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Alexeeva E, Horneff G, Dvoryakovskaya T, Denisova R, Nikishina I, Zholobova E, Malievskiy V, Santalova G, Stadler E, Balykova L, Spivakovskiy Y, Kriulin I, Alshevskaya A, Moskalev A. Early combination therapy with etanercept and methotrexate in JIA patients shortens the time to reach an inactive disease state and remission: results of a double-blind placebo-controlled trial. Pediatr Rheumatol Online J 2021; 19:5. [PMID: 33407590 PMCID: PMC7788754 DOI: 10.1186/s12969-020-00488-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 12/09/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Remission is the primary objective of treating juvenile idiopathic arthritis (JIA). It is still debatable whether early intensive treatment is superior in terms of earlier achievement of remission. The aim of this study was to evaluate the effectiveness of early etanercept+methotrexate (ETA+MTX) combination therapy versus step-up MTX monotherapy with ETA added in refractory disease. METHODS A multi-centre, double-blind, randomized study in active polyarticular JIA patients treated with either ETA+MTX (n = 35) or placebo+MTX (n = 33) for up to 24 weeks, followed by a 24-week open-label phase. The efficacy endpoints included pedACR30 criteria improvement at week 12, inactive disease at week 24, and remission at week 48. Patients who failed to achieve the endpoints at week 12 or at week 24 escaped to open-label ETA+MTX. Safety was assessed at each visit. RESULTS By intention-to-treat analysis, more patients in the ETA+MTX group reached the pedACR30 response at week 12 (33 (94.3%)) than in the placebo+MTX group (20 (60.6%); p = 0.001). At week 24, comparable percentages of patients reached inactive disease (11 (31.4%) vs 11 (33.3%)). At week 48, 11 (31.4%) and eight (24.2%) patients achieved remission. The median (+/-IQR) times to achieve an inactive disease state in the ETA+MTX and placebo+MTX groups were 24 (14-32) and 32 (24-40) weeks, respectively. Forty-four (74/100 patient-years) adverse events (AEs) were reported, leading to treatment discontinuation in 6 patients. CONCLUSIONS Early combination therapy with ETA+MTX proved to be highly effective compared to the standard step-up regimen. Compared to those treated with the standard regimen, more patients treated with a combination of ETA+MTX reached the pedACR30 response and achieved inactive disease and remission more rapidly.
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Affiliation(s)
- Ekaterina Alexeeva
- Federal State Autonomous Institution, National Medical Research Center of Children’s Health, Moscow, Russian Federation ,grid.448878.f0000 0001 2288 8774Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Gerd Horneff
- Asklepios Clinic Sankt Augustin, General Paediatrics, Arnold-Janssen-Straße 29, 53757, Sankt Augustin, Germany. .,Department of Pediatric and Adolescent medicine, Medical Faculty, University Hospital of Cologne, Cologne, Germany.
| | - Tatyana Dvoryakovskaya
- Federal State Autonomous Institution, National Medical Research Center of Children’s Health, Moscow, Russian Federation ,grid.448878.f0000 0001 2288 8774Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Rina Denisova
- Federal State Autonomous Institution, National Medical Research Center of Children’s Health, Moscow, Russian Federation ,grid.448878.f0000 0001 2288 8774Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Irina Nikishina
- grid.488825.bV.A. Nasonova Research Institute of Rheumatology, Moscow, Russian Federation
| | - Elena Zholobova
- grid.448878.f0000 0001 2288 8774Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Viktor Malievskiy
- grid.411540.50000 0001 0436 3958Federal State Educational Institution of Higher Education Bashkir State Medical University of the Ministry of Health of the Russian Federation, Ufa, Russian Federation
| | - Galina Santalova
- grid.445780.a0000 0001 0235 2817State Samara Medical University, Samara, Russian Federation
| | - Elena Stadler
- grid.445780.a0000 0001 0235 2817State Samara Medical University, Samara, Russian Federation
| | - Larisa Balykova
- grid.48430.3b0000 0001 2161 7585Medical Institute of National Research Ogarev Mordovia State University, Saransk, Russian Federation
| | - Yuriy Spivakovskiy
- grid.412420.10000 0000 8546 8761Saratov State Medical University n.a. V.I. Razumovsky, Saratov, Russian Federation
| | - Ivan Kriulin
- grid.448878.f0000 0001 2288 8774Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Alina Alshevskaya
- Biostatistics and Clinical Trials Center, Novosibirsk, Russian Federation
| | - Andrey Moskalev
- Biostatistics and Clinical Trials Center, Novosibirsk, Russian Federation
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Armaroli G, Klein A, Ganser G, Ruehlmann MJ, Dressler F, Hospach A, Minden K, Trauzeddel R, Foeldvari I, Kuemmerle-Deschner J, Weller-Heinemann F, Urban A, Horneff G. Long-term safety and effectiveness of etanercept in JIA: an 18-year experience from the BiKeR registry. Arthritis Res Ther 2020; 22:258. [PMID: 33121528 PMCID: PMC7597050 DOI: 10.1186/s13075-020-02326-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 09/22/2020] [Indexed: 01/22/2023] Open
Abstract
Background At present, etanercept represents the most commonly prescribed biologic agent for juvenile idiopathic arthritis (JIA) treatment. Children and adolescents with JIA are often treated with etanercept over long periods, sometimes even into adulthood. The objectives of this analysis were to determine the long-term safety of etanercept compared to a biologic-naïve cohort and to assess the long-term treatment response upon continuous etanercept exposure using data from the German biologics registry (BiKeR). Methods JIA patients newly exposed to etanercept were documented in the BiKeR registry from January 2001 to March 2019, and baseline characteristics, effectiveness, and safety parameters were analysed. Response to treatment was assessed according to 10-joint Juvenile Arthritis Disease Activity Score (JADAS10), JADAS-defined minimal disease activity and remission, JIA-American College of Rheumatology (ACR) improvement criteria, and ACR-inactive disease definition. Safety assessments were based on adverse event (AE) reports. Results A total of 2725 new etanercept users with a diagnosis of JIA were registered. Of these, etanercept was received as a first-line biologic by 95.8% and as monotherapy without concomitant methotrexate by 31.5%. After nine years on continuous treatment, 68.1% of patients presented minimal disease activity, 43.1% JADAS-defined remission on drug, and 36.6% ACR-inactive disease. JIA-ACR30/50/70/90 response rates were still 82/79/71/54% after nine years of treatment. Overall, 2053 AEs (34.3/100PY), including 226 serious AEs (SAE, 3.8/100PY), were observed upon etanercept, compared to 1345 AEs [35.6/100PY; p = 0.3] and 52 SAEs (1.4/100PY; p = 0.0001) in the biologic-naïve cohort. Respective exposure-adjusted rates for etanercept and biologic-naïve patients were 0.9/100PY and 0.2/100PY (p = 0.0001) for serious infections, 0.4/100PY and 0.1/100PY (p = 0.01) for zoster reactivation, 0.3/100PY and 0.03/100PY (p = 0.015) for inflammatory bowel disease, and 1.9/100PY and 1.4/100PY (p = 0.09) for uveitis. Three and two malignancies were documented in the etanercept and biologic-naïve groups, as well as three and one deaths, respectively. Conclusions No new safety signal was observed, especially no increased risk for malignancies or autoimmune disorders other than inflammatory bowel disease. However, SAEs and serious infections, though infrequent, were more often reported on etanercept than in biologic-naïve patients. In addition, etanercept demonstrated a long-term maintenance of clinical benefits up to nine years of continuous treatment.
