, but anti-TNF-induced psoriasiform lesions were the most common cause for anti-TNF therapy definitive discontinuation.
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85
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A Systematic Review about the Efficacy and Safety of Tripterygium wilfordii Hook.f. Preparations Used for the Management of Rheumatoid Arthritis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2018; 2018:1567463. [PMID: 29576791 PMCID: PMC5822783 DOI: 10.1155/2018/1567463] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 11/22/2017] [Accepted: 12/19/2017] [Indexed: 12/20/2022]
Abstract
Tripterygium wilfordii Hook.f. (TWHF) is a traditional Chinese herb long used for rheumatoid arthritis (RA) treatment, in modern times, often in the form of various Tripterygium wilfordii Hook.f. preparations (TWPs). This systematic review and meta-analysis focuses on analyzing the clinical efficacy and safety of TWPs in the treatment of RA. Databases were searched to collect the randomized controlled trials (RCTs) on TWPs treating RA published on or before April 10, 2017. Data from 11 studies were included in this meta-analysis. Compared with the control group, TWPs can increase effectiveness, while decreasing erythrocyte sedimentation rate (ESR), rheumatoid factor (RF), C-reactive protein (CRP), and risk of adverse events. TWPs treatment was also more effective than treatment by conventional western medicine (CWM) and Chinese patent medicine or placebo (COP). TWPs significantly decreased the risk of adverse events compared with the CWM group, but not compared with the COP group. Current evidence shows that TWPs are more effective than other western or Chinese medicines we included in this meta-analysis for RA treatment with relatively lower toxicity.
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86
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Frantzen L, Oréfice D, Sparsa L, Afif N, Waltsburger A, Ardizzone M. Impact de l'éducation thérapeutique sur les compétences de sécurité de patients traités par biothérapie intraveineuse pour un rhumatisme inflammatoire en hôpital de jour. ACTA ACUST UNITED AC 2017. [DOI: 10.1051/tpe/2017011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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87
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Vashisht P, O'dell J. Not all TNF inhibitors in rheumatoid arthritis are created equal: important clinical differences. Expert Opin Biol Ther 2017; 17:989-999. [PMID: 28594252 DOI: 10.1080/14712598.2017.1340453] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Anti-TNF therapy has dramatically changed how we manage rheumatoid arthritis. There are many similarities among the five approved agents but also some important differences. Rheumatologists have 5 different options to choose from when they are ready to commence anti-TNF therapy. Although all block the TNF cytokine, there are important critical differences among them that affect their safety profile and clinical utility in certain scenarios. Unfortunately, there are no head to head trials to compare the different anti-TNF agents and none appear to be in the horizon. Areas covered: This article reviews the various clinical situations where it may be important to use a particular anti-TNF agent. The authors also give their expert opinion and future perspectives on the area. Expert opinion: Although there are many similarities among the five different TNFi that are clinically available, there are important clinical niches, where the limited data that are available, that clearly support the preferential use of a particular agent or class of agents. Assays or tests that allow us to find the 'sweet spot' of TNF inhibition at the level of each patient are long overdue.
