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Migliore A, Bizzi E, Egan CG, Bernardi M, Petrella L. Efficacy of biological agents administered as monotherapy in rheumatoid arthritis: a Bayesian mixed-treatment comparison analysis. Ther Clin Risk Manag 2015; 11:1325-35. [PMID: 26366085 PMCID: PMC4562742 DOI: 10.2147/tcrm.s89678] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Biological agents provide an important therapeutic alternative for rheumatoid arthritis patients refractory to conventional disease-modifying antirheumatic drugs. Few head-to-head comparative trials are available. PURPOSE The aim of this meta-analysis was to compare the relative efficacy of different biologic agents indicated for use as monotherapy in rheumatoid arthritis. METHODS A systemic literature search was performed on electronic databases to identify articles reporting double-blind randomized controlled trials investigating the efficacy of biologic agents indicated for monotherapy. Efficacy was assessed using American College of Rheumatology (ACR) 20, 50, and 70 criteria at 16-24 weeks. Relative efficacy was estimated using Bayesian mixed-treatment comparison models. Outcome measures were expressed as odds ratio and 95% credible intervals. RESULTS Ten randomized controlled trials were selected for data extraction and analysis. Mixed-treatment comparison analysis revealed that tocilizumab offered 100% probability of being the best treatment for inducing an ACR20 response versus placebo, methotrexate, adalimumab, or etanercept. Likewise, for ACR50 and ACR70 outcome responses, tocilizumab had a 99.8% or 98.7% probability of being the best treatment, respectively, compared to other treatments or placebo. Tocilizumab increased the relative probability of being the best treatment (vs methotrexate) by 3.2-fold (odds ratio: 2.1-3.89) for all ACR outcomes. CONCLUSION Tocilizumab offered the greatest possibility of obtaining an ACR20, ACR50, and ACR70 outcome vs other monotherapies or placebo.
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Affiliation(s)
- Alberto Migliore
- Rheumatology Unit, San Pietro Fatebenefratelli Hospital, Rome, Italy
| | - Emanuele Bizzi
- Rheumatology Unit, San Pietro Fatebenefratelli Hospital, Rome, Italy
| | | | - Mauro Bernardi
- Department of Statistical Sciences, University of Padova, Padova, Italy
| | - Lea Petrella
- MEMOTEF Department, Sapienza University of Rome, Rome, Italy
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Kang EH, Lee JT, Lee HJ, Lee JY, Chang SH, Cho HJ, Choi BY, Ha YJ, Park KU, Song YW, Van Dyke TE, Lee YJ. Chronic Periodontitis Is Associated With Spinal Dysmobility in Patients With Ankylosing Spondylitis. J Periodontol 2015; 86:1303-13. [PMID: 26291296 DOI: 10.1902/jop.2015.150202] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although microbes have been suggested to play a role in the pathogenesis of ankylosing spondylitis (AS), several studies present contradictory results regarding the association between AS and chronic periodontitis (CP). METHODS Clinical, laboratory, and medication data were collected from 84 patients with AS and 84 age- and sex-matched controls. Periodontal measurements, including probing depths (PDs), clinical attachment loss (AL), serum anti-Porphyromonas gingivalis titers, and the detection of P. gingivalis DNA in gingival crevicular fluid, were recorded. All participants with periodontitis with PD ≥4 to <7 mm received scaling and root planing and were re-evaluated at 12 weeks; those still exhibiting periodontitis with PD of ≥4 to <7 mm at 12 weeks were followed at 24 weeks. RESULTS The prevalence of moderate-to-severe CP was not different between patients with AS and controls (70.2% versus 66.6%). The P. gingivalis detection rate was not different between patients with AS and controls or between patients with AS receiving and not receiving anti-tumor necrosis factor (TNF)-α agents. However, CP was positively associated with impaired spinal mobility of patients with AS in multivariate analyses. After periodontal treatment, PD and AL levels were improved in both groups, but the change was significantly greater in patients with AS than in controls. Patients with AS receiving anti-TNF-α agents exhibited a greater improvement in PD and AL than those who did not. CONCLUSIONS Although AS was not associated with the presence of CP, CP was associated positively with the severity of spinal dysmobility in Korean patients with AS. These results suggest that periodontitis can have a negative effect on axial movement in AS.
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Affiliation(s)
- Eun Ha Kang
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jung Tae Lee
- Department of Periodontology, Section of Dentistry, Seoul National University Bundang Hospital
| | - Hyo-Jung Lee
- Department of Periodontology, Section of Dentistry, Seoul National University Bundang Hospital
| | - Joo Youn Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sung Hae Chang
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Hyon Joung Cho
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Byoong Yong Choi
- Department of Internal Medicine, Seoul Medical Center Public Corporation, Seoul, Korea
| | - You-Jung Ha
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyoung Un Park
- Department of Laboratory Medicine, Seoul National University Bundang Hospital
| | - Yeong Wook Song
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Thomas E Van Dyke
- Department of Applied Oral Sciences, Forsyth Institute, Cambridge, MA
| | - Yun Jong Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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103
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Scott DL, Ibrahim F, Farewell V, O'Keeffe AG, Ma M, Walker D, Heslin M, Patel A, Kingsley G. Randomised controlled trial of tumour necrosis factor inhibitors against combination intensive therapy with conventional disease-modifying antirheumatic drugs in established rheumatoid arthritis: the TACIT trial and associated systematic reviews. Health Technol Assess 2015; 18:i-xxiv, 1-164. [PMID: 25351370 DOI: 10.3310/hta18660] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA) is initially treated with methotrexate and other disease-modifying antirheumatic drugs (DMARDs). Active RA patients who fail such treatments can receive tumour necrosis factor inhibitors (TNFis), which are effective but expensive. OBJECTIVE We assessed whether or not combination DMARDs (cDMARDs) give equivalent clinical benefits at lower costs in RA patients eligible for TNFis. DESIGN An open-label, 12-month, pragmatic, randomised, multicentre, two-arm trial [Tumour necrosis factor inhibitors Against Combination Intensive Therapy (TACIT)] compared these treatment strategies. We then systematically reviewed all comparable published trials. SETTING The TACIT trial involved 24 English rheumatology clinics. PARTICIPANTS Active RA patients eligible for TNFis. INTERVENTIONS The TACIT trial compared cDMARDs with TNFis plus methotrexate or another DMARD; 6-month non-responders received (a) TNFis if in the cDMARD group; and (b) a second TNFi if in the TNFi group. MAIN OUTCOME MEASURES The Heath Assessment Questionnaire (HAQ) was the primary outcome measure. The European Quality of Life-5 Dimensions (EQ-5D), joint damage, Disease Activity Score for 28 Joints (DAS28), withdrawals and adverse effects were secondary outcome measures. Economic evaluation linked costs, HAQ changes and quality-adjusted life-years (QALYs). RESULTS In total, 432 patients were screened; 104 started on cDMARDs and 101 started on TNFis. The initial demographic and disease assessments were similar between the groups. In total, 16 patients were lost to follow-up (nine in the cDMARD group, seven in the TNFi group) and 42 discontinued their intervention but were followed up (23 in the cDMARD group and 19 in the TNFi group). Intention-to-treat analysis with multiple imputation methods used for missing data showed greater 12-month HAQ score reductions with initial cDMARDs than with initial TNFis [adjusted linear regression coefficient 0.15, 95% confidence interval (CI) -0.003 to 0.31; p = 0.046]. Increases in 12-month EQ-5D scores were greater with initial cDMARDs (adjusted linear regression coefficient -0.11, 95% CI -0.18 to -0.03; p = 0.009) whereas 6-month changes in HAQ and EQ-5D scores and 6- and 12-month changes in joint damage were similar between the initial cDMARD