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Abstract
The advent of biologic therapies, particularly antibody therapeutics, has revolutionized the pharmacological treatment of many rheumatic diseases. Antibody discovery began with the immunization of mice for the production of rodent immunoglobulins, but advances in protein and genetic engineering have now made it possible to generate fully human antibodies, which are better tolerated by patients. For most clinical applications in rheumatology, antibodies have been used as blocking agents capable of neutralizing the function of pro-inflammatory proteins, such as TNF. The latest strategies involve antibody products armed with effector moieties, such as anti-inflammatory drugs or cytokines, or antibody products that are specific for multiple targets for the selective inhibition of inflammation at sites of disease. Antibodies are some of the best-selling drugs in the world, and with further advances in antibody development, engineering of armed antibodies and bispecific products will have an important role in the treatment of rheumatic diseases.
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Chetaille Nézondet AL, Poubelle PE, Pelletier M. The evaluation of cytokines to help establish diagnosis and guide treatment of autoinflammatory and autoimmune diseases. J Leukoc Biol 2020; 108:647-657. [PMID: 32040246 DOI: 10.1002/jlb.5mr0120-218rrr] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 01/11/2020] [Accepted: 01/13/2020] [Indexed: 12/17/2022] Open
Abstract
Our knowledge of the role of cytokines in pathologic conditions has increased considerably with the emergence of molecular and genetic studies, particularly in the case of autoinflammatory monogenic diseases. Many rare disorders, considered orphan until recently, are directly related to abnormal gene regulation, and the treatment with biologic agents (biologics) targeting cytokine receptors, intracellular signaling or specific cytokines improve the symptoms of an increasing number of chronic inflammatory diseases. As it is currently impossible to systematically conduct genetic studies for all patients with autoinflammatory and autoimmune diseases, the evaluation of cytokines can be seen as a simple, less time consuming, and less expensive alternative. This approach could be especially useful when the diagnosis of syndromes of diseases of unknown etiology remains problematic. The evaluation of cytokines could also help avoid the current trial-and-error approach, which has the disadvantages of exposing patients to ineffective drugs with possible unnecessary side effects and permanent organ damages. In this review, we discuss the various possibilities, as well as the limitations of evaluating the cytokine profiles of patients suffering from autoinflammatory and autoimmune diseases, with methods such as direct detection of cytokines in the plasma/serum or following ex vivo stimulation of PBMCs leading to the production of their cytokine secretome. The patients' secretome, combined with biomarkers ranging from genetic and epigenetic analyses to immunologic biomarkers, may help not only the diagnosis but also guide the choice of biologics for more efficient and rapid treatments.
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Affiliation(s)
- Anne-Laure Chetaille Nézondet
- Department of Medicine, Faculty of Medicine, Laval University, Québec, Canada.,Reproduction, Mother and Youth Health Axis, CHU de Québec-Université Laval Research Center, Québec, Canada
| | - Patrice E Poubelle
- Department of Medicine, Faculty of Medicine, Laval University, Québec, Canada.,Infectious and Immune Diseases Axis, CHU de Québec-Université Laval Research Center, Québec, Canada
| | - Martin Pelletier
- Infectious and Immune Diseases Axis, CHU de Québec-Université Laval Research Center, Québec, Canada.,Department of Microbiology-Infectious Diseases and Immunology, Faculty of Medicine, Laval University, Québec, Canada.,ARThrite Research Center, Laval University, Québec, Canada
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53
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Scarneo SA, Hughes PF, Yang KW, Carlson DA, Gurbani D, Westover KD, Haystead TAJ. A highly selective inhibitor of interleukin-1 receptor-associated kinases 1/4 (IRAK-1/4) delineates the distinct signaling roles of IRAK-1/4 and the TAK1 kinase. J Biol Chem 2020; 295:1565-1574. [PMID: 31914413 PMCID: PMC7008364 DOI: 10.1074/jbc.ra119.011857] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/23/2019] [Indexed: 12/11/2022] Open
Abstract
Interleukin-1 receptor-associated kinase-1 (IRAK-1) and IRAK-4, as well as transforming growth factor β-activated kinase 1 (TAK1), are protein kinases essential for transducing inflammatory signals from interleukin receptors. IRAK family proteins and TAK1 have high sequence identity within the ATP-binding pocket, limiting the development of highly selective IRAK-1/4 or TAK1 inhibitors. Beyond kinase activity, IRAKs and TAK1 act as molecular scaffolds along with other signaling proteins, complicating the interpretation of experiments involving knockin or knockout approaches. In contrast, pharmacological manipulation offers the promise of targeting catalysis-mediated signaling without grossly disrupting the cellular architecture. Recently, we reported the discovery of takinib, a potent and highly selective TAK1 inhibitor that has only marginal activity against IRAK-4. On the basis of the TAK1-takinib complex structure and the structure of IRAK-1/4, here we defined critical contact sites of the takinib scaffold within the nucleotide-binding sites of each respective kinase. Kinase activity testing of takinib analogs against IRAK-4 identified a highly potent IRAK-4 inhibitor (HS-243). In a kinome-wide screen of 468 protein kinases, HS-243 had exquisite selectivity toward both IRAK-1 (IC50 = 24 nm) and IRAK-4 (IC50 = 20 nm), with only minimal TAK1-inhibiting activity (IC50 = 0.5 μm). Using HS-243 and takinib, we evaluated the consequences of cytokine/chemokine responses after selective inhibition of IRAK-1/4 or TAK1 in response to lipopolysaccharide challenge in human rheumatoid arthritis fibroblast-like synoviocytes. Our results indicate that HS-243 specifically inhibits intracellular IRAKs without TAK1 inhibition and that these kinases have distinct, nonredundant signaling roles.
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Affiliation(s)
- Scott A Scarneo
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, North Carolina 27710
| | - Philip F Hughes
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, North Carolina 27710
| | - Kelly W Yang
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, North Carolina 27710
| | - David A Carlson
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, North Carolina 27710
| | - Deepak Gurbani
- Departments of Biochemistry and Radiation Oncology, University of Texas, Southwestern Medical Center, Dallas, Texas 75390
| | - Kenneth D Westover
- Departments of Biochemistry and Radiation Oncology, University of Texas, Southwestern Medical Center, Dallas, Texas 75390
| | - Timothy A J Haystead
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, North Carolina 27710.
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54
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Bispecific Antibodies for Autoimmune and Inflammatory Diseases: Clinical Progress to Date. BioDrugs 2020; 34:111-119. [DOI: 10.1007/s40259-019-00400-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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55
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Failure of anti-TNF treatment in patients with rheumatoid arthritis: The pros and cons of the early use of alternative biological agents. Autoimmun Rev 2019; 18:102398. [DOI: 10.1016/j.autrev.2019.102398] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 06/06/2019] [Indexed: 12/16/2022]
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56
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Ma Z, Tao C, Sun L, Qi S, Le Y, Wang J, Li C, Liu X, Zhang J, Zhao J. In Situ Forming Injectable Hydrogel For Encapsulation Of Nanoiguratimod And Sustained Release Of Therapeutics. Int J Nanomedicine 2019; 14:8725-8738. [PMID: 31806967 PMCID: PMC6847989 DOI: 10.2147/ijn.s214507] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 10/21/2019] [Indexed: 01/17/2023] Open
Abstract
Background Iguratimod (IGUR) is a novel disease-modifying antirheumatic drug used for treating rheumatoid arthritis (RA). To improve its bioavailability and to alleviate gastrointestinal side effects, we changed the formulation into nanoiguratimod-loaded hydrogel (NanoIGUR-loaded hydrogel) composites for sustained release of therapeutics. Methods IGUR was first encapsulated in biodegradable polyvinyl alcohol micelle by liquid antisolvent precipitation (LAP) technology, and then loaded into an in situ injectable hyaluronic acid hydrogel, which was cross-linked by PEG (Thiol)2 (HS-PEG-SH) through Michael addition reaction. In vitro, the biological effects (proliferation, migration, and invasion) of NanoIGUR-loaded hydrogel on fibroblast-like synoviocytes (RA-FLS) from RA patients were evaluated. In vivo, the pharmacokinetics of NanoIGUR-loaded hydrogel was assessed and the efficacy of NanoIGUR-loaded hydrogel in treating collagen-induced arthritis (CIA) rats was evaluated. Results By the LAP technique, we acquired the amorphous form nanoiguratimod, with an average size of 458 nm, which had higher dissolution rates and higher stability. The release of IGUR from hydrogel composite in PBS was gradual and sustained for up to 72 hrs compared with nanoiguratimod. Different concentrations of NanoIGUR-loaded hydrogel inhibited the proliferation, migration, and invasion of RA-FLS. The pharmacokinetic parameters showed better bioavailability and longer half-life time with NanoIGUR-loaded hydrogel by subcutaneous administration than oral raw iguratimod. Animal experiments confirmed that subcutaneous injection of NanoIGUR-loaded hydrogel (10 mg/kg every 3 days) and oral raw iguratimod (10mg/kg daily) showed similar efficacy in decreasing arthritis index score, pathological score, and expression of inflammatory cytokines. Conclusion Overall, we demonstrate that NanoIGUR-loaded hydrogel provides a new route of administration and extends the administration interval. It could be a promising drug-delivery approach in the management of RA.
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Affiliation(s)
- Zhenzhen Ma
- Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing 100191, People's Republic of China
| | - Cheng Tao
- College of Chemical Engineering, Beijing University of Chemical Technology, Beijing 100029, People's Republic of China
| | - Lin Sun
- Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing 100191, People's Republic of China
| | - Shengbei Qi
- College of Chemical Engineering, Beijing University of Chemical Technology, Beijing 100029, People's Republic of China
| | - Yuan Le
- College of Chemical Engineering, Beijing University of Chemical Technology, Beijing 100029, People's Republic of China.,Research Center of the Ministry of Education for High Gravity Engineering and Technology, Beijing University of Chemical Technology, Beijing 100029, People's Republic of China
| | - Jiexin Wang
- College of Chemical Engineering, Beijing University of Chemical Technology, Beijing 100029, People's Republic of China.,Research Center of the Ministry of Education for High Gravity Engineering and Technology, Beijing University of Chemical Technology, Beijing 100029, People's Republic of China.,Beijing Advanced Innovation Center for Soft Matter Science and Engineering, Beijing University of Chemical Technology, Beijing 100029, People's Republic of China
| | - Changhong Li
- Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing 100191, People's Republic of China
| | - Xiangyuan Liu
- Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing 100191, People's Republic of China
| | - Jianjun Zhang
- College of Chemical Engineering, Beijing University of Chemical Technology, Beijing 100029, People's Republic of China
| | - Jinxia Zhao
- Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing 100191, People's Republic of China
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57
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Allard-Chamard H. Laboratory Testing in the Context of Biologics and Cellular Therapies. Clin Lab Med 2019; 39:657-668. [PMID: 31668276 DOI: 10.1016/j.cll.2019.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
"With the increasing application of biotechnology to the realm of pharmacology and therapeutics, the types of biological treatments available have significantly expanded. Currently, recombinant proteins, humanized antibodies, or rationally engineered monoclonal antibodies are used on a regular basis in the clinical setting. Moreover, cell-based therapeutics with molecularly rewired antigenic specificities are becoming increasingly common in oncology and are actively being developed for a broad range of diseases. Nonetheless, there has been a significant lag between the development of these technologies and the emergence of assays that can monitor these novel interventions."
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Affiliation(s)
- Hugues Allard-Chamard
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA; Division of Rheumatology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada; Centre de Recherche Clinique du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada; Division of Rheumatology, Centre intégré universitaire de santé et de service sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke (CIUSSS de l'Estrie-CHUS), 3001, 12th Avenue North, Room 3853, Sherbrooke, Québec J1H 5N4, Canada.
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58
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Mongin D, Lauper K, Turesson C, Hetland ML, Klami Kristianslund E, Kvien TK, Santos MJ, Pavelka K, Iannone F, Finckh A, Courvoisier DS. Imputing missing data of function and disease activity in rheumatoid arthritis registers: what is the best technique? RMD Open 2019; 5:e000994. [PMID: 31673410 PMCID: PMC6802981 DOI: 10.1136/rmdopen-2019-000994] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 09/02/2019] [Accepted: 09/20/2019] [Indexed: 01/24/2023] Open
Abstract
Objective To compare several methods of missing data imputation for function (Health Assessment Questionnaire) and for disease activity (Disease Activity Score-28 and Clinical Disease Activity Index) in rheumatoid arthritis (RA) patients. Methods One thousand RA patients from observational cohort studies with complete data for function and disease activity at baseline, 6, 12 and 24 months were selected to conduct a simulation study. Values were deleted at random or following a predicted attrition bias. Three types of imputation were performed: (1) methods imputing forward in time (last observation carried forward; linear forward extrapolation); (2) methods considering data both forward and backward in time (nearest available observation-NAO; linear extrapolation; polynomial extrapolation); and (3) methods using multi-individual models (linear mixed effects cubic regression-LME3; multiple imputation by chained equation-MICE). The performance of each estimation method was assessed using the difference between the mean outcome value, the remission and low disease activity rates after imputation of the missing values and the true value. Results When imputing missing baseline values, all methods underestimated equally the true value, but LME3 and MICE correctly estimated remission and low disease activity rates. When imputing missing follow-up values at 6, 12, or 24 months, NAO provided the least biassed estimate of the mean disease activity and corresponding remission rate. These results were not affected by the presence of attrition bias. Conclusion When imputing function and disease activity in large registers of active RA patients, researchers can consider the use of a simple method such as NAO for missing follow-up data, and the use of mixed-effects regression or multiple imputation for baseline data.
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Affiliation(s)
- Denis Mongin
- Division of Rheumatology, Geneva University Hospitals, Geneva, Switzerland
| | - Kim Lauper
- Division of Rheumatology, Geneva University Hospitals, Geneva, Switzerland
| | - Carl Turesson
- Department of Internal Medicine, Lund University, Lund, Sweden
- Department of Rheumatology, Skåne University Hospital, Malmö, Sweden
| | - Merete Lund Hetland
- Centre for Rheumatology and Spine Diseases, Rigshospitalet Glostrup, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Maria Jose Santos
- Department of Rheumatology, Hospital Garcia de Orta, Almada, Portugal
| | - Karel Pavelka
- Institute of Rheumatology and Clinic of Rheumatology, Charles University, Prague, Czech Republic
| | - Florenzo Iannone
- Department of Emergency and Transplantation, Rheumatology Unit, GISEA, University Hospital of Bari, Bari, Italy
| | - Axel Finckh
- Division of Rheumatology, Geneva University Hospitals, Geneva, Switzerland
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59
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Anti-IL-13Rα2 therapy promotes recovery in a murine model of inflammatory bowel disease. Mucosal Immunol 2019; 12:1174-1186. [PMID: 31308480 PMCID: PMC6717533 DOI: 10.1038/s41385-019-0189-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 05/21/2019] [Accepted: 06/23/2019] [Indexed: 02/08/2023]
Abstract
There continues to be a major need for more effective inflammatory bowel disease (IBD) therapies. IL-13Rα2 is a decoy receptor that binds the cytokine IL-13 with high affinity and diminishes its STAT6-mediated effector functions. Previously, we found that IL-13Rα2 was necessary for IBD in mice deficient in the anti-inflammatory cytokine IL-10. Here, we tested for the first time a therapeutic antibody specifically targeting IL-13Rα2. We also used the antibody and Il13ra2-/- mice to dissect the role of IL-13Rα2 in IBD pathogenesis and recovery. Il13ra2-/- mice were modestly protected from induction of dextran sodium sulfate (DSS)-induced colitis. Following a 7-day recovery period, Il13ra2-/- mice or wild-type mice administered the IL-13Rα2-neutralizing antibody had significantly improved colon health compared to control mice. Neutralizing IL-13Rα2 to increase IL-13 bioavailability promoted resolution of IBD even if neutralization occurred only during recovery. To link our observations in mice to a large human cohort, we conducted a phenome-wide association study of a more active variant of IL-13 (R130Q) that has reduced affinity for IL-13Rα2. Human subjects carrying R130Q reported a lower risk for Crohn's disease. Our findings endorse moving anti-IL-13Rα2 into preclinical drug development with the goal of accelerating recovery and maintaining remission in Crohn's disease patients.