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Affiliation(s)
| | - James O'dell
- b Internal Medicine , Chief Division of Rheumatology , Omaha , NE , USA
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88
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Chan M, Wen Y, Huang Y, Chuang H, Tain Y, Lily Wang Y, Hsu C. Risk of tuberculosis comparison in new users of antitumour necrosis factor‐α and with existing disease‐modifying antirheumatic drug therapy. J Clin Pharm Ther 2017; 43:256-264. [DOI: 10.1111/jcpt.12644] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 10/05/2017] [Indexed: 01/17/2023]
Affiliation(s)
- M.‐J. Chan
- School of Pharmacy Kaohsiung Medical University Kaohsiung Taiwan
| | - Y.‐H. Wen
- School of Pharmacy Kaohsiung Medical University Kaohsiung Taiwan
| | - Y.‐B. Huang
- School of Pharmacy Kaohsiung Medical University Kaohsiung Taiwan
- Department of Pharmacy Kaohsiung Medical University Chung‐Ho Memorial Hospital Kaohsiung Taiwan
| | - H.‐Y. Chuang
- Department of Public Health Center of Excellence for Environmental Medicine Kaohsiung Medical University Hospital Kaohsiung Taiwan
| | - Y.‐L. Tain
- Department of Pediatrics Kaohsiung Chang Gung Memorial Hospital and College of Medicine Chang Gung University Kaohsiung Taiwan
| | - Y.‐C. Lily Wang
- Department of Pharmacy Kaohsiung Chang Gung Memorial Hospital Kaohsiung Taiwan
| | - C.‐N. Hsu
- School of Pharmacy Kaohsiung Medical University Kaohsiung Taiwan
- Department of Pharmacy Kaohsiung Chang Gung Memorial Hospital Kaohsiung Taiwan
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89
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Tomio J, Yamana H, Matsui H, Yamashita H, Yoshiyama T, Yasunaga H. Tuberculosis screening prior to anti‐tumor necrosis factor therapy among patients with immune‐mediated inflammatory diseases in Japan: a longitudinal study using a large‐scale health insurance claims database. Int J Rheum Dis 2017; 20:1674-1683. [DOI: 10.1111/1756-185x.13190] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Jun Tomio
- Department of Public HealthGraduate School of MedicineThe University of TokyoTokyo Japan
| | - Hayato Yamana
- Department of Clinical Epidemiology and Health Economics Graduate School of Medicine The University of TokyoTokyoJapan
- Health and Sanitation Department, Bunkyo City Tokyo Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics Graduate School of Medicine The University of TokyoTokyoJapan
| | - Hiroyuki Yamashita
- Division of Rheumatic Diseases National Center for Global Health and MedicineTokyoJapan
| | - Takashi Yoshiyama
- Research Institute of Tuberculosis Tokyo Japan
- Fukujuji Hospital Tokyo Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics Graduate School of Medicine The University of TokyoTokyoJapan
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90
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Pieringer H, Hintenberger R, Pohanka E, Steinwender C, Meier J, Gruber F, Auer-Hackenberg L. RABBIT risk score and ICU admission due to infection in patients with rheumatoid arthritis. Clin Rheumatol 2017; 36:2439-2445. [PMID: 28905133 DOI: 10.1007/s10067-017-3825-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 08/30/2017] [Accepted: 09/04/2017] [Indexed: 01/26/2023]
Abstract
Rheumatoid arthritis (RA) patients are at increased risk of infection. Aim of the present study was to investigate whether RA patients admitted to an intensive care unit (ICU) due to infection have higher Rheumatoid Arthritis Observation of Biologic Therapy (RABBIT) risk scores compared to control RA patients. Seventy-four RA patients (32.4% male) admitted to an ICU due to infection (from January 2002 to December 2013) and 74 frequency-matched control RA patients (16.2% male) were included in this cross-sectional study. There was strong evidence for a higher RABBIT risk score in ICU patients (median 2.0; IQR 1.3-3.2) as compared to controls (1.3; IQR 0.8-2.0; p < 0.0001). Traditional disease-modifying anti-rheumatic drugs (DMARDs) (82.4 vs 64.9%; p = 0.015) and biological DMARDs (28.4 vs 14.9%; p = 0.012) were more frequently given to RA patients without ICU admission. Glucocorticoid users were more frequently found in the ICU group (51.4 vs 31.1%; p = 0.012). In a multivariable analysis tDMARD use was associated with lower (OR 0.38; 95% CI 0.15-0.93; p = 0.034) and glucocorticoid use with borderline higher odds of ICU admission (OR 2.05; 95% CI 0.92-4.58; p = 0.078). Chronic obstructive pulmonary disease (OR 2.89; 95% CI 1.10-7.54; p = 0.03), chronic kidney disease (OR 16.08; 95% CI 2.00-129.48; p = 0.009), and age category (OR 2.67; 95% CI 1.46-4.87; p = 0.001) were strongly associated with ICU admission. There was a strong trend towards higher odds of ICU admission with increasing RABBIT risk score. Use of tDMARDs was associated with lower odds of ICU admission. In an adjusted analysis, bDMARDs were not associated with ICU admission. COPD, CKD, and age were strong risk factors for ICU admission.