group and the initial TNFi group. Longitudinal analyses (adjusted general estimating equations) showed that the DAS28 was lower in the initial TNFi group in the first 6 months (coefficient -0.63, 95% CI -0.93 to -0.34; p < 0.001) but there were no differences between the groups in months 6-12. In total, 36 patients in the initial cDMARD group and 44 in the initial TNFi group achieved DAS28 remission. The onset of remission did not differ between groups (p = 0.085 on log-rank test). In total, 10 patients in the initial cDMARD group and 18 in the initial TNFi group experienced serious adverse events; stopping therapy because of toxicity occurred in 10 and six patients respectively. Economic evaluation showed that the cDMARD group had similar or better QALY outcomes than TNFi with significantly lower costs at 6 and 12 months. In the systematic reviews we identified 32 trials (including 20-1049 patients) on early RA and 19 trials (including 40-982 patients) on established RA that compared (1) cDMARDs with DMARD monotherapy; (2) TNFis/methotrexate with methotrexate monotherapy; and (3) cDMARDs with TNFis/methotrexate. They showed that cDMARDs and TNFis had similar efficacies and toxicities. CONCLUSIONS Active RA patients who have failed methotrexate and another DMARD achieve equivalent clinical benefits at a lower cost from starting cDMARDs or from starting TNFis (reserving TNFis for non-responders). Only a minority of patients achieve sustained remission with cDMARDs or TNFis; new strategies are needed to maximise the frequency of remission. TRIAL REGISTRATION Current Control Trials ISRCTN37438295. FUNDING This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 18, No. 66. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- David L Scott
- Department of Rheumatology, King's College London School of Medicine, London, UK
| | - Fowzia Ibrahim
- Department of Rheumatology, King's College London School of Medicine, London, UK
| | - Vern Farewell
- MRC Biostatistics Unit, Cambridge Institute of Public Health, Cambridge, UK
| | - Aidan G O'Keeffe
- MRC Biostatistics Unit, Cambridge Institute of Public Health, Cambridge, UK
| | - Margaret Ma
- Department of Rheumatology, King's College London School of Medicine, London, UK
| | - David Walker
- Musculoskeletal Unit, Freeman Hospital, Newcastle upon Tyne, UK
| | - Margaret Heslin
- Centre for the Economics of Mental and Physical Health, Institute of Psychiatry, King's College London, London, UK
| | - Anita Patel
- Centre for the Economics of Mental and Physical Health, Institute of Psychiatry, King's College London, London, UK
| | - Gabrielle Kingsley
- Department of Rheumatology, King's College London School of Medicine, London, UK
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Duan XW, Zhang XL, Mao SY, Shang JJ, Shi XD. Efficacy and safety evaluation of a combination of iguratimod and methotrexate therapy for active rheumatoid arthritis patients: a randomized controlled trial. Clin Rheumatol 2015; 34:1513-9. [PMID: 26139202 DOI: 10.1007/s10067-015-2999-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 06/18/2015] [Accepted: 06/21/2015] [Indexed: 12/29/2022]
Abstract
This study aimed to investigate the efficacy and safety of iguratimod (T-614) in combination with methotrexate (MTX) for active rheumatoid arthritis (RA) patients. Sixty active RA patients were enrolled according to the 2010 American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR) classification criteria, and were randomized into MTX + T-614 group and MTX group. T-614 was orally administered at a dosage of 50 mg/day (25 mg twice daily) for 24 weeks. MTX was orally administered to RA patients at a stable weekly dosage of 10 mg/week for the first 4 weeks and subsequent 12.5 mg/week for the later 20 weeks. Clinical features at baseline and efficacy endpoints of the ACR 20 % response (ACR20), ACR50, ACR70, and adverse events at 24 weeks were evaluated, respectively. After 24 weeks of treatment, clinical features at baseline, including counts for tender joints and swelling joints, visual analog scale for pain, patient's and physician's global assessment, erythrocyte sedimentation rate, C-reactive protein, disease activity score 28, health assessment questionnaire, simplified disease activity index, and ACR50 in the MTX + T-614 group, showed statistically significant differences comparing with the MTX group (P < 0.05). There was no significant increase in adverse events in the MTX + T-614 group comparing with the MTX group (P > 0.05). The combination of MTX and T-614 therapy appeared to have a good efficacy and safety for active RA and was superior to MTX-alone therapy after 24 weeks of treatment.
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Affiliation(s)
- Xin-Wang Duan
- Department of Rheumatology, The Second Affiliated Hospital of Nanchang University, No. 1 MinDe Road, Nanchang, 330006, China,
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105
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Heterogeneity of autoimmune diseases: pathophysiologic insights from genetics and implications for new therapies. Nat Med 2015; 21:730-8. [PMID: 26121193 DOI: 10.1038/nm.3897] [Citation(s) in RCA: 160] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 06/08/2015] [Indexed: 02/08/2023]
Abstract
Recent advances in genome-wide association studies (GWAS) across autoimmune and immune-mediated diseases have augmented our understanding of pathogenic mechanisms underlying these diseases. This has further highlighted their heterogeneous nature, both within and between diseases. Furthermore, varying responses to therapy have also served to underline the importance of this heterogeneity in the manner in which these diseases are diagnosed and treated. Here we discuss our current understanding of the shared pathways of autoimmunity, including the tumor necrosis factor (TNF), major histocompatibility complex (MHC), interleukin 23 receptor (IL23R) and protein tyrosine phosphatase non-receptor type 22 (PTPN22) pathways. In addition, we summarize effective specific therapies tested across major autoimmune diseases, highlighting the insight they have provided into disease mechanisms and their implications for potential future improvements.
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Schotte H, Schlüter B, Schmidt H, Gaubitz M, Drynda S, Kekow J, Willeke P. Putative IL-10 Low Producer Genotypes Are Associated with a Favourable Etanercept Response in Patients with Rheumatoid Arthritis. PLoS One 2015; 10:e0130907. [PMID: 26107717 PMCID: PMC4479553 DOI: 10.1371/journal.pone.0130907] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 05/25/2015] [Indexed: 12/21/2022] Open
Abstract
Outcome predictors of biologic therapeutic drugs like TNF inhibitors are of interest since side effects like serious infections or malignancy cannot be completely ruled out. Response rates are heterogeneous. The present study addressed the question whether in patients with rheumatoid arthritis (RA) interleukin-10 (IL-10) promoter genotypes with potential relevance for IL-10 production capacity are associated with response to long-term treatment with etanercept. Caucasian RA patients that, according to the EULAR criteria, responded well (n = 25), moderately (n = 17) or not (n = 8) to etanercept therapy (median 36 months, range 4–52), and 160 matched controls were genotyped for the IL-10 promoter SNPs -2849 G>A (rs6703630), -1082 G>A (rs1800896), -819 C>T (rs1800871) and -592 C>A (rs1800872). Haplotypes were reconstructed via mathematic model and tested for associations with disease susceptibility and therapy response. We identified the four predominant haplotypes AGCC, GATA, GGCC, and GACC in almost equal distribution. Patients that responded well carried the putative IL-10 low producer allele -2849 A or the haplotypes AGCC and GATA (RR 2.1 and 4.0, respectively; 95% CI 1.1–4.0 and 1.1–14.8), whereas an unfavourable response was associated with carriage of the putative high producer haplotype GGCC (RR 1.9, 95% CI 1.1–3.3). No significant associations of alleles or haplotypes with disease susceptibility were observed. In RA, a low IL-10 production which is genetically determined rather by haplotypes than by SNPs may favour the response to etanercept treatment. Iatrogenic blockade of TNF may reveal proinflammatory effects of its endogeneous antagonist IL-10. Further studies are needed to correlate these genetic findings to direct cytokine measurements.