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60
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Liu L, Wong CW, Han M, Farhoodi HP, Liu G, Liu Y, Liao W, Zhao W. Meta-analysis of preclinical studies of mesenchymal stromal cells to treat rheumatoid arthritis. EBioMedicine 2019; 47:563-577. [PMID: 31501076 PMCID: PMC6796567 DOI: 10.1016/j.ebiom.2019.08.073] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/27/2019] [Accepted: 08/29/2019] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND This study aims to evaluate the quality of preclinical data, determine the effect sizes, and identify experimental measures that inform efficacy using mesenchymal stromal (or stem) cells (MSC) therapy in animal models of rheumatoid arthritis (RA). METHODS Literature searches were performed on MSC preclinical studies to treat RA. MSC treatment effect sizes were determined by the most commonly used outcome measures, including paw thickness, clinical score, and histological score. FINDINGS A total of 48 studies and 94 treatment arms were included, among which 42 studies and 79 treatment arms reported that MSC improved outcomes. The effect sizes of RA treatments using MSC, when compared to the controls, were: paw thickness was ameliorated by 53.6% (95% confidence interval (CI): 26.7% -80.4%), histological score was decreased by 44.9% (95% CI: 33.3% -56.6%), and clinical score was decreased by 29.9% (95% CI: 16.7% -43.0%). Specifically, our results indicated that human umbilical cord derived MSC led to large improvements of the clinical score (-42.1%) and histological score (-51.4%). INTERPRETATION To the best of our knowledge, this meta-analysis is to quantitatively answer whether MSC represent a robust RA treatment in animal models. It suggests that in preclinical studies, MSC have consistently exhibited therapeutic benefits. The findings demonstrate a need for considering variations in different animal models and treatment protocols in future studies using MSC to treat RA in humans to maximise the therapeutic gains in the era of precision medicine. FUNDS NIH [1DP2CA195763], Baylx Inc.: BI-206512, NINDS/NIH Training Grant [Award# NS082174].
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Affiliation(s)
- Linan Liu
- Sue and Bill Gross Stem Cell Research Center, 845 Health Sciences Road, University of California-Irvine, Irvine, CA 92697, USA; Department of Pharmaceutical Sciences, University of California-Irvine, Irvine, CA 92697, USA; Chao Family Comprehensive Cancer Center, University of California-Irvine, Irvine, CA 92697, USA; Edwards Life Sciences Center for Advanced Cardiovascular Technology, University of California-Irvine, Irvine, CA 92697, USA
| | - Chi W Wong
- Sue and Bill Gross Stem Cell Research Center, 845 Health Sciences Road, University of California-Irvine, Irvine, CA 92697, USA; Department of Pharmaceutical Sciences, University of California-Irvine, Irvine, CA 92697, USA; Chao Family Comprehensive Cancer Center, University of California-Irvine, Irvine, CA 92697, USA; Edwards Life Sciences Center for Advanced Cardiovascular Technology, University of California-Irvine, Irvine, CA 92697, USA
| | - Menglu Han
- Sue and Bill Gross Stem Cell Research Center, 845 Health Sciences Road, University of California-Irvine, Irvine, CA 92697, USA; Department of Pharmaceutical Sciences, University of California-Irvine, Irvine, CA 92697, USA; Chao Family Comprehensive Cancer Center, University of California-Irvine, Irvine, CA 92697, USA; Edwards Life Sciences Center for Advanced Cardiovascular Technology, University of California-Irvine, Irvine, CA 92697, USA
| | - Henry P Farhoodi
- Sue and Bill Gross Stem Cell Research Center, 845 Health Sciences Road, University of California-Irvine, Irvine, CA 92697, USA; Department of Pharmaceutical Sciences, University of California-Irvine, Irvine, CA 92697, USA; Chao Family Comprehensive Cancer Center, University of California-Irvine, Irvine, CA 92697, USA; Edwards Life Sciences Center for Advanced Cardiovascular Technology, University of California-Irvine, Irvine, CA 92697, USA
| | - Guangyang Liu
- Sue and Bill Gross Stem Cell Research Center, 845 Health Sciences Road, University of California-Irvine, Irvine, CA 92697, USA; Department of Surgery, University of California-Irvine, Irvine, CA 92697, USA
| | - Yongjun Liu
- Sue and Bill Gross Stem Cell Research Center, 845 Health Sciences Road, University of California-Irvine, Irvine, CA 92697, USA; Department of Pharmaceutical Sciences, University of California-Irvine, Irvine, CA 92697, USA; Chao Family Comprehensive Cancer Center, University of California-Irvine, Irvine, CA 92697, USA; Edwards Life Sciences Center for Advanced Cardiovascular Technology, University of California-Irvine, Irvine, CA 92697, USA
| | - Wenbin Liao
- Baylx, Inc., 1 Technology Dr, C511, Irvine, CA 92618, USA.
| | - Weian Zhao
- Sue and Bill Gross Stem Cell Research Center, 845 Health Sciences Road, University of California-Irvine, Irvine, CA 92697, USA; Department of Pharmaceutical Sciences, University of California-Irvine, Irvine, CA 92697, USA; Chao Family Comprehensive Cancer Center, University of California-Irvine, Irvine, CA 92697, USA; Edwards Life Sciences Center for Advanced Cardiovascular Technology, University of California-Irvine, Irvine, CA 92697, USA; Departments of Biomedical Engineering and Biological Chemistry, University of California-Irvine, Irvine, CA 92697, USA.
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Keystone EC, Rampakakis E, Movahedi M, Cesta A, Stutz M, Sampalis JS, Nantel F, Maslova K, Bombardier C. Toward Defining Primary and Secondary Nonresponse in Rheumatoid Arthritis Patients Treated with Anti-TNF: Results from the BioTRAC and OBRI Registries. J Rheumatol 2019; 47:510-517. [PMID: 31263067 DOI: 10.3899/jrheum.190102] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Although most patients with rheumatoid arthritis (RA) respond to anti-tumor necrosis factor (anti-TNF) treatment, some present with initial nonresponse (1ry nonresponse) or lose initial responsiveness (2ry nonresponse). We compared the rate of real-world "nonresponse" to first anti-TNF as reported by treating physicians to the nonresponse rate per accepted definitions and recommended treat-to-target strategies. METHODS Patients were included from the Biologic Treatment Registry Across Canada (BioTRAC) and Ontario Best Practices Research Initiative (OBRI) registries who were taking their first anti-TNF, with ≥ 1 followup visit. Posthoc reclassification of physician-reported nonresponse was based on prior achievement of 28-joint count Disease Activity Score based on erythrocyte sedimentation rate (DAS28-ESR) low disease activity (LDA), Clinical Disease Activity Index (CDAI) LDA, or good/moderate European League Against Rheumatism (EULAR) response, and actual time of physician-reported nonresponse. RESULTS Among 736 BioTRAC and 640 OBRI patients, 13.7% and 18%, respectively, discontinued their anti-TNF because of physician-reported nonresponse. Based on reclassification using disease activity, 65.6% (BioTRAC) and 87.2% (OBRI) of 1ry nonresponders did not achieve DAS28-ESR LDA, 65.6%/90.7% CDAI LDA, and 46.9%/61.5% good/moderate EULAR response. Among 2ry nonresponders, 50.7%/47.8% did not achieve DAS28-ESR LDA, 37.7%/52.9% CDAI LDA, and 15.9%/19.6% good/moderate EULAR response before treatment discontinuation. Regarding actual time of nonresponse, 18.8% of BioTRAC and 60.8% of OBRI 1ry nonresponders discontinued at ≤ 6 months. In both registries, a high proportion of 2ry nonresponders discontinued their anti-TNF after 12 months (87.0% BioTRAC, 60.9% OBRI). CONCLUSION Physician-reported 1ry nonresponse was more correlated with non-achievement of DAS28-ESR LDA or CDAI LDA, whereas 2ry nonresponse with actual time of discontinuation. Further work is needed to confirm the importance of response and type of response to the initial anti-TNF in identifying patients most likely to benefit from a second biologic agent treatment.
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Affiliation(s)
- Edward C Keystone
- From The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; Toronto General Hospital Research Institute, University Health Network; Janssen Inc.; University of Toronto, Department of Medicine (DMO) and Institute of Health Policy, Management, and Evaluation (IHPME); Mount Sinai Hospital, Division of Rheumatology, Toronto, Ontario; JSS Medical Research Inc., Montreal, Quebec, Canada. .,E.C. Keystone, MD, The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; E. Rampakakis, PhD, JSS Medical Research Inc.; M. Movahedi, MD, PhD, Toronto General Hospital Research Institute, University Health Network; A. Cesta, MSc, Toronto General Hospital Research Institute, University Health Network; M. Stutz, MSc, JSS Medical Research Inc.; J.S. Sampalis, PhD, JSS Medical Research Inc.; F. Nantel, PhD, Janssen Inc.; K. Maslova, PhD, Janssen Inc.; C. Bombardier, MD, Toronto General Hospital Research Institute, University Health Network, and University of Toronto, DMO and IHPME, and Mount Sinai Hospital, Division of Rheumatology.
| | - Emmanouil Rampakakis
- From The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; Toronto General Hospital Research Institute, University Health Network; Janssen Inc.; University of Toronto, Department of Medicine (DMO) and Institute of Health Policy, Management, and Evaluation (IHPME); Mount Sinai Hospital, Division of Rheumatology, Toronto, Ontario; JSS Medical Research Inc., Montreal, Quebec, Canada.,E.C. Keystone, MD, The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; E. Rampakakis, PhD, JSS Medical Research Inc.; M. Movahedi, MD, PhD, Toronto General Hospital Research Institute, University Health Network; A. Cesta, MSc, Toronto General Hospital Research Institute, University Health Network; M. Stutz, MSc, JSS Medical Research Inc.; J.S. Sampalis, PhD, JSS Medical Research Inc.; F. Nantel, PhD, Janssen Inc.; K. Maslova, PhD, Janssen Inc.; C. Bombardier, MD, Toronto General Hospital Research Institute, University Health Network, and University of Toronto, DMO and IHPME, and Mount Sinai Hospital, Division of Rheumatology
| | - Mohammad Movahedi
- From The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; Toronto General Hospital Research Institute, University Health Network; Janssen Inc.; University of Toronto, Department of Medicine (DMO) and Institute of Health Policy, Management, and Evaluation (IHPME); Mount Sinai Hospital, Division of Rheumatology, Toronto, Ontario; JSS Medical Research Inc., Montreal, Quebec, Canada.,E.C. Keystone, MD, The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; E. Rampakakis, PhD, JSS Medical Research Inc.; M. Movahedi, MD, PhD, Toronto General Hospital Research Institute, University Health Network; A. Cesta, MSc, Toronto General Hospital Research Institute, University Health Network; M. Stutz, MSc, JSS Medical Research Inc.; J.S. Sampalis, PhD, JSS Medical Research Inc.; F. Nantel, PhD, Janssen Inc.; K. Maslova, PhD, Janssen Inc.; C. Bombardier, MD, Toronto General Hospital Research Institute, University Health Network, and University of Toronto, DMO and IHPME, and Mount Sinai Hospital, Division of Rheumatology
| | - Angela Cesta
- From The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; Toronto General Hospital Research Institute, University Health Network; Janssen Inc.; University of Toronto, Department of Medicine (DMO) and Institute of Health Policy, Management, and Evaluation (IHPME); Mount Sinai Hospital, Division of Rheumatology, Toronto, Ontario; JSS Medical Research Inc., Montreal, Quebec, Canada.,E.C. Keystone, MD, The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; E. Rampakakis, PhD, JSS Medical Research Inc.; M. Movahedi, MD, PhD, Toronto General Hospital Research Institute, University Health Network; A. Cesta, MSc, Toronto General Hospital Research Institute, University Health Network; M. Stutz, MSc, JSS Medical Research Inc.; J.S. Sampalis, PhD, JSS Medical Research Inc.; F. Nantel, PhD, Janssen Inc.; K. Maslova, PhD, Janssen Inc.; C. Bombardier, MD, Toronto General Hospital Research Institute, University Health Network, and University of Toronto, DMO and IHPME, and Mount Sinai Hospital, Division of Rheumatology
| | - Melissa Stutz
- From The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; Toronto General Hospital Research Institute, University Health Network; Janssen Inc.; University of Toronto, Department of Medicine (DMO) and Institute of Health Policy, Management, and Evaluation (IHPME); Mount Sinai Hospital, Division of Rheumatology, Toronto, Ontario; JSS Medical Research Inc., Montreal, Quebec, Canada.,E.C. Keystone, MD, The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; E. Rampakakis, PhD, JSS Medical Research Inc.; M. Movahedi, MD, PhD, Toronto General Hospital Research Institute, University Health Network; A. Cesta, MSc, Toronto General Hospital Research Institute, University Health Network; M. Stutz, MSc, JSS Medical Research Inc.; J.S. Sampalis, PhD, JSS Medical Research Inc.; F. Nantel, PhD, Janssen Inc.; K. Maslova, PhD, Janssen Inc.; C. Bombardier, MD, Toronto General Hospital Research Institute, University Health Network, and University of Toronto, DMO and IHPME, and Mount Sinai Hospital, Division of Rheumatology
| | - John S Sampalis
- From The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; Toronto General Hospital Research Institute, University Health Network; Janssen Inc.; University of Toronto, Department of Medicine (DMO) and Institute of Health Policy, Management, and Evaluation (IHPME); Mount Sinai Hospital, Division of Rheumatology, Toronto, Ontario; JSS Medical Research Inc., Montreal, Quebec, Canada.,E.C. Keystone, MD, The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; E. Rampakakis, PhD, JSS Medical Research Inc.; M. Movahedi, MD, PhD, Toronto General Hospital Research Institute, University Health Network; A. Cesta, MSc, Toronto General Hospital Research Institute, University Health Network; M. Stutz, MSc, JSS Medical Research Inc.; J.S. Sampalis, PhD, JSS Medical Research Inc.; F. Nantel, PhD, Janssen Inc.; K. Maslova, PhD, Janssen Inc.; C. Bombardier, MD, Toronto General Hospital Research Institute, University Health Network, and University of Toronto, DMO and IHPME, and Mount Sinai Hospital, Division of Rheumatology
| | - Francois Nantel
- From The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; Toronto General Hospital Research Institute, University Health Network; Janssen Inc.; University of Toronto, Department of Medicine (DMO) and Institute of Health Policy, Management, and Evaluation (IHPME); Mount Sinai Hospital, Division of Rheumatology, Toronto, Ontario; JSS Medical Research Inc., Montreal, Quebec, Canada.,E.C. Keystone, MD, The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; E. Rampakakis, PhD, JSS Medical Research Inc.; M. Movahedi, MD, PhD, Toronto General Hospital Research Institute, University Health Network; A. Cesta, MSc, Toronto General Hospital Research Institute, University Health Network; M. Stutz, MSc, JSS Medical Research Inc.; J.S. Sampalis, PhD, JSS Medical Research Inc.; F. Nantel, PhD, Janssen Inc.; K. Maslova, PhD, Janssen Inc.; C. Bombardier, MD, Toronto General Hospital Research Institute, University Health Network, and University of Toronto, DMO and IHPME, and Mount Sinai Hospital, Division of Rheumatology
| | - Karina Maslova
- From The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; Toronto General Hospital Research Institute, University Health Network; Janssen Inc.; University of Toronto, Department of Medicine (DMO) and Institute of Health Policy, Management, and Evaluation (IHPME); Mount Sinai Hospital, Division of Rheumatology, Toronto, Ontario; JSS Medical Research Inc., Montreal, Quebec, Canada.,E.C. Keystone, MD, The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; E. Rampakakis, PhD, JSS Medical Research Inc.; M. Movahedi, MD, PhD, Toronto General Hospital Research Institute, University Health Network; A. Cesta, MSc, Toronto General Hospital Research Institute, University Health Network; M. Stutz, MSc, JSS Medical Research Inc.; J.S. Sampalis, PhD, JSS Medical Research Inc.; F. Nantel, PhD, Janssen Inc.; K. Maslova, PhD, Janssen Inc.; C. Bombardier, MD, Toronto General Hospital Research Institute, University Health Network, and University of Toronto, DMO and IHPME, and Mount Sinai Hospital, Division of Rheumatology
| | - Claire Bombardier
- From The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; Toronto General Hospital Research Institute, University Health Network; Janssen Inc.; University of Toronto, Department of Medicine (DMO) and Institute of Health Policy, Management, and Evaluation (IHPME); Mount Sinai Hospital, Division of Rheumatology, Toronto, Ontario; JSS Medical Research Inc., Montreal, Quebec, Canada.,E.C. Keystone, MD, The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; E. Rampakakis, PhD, JSS Medical Research Inc.; M. Movahedi, MD, PhD, Toronto General Hospital Research Institute, University Health Network; A. Cesta, MSc, Toronto General Hospital Research Institute, University Health Network; M. Stutz, MSc, JSS Medical Research Inc.; J.S. Sampalis, PhD, JSS Medical Research Inc.; F. Nantel, PhD, Janssen Inc.; K. Maslova, PhD, Janssen Inc.; C. Bombardier, MD, Toronto General Hospital Research Institute, University Health Network, and University of Toronto, DMO and IHPME, and Mount Sinai Hospital, Division of Rheumatology
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Xu H, Jia S, Xu H. Potential therapeutic applications of exosomes in different autoimmune diseases. Clin Immunol 2019; 205:116-124. [PMID: 31228581 DOI: 10.1016/j.clim.2019.06.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 06/13/2019] [Accepted: 06/17/2019] [Indexed: 02/07/2023]
Abstract
Autoimmune diseases are caused by self-immune responses to autoantigens, which damage body tissues and severely affect the patient's quality of life. Therapeutic drugs are associated with adverse side effects and their beneficial effects are limited to specific populations. Evidence indicates that exosomes which are small vesicles secreted by most cell types and body fluids, and may play roles in both immune stimulation and tolerance since they are involved in many processes such as immune signaling, inflammation and angiogenesis. Exosomes have also emerged as promising tools for therapeutic delivery, given their intrinsic features such as stability, biocompatibility and a capacity for stealth. In this review, we summarize existing literature regarding the production, efficacy, action mechanism, and potential therapeutic uses of exosomes in the contexts of autoimmune diseases such as type 1 diabetes mellitus, multiple sclerosis, systemic lupus erythematosus, rheumatoid arthritis, and Sjogren's syndrome.