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Affiliation(s)
- Giulia Armaroli
- Division of Paediatric Rheumatology, Sankt Augustin Asklepios Children's Hospital, 53757 Sankt Augustin, Germany.
| | - Ariane Klein
- Division of Paediatric Rheumatology, Sankt Augustin Asklepios Children's Hospital, 53757 Sankt Augustin, Germany.,Cologne University, Medical School, Cologne, Germany
| | - Gerd Ganser
- Division of Paediatric Rheumatology, Northwest German Rheumatology Center, St. Josef Stift, Sendenhorst, Germany
| | | | - Frank Dressler
- Division of Paediatric Pulmonology, Allergology and Immunology, Hannover Medical School, Hannover, Germany
| | - Anton Hospach
- Division of Paediatric Rheumatology, Olgahospital, Stuttgart, Germany
| | - Kirsten Minden
- German Rheumatism Research Center, Charité University Hospital, Berlin, Germany
| | - Ralf Trauzeddel
- Department of Paediatrics, Berlin-Buch Helios Hospital, Berlin, Germany
| | - Ivan Foeldvari
- Paediatric Rheumatology Medical Center, Hamburg, Germany
| | | | | | - Andreas Urban
- Department of Paediatrics, St. Marien Hospital, Amberg, Germany
| | - Gerd Horneff
- Division of Paediatric Rheumatology, Sankt Augustin Asklepios Children's Hospital, 53757 Sankt Augustin, Germany.,Cologne University, Medical School, Cologne, Germany
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53
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Parigi S, Licari A, Manti S, Marseglia GL, Tosca MA, Miraglia Del Giudice M, Caffarelli C, Calvani M, Martelli A, Cardinale F, Cravidi C, Duse M, Chiappini E. Tuberculosis and TNF-α inhibitors in children: how to manage a fine balance. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020009. [PMID: 33004779 PMCID: PMC8023060 DOI: 10.23750/abm.v91i11-s.10311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 07/22/2020] [Indexed: 11/23/2022]
Abstract
Since the introduction of biologic response modifiers (BRMs) in the management of children affected by the immune-mediated inflammatory disease, these patients substantially improved their quality of life. BRMs are generally well tolerated and effective in most children and adolescents refractory to conventional immunosuppressive therapy. On the other hand, patients receiving BRMs, especially TNF-α inhibitors, display an increased risk of primary infections or reactivations, i.e. due to Mycobacterium tuberculosis. M. tuberculosis can cause severe disease with consequent short- and long-term morbidity in children on anti-TNF-α treatment. The present paper analyses the increased risk of reactivation of latent tuberculosis infection (LTBI) or de novo TB infection in children treated with TNF-α inhibitors, with the purpose to provide recommendations for screening strategies and safety monitoring of paediatric patients. Special attention is also given to the currently available TB screening tools (IGRAs and TST) and their utility in the diagnosis of LTBI before starting the biologic therapy and during the treatment. Finally, the paper analyses the suggested TB-preventing therapies to adopt in these children and the correct timing to overlap anti-TB and anti-TNF-a treatment.
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Affiliation(s)
- Sara Parigi
- Post-graduate School of Paediatrics, Anna Meyer Children's University Hospital, Department of Health Sciences, University of Florence, Florence, Italy.
| | - Amelia Licari
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
| | - Sara Manti
- UOC Broncopneumologia Pediatrica e Fibrosi Cistica, AOUP "Vittorio-Emanuele", San Marco Hospital, Università di Catania, Catania, Italy.
| | - Gian Luigi Marseglia
- Pediatric Clinic Department of Pediatrics, Fondazione IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy.
| | - Maria Angela Tosca
- Allergy Center, Department of Pediatrics, Istituto G. Gaslini, Genoa, Italy.
| | - Michele Miraglia Del Giudice
- Department of Woman, Child and of General and Specialized Surgery. University of Campania "Luigi Vanvitelli" Naples, Italy.
| | - Carlo Caffarelli
- Clinica Pediatrica, Dipartimento di Medicina e Chirurgia, Università di Parma, Italy.
| | - Mauro Calvani
- UOC di Pediatria. Azienda Ospedaliera S. Camillo Forlanini, Roma, Italy.
| | - Alberto Martelli
- Department of Pediatrics, G.Salvini Hospital, Garbagnate Milanese, Milan - Italy.
| | - Fabio Cardinale
- Department of Pediatrics and Emergency, Pediatric Allergy and Pulmunology Unit, Azienda Ospedaliera-Universitaria Consorziale-Policlinico, Ospedale Pediatrico Giovanni XXIII, Bari, Italy..
| | - Claudio Cravidi
- Agenzia Tutela della Salute, ATS (National Healthcare System), Pavia, Italy. .
| | - Marzia Duse
- Department of Pediatrics, Sapienza University, Rome, Italy.
| | - Elena Chiappini
- Division of Paediatric Infectious Disease, Anna Meyer Children's University Hospital, Department of Health Sciences, University of Florence, Florence, Italy..
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Abstract
PURPOSE OF REVIEW Several biologic drugs are available for treatment of immune-mediated diseases, and the number of children treated with biologics is increasing. This review summarises current knowledge about the safety and immunogenicity of vaccines in children treated with biologic therapy. RECENT FINDINGS A recent retrospective, multicentre study reported that the booster dose of live-attenuated vaccine (MMR/V) was safe for patients with rheumatic diseases treated with biologic therapy. Recent publications revealed that immunogenicity of vaccines in children treated with biologics was lower than in the healthy population, especially on long-term follow-up. Children treated with biologic therapy are at greater danger of infections, compared to the healthy population. Therefore, they should be vaccinated according to national guidelines. Regardless of the therapy, non-live vaccines are recommended. However, it is common practice to advise postponing vaccination with live-attenuated vaccines in children while they are on immunosuppressive therapy. Newly published data suggest that booster dose MMR/V is safe for children treated with biologic therapy.