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Affiliation(s)
- Herwig Pieringer
- Academic Research Unit, 2nd Department of Internal Medicine, Kepler University Hospital, Med Campus III, Krankenhausstr. 9, 4020, Linz, Austria. .,Paracelsus Private Medical University Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria.
| | - Rainer Hintenberger
- Academic Research Unit, 2nd Department of Internal Medicine, Kepler University Hospital, Med Campus III, Krankenhausstr. 9, 4020, Linz, Austria
| | - Erich Pohanka
- Academic Research Unit, 2nd Department of Internal Medicine, Kepler University Hospital, Med Campus III, Krankenhausstr. 9, 4020, Linz, Austria
| | - Clemens Steinwender
- Paracelsus Private Medical University Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria.,1st Department of Internal Medicine, Kepler University Hospital, Med Campus III, Krankenhausstr. 9, 4020, Linz, Austria
| | - Jens Meier
- Department of Anesthesiology and Operative Intensive Care Medicine, Kepler University Hospital Linz, Krankenhausstr. 9, Linz, Austria
| | - Franz Gruber
- Department of Neurology 2, Kepler University Hospital, Med Campus III, Krankenhausstr. 9, Linz, Austria
| | - Lorenz Auer-Hackenberg
- Academic Research Unit, 2nd Department of Internal Medicine, Kepler University Hospital, Med Campus III, Krankenhausstr. 9, 4020, Linz, Austria
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91
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Dobry AS, Quesenberry CP, Ray GT, Geier JL, Asgari MM. Serious infections among a large cohort of subjects with systemically treated psoriasis. J Am Acad Dermatol 2017; 77:838-844. [PMID: 28917384 DOI: 10.1016/j.jaad.2017.07.047] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 07/26/2017] [Accepted: 07/30/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Biologic therapy is effective for treatment of moderate-to-severe psoriasis but may be associated with an increased risk for serious infection. OBJECTIVE To estimate the serious infection rate among patients with psoriasis treated with biologic as compared with nonbiologic systemic agents within a community-based health care delivery setting. METHODS We identified 5889 adult Kaiser Permanente Northern California health plan members with psoriasis who had ever been treated with systemic therapies and calculated the incidence rates and 95% confidence intervals (CIs) for serious infections over 29,717 person-years of follow-up. Adjusted hazard ratios (aHRs) were calculated using Cox regression. RESULTS Adjusting for age, sex, race or ethnicity, and comorbidities revealed a significantly increased risk for overall serious infection among patients treated with biologics as compared with those treated with nonbiologics (aHR, 1.31; 95% CI, 1.02-1.68). More specifically, there was a significantly elevated risk for skin and soft tissue infection (aHR, 1.75; 95% CI, 1.19-2.56) and meningitis (aHR, 9.22; 95% CI, 1.77-48.10) during periods of active biologic use. LIMITATIONS Risk associated with individual drugs was not examined. CONCLUSION We found an increased rate of skin and soft tissue infections among patients with psoriasis treated with biologic agents. There also was a signal suggesting increased risk for meningitis. Clinicians should be aware of these potential adverse events when prescribing biologic agents.
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Affiliation(s)
- Allison S Dobry
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Department of Population Medicine, Harvard Medical School, Boston, Massachusetts
| | | | - G Thomas Ray
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | | | - Maryam M Asgari
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Department of Population Medicine, Harvard Medical School, Boston, Massachusetts; Division of Research, Kaiser Permanente Northern California, Oakland, California
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92
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Feldman CH, Marty FM, Winkelmayer WC, Guan H, Franklin JM, Solomon DH, Costenbader KH, Kim SC. Comparative Rates of Serious Infections Among Patients With Systemic Lupus Erythematosus Receiving Immunosuppressive Medications. Arthritis Rheumatol 2017; 69:387-397. [PMID: 27589220 DOI: 10.1002/art.39849] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 08/18/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVE While infection burden is high among patients with systemic lupus erythematosus (SLE), there is uncertainty about whether infection rates differ by immunosuppressive drug regimens. We undertook this study to compare infection rates among SLE patients newly initiating immunosuppressive therapy with mycophenolate mofetil (MMF), azathioprine (AZA), or cyclophosphamide (CYC). METHODS Within the Medicaid Analytic eXtract database (2000-2010; 29 most populated US states), we identified adults with SLE starting MMF, AZA, or CYC treatment. We estimated propensity scores for receipt of MMF versus AZA and MMF versus CYC based on sociodemographic, comorbidity, and medication use information. After 1:1 propensity score matching, we estimated incidence rates of serious infections up to 6 and 12 months after drug initiation and used Cox regression to estimate hazard ratios (HRs) of first infection and death, with 95% confidence intervals (95% CIs). We performed primary intent-to-treat (ITT) and secondary as-treated analyses. RESULTS We studied 1,350 propensity score-matched pairs of MMF and AZA initiators and 674 propensity score-matched pairs of MMF and CYC initiators. In 6-month ITT analyses, the incidence rate per 100 person-years for first serious hospitalized infection was 14.6 in MMF users and 15.2 in AZA users (HR of MMF versus AZA 0.99 [95% CI 0.74-1.32]). Comparing MMF to CYC, the incidence rate per 100 person-years for first serious infection was 24.1 in MMF users and 24.6 in CYC users (HR 0.95 [95% CI 0.69-1.32]). There were no differences in mortality in either comparison. As-treated analyses yielded similar results. CONCLUSION In a nationwide longitudinal study of Medicaid SLE patients at high risk of infection, rates of serious infection and mortality did not differ among new users of MMF, AZA, or CYC.