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Affiliation(s)
- Hui Xu
- The Engineering Research Center of polypeptide Drug Discovery and Evaluation of Jiangsu Province, College of Life Science and Technology, China Pharmaceutical University, Nanjing 210009, China
| | - Shaochang Jia
- Department of Bio-Treatment, Jinling Hospital, Nanjing, PR China.
| | - Hanmei Xu
- The Engineering Research Center of polypeptide Drug Discovery and Evaluation of Jiangsu Province, College of Life Science and Technology, China Pharmaceutical University, Nanjing 210009, China.
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Vanderpoel J, Tkacz J, Brady BL, Ellis L. Health Care Resource Utilization and Costs Associated With Switching Biologics in Rheumatoid Arthritis. Clin Ther 2019; 41:1080-1089.e5. [DOI: 10.1016/j.clinthera.2019.04.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 03/07/2019] [Accepted: 04/18/2019] [Indexed: 11/30/2022]
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Brown S, Everett CC, Naraghi K, Davies C, Dawkins B, Hulme C, McCabe C, Pavitt S, Emery P, Sharples L, Buch MH. Alternative tumour necrosis factor inhibitors (TNFi) or abatacept or rituximab following failure of initial TNFi in rheumatoid arthritis: the SWITCH RCT. Health Technol Assess 2019; 22:1-280. [PMID: 29900829 DOI: 10.3310/hta22340] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA), the most common autoimmune disease in the UK, is a chronic systemic inflammatory arthritis that affects 0.8% of the UK population. OBJECTIVES To determine whether or not an alternative class of biologic disease-modifying antirheumatic drugs (bDMARDs) are comparable to rituximab in terms of efficacy and safety outcomes in patients with RA in whom initial tumour necrosis factor inhibitor (TNFi) bDMARD and methotrexate (MTX) therapy failed because of inefficacy. DESIGN Multicentre, Phase III, open-label, parallel-group, three-arm, non-inferiority randomised controlled trial comparing the clinical and cost-effectiveness of alternative TNFi and abatacept with that of rituximab (and background MTX therapy). Eligible consenting patients were randomised in a 1 : 1 : 1 ratio using minimisation incorporating a random element. Minimisation factors were centre, disease duration, non-response category and seropositive/seronegative status. SETTING UK outpatient rheumatology departments. PARTICIPANTS Patients aged ≥ 18 years who were diagnosed with RA and were receiving MTX, but had not responded to two or more conventional synthetic disease-modifying antirheumatic drug therapies and had shown an inadequate treatment response to a first TNFi. INTERVENTIONS Alternative TNFi, abatacept or rituximab (and continued background MTX). MAIN OUTCOME MEASURES The primary outcome was absolute reduction in the Disease Activity Score of 28 joints (DAS28) at 24 weeks post randomisation. Secondary outcome measures over 48 weeks were additional measures of disease activity, quality of life, cost-effectiveness, radiographic measures, safety and toxicity. LIMITATIONS Owing to third-party contractual issues, commissioning challenges delaying centre set-up and thus slower than expected recruitment, the funders terminated the trial early. RESULTS Between July 2012 and December 2014, 149 patients in 35 centres were registered, of whom 122 were randomised to treatment (alternative TNFi, n = 41; abatacept, n = 41; rituximab, n = 40). The numbers, as specified, were analysed in each group [in line with the intention-to-treat (ITT) principle]. Comparing alternative TNFi with rituximab, the difference in mean reduction in DAS28 at 24 weeks post randomisation was 0.3 [95% confidence interval (CI) -0.45 to 1.05] in the ITT patient population and -0.58 (95% CI -1.72 to 0.55) in the per protocol (PP) population. Corresponding results for the abatacept and rituximab comparison were 0.04 (95% CI -0.72 to 0.79) in the ITT population and -0.15 (95% CI -1.27 to 0.98) in the PP population. General improvement in the Health Assessment Questionnaire Disability Index, Rheumatoid Arthritis Quality of Life and the patients' general health was apparent over time, with no notable differences between treatment groups. There was a marked initial improvement in the patients' global assessment of pain and arthritis at 12 weeks across all three treatment groups. Switching to alternative TNFi may be cost-effective compared with rituximab [incremental cost-effectiveness ratio (ICER) £5332.02 per quality-adjusted life-year gained]; however, switching to abatacept compared with switching to alternative TNFi is unlikely to be cost-effective (ICER £253,967.96), but there was substantial uncertainty in the decisions. The value of information analysis indicated that further research would be highly valuable to the NHS. Ten serious adverse events in nine patients were reported; none were suspected unexpected serious adverse reactions. Two patients died and 10 experienced toxicity. FUTURE WORK The results will add to the randomised evidence base and could be included in future meta-analyses. CONCLUSIONS How to manage first-line TNFi treatment failures remains unresolved. Had the trial recruited to target, more credible evidence on whether or not either of the interventions were non-inferior to rituximab may have been provided, although this remains speculative. TRIAL REGISTRATION Current Controlled Trials ISRCTN89222125 and ClinicalTrials.gov NCT01295151. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 34. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Sarah Brown
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Colin C Everett
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Kamran Naraghi
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Claire Davies
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Bryony Dawkins
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Claire Hulme
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Christopher McCabe
- Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada
| | - Sue Pavitt
- Dental Translational and Clinical Research Unit, University of Leeds, Leeds, UK
| | - Paul Emery
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.,National Institute for Health Research Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Linda Sharples
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Maya H Buch
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.,National Institute for Health Research Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Ren SX, Zhan B, Lin Y, Ma DS, Yan H. Selenium Nanoparticles Dispersed in Phytochemical Exert Anti-Inflammatory Activity by Modulating Catalase, GPx1, and COX-2 Gene Expression in a Rheumatoid Arthritis Rat Model. Med Sci Monit 2019; 25:991-1000. [PMID: 30718447 PMCID: PMC6373223 DOI: 10.12659/msm.912545] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Literature shows that serum selenium concentration is low in rheumatoid arthritis (RA) patients. Biochemical properties of nanoparticles (NPs) are depend in its medium dispersed. Biochemical properties could effectively alter the therapeutic potential of NPs. Phytochemicals could serve as suitable medium for dispersion of NPs. P-Coumaric acid (CA) known to have anti-inflammatory activity. MATERIAL AND METHODS In the present experiment, we investigated the anti-inflammatory effect of SeNPs dispersed in 1% CA against Complete Freund's adjuvant induced RA. Celecoxib was used as a reference drug. RESULTS Selenium NPs (SeNPs) size is maintained in 1% CA solution. We observed that supplementation with 500 μg/Kg body weight (b.w.) eNPs significantly restored the levels of thiobarbituric acid reactive substances, COX-2 activity, different antioxidant enzyme activities, and inflammatory cytokines (TNF-α, IL-1β, IL-6, and MCP-1) in RA rats. The mRNA expression of antioxidant enzymes such as MnSOD, Cu/ZnSOD, ECSOD, CAT, and GPx1 was found to be downregulated, whereas COX-2 was upregulated in RA rats; however, the mRNA expression of CAT, GPx1, and COX-2 reverted back to near normal levels in SeNPs-treated animals. CONCLUSIONS The therapeutic potential of SeNPs was confirmed through histological observation of angle joints in different experimental animals. Our results collectively suggest that SeNPs dispersed in CA can be an effective therapeutic agent for inflammatory disorders like acute gouty arthritis.
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Affiliation(s)
- Shi-Xiang Ren
- Department of Orthopedics, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing, China (mainland)
| | - Bo Zhan
- Department of Orthopedics, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing, China (mainland)
| | - Yuan Lin
- Department of Orthopedics, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing, China (mainland)
| | - De-Si Ma
- Department of Orthopedics, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing, China (mainland)
| | - Hui Yan
- Department of Orthopedics, Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing, China (mainland)
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Weinblatt ME, McInnes IB, Kremer JM, Miranda P, Vencovsky J, Guo X, White WI, Ryan PC, Godwood A, Albulescu M, Close D, Burmester GR. A Randomized Phase IIb Study of Mavrilimumab and Golimumab in Rheumatoid Arthritis. Arthritis Rheumatol 2019; 70:49-59. [PMID: 28941039 PMCID: PMC5767745 DOI: 10.1002/art.40323] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 09/11/2017] [Indexed: 12/29/2022]
Abstract
Objective This 24‐week, phase IIb, double‐blind study was undertaken to evaluate the efficacy and safety of mavrilimumab (a monoclonal antibody to granulocyte–macrophage colony‐stimulating factor receptor α) and golimumab (a monoclonal antibody to tumor necrosis factor [anti‐TNF]) in patients with rheumatoid arthritis (RA) who have had an inadequate response to disease‐modifying antirheumatic drugs (DMARDs) (referred to as DMARD‐IR) and/or inadequate response to other anti‐TNF agents (referred to as anti‐TNF–IR). Methods Patients with active RA and a history of DMARD‐IR (≥1 failed regimen) or DMARD‐IR (≥1 failed regimen) and anti‐TNF–IR (1–2 failed regimens) were randomized 1:1 to receive either mavrilimumab 100 mg subcutaneously every other week or golimumab 50 mg subcutaneously every 4 weeks alternating with placebo every 4 weeks, administered concomitantly with methotrexate. The primary end points were the American College of Rheumatology 20% improvement (ACR20), 50% improvement, and 70% improvement response rates at week 24, percentage of patients achieving a Disease Activity Score in 28 joints using C‐reactive protein level (DAS28‐CRP) of <2.6 at week 24, percentage of patients with a score improvement of >0.22 on the Health Assessment Questionnaire (HAQ) disability index (DI) at week 24, and safety/tolerability measures. This study was not powered to formally compare the 2 treatments. Results At week 24, differences in the ACR20, ACR50, and ACR70 response rates between the mavrilimumab treatment group (n = 70) and golimumab treatment group (n = 68) were as follows: in all patients, −3.5% (90% confidence interval [90% CI] −16.8, 9.8), −8.6% (90% CI −22.0, 4.8), and −9.8% (90% CI −21.1, 1.4), respectively; in the anti‐TNF–IR group, 11.1% (90% CI −7.8, 29.9), −8.7% (90% CI −28.1, 10.7), and −0.7% (90% CI −18.0, 16.7), respectively. Differences in the percentage of patients achieving a DAS28‐CRP of <2.6 at week 24 between the mavrilimumab and golimumab groups were −11.6% (90% CI −23.2, 0.0) in all patients, and −4.0% (90% CI −20.9, 12.9) in the anti‐TNF–IR group. The percentage of patients achieving a >0.22 improvement in the HAQ DI score at week 24 was similar between the treatment groups. Treatment‐emergent adverse events were reported in 51.4% of mavrilimumab‐treated patients and 42.6% of golimumab‐treated patients. No deaths were reported, and no specific safety signals were identified. Conclusion The findings of this study demonstrate the clinical efficacy of both treatments, mavrilimumab at a dosage of 100 mg every other week and golimumab at a dosage of 50 mg every 4 weeks, in patients with RA. Both regimens were well‐tolerated in patients who had shown an inadequate response to DMARDs and/or other anti‐TNF agents.
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Affiliation(s)
| | | | | | - Pedro Miranda
- Universidad de Chile and Hospital San Juan de Dios, Santiago, Chile
| | - Jiri Vencovsky
- Institute of Rheumatology, Charles University, Prague, Czech Republic
| | | | | | | | | | | | | | - Gerd R Burmester
- Charité-University Medicine Berlin, Free University of Berlin, and Humboldt University of Berlin, Berlin, Germany
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Farajzadeh D, Karimi-Gharigh S, Jalali-Kondori P, Dastmalchi S. Design and Construction of a Novel Humanized Single-Chain Variable-Fragment Antibody Against the Tumor Necrosis Factor Alpha. IRANIAN JOURNAL OF PHARMACEUTICAL RESEARCH : IJPR 2019; 18:308-319. [PMID: 31089365 PMCID: PMC6487432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The pro-inflammatory cytokine, TNF-α, which plays a major role in the development and persistence of diseases such as Crohn's disease, psoriasis, psoriatic arthritis, and rheumatoid arthritis, is the basis for the use of anti-TNF-α therapies. The neutralization of TNF-α or blockage of its binding to the corresponding receptor has mainly served as a therapeutic strategy against some inflammatory diseases. This study aimed to investigate the production of a humanized single chain antibody (scFv) against TNF-α. Therefore, a murine monoclonal antibody, D2 mAb, was selected for humanizing by the complementarity determining region (CDR)-grafting method. Briefly, the replacement of the CDRs from D2 mAb with the specific human single chain scaffold led to the production of a novel humanized single chain fragment variable mAb against human TNF-α (hD2). The subsequent cloning of hD2 into a suitable expression vector, pGEX-6P-1, resulted in the expression of a 52-kDa GST-fusion protein in E. coli, mostly in the form of inclusion bodies. The solubilization and refolding of GST-hD2 inclusion bodies was achieved with the addition of 4 M urea and subsequent dialysis to recover the fusion protein in soluble form. Then the soluble GST-hD2 was purified by affinity chromatography through immobilized glutathione. The GST pull-down experiment showed a positive interaction between GST-hD2 and TNF-α protein. Moreover, the results of an MTT assay showed that the purified GST-hD2 has TNF-α neutralizing activity (Kd of 1.03 nM) and hence hD2 has the potential to be developed into a therapeutic agent. However, more investigation is needed to elucidate the potential of in-vivo TNF-α neutralizing activity of hD2 in comparison to other anti-TNF-α antibodies.