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Affiliation(s)
- Nataša Toplak
- Department of Allergology, Rheumatology and Clinical Immunology, University Children's Hospital, University Medical Centre Ljubljana, Bohoričeva 20, 1000, Ljubljana, Slovenia. .,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
| | - Yosef Uziel
- Pediatric Rheumatology Unit, Department of Pediatrics, Meir Medical Center, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Maccora I, dell’Anna MP, Vannacci A, Simonini G. Safety evaluations of adalimumab for childhood chronic rheumatic diseases. Expert Opin Drug Saf 2020; 19:661-671. [DOI: 10.1080/14740338.2020.1763300] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Ilaria Maccora
- Rheumatology Unit, Anna Meyer Children’s Hospital, NEUROFARBA Department, University of Florence, Florence, Italy
| | - Maria Pia dell’Anna
- Rheumatology Unit, Anna Meyer Children’s Hospital, NEUROFARBA Department, University of Florence, Florence, Italy
| | - Alfredo Vannacci
- Department of Neurosciences, Psychology, Drug Research and Child Health, Unit of Adverse Drug Reaction Monitoring and Pharmacoepidemiology, Tuscan Regional Centre of Pharmacovigilance, University of Florence, Florence, Italy
| | - Gabriele Simonini
- Rheumatology Unit, Anna Meyer Children’s Hospital, NEUROFARBA Department, University of Florence, Florence, Italy
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56
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Price E, MacPhie E, Kay L, Lanyon P, Griffiths B, Holroyd C, Abhishek A, Youngstein T, Bailey K, Clinch J, Shaikh M, Rivett A. Identifying rheumatic disease patients at high risk and requiring shielding during the COVID-19 pandemic. Clin Med (Lond) 2020; 20:256-261. [PMID: 32371418 PMCID: PMC7354033 DOI: 10.7861/clinmed.2020-0149] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Rheumatology teams care for patients with diverse, systemic autoimmune diseases who are often immunosuppressed and at high risk of infections. The current COVID-19 pandemic has presented particular challenges in caring for and managing this patient group. The office of the chief medical officer (CMO) for England contacted the rheumatology community to provide expert advice on the identification of extremely vulnerable patients at very high risk during the COVID-19 pandemic who should be 'shielded'. This involves the patients being asked to strictly self-isolate for at least 12 weeks with additional funded support provided for them to remain at home. A group of rheumatologists (the authors) have devised a pragmatic guide to identifying the very highest risk group using a rapidly developed scoring system which went live simultaneous with the Government announcement on shielding and was cascaded to all rheumatologists working in England.
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Affiliation(s)
- Elizabeth Price
- Great Western Hospital, Swindon, UK and president, British Society for Rheumatology, London, UK
| | - Elizabeth MacPhie
- Lancashire and South Cumbria NHS Foundation Trust, Preston, UK and chair of the Clinical Affairs Committee, British Society for Rheumatology, London, UK
| | - Lesley Kay
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK and joint national clinical lead for rheumatology, NHS England and Improvement, London, UK
| | - Peter Lanyon
- Nottingham University Hospitals NHS Trust, Nottingham, UK and national clinical co-lead for rheumatology, NHS Improvement, London, UK
| | - Bridget Griffiths
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK and chair of the Specialised Rheumatology Clinical Reference Group, NHS England, London, UK
| | | | - Abhishek Abhishek
- The University of Nottingham, Nottingham, UK and Nottingham Biomedical Research Centre, Nottingham, UK
| | - Taryn Youngstein
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Kathryn Bailey
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jacqui Clinch
- Bristol Royal Hospital for Children, Bristol, UK and medical lead, Bath Centre for Pain Services, Bath, UK
| | | | - Ali Rivett
- British Society for Rheumatology, London, UK
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The necessity, efficacy and safety of biologics in juvenile idiopathic arthritis. North Clin Istanb 2020; 7:118-123. [PMID: 32259032 PMCID: PMC7117638 DOI: 10.14744/nci.2019.57873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 09/13/2019] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE: Juvenile idiopathic arthritis (JIA) is the most common cause of chronic arthritis in children. Biologics have changed the faith of children with rheumatic diseases. The main objective of this study was to demonstrate the rate of usage, efficacy and safety of biologics in JIA subtypes. METHODS: This retrospective observational cohort study was conducted between May 2010 and September 2017. All children with the diagnosis of JIA and children under a biological agent treatment were recorded into the local registry system. Age, gender, JIA subtype, medications used, the clinical status of the patient, tuberculosis screening results, and side effects observed under biologics were retrieved from the registry. RESULTS: There were 405 patients with the diagnosis of JIA in the cohort. Biologics were used in 123 (30.3%) JIA patients. Subtype frequencies of JIA patients were as follows: persistent oligoarticular JIA (33.6%), enthesitis-related arthritis (29.2%), systemic JIA (13%), rheumatoid factor (RF)-negative polyarticular JIA (13%), extended oligoarticular JIA (4.2%), RF-positive polyarticular JIA (3.4%), psoriatic arthritis (1.8%) and unclassified arthritis (1.8%). The rate of biologic use was high in extended oligoarticular JIA (64.7% of the cases), RF-positive polyarticular JIA (57.1%), psoriatic arthritis (57.1%), RF-negative polyarticular JIA (41.5%), and in systemic JIA (39.6%). Enthesitis-related arthritis (27.1%), persistent oligoarticular JIA (17.6%) and unclassified arthritis (16.6%) patients were the cases that needed a biologic agent in the last order. At the last control, 78.9% of the cases were in remission, while 21.1% of them were active despite biologic treatment. Isoniazid prophylaxis was used in 30.8% of the patients. None of the patients developed active tuberculosis infection under prophylaxis. Adverse events were observed in 18.6% of patients under biologics as recurrent uncomplicated upper respiratory tract infections being the most common. CONCLUSION: Biologics are safe and effective treatment options in children with JIA. Most of the JIA patients with polyarticular involvement require biologics earlier in the disease course. The risk of tuberculosis infection seems not to be increased after appropriate screening and prophylaxis.