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Affiliation(s)
- Candace H Feldman
- Brigham and Women's Hospital and Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | | | | | - Hongshu Guan
- Brigham and Women's Hospital, Boston, Massachusetts
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Cañete JD, Hernández MV, Sanmartí R. Safety profile of biological therapies for treating rheumatoid arthritis. Expert Opin Biol Ther 2017; 17:1089-1103. [DOI: 10.1080/14712598.2017.1346078] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Juan D. Cañete
- Arthritis Unit, Rheumatology Department, Hospital Clinic and IDIBAPS, Barcelona, Spain
| | - Ma Victoria Hernández
- Arthritis Unit, Rheumatology Department, Hospital Clinic and IDIBAPS, Barcelona, Spain
| | - Raimon Sanmartí
- Arthritis Unit, Rheumatology Department, Hospital Clinic and IDIBAPS, Barcelona, Spain
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Harrold LR, Reed GW, Karki C, Magner R, Shewade A, John A, Kremer JM, Greenberg JD. Risk of Infection Associated With Subsequent Biologic Agent Use After Rituximab: Results From a National Rheumatoid Arthritis Patient Registry. Arthritis Care Res (Hoboken) 2017; 68:1888-1893. [PMID: 27111064 PMCID: PMC5132134 DOI: 10.1002/acr.22912] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 03/20/2016] [Accepted: 04/05/2016] [Indexed: 12/12/2022]
Abstract
Objective To assess whether the time between the last rituximab infusion and initiation of a different biologic agent influenced infection risk in patients with rheumatoid arthritis (RA). Methods Patients with RA who newly initiated rituximab within the Consortium of Rheumatology Researchers of North America registry were included if they switched to a nonrituximab biologic agent and had ≥1 followup visit within 12 months of switching. Patients were categorized by duration of time between their last rituximab infusion and initiation of a subsequent biologic agent (≤5 months, 6–11 months, and ≥12 months). The primary outcome was time to first infectious event. Adjusted Cox regression models estimated the association between time to starting a subsequent biologic agent and infection. Results A total of 44 overall infections (7 serious, 37 nonserious) were reported during the 12‐month followup in the 215 patients included in this analysis (104 switched at ≤5 months, 67 at 6–11 months, and 44 at ≥12 months). Median (interquartile range) time to infection was 4 (2–5) months. Infection rates per patient‐year in the ≤5‐month, 6–11‐month, and ≥12‐month groups were 0.34 (95% confidence interval [95% CI] 0.22–0.52), 0.30 (95% CI 0.17–0.52), and 0.41 (95% CI 0.22–0.77), respectively. After adjustment, time to switch to a subsequent biologic agent was not associated with infection, which remained unchanged when number and rate of rituximab retreatments were included in the models. Conclusion In this real‐world cohort of patients with RA, infection rates ranged from 0.30 to 0.41 per patient‐year, with no significant difference in the rate between patients who initiated a subsequent biologic agent earlier versus later after rituximab treatment.