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Affiliation(s)
- Davoud Farajzadeh
- Department of Cellular and Molecular Biology, Faculty of Basic Sciences, Azarbaijan Shahid Madani University, Tabriz, Iran.
| | - Sadigheh Karimi-Gharigh
- Department of Cellular and Molecular Biology, Faculty of Basic Sciences, Azarbaijan Shahid Madani University, Tabriz, Iran.
| | - Parisa Jalali-Kondori
- Department of Cellular and Molecular Biology, Faculty of Basic Sciences, Azarbaijan Shahid Madani University, Tabriz, Iran.
| | - Siavoush Dastmalchi
- Biotechnology Research Center and Department of Medicinal Chemistry, School of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran.,Faculty of Pharmacy, Near East University, Nicosia, North Cyprus, Mersin 10, Turkey,Corresponding author: E-mail:
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Switching of biological therapies in Brazilian patients with rheumatoid arthritis. Future Sci OA 2018; 5:FSO355. [PMID: 30652022 PMCID: PMC6331703 DOI: 10.4155/fsoa-2018-0025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 10/05/2018] [Indexed: 12/04/2022] Open
Abstract
Aim: To assess drug switching, rates of remission and disease activity in Brazilian patients with rheumatoid arthritis (RA) treated with biologic agents. Materials & methods: Using a retrospective method, a total of 94 adult patients were included. Results: Anti-TNF was the first choice therapy in 85 (90.4%) patients. After an average of 8 years of follow-up, 55 (59%) patients were taking anti-TNF, 18 (19%) abatacept, eight (9%) tocilizumab and 13 (14%) rituximab. In this period, 99 switches of biological therapy were registered in 55 patients. Conclusion: After 8 years of follow-up, 54% of the RA patients on biological therapy were still experiencing high or moderate activity despite established treatment, including switching between different biologic agents. Biological therapies are new drugs made through biotechnology processes that have greatly improved the treatment of RA. However, sometimes biologic agents must be switched to another biologic or other therapy due to lack of response, intolerance, adverse effects or other reasons. This study aimed to assess drug switching, rates of remission and disease activity in Brazilian patients with RA treated with biologics. Within a follow-up of 8 years, 99 switches of biological therapy were registered in 55 patients. After 8 years of follow-up, activity of disease still remained high or moderate in nearly half of patients.
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Guo X, Wang S, Godwood A, Close D, Ryan PC, Roskos LK, White WI. Pharmacodynamic biomarkers and differential effects of TNF- and GM-CSF-targeting biologics in rheumatoid arthritis. Int J Rheum Dis 2018; 22:646-653. [PMID: 30358109 PMCID: PMC6587493 DOI: 10.1111/1756-185x.13395] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 07/20/2018] [Accepted: 08/28/2018] [Indexed: 12/13/2022]
Abstract
Aim The aim of our study was to identify pharmacodynamic biomarkers and assess differential effects of tumor necrosis factor (TNF)‐ and non‐TNF‐targeting agents on rheumatoid arthritis (RA) patients with an inadequate response to anti‐TNF agents (anti‐TNF‐IR) in comparison with biologic‐naïve patients. Methods EARTH EXPLORER 2, a phase IIb trial, evaluated golimumab, an anti‐TNF antibody, and mavrilimumab, an granulocyte‐macrophage colony‐stimulating factor (GM‐CSF) receptor antibody, in disease‐modifying antirheumatic drug (DMARD)‐IR and anti‐TNF‐IR patients. Our current study assessed peripheral protein markers and gene expression levels in association with clinical response post‐treatment in two disease strata. Results Serum proteomics results indicated the existence of specific pharmacodynamic markers for golimumab and mavrilimumab, regardless of prior anti‐TNF treatment. In contrast, both antibodies induced early and sustained suppression of RA disease markers, including interleukin (IL)‐6, C‐reactive protein, IL2RA, and matrix metalloproteinase 1, in DMARD‐IR patients. Golimumab‐induced early changes rapidly returned toward baseline concentrations in anti‐TNF‐IR patients, whereas mavrilimumab‐induced changes were maintained through to day 169. RNA sequencing demonstrated gene expression changes at day 169 after administration of mavrilimumab but not golimumab in anti‐TNF‐IR patients. Additionally, receiver operating characteristic curve and regression analysis showed the association of early IL‐6 change and subsequent clinical responses to golimumab in anti‐TNF‐IR patients. Conclusion Our results revealed golimumab‐ and mavrilimumab‐specific pharmacodynamic biomarkers, and demonstrated differential biomarker‐treatment relationships in anti‐TNF‐IR and DMARD‐IR patients, respectively. Early IL‐6 change after anti‐TNF antibody treatment may be a potential predictive biomarker for selection of different treatment regimens in anti‐TNF‐IR patients.
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Affiliation(s)
- Xiang Guo
- Clinical Pharmacology & DMPK, MedImmune, Gaithersburg, Maryland
| | - Shiliang Wang
- Clinical Pharmacology & DMPK, MedImmune, Gaithersburg, Maryland
| | | | - David Close
- Clinical Development, MedImmune, Cambridge, UK
| | - Patricia C Ryan
- Biologics Safety Assessment, MedImmune, Gaithersburg, Maryland
| | - Lorin K Roskos
- Clinical Pharmacology & DMPK, MedImmune, Gaithersburg, Maryland
| | - Wendy I White
- Clinical Pharmacology & DMPK, MedImmune, Gaithersburg, Maryland
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Genovese MC, Weinblatt ME, Aelion JA, Mansikka HT, Peloso PM, Chen K, Li Y, Othman AA, Khatri A, Khan NS, Padley RJ. ABT-122, a Bispecific Dual Variable Domain Immunoglobulin Targeting Tumor Necrosis Factor and Interleukin-17A, in Patients With Rheumatoid Arthritis With an Inadequate Response to Methotrexate: A Randomized, Double-Blind Study. Arthritis Rheumatol 2018; 70:1710-1720. [PMID: 29855172 PMCID: PMC6704363 DOI: 10.1002/art.40580] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 05/29/2018] [Indexed: 12/28/2022]
Abstract
Objective Tumor necrosis factor (TNF) and interleukin‐17A (IL‐17A) may independently contribute to the pathophysiology of rheumatoid arthritis (RA). This study sought to evaluate the safety and efficacy of ABT‐122, a novel dual variable domain immunoglobulin targeting human TNF and IL‐17A, in patients with RA who have experienced an inadequate response to methotrexate. Methods Patients with active RA who were receiving treatment with methotrexate and had no prior exposure to biologic agents (n = 222) were enrolled in a 12‐week phase II randomized, double‐blind, active‐controlled, parallel‐group study. Patients were randomized to receive either ABT‐122 at dosages of 60 mg every other week, 120 mg every other week, or 120 mg every week or adalimumab at 40 mg every other week, administered subcutaneously. The primary efficacy end point was the proportion of patients achieving a ≥20% improvement response based on the American College of Rheumatology criteria for 20% improvement (ACR20) at week 12. Results Treatment‐emergent adverse events were similar across all treatment groups, with no serious infections or systemic hypersensitivity reactions reported with ABT‐122. ACR20 response rates at week 12 were 62%, 75%, and 80% with ABT‐122 60 mg every other week, 120 mg every other week, and 120 mg every week, respectively, compared with an ACR20 response rate of 68% with 40 mg adalimumab every other week. The corresponding response rates for ACR50 and ACR70 improvement in the ABT‐122 dose groups and adalimumab group were 35%, 46%, 47%, and 48%, respectively, and 22%, 18%, 36%, and 21%, respectively. Conclusion Over the 12‐week study period, dual inhibition of TNF and IL‐17A with ABT‐122 produced a safety profile consistent with that of adalimumb used for inhibition of TNF alone. The efficacy of ABT‐122 over 12 weeks at dosages of 120 mg every other week or 120 mg every week was not meaningfully differentiated from that of adalimumab at a dosage of 40 mg every other week in patients with RA receiving concomitant methotrexate.
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Affiliation(s)
| | | | - Jacob A Aelion
- University of Tennessee Heath Science Center, Memphis, Tennessee
| | | | | | - Kun Chen
- AbbVie Incorporated, North Chicago, Illinois
| | - Yihan Li
- AbbVie Incorporated, North Chicago, Illinois
| | | | - Amit Khatri
- AbbVie Incorporated, North Chicago, Illinois
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Proposing novel TNFα direct inhibitor Scaffolds using fragment-docking based e-pharmacophore modeling and binary QSAR-based virtual screening protocols pipeline. J Mol Graph Model 2018; 85:111-121. [DOI: 10.1016/j.jmgm.2018.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 07/11/2018] [Accepted: 07/12/2018] [Indexed: 01/08/2023]
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Kucharz EJ, Stajszczyk M, Kotulska-Kucharz A, Batko B, Brzosko M, Jeka S, Leszczyński P, Majdan M, Olesińska M, Samborski W, Wiland P. Tofacitinib in the treatment of patients with rheumatoid arthritis: position statement of experts of the Polish Society for Rheumatology. Reumatologia 2018; 56:203-211. [PMID: 30237624 PMCID: PMC6142023 DOI: 10.5114/reum.2018.77971] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 08/29/2018] [Indexed: 12/30/2022] Open
Abstract
Tofacitinib is a newly approved small-molecule targeted synthetic disease-modifying antirheumatic drug. The drug was designed as a selective and specific inhibitor of pro-inflammatory receptor signalling. Tofacitinib inhibits the process of intracellular signalling from the receptor to the cellular nucleus and inhibits the inflammation process via a new pathway (inhibition of the Janus kinases), which is unavailable to biological medicines. Tofacitinib has been approved for use in the treatment of patients with moderate to severe active RA. The drug may be used in combination with methotrexate or another conventional synthetic disease-modifying antirheumatic drug or in monotherapy. The efficacy of tofacitinib has been confirmed in several clinical trials. The drug inhibits radiographic progression of the disease. The innovative mechanism of action of tofacitinib is a noteworthy feature because it offers hope of effective treatment for patients who fail to respond to other drugs. The presented article discusses the mechanism of action and the clinical application of tofacitinib. Tofacitinib represents a new group of disease-modifying antirheumatic drugs that can be placed on an equal footing with biological drugs already available.
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Affiliation(s)
- Eugeniusz J. Kucharz
- Department of Internal Medicine, Rheumatology, and Clinical Immunology, Medical University of Silesia in Katowice, Poland
| | - Marcin Stajszczyk
- Department of Rheumatology and Autoimmune Diseases, Silesian Centre for Rheumatology, Rehabilitation, and Disability Prevention in Ustroń, Poland
| | - Anna Kotulska-Kucharz
- Department of Internal Medicine, Rheumatology, and Clinical Immunology, Medical University of Silesia in Katowice, Poland
| | - Bogdan Batko
- Department of Rheumatology, J. Dietl Memorial Specialist Hospital in Kraków, Poland
| | - Marek Brzosko
- Department of Rheumatology, Internal Medicine, and Geriatrics, Pomeranian Medical University in Szczecin, Poland
| | - Sławomir Jeka
- Department of Rheumatology and Systemic Connective Tissue Disorders, Jan Biziel University Hospital No. 2 in Bydgoszcz, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Poland
| | - Piotr Leszczyński
- Department of Rheumatology and Rehabilitation, Poznań University of Medical Sciences, Poland
- Department of Rheumatology and Osteoporosis, J. Struś Memorial Multidisciplinary Municipal Hospital in Poznań, Poland
| | - Maria Majdan
- Department of Rheumatology and Systemic Connective Tissue Disorders, Medical University of Lublin, Poland
| | - Marzena Olesińska
- Clinic of Connective Tissue Diseases, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Włodzimierz Samborski
- Department of Rheumatology and Rehabilitation, Poznań University of Medical Sciences, Poland
| | - Piotr Wiland
- Department of Rheumatology and Internal Medicine, Wrocław Medical University, Poland
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Comparative study of anti-VEGF Ranibizumab and Interleukin-6 receptor antagonist Tocilizumab in Adjuvant-induced Arthritis. Toxicol Appl Pharmacol 2018; 356:65-75. [PMID: 30025850 DOI: 10.1016/j.taap.2018.07.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 06/30/2018] [Accepted: 07/13/2018] [Indexed: 02/08/2023]
Abstract
Although the precise etiology of Rheumatoid arthritis (RA) remains obscure, heightened immune response is thought to play a vital role in provoking joint inflammation and bone erosion. This study aims at comparatively evaluating the effects of two monoclonal antibodies Ranibizumab (RANI) as anti-VEGF antibody and Tocilizumab (TCZ) as interleukin-6 receptor (IL-6R) antagonist, against adjuvant induced arthritis in rats. CFA-induced arthritic rats were treated for three consecutive weeks with Methotrexate (MTX), TCZ and RANI monotherapy. Clinical assessment of RA, bone erosion, inflammatory, angiogenic and apoptotic markers were determined to assess the anti-arthritic effect. Liver enzymes and histopathological examination of liver and spleen were assessed to evaluate the toxicity profile of the tested therapeutic agents. MTX, TCZ and RANI monotherapy significantly enhanced the anti-arthritic parameters in comparison with the Complete Freund's Adjuvant (CFA)-induced arthritic rats through significant reduction of ankle and paw swelling. Also, they significantly reduced inflammatory, angiogenic and apoptotic markers. Importantly, Ranibizumab showed better effect than the standard anti-rheumatic drugs Methotrexate (MTX) or Tocilizumab (TCZ) in bone protection and cartilage health; hence proves to be a promising new therapeutic agent for RA.