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Affiliation(s)
- Heiko Schotte
- Niels-Stensen-Kliniken, Franziskus-Hospital Harderberg, Georgsmarienhütte, Germany
- * E-mail:
| | - Bernhard Schlüter
- Centrum für Laboratoriumsmedizin, Universitätsklinkum Münster, Münster, Germany
| | - Hartmut Schmidt
- Centrum für Laboratoriumsmedizin, Universitätsklinkum Münster, Münster, Germany
| | - Markus Gaubitz
- Akademie für Manuelle Medizin, Rheumatologie, Münster, Germany
| | - Susanne Drynda
- Klinik für Rheumatologie, Universität Magdeburg, Vogelsang / Gommern, Germany
| | - Jörn Kekow
- Klinik für Rheumatologie, Universität Magdeburg, Vogelsang / Gommern, Germany
| | - Peter Willeke
- Medizinische Klinik D, Universitätsklinikum Münster, Münster, Germany
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107
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Harrison M, Marra C, Shojania K, Bansback N. Societal preferences for rheumatoid arthritis treatments: evidence from a discrete choice experiment. Rheumatology (Oxford) 2015; 54:1816-25. [PMID: 25989956 DOI: 10.1093/rheumatology/kev113] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE There is a concern that cost-effectiveness analysis using quality-adjusted life years does not capture all valuable benefits of treatments. The objective of this study was to determine the value society places on aspects of RA treatment to inform policymaking. METHODS A discrete choice experiment was administered to a representative sample of the Canadian general population. The discrete choice experiment, developed using focus groups, had seven attributes (route and frequency of administration, chance of benefit, chance of serious and minor side effects, confidence in evidence and life expectancy). A conditional logit regression model was used to estimate the significance and relative importance of attributes in influencing preferences on the quality-adjusted life years scale. RESULTS Responses from 733 respondents who provided rational responses were analysed. Six attribute levels within four attributes significantly influenced preferences for treatments: a willingness to trade a year of life expectancy over a 10-year period to increase the probability of benefiting from treatment, or two-thirds of a year to reduce minor or serious side effects to the lowest level or improve the confidence in benefit/side-effect estimates. There was also some evidence of a preference for oral drug delivery, though a subgroup analysis suggested this preference was restricted to injection-naive respondents. CONCLUSION Our results suggest society values the degree of confidence in the estimates of risks and benefits of RA treatments and the route of administration, as well as benefits and side effects. This study provides important evidence to policymakers determining the cost-effectiveness of treatments in arthritis.
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Affiliation(s)
- Mark Harrison
- Faculty of Pharmaceutical Sciences, University of British Columbia, Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, Canada, Manchester Centre for Health Economics, Institute of Population Health, University of Manchester, UK
| | - Carlo Marra
- Faculty of Pharmaceutical Sciences, University of British Columbia, Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, Canada, Arthritis Research Centre of Canada
| | - Kam Shojania
- Arthritis Research Centre of Canada, Division of Rheumatology, University of British Columbia and
| | - Nick Bansback
- Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, Canada, Arthritis Research Centre of Canada, School of Population and Public Health, University of British Columbia, Vancouver, Canada
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Abstract
Biologics, possibly in combination with a conventional disease-modifying antirheumatic drug (DMARD) - preferably methotrexate (MTX), are used in accordance with the recommendations of the international rheumatological societies. However, in clinical practice, this recommendation is often problematic, as many rheumatologists know from personal experience. The quality of life of the patient is affected mainly by drug-induced intolerances (eg, MTX). Thus, the acceptance of the patient to treatment is often so inadequate that a discontinuation of the drug is necessary. In daily practice, approximately 30% of patients with biological therapy receive no concomitant DMARD according to the register data.
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Affiliation(s)
- Jacqueline Detert
- Department of Rheumatology and Clinical Immunology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Pascal Klaus
- Department of Rheumatology and Clinical Immunology, Charité – Universitätsmedizin Berlin, Berlin, Germany
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Comparative Effectiveness of Tocilizumab and TNF Inhibitors in Rheumatoid Arthritis Patients: Data from the Rheumatic Diseases Portuguese Register, Reuma.pt. BIOMED RESEARCH INTERNATIONAL 2015; 2015:279890. [PMID: 26000286 PMCID: PMC4427085 DOI: 10.1155/2015/279890] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 02/11/2015] [Indexed: 01/10/2023]
Abstract
Objectives. To compare the effectiveness of TNF inhibitors (TNFi) and tocilizumab in rheumatoid arthritis (RA) treatment, according to different response criteria. Methods. We included RA patients registered in the Rheumatic Diseases Portuguese Register treated with TNFi or tocilizumab for at least 6 months, between January 2008 and July 2013. We assessed remission/low disease activity (LDA) at 6 months according to DAS28, CDAI, and SDAI, as well as Boolean ACR/EULAR remission and EULAR response rate, adjusting for measured confounders. Results. Tocilizumab-treated patients (n = 95) presented higher baseline disease activity and were less frequently naïve to biologics compared to TNFi users (n = 429). Multivariate logistic regression analysis including the propensity score for receiving tocilizumab showed that patients treated with tocilizumab were more likely to achieve remission or LDA according to DAS28 (OR = 11.0/6.2, 95% CI 5.6–21.6/3.2–12.0), CDAI (OR = 2.8/2.6, 95% CI 1.2–6.5/1.3–5.5), or SDAI (OR = 3.6/2.5, 95% CI 1.5–8.7/1.1–5.5), as well as a good EULAR response (OR = 6.4, 95% CI 3.4–12.0). However, both groups did not differ in Boolean remission (OR = 1.9, 95% CI 0.8–4.8) or good/moderate EULAR response (OR = 1.8, 95% CI 0.8–4.5). Conclusions. Compared with TNFi, tocilizumab was associated with greater likelihood of achieving DAS28, CDAI, and SDAI remission/LDA and EULAR good response. Boolean remission and EULAR good/moderate response did not differ significantly between groups.
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110
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Emery P. Why is there persistent disease despite biologic therapy? Importance of early intervention. Arthritis Res Ther 2015; 16:115. [PMID: 25167379 PMCID: PMC4075238 DOI: 10.1186/ar4594] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
This short article hypothesizes that the major reason for persistent disease despite biologic therapy is the inappropriately late timing of therapy with biologic agents. There is clear evidence to support this hypothesis. This short review will indicate that patients treated at an earlier phase of disease can achieve a clinical remission rate of 70% and a response rate of above 95%.
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111
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Wang P, Wang Q, Yin Y, Yang Z, Li W, Liang D, Zhou P. Association between Peroxisome Proliferator-activated Receptor Gamma Gene Polymorphisms and Atherosclerotic Diseases: A Meta-analysis of Case-control Studies. J Atheroscler Thromb 2015; 22:912-25. [PMID: 25832497 DOI: 10.5551/jat.26138] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM The aim of this study was to perform a meta-analysis to investigate the association between PPARγ rs1801282/rs3856806 polymorphisms and atherosclerotic diseases. METHODS The meta-analysis was performed by searching the PubMed, Embase and Web of Science databases from the first available year to September 10, 2013. Additionally, reference lists from the identified articles, reviews and abstracts presented at the meetings of related scientific societies were also checked. All case-control studies investigating the association between PPARγ rs1801282/rs3856806 polymorphisms and the risk of atherosclerotic disease were included. The association was assessed according to the odds ratio (OR) with a 95% confidence interval (CI). Publication bias was analyzed using Begg's funnel plot and Egger's regression test. RESULTS A total of 29 studies reporting PPARγ rs1801282/rs3856806 polymorphism were included in the final meta-analysis. Neither the rs1801282 (Pro12Ala) nor rs3856806 (C161T) polymorphisms showed any significant associations with susceptibility to atherosclerotic diseases. In the meta-analysis performed to assess the association between the rs3856806 gene polymorphism and atherosclerotic disease based on ethnicity and the type of disease, significant associations were found in the Caucasian subgroup, Asian, CAD and MI subgroups. CONCLUSIONS The present data suggest that there is no statistical evidence of a significant association between the PPARγ gene rs1801282/rs3856806 polymorphism and the risk of atherosclerotic disease. In contrast, the rs3856806 polymorphism was associated with an increased risk in the Caucasian and MI subgroups, whereas decreased risks were noted in the Asian and CAD subgroups. Due to significant between-study heterogeneity, further studies with a larger sample size involving homogeneous AS patients and well-matched controls are required in the future.