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Giancane G, Swart JF, Castagnola E, Groll AH, Horneff G, Huppertz HI, Lovell DJ, Wolfs T, Herlin T, Dolezalova P, Sanner H, Susic G, Sztajnbok F, Maritsi D, Constantin T, Vargova V, Sawhney S, Rygg M, K Oliveira S, Cattalini M, Bovis F, Bagnasco F, Pistorio A, Martini A, Wulffraat N, Ruperto N. Opportunistic infections in immunosuppressed patients with juvenile idiopathic arthritis: analysis by the Pharmachild Safety Adjudication Committee. Arthritis Res Ther 2020; 22:71. [PMID: 32264969 PMCID: PMC7136994 DOI: 10.1186/s13075-020-02167-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 03/27/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND To derive a list of opportunistic infections (OI) through the analysis of the juvenile idiopathic arthritis (JIA) patients in the Pharmachild registry by an independent Safety Adjudication Committee (SAC). METHODS The SAC (3 pediatric rheumatologists and 2 pediatric infectious disease specialists) elaborated and approved by consensus a provisional list of OI for use in JIA. Through a 5 step-procedure, all the severe and serious infections, classified as per MedDRA dictionary and retrieved in the Pharmachild registry, were evaluated by the SAC by answering six questions and adjudicated with the agreement of 3/5 specialists. A final evidence-based list of OI resulted by matching the adjudicated infections with the provisional list of OI. RESULTS A total of 772 infectious events in 572 eligible patients, of which 335 serious/severe/very severe non-OI and 437 OI (any intensity/severity), according to the provisional list, were retrieved. Six hundred eighty-two of 772 (88.3%) were adjudicated as infections, of them 603/682 (88.4%) as common and 119/682 (17.4%) as OI by the SAC. Matching these 119 opportunistic events with the provisional list, 106 were confirmed by the SAC as OI, and among them infections by herpes viruses were the most frequent (68%), followed by tuberculosis (27.4%). The remaining events were divided in the groups of non-OI and possible/patient and/or pathogen-related OI. CONCLUSIONS We found a significant number of OI in JIA patients on immunosuppressive therapy. The proposed list of OI, created by consensus and validated in the Pharmachild cohort, could facilitate comparison among future pharmacovigilance studies. TRIAL REGISTRATION Clinicaltrials.gov NCT01399281; ENCePP seal: awarded on 25 November 2011.
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Affiliation(s)
- Gabriella Giancane
- IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO, Genoa, Italy
| | - Joost F Swart
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, University Utrecht, European Reference Network-RITA, Utrecht, The Netherlands
| | - Elio Castagnola
- Department of Infectious Diseases, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Andreas H Groll
- Infectious Disease Research Program, Department of Pediatric Hematology and Oncology, University Children's Hospital, Münster, Germany
| | - Gerd Horneff
- Asklepios Clinic Sankt Augustin, Department of General Paediatrics, Sankt Augustin, Germany
- Medical Faculty, Department of Paediatric and Adolescents Medicine, University Hospital of Cologne, Cologne, Germany
| | - Hans-Iko Huppertz
- Clinic Bremen-Mitte, Prof.-Hesse Children's Hospital and Pediatric Intensive Care Medicine, Bremen, Germany
| | - Daniel J Lovell
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Tom Wolfs
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, University Utrecht, European Reference Network-RITA, Utrecht, The Netherlands
| | - Troels Herlin
- Pediatric Rheumatology Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Pavla Dolezalova
- 1st Faculty of Medicine, Department of Pediatrics and Adolescent Medicine, Charles University in Prague and General University Hospital, Praha, Czech Republic
| | - Helga Sanner
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway
- Norwegian National Advisory Unit on Rheumatic Diseases in Children and Adolescents, Oslo, Norway
| | - Gordana Susic
- Institute of Rheumatology of Belgrade, Division of Pediatric Rheumatology, Belgrade, Serbia
| | - Flavio Sztajnbok
- Hospital Universitario Pedro Ernesto, Nucleo de Estudos da Saúde do Adolescente, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Despoina Maritsi
- 2nd Department of Pediatrics Athens Medical School, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Tamas Constantin
- Unit of Pediatric Rheumatology-Immunology, Second Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Veronika Vargova
- Faculty of Medicine, Department of Paediatrics and Adolescent Medicine, Pavol Jozef Šafárik University in Košice, Kosice, Slovakia
| | - Sujata Sawhney
- Sir Ganga Ram Hospital Marg, Centre for Child Health, Sir Ganga Ram Hospital, New Delhi, India
| | - Marite Rygg
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
- Department of Pediatrics, St. Olavs University Hospital of Trondheim, Trondheim, Norway
| | - Sheila K Oliveira
- Instituto de Puericultura e Pediatria Martagao Gesteira (IPPMG), Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marco Cattalini
- Clinica Pediatrica dell'Università di Brescia, Spedali Civili, Unità di Immunologia e Reumatologia Pediatrica, Brescia, Italy
| | - Francesca Bovis
- IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO, Genoa, Italy
| | - Francesca Bagnasco
- IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO, Genoa, Italy
| | - Angela Pistorio
- IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica, Genoa, Italy
| | - Alberto Martini
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DiNOGMI), Università degli Studi di Genova, Genoa, Italy
| | - Nico Wulffraat
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, University Utrecht, European Reference Network-RITA, Utrecht, The Netherlands
| | - Nicolino Ruperto
- IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO, Genoa, Italy.
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Swart JF, de Roock S, Nievelstein RAJ, Slaper-Cortenbach ICM, Boelens JJ, Wulffraat NM. Bone-marrow derived mesenchymal stromal cells infusion in therapy refractory juvenile idiopathic arthritis patients. Rheumatology (Oxford) 2020; 58:1812-1817. [PMID: 31070229 PMCID: PMC6758577 DOI: 10.1093/rheumatology/kez157] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/25/2019] [Indexed: 12/29/2022] Open
Abstract
Objectives To compare the total number of adverse events (AEs) before and after mesenchymal stromal cell (MSC) infusion in refractory JIA and to evaluate its effectiveness. Methods Single-centre Proof of Mechanism Phase Ib, open label intervention study in JIA patients previously failing all biologicals registered for their diagnosis. Six patients received 2 million/kg intravenous infusions of allogeneic bone-marrow derived MSC. In case of ACR-Ped30-response but subsequent loss of response one and maximal two repeated infusions are allowed. Results Six JIA patients with 9.2 years median disease duration, still active arthritis and damage were included. All had failed methotrexate, corticosteroids and median five different biologicals. MSC were administered twice in three patients. No acute infusion reactions were observed and a lower post-treatment than pre-treatment incidence in AEs was found. The one systemic onset JIA (sJIA) patient had again an evolving macrophage activation syndrome, 9 weeks after tocilizumab discontinuation and 7 weeks post-MSC infusion. Statistically significant decreases were found 8 weeks after one MSC infusion in VAS well-being (75–56), the JADAS-71 (24.5–11.0) and the cJADAS10 (18.0–10.6). Conclusion MSC infusions in six refractory JIA patients were safe, although in sJIA stopping the ‘failing’ biologic treatment carries a risk of a MAS flare, as the drug might still suppress the systemic features. Trial registration Trial register.nl, http://https://www.trialregister.nl, NTR4146.