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Genovese MC, Fleischmann R, Combe B, Hall S, Rubbert-Roth A, Zhang Y, Zhou Y, Mohamed MEF, Meerwein S, Pangan AL. Safety and efficacy of upadacitinib in patients with active rheumatoid arthritis refractory to biologic disease-modifying anti-rheumatic drugs (SELECT-BEYOND): a double-blind, randomised controlled phase 3 trial. Lancet 2018; 391:2513-2524. [PMID: 29908670 DOI: 10.1016/s0140-6736(18)31116-4] [Citation(s) in RCA: 279] [Impact Index Per Article: 46.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 05/07/2018] [Accepted: 05/10/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Phase 2 studies with upadacitinib, a selective Janus kinase 1 (JAK1) inhibitor, have shown safety and efficacy in the treatment of patients with active rheumatoid arthritis. We did this study to further assess the safety and efficacy of upadacitinib in patients with an inadequate response to biologic disease-modifying anti-rheumatic drugs (bDMARDs). METHODS We did this double-blind, randomised controlled phase 3 trial at 153 sites in 26 countries. Patients were aged 18 years or older, had active rheumatoid arthritis and previous inadequate response or intolerance to bDMARDs, and were receiving concomitant background conventional synthetic DMARDS (csDMARDs). We randomly assigned patients (2:2:1:1) by interactive response technology to receive once-daily oral extended-release upadacitinib 15 mg or 30 mg or placebo for 12 weeks, followed by upadacitinib 15 mg or 30 mg from week 12 onwards. The two separate primary endpoints were the proportions of patients achieving a 20% improvement in American College of Rheumatology criteria (ACR20) at week 12 and the proportion of patients achieving a 28-joint disease activity score using C-reactive protein (DAS28[CRP]) of 3·2 or less at week 12. Efficacy and safety analyses were done in the modified intention-to-treat population of all patients who received at least one dose of study drug. Data are presented up to week 24 of this ongoing study. The trial is registered with ClinicalTrials.gov (NCT02706847). FINDINGS Between March 15, 2016, and Jan 10, 2017, 499 patients were randomly assigned (n=165 upadacitinib 15 mg; n=165 upadacitinib 30 mg; n=85 placebo then upadacitinib 15 mg; and n=84 placebo then upadacitinib 30 mg) and one patient was withdrawn from the 15 mg upadacitinib group before the start of study treatment. Mean disease duration was 13·2 years (SD 9·5); 235 (47%) of 498 patients had received one previous bDMARD, 137 (28%) had received two, and 125 (25%) had received at least three; 451 (91%) patients completed treatment up to week 12 and 419 (84%) patients completed treatment up to week 24. At week 12, ACR20 was achieved by 106 (65%; 95% CI 57-72) of 164 patients receiving upadacitinib 15 mg and 93 (56%; 49-64) of 165 patients receiving upadacitinib 30 mg compared with 48 (28%; 22-35) of 169 patients receiving placebo (p<0·0001 for each dose vs placebo). DAS28(CRP) of 3·2 or less was achieved by 71 (43%; 95% CI 36-51) of 164 patients receiving upadacitinib 15 mg and 70 (42%; 35-50) of 165 patients receiving upadacitinib 30 mg versus 24 (14%; 9-20) of 169 patients receiving placebo (p<0·0001 for each dose vs placebo). Up to week 12, overall numbers of patients with adverse events were similar for the placebo group (95 [56%] of 169) and the upadacitinib 15 mg group (91 [55%] of 164), but higher in the upadacitinib 30 mg group (111 [67%] of 165). At week 12, the most common adverse events occurring in at least 5% of patients in any treatment group were upper respiratory tract infection (13 [8%] of 169 in the placebo group; 13 [8%] of 164 in the upadacitinib 15 mg group; ten [6%] of 165 in the upadacitinib 30 mg group), nasopharyngitis (11 [7%]; seven [4%]; nine [5%]), urinary tract infection (ten [6%]; 15 [9%]; nine [5%]), and worsening of rheumatoid arthritis (ten [6%]; four [2%]; six [4%]). The number of patients with serious adverse events was higher in the upadacitinib 30 mg group (12 [7%]) than in the upadacitinib 15 mg group (eight [5%]); no serious adverse events were reported in patients receiving placebo. More patients in the upadacitinib 30 mg group had serious infections, herpes zoster, and adverse events leading to discontinuation than in the upadacitinib 15 mg and placebo groups. During the placebo-controlled phase of the study, one case of pulmonary embolism, three malignancies, one major adverse cardiovascular event, and one death were reported in patients receiving upadacitinib; none were reported in patients receiving placebo. INTERPRETATION Both doses of upadacitinib led to rapid and significant improvements compared with placebo over 12 weeks in patients with refractory rheumatoid arthritis. FUNDING AbbVie Inc.
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Affiliation(s)
- Mark C Genovese
- Division of Immunology and Rheumatology, Stanford University School of Medicine, Palo Alto, CA, USA.
| | - Roy Fleischmann
- University of Texas Southwestern, Metroplex Clinical Research Center, Dallas, Texas, USA
| | - Bernard Combe
- Department of Rheumatology, CHU Montpellier, Université de Montpellier, Montpellier, France
| | - Stephen Hall
- Department of Medicine, Monash University, Cabrini Health and Emeritus Research, Malvern, VIC, Australia
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Claxton L, Taylor M, Soonasra A, Bourret JA, Gerber RA. An Economic Evaluation of Tofacitinib Treatment in Rheumatoid Arthritis After Methotrexate or After 1 or 2 TNF Inhibitors from a U.S. Payer Perspective. J Manag Care Spec Pharm 2018; 24:1010-1017. [PMID: 29897007 PMCID: PMC10397979 DOI: 10.18553/jmcp.2018.17220] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Treatment cycling with biologic disease-modifying anti-rheumatic drugs, such as tumor necrosis factor inhibitors (TNFi), is common among patients with rheumatoid arthritis (RA) and can result in reduced clinical efficacy and increased economic burden. Tofacitinib is an oral Janus kinase inhibitor for the treatment of RA. OBJECTIVE To evaluate and compare the economic effect of tofacitinib 5 mg twice daily (BID) treatment directly after methotrexate (MTX) in the MTX-inadequate responder population, or after MTX and 1 TNFi (adalimumab [ADA] or etanercept [ETN]) or 2 TNFi (ADA and ETN) in TNF-inadequate responder patients with RA, from a U.S. payer perspective. METHODS A decision-tree economic model was used to evaluate costs over 2 years. Treatment response was modeled as American College of Rheumatology (ACR) 20/50/70 response. ACR response rates at 6-month intervals were derived from U.S. prescribing information for monotherapy and combination therapy. Safety event rates were sourced from a meta-analysis. It was assumed that 75% of patients switched therapy after an adverse event or lack of response. Cost inputs included drugs, monitoring and administration (including physician visits), health care utilization, and treatment for adverse events. The population comprised all organization members (i.e., RA and non-RA members); RA patients receiving TNFi were estimated using epidemiologic data. Results were based on an organization size of 1 million. Economic endpoints were total 2-year costs, costs per member per month (PMPM), and costs per ACR20/50 responder. RESULTS 1,321 patients were included for analysis. Based on ACR20 switch criteria and either 100% or 50% monotherapy rates for all treatments, total 2-year costs and costs PMPM were lower for patients receiving tofacitinib as second-line therapy after MTX and as third-line therapy after MTX and 1 TNFi; costs were highest for patients who cycled through 2 TNFi. Similar trends were observed for switch criteria based on ACR50 response and addition of 20% rebates for ADA and ETN and 0% for tofacitinib, although differences were mitigated slightly. CONCLUSIONS A treatment strategy with tofacitinib as either second- or third-line therapy after MTX may be a lower cost treatment option, compared with fourth-line introduction of tofacitinib after cycling through 2 TNFi following MTX. DISCLOSURES All aspects of this study were funded by Pfizer. Claxton was an employee of York Health Economics Consortium, University of York, at the time of this study. Taylor is an employee of York Health Economics Consortium, The University of York, which received funding from Pfizer to conduct this study. Soonasra, Bourret, and Gerber are employees of Pfizer and hold stock/stock options in Pfizer. A previous iteration of the data reported in this manuscript (before adjustment for recent drug price increases) was presented at the Academy of Managed Care Pharmacy 28th Annual Meeting and Expo; April 19-22, 2016; held in San Francisco, CA.
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Affiliation(s)
- Lindsay Claxton
- 1 York Health Economics Consortium, University of York, United Kingdom
| | - Matthew Taylor
- 1 York Health Economics Consortium, University of York, United Kingdom
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Mosquera N, Rodriguez-Trillo A, Mera-Varela A, Gonzalez A, Conde C. Uncovering Cellular retinoic acid-binding protein 2 as a potential target for rheumatoid arthritis synovial hyperplasia. Sci Rep 2018; 8:8731. [PMID: 29880835 PMCID: PMC5992205 DOI: 10.1038/s41598-018-26027-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 05/02/2018] [Indexed: 12/19/2022] Open
Abstract
Rheumatoid arthritis (RA) is a systemic autoimmune disease including synovitis and synovial hyperplasia that contribute to joint destruction. Pivotal pathogenic mechanisms in this process are the dysregulated proliferation and apoptosis of fibroblast-like synoviocytes (FLS). Unfortunately, the mechanisms of FLS dysregulation are not completely elucidated. Here, we explored a new hypothesis based in the potent anti-proliferative and pro-apoptotic activity of retinoids in some types of cancer. Specifically, we investigated the role of retinoids and of the retinoic acid binding proteins, CRABP2 and FABP5, on the proliferation and apoptosis of FLS from RA by adding all-trans retinoic acid (ATRA) or silencing CRABP2 and FABP5. We showed an unconventional behaviour of RA FLS, which were relatively insensitive to ATRA. In effect, ATRA increased the resistance to apoptosis despite the high CRABP2/FABP5 ratio of RA FLS; and CRABP2 suppression sensitized RA FLS to Fas-induced apoptosis. This latter effect was associated with changes in expression of kinases, ASK1 up-regulation and ERK down-regulation, and increased phosphorylation of JNK. In addition, the potentiation of FLS apoptosis by CRABP2 silencing persisted in the presence of pro-inflammatory mediators, TNF e IL1β. Therefore, the results point to CRABP2 as a potential target to decrease synovial hyperplasia in RA.
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Affiliation(s)
- Nerea Mosquera
- Laboratorio de Reumatología Experimental y Observacional, y Servicio de Reumatología, Instituto de Investigacion Sanitaria de Santiago (IDIS), Hospital Clínico Universitario de Santiago de Compostela (CHUS), SERGAS. Travesía da Choupana s/n, Santiago de Compostela, 15706, Spain
| | - Angela Rodriguez-Trillo
- Laboratorio de Reumatología Experimental y Observacional, y Servicio de Reumatología, Instituto de Investigacion Sanitaria de Santiago (IDIS), Hospital Clínico Universitario de Santiago de Compostela (CHUS), SERGAS. Travesía da Choupana s/n, Santiago de Compostela, 15706, Spain
| | - Antonio Mera-Varela
- Servicio de Reumatología, Instituto de Investigacion Sanitaria de Santiago (IDIS), Hospital Clínico Universitario de Santiago de Compostela (CHUS), SERGAS. Travesía da Choupana s/n, Santiago de Compostela, 15706, Spain
| | - Antonio Gonzalez
- Laboratorio de Reumatología Experimental y Observacional, y Servicio de Reumatología, Instituto de Investigacion Sanitaria de Santiago (IDIS), Hospital Clínico Universitario de Santiago de Compostela (CHUS), SERGAS. Travesía da Choupana s/n, Santiago de Compostela, 15706, Spain
| | - Carmen Conde
- Laboratorio de Reumatología Experimental y Observacional, y Servicio de Reumatología, Instituto de Investigacion Sanitaria de Santiago (IDIS), Hospital Clínico Universitario de Santiago de Compostela (CHUS), SERGAS. Travesía da Choupana s/n, Santiago de Compostela, 15706, Spain.
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Schmid AS, Hemmerle T, Pretto F, Kipar A, Neri D. Antibody-based targeted delivery of interleukin-4 synergizes with dexamethasone for the reduction of inflammation in arthritis. Rheumatology (Oxford) 2018; 57:748-755. [PMID: 29365185 DOI: 10.1093/rheumatology/kex447] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Indexed: 12/14/2022] Open
Abstract
Objectives We have previously reported that F8-IL4, a fusion protein consisting of the F8 antibody specific to the alternatively-spliced extra domain A of fibronectin and of murine IL-4, cures mice with established arthritis, when used in combination with dexamethasone (DXM). The goal of this study was to assess whether other therapeutic agents, besides DXM, could induce cures in combination with F8-IL4 and to elucidate which leucocytes are most affected by the pharmacological treatment. Methods We performed therapy experiments in mice with CIA, using intravenous administrations of F8-IL4 in combination with DXM, MTX, murine cytotoxic T-lymphocyte-associated protein 4 fused to the fragment crystallizable portion of murine IgG2a, as well as mAbs to murine IL17A or the p40 subunit of murine IL12/IL23. Histology and immunohistochemistry for the identification of the various leucocytes were performed on the paws of mice euthanized at different therapy time points. Results Only the use of F8-IL4 in combination with DXM induced complete remissions, while all other combinations did not lead to cures. The light microscopical evaluation of paws with arthritis revealed a predominant infiltration of neutrophils, which substantially decreased 24 h after treatment with F8-IL4 and DXM. Conclusion The combination of F8-IL4 with DXM promotes a rapid anti-arthritic action by potently inhibiting neutrophil activity. A fully human analogue of F8-IL4 may find clinical utility for the treatment of neutrophil-driven chronic inflammatory conditions.
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Affiliation(s)
- Anja Sophie Schmid
- Department of Chemistry and Applied Biosciences, Swiss Federal Institute of Technology (ETH Zürich), Zürich, Switzerland
| | - Teresa Hemmerle
- Philochem AG, Otelfingen, University of Zürich, Zürich, Switzerland
| | - Francesca Pretto
- Philochem AG, Otelfingen, University of Zürich, Zürich, Switzerland
| | - Anja Kipar
- Laboratory for Animal Model Pathology, Institute of Veterinary Pathology, Vetsuisse Faculty, University of Zürich, Zürich, Switzerland
| | - Dario Neri
- Department of Chemistry and Applied Biosciences, Swiss Federal Institute of Technology (ETH Zürich), Zürich, Switzerland
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Lyman M, Lieuw V, Richardson R, Timmer A, Stewart C, Granger S, Woods R, Silacci M, Grabulovski D, Newman R. A bispecific antibody that targets IL-6 receptor and IL-17A for the potential therapy of patients with autoimmune and inflammatory diseases. J Biol Chem 2018; 293:9326-9334. [PMID: 29678878 DOI: 10.1074/jbc.m117.818559] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 04/03/2018] [Indexed: 01/10/2023] Open
Abstract
Despite the success of current biological therapeutics for rheumatoid arthritis, these therapies, targeting individual cytokines or pathways, produce beneficial responses in only about half of patients. Therefore, better therapeutics are needed. IL-6 and IL-17A are proinflammatory cytokines in many autoimmune and inflammatory diseases, and several therapeutics have been developed to specifically inhibit them. However, targeting both of these cytokines with a bispecific therapeutic agent could account for their nonoverlapping proinflammatory functions and for the fact that IL-6 and IL-17A act in a positive feedback loop. Here, we present the development of MT-6194, a bispecific antibody targeting both IL-6R and IL-17A that was developed with the FynomAb technology. We also present data from mouse inflammatory disease experiments, indicating that simultaneous inhibition of both IL-6 and IL-17A yields enhanced efficacy compared with inhibition of each cytokine alone.