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Affiliation(s)
- Leslie R Harrold
- University of Massachusetts Medical School, Worcester, and Corrona, Southborough, Massachusetts
| | - George W Reed
- University of Massachusetts Medical School, Worcester, and Corrona, Southborough, Massachusetts
| | | | - Robert Magner
- University of Massachusetts Medical School, Worcester
| | | | - Ani John
- Genentech, South San Francisco, California
| | - Joel M Kremer
- Albany Medical College and the Center for Rheumatology, Albany, New York
| | - Jeffrey D Greenberg
- Corrona, Southborough, Massachusetts, and New York University School of Medicine, New York
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Moots RJ, Sebba A, Rigby W, Ostor A, Porter-Brown B, Donaldson F, Dimonaco S, Rubbert-Roth A, van Vollenhoven R, Genovese MC. Effect of tocilizumab on neutrophils in adult patients with rheumatoid arthritis: pooled analysis of data from phase 3 and 4 clinical trials. Rheumatology (Oxford) 2017; 56:541-549. [PMID: 28013198 PMCID: PMC5410975 DOI: 10.1093/rheumatology/kew370] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Indexed: 01/29/2023] Open
Abstract
Objectives To investigate changes in neutrophil count and occurrences of infection in RA patients treated with the IL-6 receptor-α inhibitor tocilizumab (TCZ). Methods Data were pooled from patients who received i.v. TCZ (4 mg/kg + MTX, 8 mg/kg ± DMARDs, 10 mg/kg) or placebo + DMARDs in phase 3/4 clinical trials, long-term extensions or a pharmacology study. Neutrophil counts were measured routinely according to the Common Toxicity Criteria for Adverse Events grades; TCZ dosing was adjusted if necessary. Covariates associated with decreased neutrophil counts were assessed with multivariate regression analysis. Infection rates within 30 days of neutrophil count changes were calculated per 100 patient-years of TCZ exposure. Results In placebo-controlled parts of trials, more TCZ-treated than placebo-treated patients had grade 1/2 or 3/4 neutrophil counts (TCZ: 28.2%/3.1%; placebo: 8.9%/0.2%). In placebo-controlled trials + long-term extensions, 4171 patients provided 16204.8 patient-years of TCZ exposure. Neutrophil counts decreased through week 6 from baseline [mean ( s . d .) change, -2.17 (2.16) × 10 9 /l) and remained stable thereafter. Rates (95% CI) of serious infections within 30 days of normal [4.66 (4.31, 5.03)], grade 1/2 [2.48 (1.79, 3.34)] and 3/4 [2.77 (0.34, 10.01)] neutrophil counts were similar. Baseline neutrophil count <2 × 10 9 /l and female gender were associated with grade 3/4 neutrophil counts [odds ratio (OR) (95% CI): 19.02 (6.76, 53.52), 2.55 (1.40, 4.66)]. Patients who stopped TCZ in response to decreased neutrophil count returned more quickly to normal levels than patients who reduced or continued their dose. Conclusion Decreases in neutrophil counts in patients taking TCZ do not appear to be associated with serious infections and are normalized by current risk mitigation guidelines.
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Affiliation(s)
- Robert J Moots
- Department of Musculoskeletal Biology, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Anthony Sebba
- Department of Rheumatology, University of South Florida, Tampa, FL
| | - William Rigby
- Medicine/Microbiology and Immunology, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Andrew Ostor
- Department of Rheumatology, Addenbrookes Hospital, Cambridge
| | | | | | | | | | | | - Mark C Genovese
- Division of Rheumatology, Stanford University Medical Center, Palo Alto, CA, USA
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Carroll GJ, Makin K, Garnsey M, Bulsara M, Carroll BV, Curtin SM, Allan EM, McLean-Tooke A, Bundell C, Kemp ML, Deshpande P, Ihdayhid D, Coleman S, Easter T, Triplett J, Disteldorf T, Marsden CH, Lucas M. Undetectable Mannose Binding Lectin and Corticosteroids Increase Serious Infection Risk in Rheumatoid Arthritis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017. [PMID: 28634103 DOI: 10.1016/j.jaip.2017.02.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Infection is the leading cause of death in rheumatoid arthritis (RA). Corticosteroid (CS) use is a known and important risk factor for serious infections (SIs). Mannose binding lectin (MBL) is a genetically determined component of the innate immune system implicated in neonatal infections. OBJECTIVE Our aim was to determine whether MBL deficiency is a risk factor for SIs in RA and to compare it with CS use and also synthetic and biologic disease-modifying antirheumatic drug (DMARD) therapy. METHODS Data on 228 patients with RA were collected for up to 7 years (median = 5.9 years). Serum MBL concentrations were determined in all patients receiving synthetic (n = 96) or biologic (n = 132) DMARD therapy. RESULTS High rates of SIs were observed in RA irrespective of treatment (17%). Similar rates of SIs were observed in synthetic and biologic DMARD users. The rates of single and multiple SIs were similar, irrespective of the use of a biologic agent. Undetectable MBL (<56 ng/mL) concentrations and maintenance prednisolone at 10 mg per day or higher were associated with an increased risk for an SI, with incident risk ratio of 4.67 (P = .001) and 4.70 (P < .001), respectively. CONCLUSIONS Undetectable MBL and prednisolone confer a high risk for an SI. The use of biologic DMARDs did not confer substantial SI risk in this observational study. MBL deficiency is hitherto an unrecognized risk factor for an SI in RA.