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Affiliation(s)
- Joost F Swart
- Department of Pediatric Immunology and Rheumatology, UMC Utrecht, Wilhelmina Children's Hospital.,Faculty of Medicine, Utrecht University
| | - Sytze de Roock
- Department of Pediatric Immunology and Rheumatology, UMC Utrecht, Wilhelmina Children's Hospital.,Faculty of Medicine, Utrecht University
| | - Rutger A J Nievelstein
- Faculty of Medicine, Utrecht University.,Department of Pediatric Radiology, Division Imaging, UMC Utrecht, Utrecht, The Netherlands
| | | | - Jaap J Boelens
- Department of Pediatric Immunology and Rheumatology, UMC Utrecht, Wilhelmina Children's Hospital.,Faculty of Medicine, Utrecht University
| | - Nico M Wulffraat
- Department of Pediatric Immunology and Rheumatology, UMC Utrecht, Wilhelmina Children's Hospital.,Faculty of Medicine, Utrecht University
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Batthish M, Berard R, Cabral D, Bolaria R, Chédeville G, Duffy C, Gerhold K, Gerschman T, Huber A, Proulx-Gauthier JP, Rosenberg A, Rumsey D, Schmeling H, Shiff N, Soon G, Bruns A, Tucker L, Guzman J. A new Canadian inception cohort for juvenile idiopathic arthritis: The Canadian Alliance of Pediatric Rheumatology Investigators Registry. Rheumatology (Oxford) 2020; 59:2796-2805. [DOI: 10.1093/rheumatology/keaa006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 12/19/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
The aim was to describe the design, methods and initial findings of a new Canadian inception cohort of children with JIA, The Canadian Alliance of Pediatric Rheumatology Investigators (CAPRI) JIA Registry.
Methods
The CAPRI JIA Registry was started in 2017 to collect information prospectively on children enrolled within 3 months of JIA diagnosis across Canada. The registry has a non-traditional modular design, with no artificially set times for registry visits to occur, streamlined multi-method data collection that requires 2–4 min per visit, and reports cumulative incidence of treatments, outcomes and adverse events calculated by Kaplan–Meier survival methods.
Results
A total of 166 patients, enrolled a median of 6 weeks after JIA diagnosis at 10 centres, were included. The median age at diagnosis was 9 years [interquartile range (IQR) 3, 13], 61% were female and 51% had oligoarticular JIA. The median three-variable clinical Juvenile Arthritis Disease Activity Score was 6.5 (IQR 4, 10) at enrolment, and the median time to first attainment of clinically inactive disease (CID) was 24 weeks (by 1 year, 81%). Within 1 year of diagnosis, 70% of patients had started a DMARD and 35% a biologic agent. The rates of adverse events and serious adverse events were 60 and 5.8 per 100 patient-years, respectively.
Conclusion
This streamlined and flexible registry minimizes the burden of data collection and interference with clinic operations. Initial findings suggest that treatments for newly diagnosed patients with JIA in Canada have intensified, and now 81% of patients attain CID within 1 year of diagnosis.
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Affiliation(s)
- Michelle Batthish
- Division of Rheumatology, Department of Pediatrics, McMaster University, Hamilton, Ontario
| | - Roberta Berard
- Division of Rheumatology, Department of Pediatrics, Western University, London, Ontario
| | - David Cabral
- Division of Rheumatology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
| | - Roxana Bolaria
- Division of Rheumatology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
| | - Gaëlle Chédeville
- Division of Rheumatology, Department of Pediatrics, McGill University, Montreal, Quebec
| | - Ciaran Duffy
- Division of Rheumatology, Department of Pediatrics, University of Ottawa, Ottawa, Ontario
| | - Kerstin Gerhold
- Division of Rheumatology, Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba
| | - Tommy Gerschman
- Division of Rheumatology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
| | - Adam Huber
- Division of Rheumatology, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia
| | | | - Alan Rosenberg
- Division of Rheumatology, Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan
| | - Dax Rumsey
- Division of Rheumatology, Department of Pediatrics, University of Alberta, Edmonton, Alberta
| | - Heinrike Schmeling
- Division of Rheumatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Natalie Shiff
- Division of Rheumatology, Department of Pediatrics, University of Florida, Gainesville, FL, USA
| | - Gordon Soon
- Division of Rheumatology, Department of Pediatrics, University of Toronto, Toronto, Ontario
| | - Alessandra Bruns
- Division of Rheumatology, Department of Pediatrics, University de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Lori Tucker
- Division of Rheumatology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
| | - Jaime Guzman
- Division of Rheumatology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
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242nd ENMC International Workshop: Diagnosis and management of juvenile myasthenia gravis Hoofddorp, the Netherlands, 1-3 March 2019. Neuromuscul Disord 2020; 30:254-264. [PMID: 32173249 DOI: 10.1016/j.nmd.2020.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 02/03/2020] [Indexed: 12/13/2022]
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62
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Saper VE, Chen G, Deutsch GH, Guillerman RP, Birgmeier J, Jagadeesh K, Canna S, Schulert G, Deterding R, Xu J, Leung AN, Bouzoubaa L, Abulaban K, Baszis K, Behrens EM, Birmingham J, Casey A, Cidon M, Cron RQ, De A, De Benedetti F, Ferguson I, Fishman MP, Goodman SI, Graham TB, Grom AA, Haines K, Hazen M, Henderson LA, Ho A, Ibarra M, Inman CJ, Jerath R, Khawaja K, Kingsbury DJ, Klein-Gitelman M, Lai K, Lapidus S, Lin C, Lin J, Liptzin DR, Milojevic D, Mombourquette J, Onel K, Ozen S, Perez M, Phillippi K, Prahalad S, Radhakrishna S, Reinhardt A, Riskalla M, Rosenwasser N, Roth J, Schneider R, Schonenberg-Meinema D, Shenoi S, Smith JA, Sönmez HE, Stoll ML, Towe C, Vargas SO, Vehe RK, Young LR, Yang J, Desai T, Balise R, Lu Y, Tian L, Bejerano G, Davis MM, Khatri P, Mellins ED. Emergent high fatality lung disease in systemic juvenile arthritis. Ann Rheum Dis 2019; 78:1722-1731. [PMID: 31562126 PMCID: PMC7065839 DOI: 10.1136/annrheumdis-2019-216040] [Citation(s) in RCA: 112] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/11/2019] [Accepted: 09/13/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To investigate the characteristics and risk factors of a novel parenchymal lung disease (LD), increasingly detected in systemic juvenile idiopathic arthritis (sJIA). METHODS In a multicentre retrospective study, 61 cases were investigated using physician-reported clinical information and centralised analyses of radiological, pathological and genetic data. RESULTS LD was associated with distinctive features, including acute erythematous clubbing and a high frequency of anaphylactic