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Affiliation(s)
- Michael Lyman
- From Tanabe Research Labs U.S.A. Inc., San Diego, California 92121 and
| | - Vincent Lieuw
- From Tanabe Research Labs U.S.A. Inc., San Diego, California 92121 and
| | - Robyn Richardson
- From Tanabe Research Labs U.S.A. Inc., San Diego, California 92121 and
| | - Anjuli Timmer
- From Tanabe Research Labs U.S.A. Inc., San Diego, California 92121 and
| | - Christine Stewart
- From Tanabe Research Labs U.S.A. Inc., San Diego, California 92121 and
| | - Steve Granger
- From Tanabe Research Labs U.S.A. Inc., San Diego, California 92121 and
| | - Richard Woods
- Covagen AG, Wagistrasse 25, 8952 Schlieren, Switzerland
| | | | | | - Roland Newman
- From Tanabe Research Labs U.S.A. Inc., San Diego, California 92121 and
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Strand V, Tundia N, Song Y, Macaulay D, Fuldeore M. Economic Burden of Patients with Inadequate Response to Targeted Immunomodulators for Rheumatoid Arthritis. J Manag Care Spec Pharm 2018; 24:344-352. [PMID: 29578852 PMCID: PMC10397636 DOI: 10.18553/jmcp.2018.24.4.344] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Targeted immunomodulators (TIMs), including biologic disease-modifying antirheumatic drugs (DMARDs) and JAK/STAT inhibitors, are effective therapies for rheumatoid arthritis (RA), but some patients fail to respond or lose response over time. This study estimated the real-world prevalence of RA patients with inadequate responses to an initial TIM (nonresponders) in the United States and assessed their direct and indirect economic burden compared with treatment responders. METHODS Administrative claims data (January 1999-March 2014) from a large private-insurer database were used, which included work-loss data from a subset of reporting companies. Eligible patients (classified as responders and nonresponders) had ≥ 1 claim for a TIM approved for the treatment of RA and ≥ 2 RA diagnoses in the claims history, with continuous pharmaceutical and medical benefit eligibility for 6 months before (baseline) and 12 months after (study period) the date of the first TIM claim (index date). All-cause and RA-related health care resource use (HCRU) and costs, work loss, and indirect costs during the study period were compared for responders versus nonresponders. Multivariable regression was used to adjust for baseline covariates. Sensitivity analyses of HCRU and direct costs were conducted for patients with index dates before and after 2008 to account for different approval dates of TIMs. RESULTS Of 7,540 eligible patients with RA, 2,527 (34%) were classified as responders, and 5,013 (66%) were classified as nonresponders; 407 and 723 had work-loss data, respectively. After adjusting for baseline covariates, nonresponders had significantly higher HCRU, including inpatient admissions (incidence rate ratio [IRR] = 1.94), outpatient visits (IRR = 1.19), emergency department visits (IRR = 1.53), and number of prescription fills (IRR = 1.09; all, P < 0.001). Nonresponders also had significantly higher adjusted all-cause ($12,868 vs. $9,621, respectively) and RA-related ($5,740 vs. $4,495; both, P < 0.001) medical costs compared with responders. In addition, nonresponders reported significantly more days of work lost compared with responders (22.1 vs. 16.7 days, respectively; IRR = 1.21; P = 0.007) and higher indirect costs ($3,548 vs. $2,890; P = 0.002). Sensitivity analyses of HCRU and direct costs by index date (before and after 2008) were consistent with the full sample. CONCLUSIONS A large portion of patients with RA had inadequate responses to their initial TIM therapy with significantly higher economic burden, including higher HCRU, medical costs, and indirect costs due to work loss, compared with TIM therapy responders. DISCLOSURES Funding for this research was provided by AbbVie, which was involved in all stages of the study research and manuscript preparation. Tundia and Fuldeore are employed by AbbVie. Song and Macaulay are employed by Analysis Group, which received grants from AbbVie to conduct this study. Strand reports grants and personal fees from AbbVie, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Celltrion, Corrona, Crescendo, Genentech/Roche, GSK, Janssen, Lilly, Novartis, Pfizer, Regeneron, Samsung, Sandoz, Sanofi, and UCB outside the submitted work. Study concept and design were contributed by Tundia, Song, and Macaulay, along with other authors. Data analyses were designed and conducted by Song and Macaulay. All authors contributed to data interpretation. Writing of the manuscript was led by Tundia, Song, and Macaulay, with revisions by all authors. A synopsis of the current research was presented at the American College of Rheumatology/Association of Rheumatology Health Professionals meeting, which took place in Washington, DC, during November 11-16, 2016.
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Affiliation(s)
- Vibeke Strand
- Division of Immunology/Rheumatology, Stanford University School of Medicine, Palo Alto, California
| | | | - Yan Song
- Analysis Group, Boston, Massachusetts
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Morita Y, Ito H, Torii M, Hanai A, Furu M, Hashimoto M, Tanaka M, Azukizawa M, Arai H, Mimori T, Matsuda S. Factors affecting walking ability in female patients with rheumatoid arthritis. PLoS One 2018; 13:e0195059. [PMID: 29584787 PMCID: PMC5870996 DOI: 10.1371/journal.pone.0195059] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 03/15/2018] [Indexed: 11/23/2022] Open
Abstract
Objective To determine the factors associated with gait parameters in female patients with rheumatoid arthritis (RA). Methods The gait analysis was performed in a large cohort of RA patients, and three basic gait parameters (step length, cadence and gait speed) were calculated. Clinical and laboratory data were also collected. Factors associated with gait parameters were analyzed using multivariable linear regression in the three models with forced entry. Then, we divided those patients with Health Assessment Questionnaire disability index (HAQ) scores ≤ 0.5 into two groups according to their gait speed that were compared to identify the characteristics of patients with a good HAQ score but poor walking ability. Results A total of 318 female patients were analyzed. Knee extension strength had the strongest positive association with all three gait parameters (P < 0.0001), while methotrexate use was also positively associated with all three gait parameters (step length: P < 0.05, cadence: P < 0.05 in model 1 and 2; P < 0.01 in model 3, gait speed: P < 0.01). The disease activity score was negatively associated with step length and gait speed (step length, gait speed: P < 0.01 in model 1 and 2; P < 0.05 in model 3). 26% of patients with good HAQ scores showed slow gait speed. Patients with good HAQ scores and slow gait speed had higher disease activity scores (P < 0.05) and lower knee extension strength (P < 0.0001) than those with good HAQ scores and normal gait speed. Conclusions High knee extension strength, low disease activity and administration of methotrexate were strongly associated with good walking ability in female patients with RA. And, even if patients showed good HAQ scores, about quarter of those patients had poor walking ability, and they showed higher disease activity, lower knee extension strength, compared to the patients with normal gait speed.
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Affiliation(s)
- Yugo Morita
- The Department of Orthopedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiromu Ito
- The Department of Orthopedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
- * E-mail:
| | - Mie Torii
- The Department of Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akiko Hanai
- The Department of Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Moritoshi Furu
- The Department of Orthopedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
- The Department of the Advanced Medicine for Rheumatic Diseases, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Motomu Hashimoto
- The Department of the Advanced Medicine for Rheumatic Diseases, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masao Tanaka
- The Department of the Advanced Medicine for Rheumatic Diseases, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masayuki Azukizawa
- The Department of Orthopedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Japan
| | - Tsuneyo Mimori
- The Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shuichi Matsuda
- The Department of Orthopedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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82
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Mehta BB, Tiwari A, Sharma S, Shukla A, Sharma M, Vasishta RK, Sen RK, Sharma A, Luthra-Guptasarma M. Amelioration of collagen antibody induced arthritis in mice by an antibody directed against the fibronectin type III repeats of tenascin-C: Targeting fibronectin type III repeats of tenascin-C in rheumatoid arthritis. Int Immunopharmacol 2018. [PMID: 29529488 DOI: 10.1016/j.intimp.2018.02.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Tenascin-C (TN-C) levels are elevated in the synovial tissue and fluid, as well as cartilage of rheumatoid arthritis (RA) patients. In addition, the presence of TN-C fragments has also been documented in arthritic cartilage. We have previously shown that a single chain variable fragment antibody (TN64), directed against the fibronectin type III repeats 1-5 (TNfnIII 1-5) of TN-C, effectively inhibits fibrotic pathology. Given that fibrosis results from chronic inflammation, and the fact that increased levels of TN-C in the synovial fluid of patients with RA contributes to synovial inflammation and joint destruction, we aimed to investigate the role of TNfnIII 1-5 region of TN-C in RA pathogenesis. Using either the wild type or variants of the two integrin-binding motifs (RGD and AEIDGIEL) present within the TNfnIII 1-5 polypeptide, we demonstrate that the adhesion and migration of synovial fibroblasts is RGD-dependent. The antibody TN64 is effective in inhibiting migration of cells in response to TnfnIII 1-5, and prevents fibroblast-mediated destruction of cartilage. The TN64 antibody was further tested in collagen antibody induced arthritic (CAIA) mice. Our data shows the efficacy of TN64 in preventing induction of arthritis, with significant downregulation of RA-associated cytokines. This suggests that components of the extracellular matrix such as the TNfnIII 1-5 region of TN-C could be exploited to develop therapies to suppress inflammation seen in RA. The TN64 antibody is one such promising candidate in the development of novel treatments for RA.
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Affiliation(s)
- Brij Bhushan Mehta
- Department of Immunopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Anil Tiwari
- Department of Immunopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Saniya Sharma
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Ashu Shukla
- Department of Immunopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Maryada Sharma
- Department of Immunopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Rakesh K Vasishta
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Ramesh K Sen
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Aman Sharma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Manni Luthra-Guptasarma
- Department of Immunopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
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83
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Takeuchi T, Tanaka Y, Yamanaka H, Harigai M, Nakano T, Akagi K, Ukyo Y, Hsu B. Efficacy and safety of sirukumab in Japanese patients with moderate to severe rheumatoid arthritis inadequately controlled by disease modifying anti-rheumatic drugs: Subgroup analysis of a phase 3 study. Mod Rheumatol 2018; 28:941-949. [PMID: 29336187 DOI: 10.1080/14397595.2018.1428929] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of sirukumab in Japanese patients with active rheumatoid arthritis (RA) uncontrolled by disease-modifying antirheumatic drugs. METHODS This subgroup analysis based on a double-blind, placebo-controlled, 52-week phase 3 study (SIRROUND-D) assessed American College of Rheumatology (ACR) 20 response at week 16 and van der Heijde-modified Sharp score (vdH-S) at week 52 (coprimary endpoints). RESULTS A total of 168 (Japanese)/1670 patients received sirukumab 50 mg/4 weeks (q4w, n = 58), 100 mg/every 2 weeks (q2w, n = 54), or placebo (n = 56) subcutaneously. Significantly more patients achieved ACR20 response at week 16 with sirukumab (50 mg q4w: 69.0%; 100mg q2w: 66.7%) vs. placebo (21.4%; p < .001). Median change from baseline in total vdH-S score at week 52 was significantly lower with sirukumab (50 mg q4w: 0.3, p = .024; 100 mg q2w: 0.0, p = .002) vs. placebo (1.3). Sirukumab consistently showed greater improvements in secondary endpoints at weeks 24 and 52. Nasopharyngitis, elevated liver enzymes, injection site erythema and upper respiratory tract infections were the common treatment-emergent adverse events (TEAEs). Incidences of TEAEs and serious AEs were consistent between sirukumab groups through week 52. CONCLUSION Sirukumab showed clinically meaningful improvements consistent with significant improvements in the global study. No new safety signals were observed.
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Affiliation(s)
- Tsutomu Takeuchi
- a Division of Rheumatology, Department of Internal Medicine , School of Medicine, Keio University , Tokyo , Japan
| | - Yoshiya Tanaka
- b First Department of Internal Medicine, School of Medicine , University of Occupational & Environmental Health Japan , Kitakyushu , Japan
| | - Hisashi Yamanaka
- c Institute of Rheumatology , Tokyo Women's Medical University , Tokyo , Japan
| | - Masayoshi Harigai
- d Department of Epidemiology and Pharmacoepidemiology , Institute of Rheumatology, Tokyo Women's Medical University , Tokyo , Japan
| | | | | | | | - Benjamin Hsu
- f Janssen Research & Development, LLC , Spring House , PA , USA
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84
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Kittaka M, Mayahara K, Mukai T, Yoshimoto T, Yoshitaka T, Gorski JP, Ueki Y. Cherubism Mice Also Deficient in c-Fos Exhibit Inflammatory Bone Destruction Executed by Macrophages That Express MMP14 Despite the Absence of TRAP+ Osteoclasts. J Bone Miner Res 2018; 33:167-181. [PMID: 28914985 PMCID: PMC5771992 DOI: 10.1002/jbmr.3295] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 08/28/2017] [Accepted: 09/07/2017] [Indexed: 11/10/2022]
Abstract
Currently, it is believed that osteoclasts positive for tartrate-resistant acid phosphatase (TRAP+) are the exclusive bone-resorbing cells responsible for focal bone destruction in inflammatory arthritis. Recently, a mouse model of cherubism (Sh3bp2KI/KI ) with a homozygous gain-of-function mutation in the SH3-domain binding protein 2 (SH3BP2) was shown to develop auto-inflammatory joint destruction. Here, we demonstrate that Sh3bp2KI/KI mice also deficient in the FBJ osteosarcoma oncogene (c-Fos) still exhibit noticeable bone erosion at the distal tibia even in the absence of osteoclasts at 12 weeks old. Levels of serum collagen I C-terminal telopeptide (ICTP), a marker of bone resorption generated by matrix metalloproteinases (MMPs), were elevated, whereas levels of serum cross-linked C-telopeptide (CTX), another resorption marker produced by cathepsin K, were not increased. Collagenolytic MMP levels were increased in the inflamed joints of the Sh3bp2KI/KI mice deficient in c-Fos. Resorption pits contained a large number of F4/80+ macrophages and genetic depletion of macrophages rescued these erosive changes. Importantly, administration of NSC405020, an MMP14 inhibitor targeted to the hemopexin (PEX) domain, suppressed bone erosion in c-Fos-deficient Sh3bp2KI/KI mice. After activation of the NF-κB pathway, macrophage colony-stimulating factor (M-CSF)-dependent macrophages from c-Fos-deficient Sh3bp2KI/KI mice expressed increased amounts of MMP14 compared with wild-type macrophages. Interestingly, receptor activator of NF-κB ligand (RANKL)-deficient Sh3bp2KI/KI mice failed to show notable bone erosion, whereas c-Fos deletion did restore bone erosion to the RANKL-deficient Sh3bp2KI/KI mice, suggesting that osteolytic transformation of macrophages requires both loss-of-function of c-Fos and gain-of-function of SH3BP2 in this model. These data provide the first genetic evidence that cells other than osteoclasts can cause focal bone destruction in inflammatory bone disease and suggest that MMP14 is a key mediator conferring pathological bone-resorbing capacity on c-Fos-deficient Sh3bp2KI/KI macrophages. In summary, the paradigm that osteoclasts are the exclusive cells executing inflammatory bone destruction may need to be reevaluated based on our findings with c-Fos-deficient cherubism mice lacking osteoclasts. © 2017 American Society for Bone and Mineral Research.
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Affiliation(s)
- Mizuho Kittaka
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Kotoe Mayahara
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri-Kansas City, Kansas City, MO, USA.,Department of Orthodontics, Nihon University, School of Dentistry, Tokyo, Japan
| | - Tomoyuki Mukai
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Tetsuya Yoshimoto
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Teruhito Yoshitaka
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Jeffrey P Gorski
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri-Kansas City, Kansas City, MO, USA.,University of Missouri-Kansas City (UMKC) Center of Excellence in the Study of Dental and Musculoskeletal Tissues (CEMT), Kansas City, MO, USA
| | - Yasuyoshi Ueki
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri-Kansas City, Kansas City, MO, USA.,University of Missouri-Kansas City (UMKC) Center of Excellence in the Study of Dental and Musculoskeletal Tissues (CEMT), Kansas City, MO, USA
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85
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Kay AG, Long G, Tyler G, Stefan A, Broadfoot SJ, Piccinini AM, Middleton J, Kehoe O. Mesenchymal Stem Cell-Conditioned Medium Reduces Disease Severity and Immune Responses in Inflammatory Arthritis. Sci Rep 2017; 7:18019. [PMID: 29269885 PMCID: PMC5740178 DOI: 10.1038/s41598-017-18144-w] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 12/05/2017] [Indexed: 12/29/2022] Open
Abstract
We evaluated the therapeutic potential of mesenchymal stem cell-conditioned medium (CM-MSC) as an alternative to cell therapy in an antigen-induced model of arthritis (AIA). Disease severity and cartilage loss were evaluated by histopathological analysis of arthritic knee joints and immunostaining of aggrecan neoepitopes. Cell proliferation was assessed for activated and naïve CD4+ T cells from healthy mice following culture with CM-MSC or co-culture with MSCs. T cell polarization was analysed in CD4+ T cells isolated from spleens and lymph nodes of arthritic mice treated with CM-MSC or MSCs. CM-MSC treatment significantly reduced knee-joint swelling, histopathological signs of AIA, cartilage loss and suppressed TNFα induction. Proliferation of CD4+ cells from spleens of healthy mice was not affected by CM-MSC but reduced when cells were co-cultured with MSCs. In the presence of CM-MSC or MSCs, increases in IL-10 concentration were observed in culture medium. Finally, CD4+ T cells from arthritic mice treated with CM-MSC showed increases in FOXP3 and IL-4 expression and positively affected the Treg:Th17 balance in the tissue. CM-MSC treatment reduces cartilage damage and suppresses immune responses by reducing aggrecan cleavage, enhancing Treg function and adjusting the Treg:Th17 ratio. CM-MSC may provide an effective cell-free therapy for inflammatory arthritis.