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Affiliation(s)
- Graeme J Carroll
- School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia; Department of Rheumatology, Fremantle Hospital, Fremantle, Western Australia, Australia; Department of Rheumatology, Fiona Stanley Hospital, Perth, Western Australia, Australia; ArthroCare, Mt Lawley, Western Australia, Australia.
| | - Krista Makin
- Department of Rheumatology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Maxine Garnsey
- Department of Rheumatology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Max Bulsara
- School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia
| | - Bronwyn V Carroll
- Department of Rheumatology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Shona M Curtin
- Department of Rheumatology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Erin M Allan
- ArthroCare, Mt Lawley, Western Australia, Australia
| | - Andrew McLean-Tooke
- Department of Clinical Immunology, Pathwest Laboratory Medicine, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
| | - Christine Bundell
- Department of Clinical Immunology, Pathwest Laboratory Medicine, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
| | - Monica L Kemp
- Department of Clinical Immunology, Pathwest Laboratory Medicine, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
| | - Pooja Deshpande
- School of Medicine, University of Western Australia, Human Anatomy and Biology, Perth, Western Australia, Australia
| | - Dana Ihdayhid
- Department of Rheumatology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | | | - Tracie Easter
- Department of Clinical Immunology, Pathwest Laboratory Medicine, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
| | - James Triplett
- Royal Perth Hospital, Perth, Western Australia, Australia
| | - Timothy Disteldorf
- School of Medicine, University of Western Australia, Human Anatomy and Biology, Perth, Western Australia, Australia
| | - C Helen Marsden
- Department of Rheumatology, Fremantle Hospital, Fremantle, Western Australia, Australia; Department of Rheumatology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Michaela Lucas
- Department of Rheumatology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia; Department of Clinical Immunology, Pathwest Laboratory Medicine, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia; Institute for Immunology and Infectious Diseases, Murdoch University, Perth, Western Australia, Australia; University of Western Australia, School of Medicine and Pharmacology, Pathology and Laboratory Medicine, Perth, Western Australia, Australia
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Mori S, Yoshitama T, Hidaka T, Sakai F, Hasegawa M, Hashiba Y, Suematsu E, Tatsukawa H, Mizokami A, Yoshizawa S, Hirakata N, Ueki Y. Comparative risk of hospitalized infection between biological agents in rheumatoid arthritis patients: A multicenter retrospective cohort study in Japan. PLoS One 2017; 12:e0179179. [PMID: 28594905 PMCID: PMC5464634 DOI: 10.1371/journal.pone.0179179] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 05/24/2017] [Indexed: 12/20/2022] Open
Abstract
Objective Knowing the risk of hospitalized infection associated with individual biological agents is an important factor in selecting the best treatment option for patients with rheumatoid arthritis (RA). This study examined the comparative risk of hospitalized infection between biological agents in a routine care setting. Methods We used data for all RA patients who had first begun biological therapy at rheumatology divisions of participating community hospitals in Japan between January 2009 and December 2014. New treatment episodes with etanercept, infliximab, adalimumab, abatacept, or tocilizumab were included. Patients were allowed to contribute multiple treatment episodes with different biological agents. Incidence rates (IRs) of hospitalized infection during the first year of follow-up were examined. Cox regression analysis was used to calculate hazard ratios (HRs) for overall hospitalized infection and for pulmonary hospitalized infection, adjusting for possible confounders. Results A total of 1596 new treatment episodes were identified. The incidence of overall hospitalized infection during the first year was 86 with 1239 person-years (PYs), yielding a crude IR of 6.9 per 100 PYs (95% confidence interval [CI], 5.6–8.6). After correction for confounders, no significant difference in risk of hospitalized infection was observed between treatment groups: adjusted HRs (95% CI) were 1.54 (0.78–3.04) for infliximab, 1.72 (0.88–3.34) for adalimumab, 1.11 (0.55–2.21) for abatacept, and 1.02 (0.55–1.87) for tocilizumab compared with etanercept. Patient-specific factors such as age, RA functional class, body mass index (BMI), prednisolone use, and chronic lung disease contributed more to the risk of hospitalized infection than specific biological agents. The incidence of pulmonary hospitalized infection was 50 and a crude IR of 4.0 per 100 PYs (95% CI, 3.1–5.3). After adjustment for confounders, adalimumab had a significantly higher HR for pulmonary hospitalized infection compared with tocilizumab: an adjusted HR (95% CI) was 4.43 (1.72–11.37) for adalimumab. BMI, prednisolone use, diabetes mellitus, and chronic lung disease were also significant factors associated with the risk of pulmonary hospitalized infection. Conclusions The magnitude of the risk of overall hospitalized infection was not determined by the type of biological agents, and patient-specific risk factors had more impact on the risk of hospitalized infection. For pulmonary hospitalized infections, the use of adalimumab was significantly associated with a greater risk of this complication than tocilizumab use.