reactions to the interleukin (IL)-6 inhibitor, tocilizumab. Serum ferritin elevation and/or significant lymphopaenia preceded LD detection. The most prevalent chest CT pattern was septal thickening, involving the periphery of multiple lobes ± ground-glass opacities. The predominant pathology (23 of 36) was pulmonary alveolar proteinosis and/or endogenous lipoid pneumonia (PAP/ELP), with atypical features including regional involvement and concomitant vascular changes. Apparent severe delayed drug hypersensitivity occurred in some cases. The 5-year survival was 42%. Whole exome sequencing (20 of 61) did not identify a novel monogenic defect or likely causal PAP-related or macrophage activation syndrome (MAS)-related mutations. Trisomy 21 and young sJIA onset increased LD risk. Exposure to IL-1 and IL-6 inhibitors (46 of 61) was associated with multiple LD features. By several indicators, severity of sJIA was comparable in drug-exposed subjects and published sJIA cohorts. MAS at sJIA onset was increased in the drug-exposed, but was not associated with LD features. CONCLUSIONS A rare, life-threatening lung disease in sJIA is defined by a constellation of unusual clinical characteristics. The pathology, a PAP/ELP variant, suggests macrophage dysfunction. Inhibitor exposure may promote LD, independent of sJIA severity, in a small subset of treated patients. Treatment/prevention strategies are needed.
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Affiliation(s)
- Vivian E Saper
- Pediatrics, Stanford University, Stanford, California, USA
| | - Guangbo Chen
- Institute for Immunity, Transplantation and Infection, Center for Biomedical Informatics Research, Medicine, Stanford University, Stanford, California, USA
| | - Gail H Deutsch
- Pathology, Seattle Children's Hospital, Seattle, Washington, USA
- University of Washington School of Medicine, Seattle, Washington, USA
| | | | | | | | - Scott Canna
- Pediatrics, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Grant Schulert
- Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Robin Deterding
- Children's Hospital Colorado, Aurora, Colorado, USA
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jianpeng Xu
- Pediatrics, Stanford University, Stanford, California, USA
| | - Ann N Leung
- Radiology, Stanford University, Stanford, California, USA
| | - Layla Bouzoubaa
- Public Health Services, Biostatistics, University of Miami School of Medicine, Miami, Florida, USA
| | - Khalid Abulaban
- Helen DeVos Children's Hospital, Grand Rapids, Michigan, USA
- Michigan State University, East Lansing, Michigan, USA
| | - Kevin Baszis
- Pediatrics, Washington University in Saint Louis, Saint Louis, Missouri, USA
| | - Edward M Behrens
- Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - James Birmingham
- Medicine, Metro Health Hospital, Wyoming, Michigan, USA
- University of Michigan, Ann Arbor, Michigan, USA
| | - Alicia Casey
- Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Michal Cidon
- Pediatrics, Children's Hospital of Los Angeles, Los Angeles, California, USA
- University of Southern California, Los Angeles, California, USA
| | - Randy Q Cron
- Children's of Alabama, Birmingham, Alabama, USA
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Aliva De
- Pediatrics, Columbia University Medical Center, New York, New York, USA
| | | | - Ian Ferguson
- Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Martha P Fishman
- Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Steven I Goodman
- Arthritis Associates of South Florida, Delray Beach, Florida, USA
| | - T Brent Graham
- Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Alexei A Grom
- Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Kathleen Haines
- Joseph M Sanzari Children's Hospital, Hackensack, New Jersey, USA
- Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Melissa Hazen
- Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Lauren A Henderson
- Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Assunta Ho
- Pediatrics, Prince of Wales Hospital, New Territories, Hong Kong
- Faculty of Medicine, Chinese University of Hong Kong, New Territories, Hong Kong
| | - Maria Ibarra
- Children's Mercy Hospitals and Clinics, Kansas City, Missouri, USA
- School of Medicine, University of Missouri Kansas City, Kansas City, Missouri, USA
| | - Christi J Inman
- Pediatrics, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Rita Jerath
- Children's Hospital of Georgia, Augusta, Georgia, USA
- Augusta University, Augusta, Georgia, USA
| | - Khulood Khawaja
- Pediatrics, Al Mafraq Hospital, Abu Dhabi, Abu Dhabi, United Arab Emirates
| | | | - Marisa Klein-Gitelman
- Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Khanh Lai
- Pediatrics, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Sivia Lapidus
- Joseph M Sanzari Children's Hospital, Hackensack, New Jersey, USA
- Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Clara Lin
- Children's Hospital Colorado, Aurora, Colorado, USA
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jenny Lin
- Children's Hospital at Montefiore, Bronx, New York, USA
- Yeshiva University Albert Einstein College of Medicine, Bronx, New York, USA
| | - Deborah R Liptzin
- Children's Hospital Colorado, Aurora, Colorado, USA
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Diana Milojevic
- Johns Hopkins All Children's Hospital, Saint Petersburg, Florida, USA
| | - Joy Mombourquette
- Pediatrics, Kaiser Permanente Roseville Medical Center, Roseville, California, USA
| | - Karen Onel
- Pediatrics, Hospital for Special Surgery, New York, New York, USA
- Weill Cornell Medical College, New York, New York, USA
| | - Seza Ozen
- Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Maria Perez
- Cook Children's Medical Center, Fort Worth, Texas, USA
| | - Kathryn Phillippi
- Akron Children's Hospital, Akron, Ohio, USA
- Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Sampath Prahalad
- Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Suhas Radhakrishna
- Rady Children's Hospital, San Diego, California, USA
- Pediatrics, University of California San Diego, La Jolla, California, USA
| | - Adam Reinhardt
- Pediatrics, University of Nebraska Medical Center College of Medicine, Omaha, Nebraska, USA
| | - Mona Riskalla
- Pediatrics, University of Minnesota Medical School Twin Cities, Minneapolis, Minnesota, USA
- University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA
| | - Natalie Rosenwasser
- Pediatrics, Hospital for Special Surgery, New York, New York, USA
- Weill Cornell Medical College, New York, New York, USA
| | - Johannes Roth
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Rayfel Schneider
- Hospital for Sick Children, Toronto, Ontario, Canada
- Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Dieneke Schonenberg-Meinema
- Emma Children's Hospital AMC, Amsterdam, The Netherlands
- University of Amsterdam, Amsterdam, Noord-Holland, The Netherlands
| | - Susan Shenoi
- University of Washington School of Medicine, Seattle, Washington, USA