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Affiliation(s)
- Alasdair G Kay
- Biology Department, University of York, Wentworth Way, York, UK.,ISTM at RJAH Orthopaedic Hospital, Keele University, Oswestry, UK
| | - Grace Long
- School of Medicine, Keele University, Staffordshire, UK
| | - George Tyler
- School of Medicine, Keele University, Staffordshire, UK
| | - Andrei Stefan
- ISTM at RJAH Orthopaedic Hospital, Keele University, Oswestry, UK
| | | | | | - Jim Middleton
- Faculty of Health Sciences, School of Oral and Dental Science, University of Bristol, Bristol, UK
| | - Oksana Kehoe
- ISTM at RJAH Orthopaedic Hospital, Keele University, Oswestry, UK.
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86
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Fu H, Hu D, Zhang L, Tang P. Role of extracellular vesicles in rheumatoid arthritis. Mol Immunol 2017; 93:125-132. [PMID: 29175592 DOI: 10.1016/j.molimm.2017.11.016] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Revised: 11/14/2017] [Accepted: 11/18/2017] [Indexed: 12/15/2022]
Abstract
Cell-derived extracellular vesicles (EVs) are involved in the pathogenesis of rheumatoid arthritis (RA), playing important roles in antigen presentation, inflammation, angiogenesis, cell-cell signal communication, thrombosis, and articular cartilage extracellular matrix degradation. Understanding the pathogenic mechanism of RA is important for developing therapies. The pathogenic indicators of RA, such as submicron-sized EVs, represent promising biomarkers for evaluating RA activity. This review summarizes the recent advances in understanding the pathogenesis of RA, and sheds light on the pathogenic as well as anti-inflammatory or immunosuppressive roles of EVs. We suggest that EVs could be harnessed as tools for drug delivery or targets for RA therapies.
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Affiliation(s)
- Haitao Fu
- Department of Orthopedics, the General Hospital of Chinese People's Liberation Army, Beijing 100853, China; School of Medicine, Nankai University, Tianjin 300110, China
| | - Die Hu
- Qingdao Eye Hospital, Shandong Eye Institute, Shandong Academy of Medical Sciences, Qingdao 266071, China
| | - Licheng Zhang
- Department of Orthopedics, the General Hospital of Chinese People's Liberation Army, Beijing 100853, China
| | - Peifu Tang
- Department of Orthopedics, the General Hospital of Chinese People's Liberation Army, Beijing 100853, China.
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87
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Rodríguez PC, Prada DM, Moreno E, Aira LE, Molinero C, López AM, Gómez JA, Hernández IM, Martínez JP, Reyes Y, Milera JM, Hernández MV, Torres R, Avila Y, Barrese Y, Viada C, Montero E, Hernández P. The anti-CD6 antibody itolizumab provides clinical benefit without lymphopenia in rheumatoid arthritis patients: results from a 6-month, open-label Phase I clinical trial. Clin Exp Immunol 2017; 191:229-239. [PMID: 28963724 DOI: 10.1111/cei.13061] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2017] [Indexed: 12/13/2022] Open
Abstract
Itolizumab is a humanized anti-CD6 monoclonal antibody (mAb) that has previously shown encouraging results, in terms of safety and positive clinical effects, in a 6-week monotherapy clinical trial conducted in rheumatoid arthritis (RA) patients. The current Phase I study evaluated the safety and clinical response for a longer treatment of 12 itolizumab intravenous doses in subjects with active RA despite previous disease-modifying anti-rheumatic drug (DMARD) therapy. Twenty-one subjects were enrolled into four dosage groups (0·1, 0·2, 0·4 and 0·8 mg/kg). Efficacy end-points including American College of Rheumatology (ACR)20, ACR50 and ACR70 response rates and disease activity score in 28 joints (DAS28) were monitored at baseline and at specific time-points during a 10-week follow-up period. Itolizumab was well tolerated up to the highest tested dose. No related serious adverse events were reported and most adverse events were mild. Remarkably, itolizumab treatment did not produce lymphopenia and, therefore, was not associated with infections. All patients achieved a clinical response (ACR20) at least once during the study. Eleven subjects (55%) achieved at least a 20% improvement in ACR just 1 week after the first itolizumab administration. The clinical response was observed from the beginning of the treatment and was sustained during 24 weeks. The efficacy profile of this 12-week treatment was similar to that of the previous study (6-week treatment). These results reinforce the safety profile of itolizumab and provide further evidence on the clinical benefit from the use of this anti-CD6 mAb in RA patients.
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Affiliation(s)
- P C Rodríguez
- Division of Clinical Research, Center of Molecular Immunology, Havana, Cuba
| | - D M Prada
- Service for Rheumatology, 10 de Octubre Hospital, Havana, Cuba
| | - E Moreno
- Facultad de Ciencias Básicas, Universidad de Medellin, Medellin, Colombia
| | - L E Aira
- Division of Clinical Research, Center of Molecular Immunology, Havana, Cuba
| | - C Molinero
- Service for Rheumatology, 10 de Octubre Hospital, Havana, Cuba
| | - A M López
- Service for Rheumatology, 10 de Octubre Hospital, Havana, Cuba
| | - J A Gómez
- Service for Rheumatology, 10 de Octubre Hospital, Havana, Cuba
| | - I M Hernández
- Service for Rheumatology, 10 de Octubre Hospital, Havana, Cuba
| | - J P Martínez
- Service for Rheumatology, 10 de Octubre Hospital, Havana, Cuba
| | - Y Reyes
- Service for Rheumatology, 10 de Octubre Hospital, Havana, Cuba
| | - J M Milera
- Service for Rheumatology, 10 de Octubre Hospital, Havana, Cuba
| | - M V Hernández
- Service for Rheumatology, 10 de Octubre Hospital, Havana, Cuba
| | - R Torres
- Service for Rheumatology, 10 de Octubre Hospital, Havana, Cuba
| | - Y Avila
- Department of Clinical Trials, National Coordinating Center of Clinical Trials, Havana, Cuba
| | - Y Barrese
- Department of Clinical Trials, National Coordinating Center of Clinical Trials, Havana, Cuba
| | - C Viada
- Division of Clinical Research, Center of Molecular Immunology, Havana, Cuba
| | - E Montero
- Experimental Immunotherapy Department, Center of Molecular Immunology, Havana, Cuba
| | - P Hernández
- Division of Clinical Research, Center of Molecular Immunology, Havana, Cuba
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Tanaka Y, Atsumi T, Amano K, Harigai M, Ishii T, Kawaguchi O, Rooney TP, Akashi N, Takeuchi T. Efficacy and safety of baricitinib in Japanese patients with rheumatoid arthritis: Subgroup analyses of four multinational phase 3 randomized trials. Mod Rheumatol 2017; 28:583-591. [PMID: 29134891 DOI: 10.1080/14397595.2017.1392057] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To evaluate efficacy/safety of baricitinib for rheumatoid arthritis (RA) in Japanese subpopulations from four phase 3 studies, and assess whether results in these subpopulations are consistent with the overall study populations. METHODS Subgroup analyses (394 patients) of four phase 3 randomized controlled trials: RA-BEGIN [no or limited treatment with disease-modifying antirheumatic drugs (DMARDs)], RA-BEAM [inadequate response (IR) to methotrexate], RA-BUILD [IR to conventional synthetic DMARDs (csDMARDs)], and RA-BEACON (IR to tumor necrosis factor inhibitors receiving csDMARDs). RESULTS For American College of Rheumatology 20% improvement (ACR20) response rate, Japanese patients receiving baricitinib 4-mg showed similar improvement compared to methotrexate at Week 24 (72 versus 69%; RA-BEGIN), and greater improvement compared with placebo at Week 12 (67 versus 34%; RA-BEAM). Japanese patients receiving baricitinib 4-mg also showed greater improvement compared with placebo at Week 12 in RA-BUILD and RA-BEACON. Across all studies, baricitinib was well-tolerated, with no deaths and one malignancy. In RA-BEGIN and RA-BEAM, herpes zoster rates were higher for Japanese patients than for overall populations; all events were mild/moderate. CONCLUSION Data for baricitinib, with/without methotrexate, in Japanese subpopulations across all stages of the RA treatment continuum accord with the efficacy/safety profile in overall study populations. Baricitinib appears to be similarly effective in Japanese patients.
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Affiliation(s)
- Yoshiya Tanaka
- a First Department of Internal Medicine, School of Medicine , University of Occupational and Environmental Health , Kitakyushu , Japan
| | - Tatsuya Atsumi
- b Division of Rheumatology, Endocrinology and Nephrology, Graduate School of Medicine , Hokkaido University , Hokkaido , Japan
| | - Koichi Amano
- c Department of Rheumatology and Clinical Immunology , Saitama Medical Center, Saitama Medical University , Kawagoe , Japan
| | - Masayoshi Harigai
- d Department of Epidemiology and Pharmacoepidemiology of Rheumatic Diseases, Institute of Rheumatology , Tokyo Women's Medical University , Tokyo , Japan
| | | | | | | | | | - Tsutomu Takeuchi
- g Division of Rheumatology, Department of Internal Medicine , Keio University School of Medicine , Tokyo , Japan
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89
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Khanna S, Jaiswal KS, Gupta B. Managing Rheumatoid Arthritis with Dietary Interventions. Front Nutr 2017; 4:52. [PMID: 29167795 PMCID: PMC5682732 DOI: 10.3389/fnut.2017.00052] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 10/10/2017] [Indexed: 12/19/2022] Open
Abstract
Self-help by means of dietary interventions can help in management of various disorders including rheumatoid arthritis (RA), a debilitating autoimmune disease. Dietary interventions necessitate a widespread appeal for both patients as well as clinicians due to factors including affordability, accessibility, and presence of scientific evidences that demonstrate substantial benefits in reducing disease symptoms such as pain, joint stiffness, swelling, tenderness and associated disability with disease progression. However, there is still an uncertainty among the community about the therapeutic benefits of dietary manipulations for RA. In the present review, we provide an account of different diets and their possible molecular mechanism of actions inducing observed therapeutic benefits for remission and management of RA. We further indicate food that can be a potential aggravating factor for the disease or may help in symptomatic relief. We thereafter summarize and thereby discuss various diets and food which help in reducing levels of inflammatory cytokines in RA patients that may play an effective role in management of RA following proper patient awareness. We thus would like to promote diet management as a tool that can both supplement and complement present treatment strategies for a better patient health and recovery.
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Affiliation(s)
- Shweta Khanna
- Disease Biology Laboratory, School of Biotechnology, KIIT University, Bhubaneswar, Odisha, India
| | - Kumar Sagar Jaiswal
- Disease Biology Laboratory, School of Biotechnology, KIIT University, Bhubaneswar, Odisha, India
| | - Bhawna Gupta
- Disease Biology Laboratory, School of Biotechnology, KIIT University, Bhubaneswar, Odisha, India
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90
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Park JS, Oh Y, Park O, Foss CA, Lim SM, Jo DG, Na DH, Pomper MG, Lee KC, Lee S. PEGylated TRAIL ameliorates experimental inflammatory arthritis by regulation of Th17 cells and regulatory T cells. J Control Release 2017; 267:163-171. [PMID: 29017854 DOI: 10.1016/j.jconrel.2017.10.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 09/02/2017] [Accepted: 10/06/2017] [Indexed: 12/24/2022]
Abstract
TNF-related apoptosis-inducing ligand (TRAIL) is a death ligand that can induce apoptosis in cells expressing its cognate death receptors (DRs). Previously, we demonstrated the therapeutic potential of recombinant human TRAIL in experimental rheumatoid arthritis (RA) models. However, the mechanisms of how DR-mediated apoptosis elicits these actions is not known. Here, we show that systemically administering a potent, long-acting PEGylated TRAIL (TRAILPEG) is profoundly anti-rheumatic against two complementary experimental RA mouse models, collagen-induced arthritis (CIA) and collagen antibody-induced arthritis (CAIA), via targeting IL-17 secreting Th17 cells and regulatory T cells (Treg). Systemic administration of TRAILPEG after disease onset ameliorated the severity of inflammatory arthritis including arthritis indices, paw thickness, cartilage damage and neutrophil infiltration in both CIA and CAIA models. Additionally, the levels of inflammatory molecules (p-p65, ICAM-1, Cox-2, MMP3, and iNOS), pro-inflammatory cytokines (TNF-α, IL-1β, IFN-γ, IL-6, IL-17) and accumulation of activated macrophages were significantly reduced after the TRAILPEG treatment. Importantly, TRAILPEG decreased the number of pro-inflammatory Th17 cells in inflamed arthritic joints through TRAIL-induced apoptosis while increasing anti-inflammatory Treg population in vivo. These results suggest that TRAILPEG ameliorates autoimmunity by targeting the Th 17-Tregs axis, making it a promising candidate drug for the treatment of RA.
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Affiliation(s)
- Jong-Sung Park
- Russell H, Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA; Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | - Yumin Oh
- Russell H, Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA; Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | - Ogyi Park
- Russell H, Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA; Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | - Catherine A Foss
- Russell H, Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | - Sung Mook Lim
- School of Pharmacy, SungKyunKwan University, Suwon 16419, Republic of Korea
| | - Dong-Gyu Jo
- School of Pharmacy, SungKyunKwan University, Suwon 16419, Republic of Korea
| | - Dong Hee Na
- College of Pharmacy, Chung-Ang University, Seoul 06974, Republic of Korea
| | - Martin G Pomper
- Russell H, Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA; Department of Materials Science and Engineering, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Kang Choon Lee
- School of Pharmacy, SungKyunKwan University, Suwon 16419, Republic of Korea.
| | - Seulki Lee
- Russell H, Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA; Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA; Department of Materials Science and Engineering, Johns Hopkins University, Baltimore, MD 21287, USA.