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Affiliation(s)
- Shunsuke Mori
- Department of Rheumatology, Clinical Research Center for Rheumatic Diseases, National Hospital Organization (NHO) Kumamoto Saishunsou National Hospital, Kohshi, Kumamoto, Japan
- * E-mail:
| | - Tamami Yoshitama
- Yoshitama Clinic for Rheumatic Diseases, Kirishima, Kagoshima, Japan
| | - Toshihiko Hidaka
- Institute of Rheumatology, Zenjinkai Shimin-no-Mori Hospital, Miyazaki, Japan
| | - Fumikazu Sakai
- Department of Diagnostic Radiology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Mizue Hasegawa
- Department of Respiratory Medicine, Tokyo Women’s Medical University Yachiyo Medical Center, Yachiyo, Chiba
| | - Yayoi Hashiba
- Institute of Rheumatology, Zenjinkai Shimin-no-Mori Hospital, Miyazaki, Japan
| | - Eiichi Suematsu
- Department of Internal Medicine and Rheumatology, Clinical Research Institute, NHO Kyushu Medical Center, Fukuoka, Japan
| | | | - Akinari Mizokami
- Department of Rheumatology, Japan Community Healthcare Organization (JCHO) Isahaya General Hospital, Isahaya, Nagasaki, Japan
| | - Shigeru Yoshizawa
- Department of Rheumatology, NHO Fukuoka National Hospital, Fukuoka, Japan
| | - Naoyuki Hirakata
- Rheumatic and Collagen Disease Center, Sasebo Chuo Hospital, Sasebo, Nagasaki, Japan
| | - Yukitaka Ueki
- Rheumatic and Collagen Disease Center, Sasebo Chuo Hospital, Sasebo, Nagasaki, Japan
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Real-life 10-year retention rate of first-line anti-TNF drugs for inflammatory arthritides in adult- and juvenile-onset populations: similarities and differences. Clin Rheumatol 2017; 36:1747-1755. [DOI: 10.1007/s10067-017-3712-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 05/22/2017] [Accepted: 05/30/2017] [Indexed: 12/19/2022]
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Biologics registers in RA: methodological aspects, current role and future applications. Nat Rev Rheumatol 2017; 13:503-510. [PMID: 28569267 DOI: 10.1038/nrrheum.2017.81] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The beginning of the 21st century saw a biopharmaceutical revolution in the treatment of inflammatory rheumatic diseases, particularly rheumatoid arthritis. The fast-evolving use of biologic therapies highlighted the need to develop registers at national and international levels with the aim of collecting long-term data on patient outcomes. Over the past 15 years, many biologics registers have contributed a wealth of data and provided robust and reliable evidence on the use, effectiveness and safety of these therapies. The unavoidable challenges posed by the continuous introduction of new therapies, particularly with regard to understanding their long-term safety, highlights the importance of learning from experience with established biologic therapies. In this Perspectives article, the role of biologics registers in bridging the evidence gap between efficacy in clinical trials and real-world effectiveness is discussed, with a focus on methodological aspects of registers, their unique features and challenges and their role going forward.
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