- Pediatrics, Seattle Children's Hospital, Seattle, Washington, USA
| | - Judith A Smith
- Pediatrics, University of Wisconsin Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | | | - Matthew L Stoll
- Children's of Alabama, Birmingham, Alabama, USA
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Christopher Towe
- Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Sara O Vargas
- Harvard Medical School, Boston, Massachusetts, USA
- Pathology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Richard K Vehe
- Pediatrics, University of Minnesota Medical School Twin Cities, Minneapolis, Minnesota, USA
- University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA
| | - Lisa R Young
- Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jacqueline Yang
- Institute for Immunity, Transplantation and Infection, Center for Biomedical Informatics Research, Medicine, Stanford University, Stanford, California, USA
| | - Tushar Desai
- Medicine, Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, California, USA
| | - Raymond Balise
- Public Health Services, Biostatistics, University of Miami School of Medicine, Miami, Florida, USA
| | - Ying Lu
- Biomedical Data Science, Stanford University, Stanford, California, USA
| | - Lu Tian
- Biomedical Data Science, Stanford University, Stanford, California, USA
| | - Gill Bejerano
- Genetics, Stanford University, Stanford, California, USA
| | - Mark M Davis
- Institute for Immunity, Transplantation and Infection, Microbiology and Immunology, Stanford University, Stanford, California, USA
| | - Purvesh Khatri
- Institute for Immunity, Transplantation and Infection, Center for Biomedical Informatics Research, Medicine, Stanford University, Stanford, California, USA
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Klein A, Becker I, Minden K, Hospach A, Schwarz T, Foeldvari I, Huegle B, Borte M, Weller-Heinemann F, Dressler F, Kuemmerle-Deschner J, Oommen PT, Foell D, Trauzeddel R, Rietschel C, Horneff G. Biologic Therapies in Polyarticular Juvenile Idiopathic Arthritis. Comparison of Long-Term Safety Data from the German BIKER Registry. ACR Open Rheumatol 2019; 2:37-47. [PMID: 31943968 PMCID: PMC6957918 DOI: 10.1002/acr2.11091] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 09/17/2019] [Indexed: 12/19/2022] Open
Abstract
Objective Biologics have an important role in the treatment of juvenile idiopathic arthritis (JIA). Long‐term safety data are limited. Direct comparison of different agents regarding occurrence of adverse events (AEs), especially of rare events, requires large quantities of patient years. In this analysis, long‐term safety with regard to AE of special interest (AESI) was compared between different biologics. Methods Patients with nonsystemic JIA were selected from the German BIKER registry. Safety assessments were based on AE reports. Number of AEs, serious AEs, and 25 predefined AESIs, including medically important infection, uveitis, inflammatory bowel disease, cytopenia, hepatic events, anaphylaxis, depression, pregnancy, malignancy, and death, were analyzed. Event rates and relative risks were calculated using AEs reported after first dose through 70 days after last dose. Results A total of 3873 patients entered the analysis with 7467 years of exposure to biologics. The most common AESIs were uveitis (n = 231) and medically important infections (n = 101). Cytopenia and elevation of transaminases were more frequent with tocilizumab (risk ratio [RR] 8.0, 95% confidence interval [CI] 4.2‐15, and RR 4.7, 95% CI 1.8‐12.2, respectively). Anaphylactic events were associated with intravenous route of administration. In patients ever exposed to biologics, eight malignancies were reported. Six pregnancies have been documented in patients with tumor necrosis factor inhibitors. No death occurred in this patient cohort during observation. Conclusion Surveillance of pharmacotherapy as provided by the BIKER registry is an import approach, especially for long‐term treatment of children. Overall, tolerance was acceptable. Differences between biologics were noted and should be considered in daily patient care.
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Affiliation(s)
- Ariane Klein
- Asklepios Klinik Sankt Augustin, Sankt Augustin, Germany, and University of Cologne, Cologne, Germany
| | | | - Kirsten Minden
- German Rheumatism Research Centre Berlin, Berlin and Charité University Medicine, Berlin, Germany
| | | | | | - Ivan Foeldvari
- Hamburg Centre for Pediatric and Adolescent Rheumatology, Hamburg, Germany
| | - Boris Huegle
- German Centre for Pediatric and Adolescent Rheumatology, Garmisch-Partenkirchen, Germany
| | | | | | | | | | | | - Dirk Foell
- University Children's Hospital Münster, Münster, Germany
| | | | | | - Gerd Horneff
- Asklepios Klinik Sankt Augustin, Sankt Augustin, Germany, and University of Cologne, Cologne, Germany
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Niehues T, Özgür TT. The Efficacy and Evidence-Based Use of Biologics in Children and Adolescents: Using Monoclonal Antibodies and Fusion Proteins as Treatments. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 116:703-710. [PMID: 31711560 PMCID: PMC6891884 DOI: 10.3238/arztebl.2019.0703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 12/27/2018] [Accepted: 07/23/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Monoclonal antibodies (mAb) and fusion proteins (FP) are increasingly being used in children and adolescents. In this review, we analyze the evidence for their safety and efficacy in the treatment of the most common chronic inflammatory diseases. METHODS We systematically searched PubMed, AWMF.org, and other databases for high-quality trials (i.e., randomized controlled trials with clinical primary endpoints) and guidelines published at any time up to 10 December 2018 that dealt with mAb and FP that are approved for pediatric use. The search term was "monoclonal anti- body/fusion protein [e. g. adalimumab] AND children." RESULTS The 620 hits included 25 high-quality trials (20 of them manufacturer- sponsored) on 9 mAb/FP (omalizumab, adalimumab, etanercept, ustekinumab, infliximab, golimumab, anakinra, canakinumab, tocilizumab, and abatacept), as well as 6 guidelines (3 each of levels S3 and S2k) on the treatment of bronchial asthma, psoriasis, juvenile idopathic arthritis, and chronic inflammatory bowel diseases. For none of these conditions are mAb and FP the drugs of first choice. Adverse drug effects are rare but sometimes severe (infection, immune dysregulation, tumors). CONCLUSION The retrieved trials have deficiencies that make it difficult to reliably evaluate the efficacy, safety, and utility of mAb/FP for children and adolescents with chronic inflammatory diseases. mAb/FP nonetheless represent a treatment option to be considered in case conventional immune-modulating drugs are ineffective. Researcher-initiated, high-quality trials and manufacturer-independent, systematic long-term evaluations of adverse effects (e.g., tumors) are sorely needed.