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Affiliation(s)
- Peijian Wang
- Department of Cardiology, The First Affiliated Hospital, Chengdu Medical College
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Abasolo L, Leon L, Rodriguez-Rodriguez L, Tobias A, Rosales Z, Maria Leal J, Castaño V, Vadillo C, Macarron P, Fontsere O, Jover JA. Safety of disease-modifying antirheumatic drugs and biologic agents for rheumatoid arthritis patients in real-life conditions. Semin Arthritis Rheum 2015; 44:506-513. [DOI: 10.1016/j.semarthrit.2014.11.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 10/10/2014] [Accepted: 11/07/2014] [Indexed: 11/15/2022]
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Cunningham C, Hennessy E. Co-morbidity and systemic inflammation as drivers of cognitive decline: new experimental models adopting a broader paradigm in dementia research. ALZHEIMERS RESEARCH & THERAPY 2015; 7:33. [PMID: 25802557 PMCID: PMC4369837 DOI: 10.1186/s13195-015-0117-2] [Citation(s) in RCA: 130] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Dementia prevalence increases with age and Alzheimer’s disease (AD) accounts for up to 75% of cases. However, significant variability and overlap exists in the extent of amyloid-β and Tau pathology in AD and non-demented populations and it is clear that other factors must influence progression of cognitive decline, perhaps independent of effects on amyloid pathology. Coupled with the failure of amyloid-clearing strategies to provide benefits for AD patients, it seems necessary to broaden the paradigm in dementia research beyond amyloid deposition and clearance. Evidence has emerged from alternative animal model approaches as well as clinical and population epidemiological studies that co-morbidities contribute significantly to neurodegeneration/cognitive decline and systemic inflammation has been a strong common theme in these approaches. We hypothesise, and discuss in this review, that a disproportionate inflammatory response to infection, injury or chronic peripheral disease is a key determinant of cognitive decline. We propose that detailed study of alternative models, which encompass acute and chronic systemic inflammatory co-morbidities, is an important priority for the field and we examine the cognitive consequences of several of these alternative experimental approaches. Experimental models of severe sepsis in normal animals or moderate acute systemic inflammation in animals with existing neurodegenerative pathology have uncovered roles for inflammatory mediators interleukin-1β, tumour necrosis factor-α, inducible nitric oxide synthase, complement, prostaglandins and NADPH oxidase in inflammation-induced cognitive dysfunction and neuronal death. Moreover, microglia are primed by existing neurodegenerative pathology to produce exaggerated responses to subsequent stimulation with bacterial lipopolysaccharide or other inflammatory stimuli and these insults drive acute dysfunction and negatively affect disease trajectory. Chronic co-morbidities, such as arthritis, atherosclerosis, obesity and diabetes, are risk factors for subsequent dementia and those with high inflammatory status are particularly at risk. Models of chronic co-morbidities, and indeed low grade systemic inflammation in the absence of specific pathology, indicate that interleukin-1β, tumour necrosis factor-α and other inflammatory mediators drive insulin resistance, hypothalamic dysfunction, impaired neurogenesis and cognitive function and impact on functional decline. Detailed study of these pathways will uncover important mechanisms of peripheral inflammation-driven cognitive decline and are already driving clinical initiatives to mitigate AD progression through minimising systemic inflammation.
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Affiliation(s)
- Colm Cunningham
- Trinity College Institute of Neuroscience and School of Biochemistry and Immunology, Trinity College Dublin, Dublin 2, Republic of Ireland
| | - Edel Hennessy
- Trinity College Institute of Neuroscience and School of Biochemistry and Immunology, Trinity College Dublin, Dublin 2, Republic of Ireland
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Joensuu JT, Huoponen S, Aaltonen KJ, Konttinen YT, Nordström D, Blom M. The cost-effectiveness of biologics for the treatment of rheumatoid arthritis: a systematic review. PLoS One 2015; 10:e0119683. [PMID: 25781999 PMCID: PMC4363598 DOI: 10.1371/journal.pone.0119683] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 01/15/2015] [Indexed: 11/30/2022] Open
Abstract
Background and Objectives Economic evaluations provide information to aid the optimal utilization of limited healthcare resources. Costs of biologics for Rheumatoid arthritis (RA) are remarkably high, which makes these agents an important target for economic evaluations. This systematic review aims to identify existing studies examining the cost-effectiveness of biologics for RA, assess their quality and report their results systematically. Methods A literature search covering Medline, Scopus, Cochrane library, ACP Journal club and Web of Science was performed in March 2013. The cost-utility analyses (CUAs) of one or more available biological drugs for the treatment of RA in adults were included. Two independent investigators systematically collected information and assessed the quality of the studies. To enable the comparison of the results, all costs were converted to 2013 euro. Results Of the 4890 references found in the literature search, 41 CUAs were included in the current systematic review. While considering only direct costs, the incremental cost-effectiveness ratio (ICER) of the tumor necrosis factor inhibitors (TNFi) ranged from 39,000 to 1 273,000 €/quality adjusted life year (QALY) gained in comparison to conventional disease-modifying antirheumatic drugs (cDMARDs) in cDMARD naïve patients. Among patients with an insufficient response to cDMARDs, biologics were associated with ICERs ranging from 12,000 to 708,000 €/QALY. Rituximab was found to be the most cost-effective alternative compared to other biologics among the patients with an insufficient response to TNFi. Conclusions When 35,000 €/QALY is considered as a threshold for the ICER, TNFis do not seem to be cost-effective among cDMARD naïve patients and patients with an insufficient response to cDMARDs. With thresholds of 50,000 to 100,000 €/QALY biologics might be cost-effective among patients with an inadequate response to cDMARDs. Standardization of multiattribute utility instruments and a validated standard conversion method for missing utility measures would enable better comparison between CUAs.
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Affiliation(s)
- Jaana T. Joensuu
- Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
- * E-mail:
| | - Saara Huoponen
- Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | | | - Yrjö T. Konttinen
- Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland
- Helsinki University Central Hospital, Helsinki, Finland
| | - Dan Nordström
- Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland
- Helsinki University Central Hospital, Helsinki, Finland
| | - Marja Blom
- Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
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Lee H, Park HY, Jeon K, Jeong BH, Hwang JW, Lee J, Cha HS, Koh EM, Kang ES, Koh WJ. QuantiFERON-TB Gold In-Tube assay for screening arthritis patients for latent tuberculosis infection before starting anti-tumor necrosis factor treatment. PLoS One 2015; 10:e0119260. [PMID: 25746854 PMCID: PMC4352032 DOI: 10.1371/journal.pone.0119260] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 01/12/2015] [Indexed: 12/29/2022] Open
Abstract
Background Patients undergoing anti-tumor necrosis factor (TNF) treatment are at an increased risk of reactivating a latent tuberculosis infection (LTBI). This study evaluated the effectiveness of the QuantiFERON-TB Gold In-Tube (QFT) assay for diagnosing LTBI in arthritis patients undergoing anti-TNF treatment. Methods We enrolled 342 consecutive patients from August 2007 to October 2013: 176 (51.5%) patients with ankylosing spondylitis and 166 (48.5%) with rheumatoid arthritis. Screening tests included tuberculin skin test (TST) and QFT assay. Positive QFT results, regardless of TST results, were considered an indicator for LTBI treatment. Results Bacillus Calmette-Guérin scars were found in 236 (69.0%) patients. Of 342 patients, TST and QFT were positive in 122 (35.7%) and 103 (30.1%) patients, respectively, and discordant in 101 (29.5%) patients. During a median follow-up duration of 41.7 months, five patients (1.5%) developed TB in a median of 20.8 months after initiation of anti-TNF treatment (428/100,000 person-years). TB did not occur in 62 TST+/QFT+ patients who received LTBI treatment. Of 41 TST−/QFT+ patients who received LTBI treatment, one (2.4%) developed TB 20.5 months after starting anti-TNF treatment (705/100,000 person-years). Of 60 TST+/QFT− patients who did not receive LTBI treatment, two (3.3%) developed TB 20.8 and 22.0 months after starting anti-TNF treatment (871/100,000 person-years). Of 179 TST−/QFT− patients, two (1.1%) developed TB 7.2 and 22.7 months, respectively, after initiating anti-TNF treatment (341/100,000 person-years). TB incidence rate during the follow-up period did not differ among TST−/QFT+, TST+/QFT−, and TST−/QFT− patients (P = 0.661). Conclusion QFT might be used instead of TST for diagnosing LTBI in patients before starting anti-TNF therapy in countries, such as Korea, where the TB prevalence is intermediate and the BCG vaccination is mandatory at birth. In the absence of a true gold standard test for LTBI, however, there is still a risk of TB development during anti-TNF treatment.