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91
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Modeled Health Economic Impact of a Hypothetical Certolizumab Pegol Risk-Sharing Scheme for Patients with Moderate-to-Severe Rheumatoid Arthritis in Finland. Adv Ther 2017; 34:2316-2332. [PMID: 28975568 PMCID: PMC5656723 DOI: 10.1007/s12325-017-0614-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Indexed: 12/19/2022]
Abstract
PURPOSE To model the American College of Rheumatology (ACR) outcomes, cost-effectiveness, and budget impact of certolizumab pegol (CZP) (with and without a hypothetical risk-sharing scheme at treatment initiation for biologic-naïve patients) versus the current mix of reimbursed biologics for treatment of moderate-to-severe rheumatoid arthritis (RA) in Finland. METHODS A probabilistic model with 12-week cycles and a societal approach was developed for the years 2015-2019, accounting for differences in ACR responses (meta-analysis), mortality, and persistence. The risk-sharing scheme included a treatment switch and refund of the costs associated with CZP acquisition if patients failed to achieve ACR20 response at week 12. For the current treatment mix, ACR20 at week 24 determined treatment continuation. Quality-adjusted life years were derived on the basis of the Health Utilities Index. RESULTS In the Finnish target population, CZP treatment with a risk-sharing scheme led to a estimated annual net expenditure decrease ranging from 1.7% in 2015 to 5.6% in 2019 compared with the current treatment mix. Per patient over the 5 years, CZP risk sharing was estimated to decrease the time without ACR response by 5%-units, decrease work absenteeism by 24 days, and increase the time with ACR20, ACR50, and ACR70 responses by 5%-, 6%-, and 1%-units, respectively, with a gain of 0.03 quality-adjusted life years. The modeled risk-sharing scheme showed reduced costs of €7866 per patient, with a more than 95% probability of cost-effectiveness when compared with the current treatment mix. CONCLUSION The present analysis estimated that CZP, with or without the risk-sharing scheme, is a cost-effective alternative treatment for RA patients in Finland. The surplus provided by the CZP risk-sharing scheme could fund treatment for 6% more Finnish RA patients. FUNDING UCB Pharma.
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92
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Tavakolpour S. Towards personalized medicine for patients with autoimmune diseases: Opportunities and challenges. Immunol Lett 2017; 190:130-138. [DOI: 10.1016/j.imlet.2017.08.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 08/03/2017] [Indexed: 02/06/2023]
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Bessette L, Khraishi M, Kivitz AJ, Kaliyaperumal A, Grantab R, Poulin-Costello M, Isaila M, Collier D. Single-Arm Study of Etanercept in Adult Patients with Moderate to Severe Rheumatoid Arthritis Who Failed Adalimumab Treatment. Rheumatol Ther 2017; 4:391-404. [PMID: 28900875 PMCID: PMC5696291 DOI: 10.1007/s40744-017-0079-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Indexed: 11/29/2022] Open
Abstract
Introduction To evaluate the efficacy and safety of etanercept treatment in adult patients with moderate to severe rheumatoid arthritis (RA) who failed to respond (primary failure) or lost a satisfactory response (secondary failure) to adalimumab. Methods All patients discontinued prior adalimumab treatment and continued methotrexate with etanercept 50 mg once weekly for 24 weeks. The primary study endpoint was American College of Rheumatology 20% improvement criteria (ACR20) at week 12. Results Eighty-five patients (mean age 56.6 years; female 80.0%) were evaluated for safety and 84 for efficacy. Thirty (35.7%) patients achieved ACR20 at week 12; the lower bound of the 95% confidence interval (CI; 25.6, 46.9) was greater than the prespecified goal of 24% based on previous research. Improvements from baseline in clinical outcomes and patient-reported outcomes were observed at each study visit. In planned subgroup analyses, patients with anti-adalimumab antibodies and secondary adalimumab failure had the highest ACR20 response to etanercept at week 12 (11/17 patients; 64.7%). Among the patients with secondary adalimumab failure, those with anti-adalimumab antibodies were fivefold more likely to have an ACR20 response to etanercept than those without anti-adalimumab antibodies (odds ratio 5.2; 95% CI 2.0, 13.5; P < 0.001). Adverse events were reported for 62 (72.9%) patients and were consistent with previous studies of etanercept. Most adverse events were mild or moderate in severity. Conclusion Switching to etanercept is a therapeutic option in patients with RA who fail adalimumab treatment. The presence of anti-adalimumab antibodies may provide additional support for switching to etanercept, particularly in patients with secondary adalimumab failure. Trial Registration ClinicalTrials.gov identifier, NCT01927757.
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Affiliation(s)
- Louis Bessette
- Centre de recherche du CHU de Québec, Quebec City, QC, Canada.
| | - Majed Khraishi
- Memorial University of Newfoundland, St. John's, NF, Canada
| | - Alan J Kivitz
- Altoona Center for Clinical Research, Duncansville, PA, USA
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94
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Neog MK, Joshua Pragasam S, Krishnan M, Rasool M. p-Coumaric acid, a dietary polyphenol ameliorates inflammation and curtails cartilage and bone erosion in the rheumatoid arthritis rat model. Biofactors 2017; 43:698-717. [PMID: 28742266 DOI: 10.1002/biof.1377] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 06/17/2017] [Accepted: 06/27/2017] [Indexed: 12/19/2022]
Abstract
This study was designed to explore the underlying mechanism of p-coumaric acid (CA), a dietary polyphenol in adjuvant-induced arthritis (AIA) rat model with reference to synovitis and osteoclastogenesis. Celecoxib (COX-2 selective inhibitor) (5 mg/kg b.wt) was used as a reference drug. CA remarkably suppressed the paw edema, body weight loss and inflammatory cytokine and chemokine levels (TNF-α, IL-1β, IL-6, and MCP-1) in serum and ankle joint of arthritic rats. Consistently, CA reduced the expression of osteoclastogenic factors (RANKL and TRAP), pro-inflammatory cytokines (TNF-α, IL-1β, IL-6, and IL-17), and inflammatory enzymes (iNOS and COX-2) in arthritic rats. However, OPG expression was found elevated. Besides, the abundance of transcription factors (NF-κB-p65, and p-NF-κB-p65, NFATc-1, and c-Fos) and MAP kinases (JNK, p-JNK, and ERK1/2) expression was alleviated in CA administered arthritic rats. In addition, CA truncated osteoclastogenesis by regulating the RANKL/OPG imbalance in arthritic rats and suppressing the RANKL-induced NFATc-1 and c-Fos expression in vitro. Radiological (CT and DEXA scan) and histological assessments authenticated that CA inhibited TRAP, bone destruction and cartilage degradation in association with enhanced bone mineral density. Taken together, our findings suggest that CA demonstrated promising anti-arthritic effect and could prove useful as an alternative drug in RA therapeutics. © 2017 BioFactors, 43(5):698-717, 2017.
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Affiliation(s)
- Manoj Kumar Neog
- Immunopathology Lab, School of Bio Sciences and Technology, VIT University, Vellore, Tamil Nadu, 632 014, India
| | - Samuel Joshua Pragasam
- Immunopathology Lab, School of Bio Sciences and Technology, VIT University, Vellore, Tamil Nadu, 632 014, India
| | - Moorthy Krishnan
- Division of Biomedical Sciences, University of California Riverside, Riverside, CA, USA
| | - Mahaboobkhan Rasool
- Immunopathology Lab, School of Bio Sciences and Technology, VIT University, Vellore, Tamil Nadu, 632 014, India
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Wei W, Knapp K, Wang L, Chen CI, Craig GL, Ferguson K, Schwartzman S. Treatment Persistence and Clinical Outcomes of Tumor Necrosis Factor Inhibitor Cycling or Switching to a New Mechanism of Action Therapy: Real-world Observational Study of Rheumatoid Arthritis Patients in the United States with Prior Tumor Necrosis Factor Inhibitor Therapy. Adv Ther 2017; 34:1936-1952. [PMID: 28674959 PMCID: PMC5565674 DOI: 10.1007/s12325-017-0578-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Indexed: 12/19/2022]
Abstract
Introduction To examine treatment persistence and clinical outcomes associated with switching from a tumor necrosis factor inhibitor (TNFi) to a medication with a new mechanism of action (MOA) (abatacept, anakinra, rituximab, tocilizumab, or tofacitinib) versus cycling to another TNFi (adalimumab, certolizumab pegol, etanercept, golimumab, or infliximab) among patients with rheumatoid arthritis. Methods This retrospective, longitudinal study included patients with rheumatoid arthritis in the JointMan® US clinical database who received a TNFi in April 2010 or later and either cycled to a TNFi or switched to a new MOA therapy by March 2015. Cox proportional hazards models were used for time to non-persistence (switching or discontinuing). An ordinary least squares regression model compared 1-year reduction from baseline for the Clinical Disease Activity Index (CDAI). Results There were 332 (54.2%) TNFi cyclers and 281 (45.8%) new MOA switchers. During a median follow-up of 29.9 months, treatment persistence was 36.7% overall. Compared with new MOA switchers, TNFi cyclers were 51% more likely to be non-persistent (adjusted hazard ratio, 1.511; 95% CI 1.196, 1.908), driven by a higher likelihood of switching again (adjusted hazard ratio, 2.016; 95% CI 1.428, 2.847). Clinical outcomes were evaluable for 239 (53.3%) TNFi cyclers and 209 (46.7%) new MOA switchers. One-year mean reduction in CDAI from baseline to end of follow-up was significantly higher for new MOA switchers than TNFi cyclers (−7.54 vs. −4.81; P = 0.037), but the difference was not statistically significant after adjustment for baseline CDAI (−6.39 vs. −5.83; P = 0.607). Conclusion In this study, TNFi cycling was common in clinical practice, but switching to a new MOA DMARD was associated with significantly better treatment persistence and a trend toward greater CDAI reduction that was not significant after adjustment for baseline disease activity. Funding Sanofi and Regeneron Pharmaceuticals.
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Affiliation(s)
- Wenhui Wei
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA.
| | | | - Li Wang
- STATinMED Research, Plano, TX, USA
| | - Chieh-I Chen
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
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Takeuchi T, Ishida K, Shiraki K, Yoshiyasu T. Safety and effectiveness of tacrolimus add-on therapy for rheumatoid arthritis patients without an adequate response to biological disease-modifying anti-rheumatic drugs (DMARDs): Post-marketing surveillance in Japan. Mod Rheumatol 2017. [PMID: 28649878 DOI: 10.1080/14397595.2017.1332471] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Post-marketing surveillance (PMS) was conducted to assess the safety and effectiveness of tacrolimus (TAC) add-on therapy for patients with rheumatoid arthritis (RA) and an inadequate response to biological disease-modifying anti-rheumatic drugs (DMARDs). METHODS Patients with RA from 180 medical sites across Japan were registered centrally with an electronic investigation system. The observational period was 24 weeks from the first day of TAC administration concomitantly with biological DMARDs. RESULTS Safety and effectiveness populations included 624 and 566 patients, respectively. Patients were predominantly female (81.1%), with a mean age of 61.9 years. Overall, 125 adverse drug reactions (ADRs) occurred in 94 patients (15.1%), and 15 serious ADRs occurred in 11 patients (1.8%). These incidences were lower compared with previously reported incidences after TAC treatment in PMS, and all of the observed ADRs were already known. A statistically significant improvement was observed in the primary effectiveness variable of Simplified Disease Activity Index after TAC treatment; 62.7% of patients achieved remission or low disease activity at week 24. CONCLUSIONS TAC is well tolerated and effective when used as an add-on to biological DMARDs in Japanese patients with RA who do not achieve an adequate response to biological DMARDs in a real-world clinical setting.
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Affiliation(s)
- Tsutomu Takeuchi
- a Division of Rheumatology, Department of Internal Medicine, School of Medicine , Keio University , Tokyo , Japan
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Yoshikawa A, Yoshida S, Kimura Y, Tokai N, Fujiki Y, Kotani T, Matsumura Y, Takeuchi T, Makino S. Add-on iguratimod as a therapeutic strategy to achieve remission in patients with rheumatoid arthritis inadequately responding to biological DMARDs: A retrospective study. Mod Rheumatol 2017. [DOI: 10.1080/14397595.2017.1336865] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Ayaka Yoshikawa
- Department of Internal Medicine IV, Osaka Medical College, Osaka, Japan
| | - Shuzo Yoshida
- Department of Internal Medicine IV, Osaka Medical College, Osaka, Japan
| | - Yuko Kimura
- Department of Internal Medicine IV, Osaka Medical College, Osaka, Japan
| | - Nao Tokai
- Department of Internal Medicine IV, Osaka Medical College, Osaka, Japan
| | - Yohei Fujiki
- Department of Internal Medicine IV, Osaka Medical College, Osaka, Japan
| | - Takuya Kotani
- Department of Internal Medicine IV, Osaka Medical College, Osaka, Japan
| | - Yoko Matsumura
- Department of Internal Medicine IV, Osaka Medical College, Osaka, Japan
| | - Tohru Takeuchi
- Department of Internal Medicine IV, Osaka Medical College, Osaka, Japan
| | - Shigeki Makino
- Department of Internal Medicine IV, Osaka Medical College, Osaka, Japan
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Identification of an in vivo orally active dual-binding protein-protein interaction inhibitor targeting TNFα through combined in silico/in vitro/in vivo screening. Sci Rep 2017; 7:3424. [PMID: 28611375 PMCID: PMC5469758 DOI: 10.1038/s41598-017-03427-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 04/28/2017] [Indexed: 12/31/2022] Open
Abstract
TNFα is a homotrimeric pro-inflammatory cytokine, whose direct targeting by protein biotherapies has been an undeniable success for the treatment of chronic inflammatory diseases. Despite many efforts, no orally active drug targeting TNFα has been identified so far. In the present work, we identified through combined in silico/in vitro/in vivo approaches a TNFα direct inhibitor, compound 1, displaying nanomolar and micromolar range bindings to TNFα. Compound 1 inhibits the binding of TNFα with both its receptors TNFRI and TNFRII. Compound 1 inhibits the TNFα induced apoptosis on L929 cells and the TNFα induced NF-κB activation in HEK cells. In vivo, oral administration of compound 1 displays a significant protection in a murine TNFα-dependent hepatic shock model. This work illustrates the ability of low-cost combined in silico/in vitro/in vivo screening approaches to identify orally available small-molecules targeting challenging protein-protein interactions such as homotrimeric TNFα.
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99
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Mbalaviele G, Novack DV, Schett G, Teitelbaum SL. Inflammatory osteolysis: a conspiracy against bone. J Clin Invest 2017; 127:2030-2039. [PMID: 28569732 DOI: 10.1172/jci93356] [Citation(s) in RCA: 155] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
There are many causes of inflammatory osteolysis, but regardless of etiology and cellular contexts, the osteoclast is the bone-degrading cell. Thus, the impact of inflammatory cytokines on osteoclast formation and function was among the most important discoveries advancing the treatment of focal osteolysis, leading to development of therapeutic agents that either directly block the bone-resorptive cell or do so indirectly via cytokine arrest. Despite these advances, a substantial number of patients with inflammatory arthritis remain resistant to current therapies, and even effective anti-inflammatory drugs frequently do not repair damaged bone. Thus, insights into events such as those impacted by inflammasomes, which signal through cytokine-dependent and -independent mechanisms, are needed to optimize treatment of inflammatory osteolysis.
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Affiliation(s)
| | - Deborah V Novack
- Department of Medicine, Division of Bone and Mineral Diseases, and.,Department of Pathology and Immunology, Division of Anatomic and Molecular Pathology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Georg Schett
- Department of Internal Medicine 3, Rheumatology and Immunology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Steven L Teitelbaum
- Department of Medicine, Division of Bone and Mineral Diseases, and.,Department of Pathology and Immunology, Division of Anatomic and Molecular Pathology, Washington University School of Medicine, St. Louis, Missouri, USA
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Wang Y, Wu Q, Liu Z, Guo X, Zhou L, Wang Y, Song L, Wang N, Zheng Q, Wang W, Ren G, Li D. A recombinant IgG-like bispecific antibody acting as interleukin-1β and interleukin-17A inhibitor exhibits a promising efficacy for rheumatoid arthritis. Biomed Pharmacother 2017; 89:426-437. [DOI: 10.1016/j.biopha.2017.02.045] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Revised: 02/14/2017] [Accepted: 02/14/2017] [Indexed: 01/04/2023] Open
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