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Affiliation(s)
- Tim Niehues
- Department of Pediatrics and Adolescent Medicine, HELIOS Klinikum Krefeld
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Khraishi M, Millson B, Woolcott J, Jones H, Marshall L, Ruperto N. Reduction in the utilization of prednisone or methotrexate in Canadian claims data following initiation of etanercept in pediatric patients with juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2019; 17:64. [PMID: 31500631 PMCID: PMC6734296 DOI: 10.1186/s12969-019-0358-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 08/07/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND In adult patients with arthritis, use of the tumor necrosis factor (TNF) inhibitor etanercept (ETN) is often associated with a reduction in the utilization of co-medications, particularly steroids. Comparatively little is known about the utilization of co-medications when ETN is initiated in pediatric patients with juvenile idiopathic arthritis (JIA). METHODS This study analyzed Canadian longitudinal claims level data spanning January 2007 to April 2017. Data were collated from the IQVIA Private Drug Plan, Ontario Public Drug Plan, and the Quebec Public Drug Plan (Régie de l'assurance maladie du Québec) databases. Patients < 18 years of age were indexed when filling a prescription for ETN between January 2008 and January 2016. Those who met the inclusion and exclusion criteria were assessed for methotrexate (MTX), and prednisone (PRD) use in the 6 months prior to and 12 months following initiation of ETN. RESULTS Longitudinal claims data for 330 biologic-naive pediatric patients initiating ETN therapy were included. The majority of patients were female (67%), aged 10-17 years (64%), and with a drug history consistent with JIA (96%). Most patients were from Quebec (36%) or Ontario (33%). Dosing of ETN was weight-based with a mean dosage over the first year of 31 mg per week. ETN dosing was relatively consistent over the first year. In total, 222 (67%) patients did not use MTX and 223 (68%) did not use PRD before or after starting ETN. A total of 17% (18/103) of MTX-treated and 50% (46/92) of PRD-treated patients discontinued use of those medications upon initiation of ETN treatment. In patients continuing MTX or PRD, significant reductions in the weekly dosage from 14.3 to 6.8 mg per week for MTX and from 56 to 23 mg per week for PRD were observed (P < 0.01). CONCLUSIONS This study of Canadian claims-level data is the first large prespecified analysis of co-medication utilization following the initiation of ETN therapy in pediatric patients. A decline in both MTX and PRD use and dosage was observed and may be associated with benefits related to safety, tolerability, and overall healthcare costs.
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Affiliation(s)
- Majed Khraishi
- 0000 0000 9130 6822grid.25055.37Memorial University of Newfoundland, St. Johns, NL Canada
| | | | - John Woolcott
- 0000 0000 8800 7493grid.410513.2Global Outcomes and Evidence, Pfizer, Collegeville, PA USA
| | - Heather Jones
- 0000 0000 8800 7493grid.410513.2Global Medical Affairs, Pfizer, Collegeville, PA USA
| | - Lisa Marshall
- 0000 0000 8800 7493grid.410513.2Global Medical Affairs, Pfizer, Collegeville, PA USA
| | - Nicolino Ruperto
- IRCCS, Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia - PRINTO, Genoa, Italy.
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Grönlund MM, Remes-Pakarinen T, Kröger L, Markula-Patjas K, Backström M, Putto-Laurila A, Aalto K, Vähäsalo P. Efficacy and safety of tocilizumab in a real-life observational cohort of patients with polyarticular juvenile idiopathic arthritis. Rheumatology (Oxford) 2019; 59:732-741. [DOI: 10.1093/rheumatology/kez291] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 05/08/2019] [Indexed: 12/14/2022] Open
Abstract
Abstract
Objectives
To evaluate the patterns of usage, efficacy and safety of tocilizumab in polyarticular JIA.
Methods
An observational study of 56 consecutive polyarticular JIA patients was conducted using patient charts and electronic JIA databases. Efficacy was assessed by tocilizumab survival, rates of low disease activity (LDA) and of inactive disease by 10-joint Juvenile Arthritis Disease Activity Score (JADAS-10), and of clinically inactive disease according to Wallace’s preliminary criteria. Efficacy and rate of adverse events (AEs) were evaluated during a 24-month period after tocilizumab commencement.
Results
Tocilizumab was started on average as third-line biological agent (median, range first- to fourth-line) at a median disease duration of 5.2 years (interquartile range 3.0–7.7). Survival rates were 82% at 12 months and 64% at 24 months. The reasons for discontinuation were inadequate treatment effect in 50%, AE plus inadequate treatment effect in 37.5% and AE alone in 12.5%. LDA (JADAS-10 ⩽3.9) was reached in 58% at 12 months and in 84% at 24 months, inactive disease (JADAS-10 ⩽0.7) in 19% and 44%, and clinically inactive disease in 28% and 46%, respectively. The rate of AEs was 200.9/100 patient years and of serious AEs 12.9/100 patient years.
Conclusion
Survival of tocilizumab was high and a large proportion of the treatment-resistant patients reached LDA at 12 months of treatment. The LDA rate continued to increase throughout 24 months. The rates of AEs and serious AEs were higher than in register studies but lower than in the originator study of tocilizumab.
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Affiliation(s)
| | | | - Liisa Kröger
- Department of Pediatrics, Kuopio University Hospital, Kuopio
| | - Kati Markula-Patjas
- Department of Paediatrics, Tampere University Hospital, Tampere
- University of Tampere, Tampere
| | | | | | - Kristiina Aalto
- Department of Children and Adolescents, Helsinki University Hospital, Helsinki
- Pediatric Research Center, University of Helsinki, Helsinki
| | - Paula Vähäsalo
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu
- Department of Children and Adolescents, Oulu University Hospital, Oulu
- PEDEGO Research Unit, University of Oulu, Oulu, Finland
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