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Affiliation(s)
- Hyun Lee
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hye Yun Park
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyeongman Jeon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byeong-Ho Jeong
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji-Won Hwang
- Division of Rheumatology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jaejoon Lee
- Division of Rheumatology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hoon-Suk Cha
- Division of Rheumatology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun-Mi Koh
- Division of Rheumatology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun-Suk Kang
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won-Jung Koh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- * E-mail:
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Pharmaceutical aspects of anti-inflammatory TNF-blocking drugs. Inflammopharmacology 2015; 23:71-7. [PMID: 25687751 DOI: 10.1007/s10787-015-0229-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 01/24/2015] [Indexed: 12/13/2022]
Abstract
Tumor necrosis factor (TNF) is a key regulator of inflammatory processes in several immune-mediated inflammatory diseases such as rheumatoid arthritis, ankylosing spondylitis, Crohn's disease, ulcerative colitis, psoriasis and psoriatic arthritis. Inactivating TNF has been found to be a plausible approach in treating these conditions. Two major strategies have been adopted by scientists to inactivate TNF: one is to use monoclonal antibodies (mAbs) that bind to TNF, and the other is to use fusion proteins that bind to TNF, both inactivate TNF and help to prevent TNF-mediated inflammatory processes. Monoclonal antibodies (mAbs) are biological products that selectively bind to specific antigen molecules, and fusion proteins are soluble receptors that bind to TNF. These types of drugs are generally known as biologics and there has been an explosion in the development and testing of biologics since the 1994 US approval and launch of abciximab, a mAb that binds to GPIIb/IIIa on platelets. Anti-TNF drugs that are currently approved by FDA for treating inflammatory conditions include adalimumab, certolizumab pegol, golimumab, infliximab and etanercept. Since these agents are complex protein molecules, the pharmacodynamics and pharmacokinetics of these drugs are different from small-molecule anti-inflammatory agents. This review focuses on the pharmaceutical aspects of these drugs such as mechanism of action, adverse effects, pharmacokinetics and drug interactions. An effort was also taken to compare the pharmacodynamics and pharmacokinetic properties of these drugs, with the available data at this time.
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Silva BDS, Tannus-Silva DGS, Rabahi MF, Kipnis A, Junqueira-Kipnis AP. The use of Mycobacterium tuberculosis HspX and GlcB proteins to identify latent tuberculosis in rheumatoid arthritis patients. Mem Inst Oswaldo Cruz 2015; 109:29-37. [PMID: 25317705 PMCID: PMC4238770 DOI: 10.1590/0074-0276140140] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 10/03/2013] [Indexed: 01/22/2023] Open
Abstract
Understanding the social conditions and immunological characteristics that allow some
human immunodeficiency virus (HIV)-exposed patients to remain uninfected represents
an on-going challenge. In this study, the socio-demographic and sexual behaviour
characteristics and immune activation profiles of uninfected individuals exposed to
HIV-infected partners were investigated. A confidential and detailed questionnaire
was administered and venous blood was tested using HIV-1/enzyme immunoassays, plasma
HIV-1 RNA levels/bDNA and immunophenotyping/flow cytometry to determine the
frequencies of CD4 and CD8 T cells expressing activation markers. The data analysis
showed significant differences (p < 0.05) for immune parameters in individuals who
were uninfected, albeit exposed to HIV-infected partners, compared with unexposed
individuals. In particular, the exposed, uninfected individuals had a higher
frequency (median, minimum-maximum) of CD4+HLA-DR+ (4.2,
1.8-6.1), CD8+HLA-DR+ (4.6, 0.9-13.7),
CD4+CD45RO+ (27.5, 14.2-46.6),
CD4+CD45RO+CD62L+ (46.7, 33.9-67.1),
CD8+CD45RA+HLA-DR+ (12.1, 3.4-35.8) and
CD8+CD45RO+HLA-DR+ (9.0, 3.2-14.8) cells, a
decreased percentage of CD8+CD28+ cells (11.7, 4.5-24.0) and a
lower cell-surface expression of Fcγ-R/CD16 on monocytes (56.5, 22.0-130.0). The
plasma HIV-1 RNA levels demonstrated detectable RNA virus loads in 57% of the
HIV-1+ female partners. These findings demonstrate an activation
profile in both CD4 and CD8 peripheral T cells from HIV-1 exposed seronegative
individuals of serodiscordant couples from a referral centre in Belo Horizonte, state
of Minas Gerais.
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Affiliation(s)
- Bruna Daniella Souza Silva
- Departamento de Microbiologia, Imunologia, Parasitologia e Patologia, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, GoiâniaGO, Brasil, Departamento de Microbiologia, Imunologia, Parasitologia e Patologia , Instituto de Patologia Tropical e Saúde Pública , Universidade Federal de Goiás , Goiânia , GO , Brasil
| | - Daniela Graner Schuwartz Tannus-Silva
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Goiás, GoiâniaGO, Brasil, Departamento de Clínica Médica , Faculdade de Medicina , Universidade Federal de Goiás , Goiânia , GO , Brasil
| | - Marcelo Fouad Rabahi
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Goiás, GoiâniaGO, Brasil, Departamento de Clínica Médica , Faculdade de Medicina , Universidade Federal de Goiás , Goiânia , GO , Brasil
| | - Andre Kipnis
- Departamento de Microbiologia, Imunologia, Parasitologia e Patologia, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, GoiâniaGO, Brasil, Departamento de Microbiologia, Imunologia, Parasitologia e Patologia , Instituto de Patologia Tropical e Saúde Pública , Universidade Federal de Goiás , Goiânia , GO , Brasil
| | - Ana Paula Junqueira-Kipnis
- Departamento de Microbiologia, Imunologia, Parasitologia e Patologia, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, GoiâniaGO, Brasil, Departamento de Microbiologia, Imunologia, Parasitologia e Patologia , Instituto de Patologia Tropical e Saúde Pública , Universidade Federal de Goiás , Goiânia , GO , Brasil
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Silva BDS, Tannus-Silva DGS, Rabahi MF, Kipnis A, Junqueira-Kipnis AP. The use of Mycobacterium tuberculosis HspX and GlcB proteins to identify latent tuberculosis in rheumatoid arthritis patients. Mem Inst Oswaldo Cruz 2015. [PMID: 24626307 PMCID: PMC4005526 DOI: 10.1590/0074-02760140140] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Rheumatoid arthritis (RA) is an autoimmune disease characterised by the destruction
of articular cartilage and bone damage. The chronic treatment of RA patients causes a
higher susceptibility to infectious diseases such as tuberculosis (TB); one-third of
the world’s population is latently infected (LTBI) with Mycobacterium
tuberculosis (Mtb). The tuberculin skin test is used to identify
individuals LTBI, but many studies have shown that this test is not suitable for RA
patients. The goal of this work was to test the specific cellular immune responses to
the Mtb malate synthase (GlcB) and heat shock protein X (HspX) antigens of RA
patients and to correlate those responses with LTBI status. The T-helper (Th)1, Th17
and Treg-specific immune responses to the GlcB and HspX Mtb antigens were analysed in
RA patients candidates for tumour necrosis factor-α blocker treatment. Our results
demonstrated that LTBI RA patients had Th1-specific immune responses to GlcB and
HspX. Patients were followed up over two years and 14.3% developed active TB. After
the development of active TB, RA patients had increased numbers of Th17 and Treg
cells, similar to TB patients. These results demonstrate that a GlcB and HspX antigen
assay can be used as a diagnostic test to identify LTBI RA patients.
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Affiliation(s)
- Bruna Daniella Souza Silva
- Departamento de Microbiologia, Imunologia, Parasitologia e Patologia, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, GoiâniaGO, Brasil, Departamento de Microbiologia, Imunologia, Parasitologia e Patologia , Instituto de Patologia Tropical e Saúde Pública , Universidade Federal de Goiás , Goiânia , GO , Brasil
| | - Daniela Graner Schuwartz Tannus-Silva
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Goiás, GoiâniaGO, Brasil, Departamento de Clínica Médica , Faculdade de Medicina , Universidade Federal de Goiás , Goiânia , GO , Brasil
| | - Marcelo Fouad Rabahi
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Goiás, GoiâniaGO, Brasil, Departamento de Clínica Médica , Faculdade de Medicina , Universidade Federal de Goiás , Goiânia , GO , Brasil
| | - Andre Kipnis
- Departamento de Microbiologia, Imunologia, Parasitologia e Patologia, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, GoiâniaGO, Brasil, Departamento de Microbiologia, Imunologia, Parasitologia e Patologia , Instituto de Patologia Tropical e Saúde Pública , Universidade Federal de Goiás , Goiânia , GO , Brasil
| | - Ana Paula Junqueira-Kipnis
- Departamento de Microbiologia, Imunologia, Parasitologia e Patologia, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, GoiâniaGO, Brasil, Departamento de Microbiologia, Imunologia, Parasitologia e Patologia , Instituto de Patologia Tropical e Saúde Pública , Universidade Federal de Goiás , Goiânia , GO , Brasil
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Cervical Spine Disease in Rheumatoid Arthritis: Incidence, Manifestations, and Therapy. Curr Rheumatol Rep 2015; 17:9. [DOI: 10.1007/s11926-014-0486-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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120
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Anti-TNF in rheumatoid arthritis: an overview. Wien Med Wochenschr 2015; 165:3-9. [DOI: 10.1007/s10354-015-0344-y] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 01/13/2015] [Indexed: 12/19/2022]
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Ferriols-Lisart R, Ferriols-Lisart F. Dose modifications of anti-TNF drugs in rheumatoid arthritis patients under real-world settings: a systematic review. Rheumatol Int 2015; 35:1193-210. [DOI: 10.1007/s00296-015-3222-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 01/17/2015] [Indexed: 12/12/2022]
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Aaltonen KJ, Joensuu JT, Virkki L, Sokka T, Aronen P, Relas H, Valleala H, Rantalaiho V, Pirilä L, Puolakka K, Uusitalo T, Blom M, Konttinen YT, Nordström D. Rates of serious infections and malignancies among patients with rheumatoid arthritis receiving either tumor necrosis factor inhibitor or rituximab therapy. J Rheumatol 2015; 42:372-8. [PMID: 25593230 DOI: 10.3899/jrheum.140853] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Because of the role of tumor necrosis factor (TNF) in host defense, it was hypothesized that its inhibition might lead to an increased risk of malignancies and infections. The objective of our study was to assess the incidence of serious infections leading to hospitalization and malignancies among patients with rheumatoid arthritis (RA) receiving either TNF inhibitor or rituximab (RTX) therapy. METHODS The study population was identified from the National Register for Biologic Treatment in Finland and the hospital records of Central Finland Central Hospital for conventional disease-modifying antirheumatic drug (cDMARD) users. Data on infections and malignancies were acquired from national healthcare registers. A Poisson model was used to calculate the adjusted incidence rate ratios (aIRR) and was composed of age, sex, time from diagnosis, year of the beginning of the followup, rheumatoid factor status, Disease Activity Score at 28 joints, Health Assessment Questionnaire, prior malignancy, prior serious infection, prior biologic use, and time-updated use of methotrexate, sulfasalazine, hydroxychloroquine, and oral corticosteroids as confounders. RESULTS In total, during the followup of 10,994 patient-years, 92 malignancies and 341 serious infections were included in the analyses. The aIRR of infections compared to cDMARD users were 1.2 (95% CI 0.63-2.3), 0.84 (95% CI 0.53-1.3), 0.98 (95% CI 0.60-1.6), and 1.1 (95% CI 0.59-1.9) for the patients treated with infliximab (IFX), etanercept, adalimumab, and RTX, respectively. The crude rates of malignancies were highest among the users of cDMARD and RTX, and lowest among patients treated with IFX with no differences in aIRR. CONCLUSION Our results provide some reassurance of the safety of biologic treatments in the treatment of RA.
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Affiliation(s)
- Kalle Jyri Aaltonen
- From the University of Helsinki, and the Helsinki University Central Hospital, Helsinki; Jyväskylä Central Hospital, Jyväskylä; Tampere University Hospital, Tampere; Turku University Central Hospital, Turku; South Karelia Central Hospital, Lappeenranta; Kanta-Häme Central Hospital, Hämeenlinna, Finland.K.J. Aaltonen, MSc (pharm); J.T. Joensuu, MSc (pharm); L. Virkki, MSc (pharm); P. Aronen, MSc; M. Blom, PhD, Professor, University of Helsinki; T. Sokka, MD, PhD, Adj. Professor, Jyväskylä Central Hospital; H. Relas, MD, PhD; H. Valleala, MD, PhD, Adj. Professor, Helsinki University Central Hospital; V. Rantalaiho, MD, PhD, Tampere University Hospital; L. Pirilä, MD, PhD, Turku University Central Hospital; K. Puolakka, MD, PhD, Adj. Professor, South Karelia Central Hospital; T. Uusitalo, MD, Kanta-Häme Central Hospital; Y.T. Konttinen, MD, PhD, Professor; D. Nordström, MD, PhD, Adj. Professor, University of Helsinki, and the Helsinki University Central Hospital.
| | - Jaana Tuulikki Joensuu
- From the University of Helsinki, and the Helsinki University Central Hospital, Helsinki; Jyväskylä Central Hospital, Jyväskylä; Tampere University Hospital, Tampere; Turku University Central Hospital, Turku; South Karelia Central Hospital, Lappeenranta; Kanta-Häme Central Hospital, Hämeenlinna, Finland.K.J. Aaltonen, MSc (pharm); J.T. Joensuu, MSc (pharm); L. Virkki, MSc (pharm); P. Aronen, MSc; M. Blom, PhD, Professor, University of Helsinki; T. Sokka, MD, PhD, Adj. Professor, Jyväskylä Central Hospital; H. Relas, MD, PhD; H. Valleala, MD, PhD, Adj. Professor, Helsinki University Central Hospital; V. Rantalaiho, MD, PhD, Tampere University Hospital; L. Pirilä, MD, PhD, Turku University Central Hospital; K. Puolakka, MD, PhD, Adj. Professor, South Karelia Central Hospital; T. Uusitalo, MD, Kanta-Häme Central Hospital; Y.T. Konttinen, MD, PhD, Professor; D. Nordström, MD, PhD, Adj. Professor, University of Helsinki, and the Helsinki University Central Hospital
| | - Liisa Virkki
- From the University of Helsinki, and the Helsinki University Central Hospital, Helsinki; Jyväskylä Central Hospital, Jyväskylä; Tampere University Hospital, Tampere; Turku University Central Hospital, Turku; South Karelia Central Hospital, Lappeenranta; Kanta-Häme Central Hospital, Hämeenlinna, Finland.K.J. Aaltonen, MSc (pharm); J.T. Joensuu, MSc (pharm); L. Virkki, MSc (pharm); P. Aronen, MSc; M. Blom, PhD, Professor, University of Helsinki; T. Sokka, MD, PhD, Adj. Professor, Jyväskylä Central Hospital; H. Relas, MD, PhD; H. Valleala, MD, PhD, Adj. Professor, Helsinki University Central Hospital; V. Rantalaiho, MD, PhD, Tampere University Hospital; L. Pirilä, MD, PhD, Turku University Central Hospital; K. Puolakka, MD, PhD, Adj. Professor, South Karelia Central Hospital; T. Uusitalo, MD, Kanta-Häme Central Hospital; Y.T. Konttinen, MD, PhD, Professor; D. Nordström, MD, PhD, Adj. Professor, University of Helsinki, and the Helsinki University Central Hospital
| | - Tuulikki Sokka
- From the University of Helsinki, and the Helsinki University Central Hospital, Helsinki; Jyväskylä Central Hospital, Jyväskylä; Tampere University Hospital, Tampere; Turku University Central Hospital, Turku; South Karelia Central Hospital, Lappeenranta; Kanta-Häme Central Hospital, Hämeenlinna, Finland.K.J. Aaltonen, MSc (pharm); J.T. Joensuu, MSc (pharm); L. Virkki, MSc (pharm); P. Aronen, MSc; M. Blom, PhD, Professor, University of Helsinki; T. Sokka, MD, PhD, Adj. Professor, Jyväskylä Central Hospital; H. Relas, MD, PhD; H. Valleala, MD, PhD, Adj. Professor, Helsinki University Central Hospital; V. Rantalaiho, MD, PhD, Tampere University Hospital; L. Pirilä, MD, PhD, Turku University Central Hospital; K. Puolakka, MD, PhD, Adj. Professor, South Karelia Central Hospital; T. Uusitalo, MD, Kanta-Häme Central Hospital; Y.T. Konttinen, MD, PhD, Professor; D. Nordström, MD, PhD, Adj. Professor, University of Helsinki, and the Helsinki University Central Hospital
| | - Pasi Aronen
- From the University of Helsinki, and the Helsinki University Central Hospital, Helsinki; Jyväskylä Central Hospital, Jyväskylä; Tampere University Hospital, Tampere; Turku University Central Hospital, Turku; South Karelia Central Hospital, Lappeenranta; Kanta-Häme Central Hospital, Hämeenlinna, Finland.K.J. Aaltonen, MSc (pharm); J.T. Joensuu, MSc (pharm); L. Virkki, MSc (pharm); P. Aronen, MSc; M. Blom, PhD, Professor, University of Helsinki; T. Sokka, MD, PhD, Adj. Professor, Jyväskylä Central Hospital; H. Relas, MD, PhD; H. Valleala, MD, PhD, Adj. Professor, Helsinki University Central Hospital; V. Rantalaiho, MD, PhD, Tampere University Hospital; L. Pirilä, MD, PhD, Turku University Central Hospital; K. Puolakka, MD, PhD, Adj. Professor, South Karelia Central Hospital; T. Uusitalo, MD, Kanta-Häme Central Hospital; Y.T. Konttinen, MD, PhD, Professor; D. Nordström, MD, PhD, Adj. Professor, University of Helsinki, and the Helsinki University Central Hospital
| | - Heikki Relas
- From the University of Helsinki, and the Helsinki University Central Hospital, Helsinki; Jyväskylä Central Hospital, Jyväskylä; Tampere University Hospital, Tampere; Turku University Central Hospital, Turku; South Karelia Central Hospital, Lappeenranta; Kanta-Häme Central Hospital, Hämeenlinna, Finland.K.J. Aaltonen, MSc (pharm); J.T. Joensuu, MSc (pharm); L. Virkki, MSc (pharm); P. Aronen, MSc; M. Blom, PhD, Professor, University of Helsinki; T. Sokka, MD, PhD, Adj. Professor, Jyväskylä Central Hospital; H. Relas, MD, PhD; H. Valleala, MD, PhD, Adj. Professor, Helsinki University Central Hospital; V. Rantalaiho, MD, PhD, Tampere University Hospital; L. Pirilä, MD, PhD, Turku University Central Hospital; K. Puolakka, MD, PhD, Adj. Professor, South Karelia Central Hospital; T. Uusitalo, MD, Kanta-Häme Central Hospital; Y.T. Konttinen, MD, PhD, Professor; D. Nordström, MD, PhD, Adj. Professor, University of Helsinki, and the Helsinki University Central Hospital
| | - Heikki Valleala
- From the University of Helsinki, and the Helsinki University Central Hospital, Helsinki; Jyväskylä Central Hospital, Jyväskylä; Tampere University Hospital, Tampere; Turku University Central Hospital, Turku; South Karelia Central Hospital, Lappeenranta; Kanta-Häme Central Hospital, Hämeenlinna, Finland.K.J. Aaltonen, MSc (pharm); J.T. Joensuu, MSc (pharm); L. Virkki, MSc (pharm); P. Aronen, MSc; M. Blom, PhD, Professor, University of Helsinki; T. Sokka, MD, PhD, Adj. Professor, Jyväskylä Central Hospital; H. Relas, MD, PhD; H. Valleala, MD, PhD, Adj. Professor, Helsinki University Central Hospital; V. Rantalaiho, MD, PhD, Tampere University Hospital; L. Pirilä, MD, PhD, Turku University Central Hospital; K. Puolakka, MD, PhD, Adj. Professor, South Karelia Central Hospital; T. Uusitalo, MD, Kanta-Häme Central Hospital; Y.T. Konttinen, MD, PhD, Professor; D. Nordström, MD, PhD, Adj. Professor, University of Helsinki, and the Helsinki University Central Hospital
| | - Vappu Rantalaiho
- From the University of Helsinki, and the Helsinki University Central Hospital, Helsinki; Jyväskylä Central Hospital, Jyväskylä; Tampere University Hospital, Tampere; Turku University Central Hospital, Turku; South Karelia Central Hospital, Lappeenranta; Kanta-Häme Central Hospital, Hämeenlinna, Finland.K.J. Aaltonen, MSc (pharm); J.T. Joensuu, MSc (pharm); L. Virkki, MSc (pharm); P. Aronen, MSc; M. Blom, PhD, Professor, University of Helsinki; T. Sokka, MD, PhD, Adj. Professor, Jyväskylä Central Hospital; H. Relas, MD, PhD; H. Valleala, MD, PhD, Adj. Professor, Helsinki University Central Hospital; V. Rantalaiho, MD, PhD, Tampere University Hospital; L. Pirilä, MD, PhD, Turku University Central Hospital; K. Puolakka, MD, PhD, Adj. Professor, South Karelia Central Hospital; T. Uusitalo, MD, Kanta-Häme Central Hospital; Y.T. Konttinen, MD, PhD, Professor; D. Nordström, MD, PhD, Adj. Professor, University of Helsinki, and the Helsinki University Central Hospital
| | - Laura Pirilä
- From the University of Helsinki, and the Helsinki University Central Hospital, Helsinki; Jyväskylä Central Hospital, Jyväskylä; Tampere University Hospital, Tampere; Turku University Central Hospital, Turku; South Karelia Central Hospital, Lappeenranta; Kanta-Häme Central Hospital, Hämeenlinna, Finland.K.J. Aaltonen, MSc (pharm); J.T. Joensuu, MSc (pharm); L. Virkki, MSc (pharm); P. Aronen, MSc; M. Blom, PhD, Professor, University of Helsinki; T. Sokka, MD, PhD, Adj. Professor, Jyväskylä Central Hospital; H. Relas, MD, PhD; H. Valleala, MD, PhD, Adj. Professor, Helsinki University Central Hospital; V. Rantalaiho, MD, PhD, Tampere University Hospital; L. Pirilä, MD, PhD, Turku University Central Hospital; K. Puolakka, MD, PhD, Adj. Professor, South Karelia Central Hospital; T. Uusitalo, MD, Kanta-Häme Central Hospital; Y.T. Konttinen, MD, PhD, Professor; D. Nordström, MD, PhD, Adj. Professor, University of Helsinki, and the Helsinki University Central Hospital
| | - Kari Puolakka
- From the University of Helsinki, and the Helsinki University Central Hospital, Helsinki; Jyväskylä Central Hospital, Jyväskylä; Tampere University Hospital, Tampere; Turku University Central Hospital, Turku; South Karelia Central Hospital, Lappeenranta; Kanta-Häme Central Hospital, Hämeenlinna, Finland.K.J. Aaltonen, MSc (pharm); J.T. Joensuu, MSc (pharm); L. Virkki, MSc (pharm); P. Aronen, MSc; M. Blom, PhD, Professor, University of Helsinki; T. Sokka, MD, PhD, Adj. Professor, Jyväskylä Central Hospital; H. Relas, MD, PhD; H. Valleala, MD, PhD, Adj. Professor, Helsinki University Central Hospital; V. Rantalaiho, MD, PhD, Tampere University Hospital; L. Pirilä, MD, PhD, Turku University Central Hospital; K. Puolakka, MD, PhD, Adj. Professor, South Karelia Central Hospital; T. Uusitalo, MD, Kanta-Häme Central Hospital; Y.T. Konttinen, MD, PhD, Professor; D. Nordström, MD, PhD, Adj. Professor, University of Helsinki, and the Helsinki University Central Hospital
| | - Tea Uusitalo
- From the University of Helsinki, and the Helsinki University Central Hospital, Helsinki; Jyväskylä Central Hospital, Jyväskylä; Tampere University Hospital, Tampere; Turku University Central Hospital, Turku; South Karelia Central Hospital, Lappeenranta; Kanta-Häme Central Hospital, Hämeenlinna, Finland.K.J. Aaltonen, MSc (pharm); J.T. Joensuu, MSc (pharm); L. Virkki, MSc (pharm); P. Aronen, MSc; M. Blom, PhD, Professor, University of Helsinki; T. Sokka, MD, PhD, Adj. Professor, Jyväskylä Central Hospital; H. Relas, MD, PhD; H. Valleala, MD, PhD, Adj. Professor, Helsinki University Central Hospital; V. Rantalaiho, MD, PhD, Tampere University Hospital; L. Pirilä, MD, PhD, Turku University Central Hospital; K. Puolakka, MD, PhD, Adj. Professor, South Karelia Central Hospital; T. Uusitalo, MD, Kanta-Häme Central Hospital; Y.T. Konttinen, MD, PhD, Professor; D. Nordström, MD, PhD, Adj. Professor, University of Helsinki, and the Helsinki University Central Hospital
| | - Marja Blom
- From the University of Helsinki, and the Helsinki University Central Hospital, Helsinki; Jyväskylä Central Hospital, Jyväskylä; Tampere University Hospital, Tampere; Turku University Central Hospital, Turku; South Karelia Central Hospital, Lappeenranta; Kanta-Häme Central Hospital, Hämeenlinna, Finland.K.J. Aaltonen, MSc (pharm); J.T. Joensuu, MSc (pharm); L. Virkki, MSc (pharm); P. Aronen, MSc; M. Blom, PhD, Professor, University of Helsinki; T. Sokka, MD, PhD, Adj. Professor, Jyväskylä Central Hospital; H. Relas, MD, PhD; H. Valleala, MD, PhD, Adj. Professor, Helsinki University Central Hospital; V. Rantalaiho, MD, PhD, Tampere University Hospital; L. Pirilä, MD, PhD, Turku University Central Hospital; K. Puolakka, MD, PhD, Adj. Professor, South Karelia Central Hospital; T. Uusitalo, MD, Kanta-Häme Central Hospital; Y.T. Konttinen, MD, PhD, Professor; D. Nordström, MD, PhD, Adj. Professor, University of Helsinki, and the Helsinki University Central Hospital
| | - Yrjö Tapio Konttinen
- From the University of Helsinki, and the Helsinki University Central Hospital, Helsinki; Jyväskylä Central Hospital, Jyväskylä; Tampere University Hospital, Tampere; Turku University Central Hospital, Turku; South Karelia Central Hospital, Lappeenranta; Kanta-Häme Central Hospital, Hämeenlinna, Finland.K.J. Aaltonen, MSc (pharm); J.T. Joensuu, MSc (pharm); L. Virkki, MSc (pharm); P. Aronen, MSc; M. Blom, PhD, Professor, University of Helsinki; T. Sokka, MD, PhD, Adj. Professor, Jyväskylä Central Hospital; H. Relas, MD, PhD; H. Valleala, MD, PhD, Adj. Professor, Helsinki University Central Hospital; V. Rantalaiho, MD, PhD, Tampere University Hospital; L. Pirilä, MD, PhD, Turku University Central Hospital; K. Puolakka, MD, PhD, Adj. Professor, South Karelia Central Hospital; T. Uusitalo, MD, Kanta-Häme Central Hospital; Y.T. Konttinen, MD, PhD, Professor; D. Nordström, MD, PhD, Adj. Professor, University of Helsinki, and the Helsinki University Central Hospital
| | - Dan Nordström
- From the University of Helsinki, and the Helsinki University Central Hospital, Helsinki; Jyväskylä Central Hospital, Jyväskylä; Tampere University Hospital, Tampere; Turku University Central Hospital, Turku; South Karelia Central Hospital, Lappeenranta; Kanta-Häme Central Hospital, Hämeenlinna, Finland.K.J. Aaltonen, MSc (pharm); J.T. Joensuu, MSc (pharm); L. Virkki, MSc (pharm); P. Aronen, MSc; M. Blom, PhD, Professor, University of Helsinki; T. Sokka, MD, PhD, Adj. Professor, Jyväskylä Central Hospital; H. Relas, MD, PhD; H. Valleala, MD, PhD, Adj. Professor, Helsinki University Central Hospital; V. Rantalaiho, MD, PhD, Tampere University Hospital; L. Pirilä, MD, PhD, Turku University Central Hospital; K. Puolakka, MD, PhD, Adj. Professor, South Karelia Central Hospital; T. Uusitalo, MD, Kanta-Häme Central Hospital; Y.T. Konttinen, MD, PhD, Professor; D. Nordström, MD, PhD, Adj. Professor, University of Helsinki, and the Helsinki University Central Hospital
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Neuhaus B, Frede A, Westendorf AM, Epple M. Gene silencing of the pro-inflammatory cytokine TNF-α with siRNA delivered by calcium phosphate nanoparticles, quantified by different methods. J Mater Chem B 2015; 3:7186-7193. [DOI: 10.1039/c5tb01377a] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The expression of the proinflammatory cytokine TNF-α was efficiently downregulated with nanoparticles, opening a way to combat inflammatory reactions.
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Affiliation(s)
- Bernhard Neuhaus
- Inorganic Chemistry and Center for Nanointegration Duisburg-Essen (CeNIDE)
- University of Duisburg-Essen
- 45117 Essen
- Germany
| | - Annika Frede
- Institute of Medical Microbiology
- University Hospital Essen
- University of Duisburg-Essen
- 45122 Essen
- Germany
| | - Astrid Maria Westendorf
- Institute of Medical Microbiology
- University Hospital Essen
- University of Duisburg-Essen
- 45122 Essen
- Germany
| | - Matthias Epple
- Inorganic Chemistry and Center for Nanointegration Duisburg-Essen (CeNIDE)
- University of Duisburg-Essen
- 45117 Essen
- Germany
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Effectiveness and safety of infliximab in two cases of severe chondrocalcinosis: nine years of follow-up. Case Rep Rheumatol 2014; 2014:536856. [PMID: 25436167 PMCID: PMC4243763 DOI: 10.1155/2014/536856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 10/14/2014] [Indexed: 11/27/2022] Open
Abstract
Objectives. To investigate the efficacy of infliximab in the treatment of severe calcium pyrophosphate deposition diseases (CPPD). Methods. Two patients with severe CPPD and diffuse idiopathic skeletal hyperostosis- (DISH-) like phenotype are described. Both patients were resistant to therapy with nonsteroidal anti-inflammatory drugs (NSAIDs). Both patients were treated with infliximab, a TNF-α receptor antagonist, for nine years.
Results. Treatment with infliximab resulted in major clinical and laboratory improvements without relevant side effects.
Conclusions. These results suggest that infliximab may be an effective treatment of severe CPDD.
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125
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Michaud TL, Rho YH, Shamliyan T, Kuntz KM, Choi HK. The comparative safety of tumor necrosis factor inhibitors in rheumatoid arthritis: a meta-analysis update of 44 trials. Am J Med 2014; 127:1208-32. [PMID: 24950486 DOI: 10.1016/j.amjmed.2014.06.012] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 05/22/2014] [Accepted: 06/09/2014] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The study objective was to evaluate and update the safety data from randomized controlled trials of tumor necrosis factor inhibitors in patients treated for rheumatoid arthritis. METHODS A systematic literature search was conducted from 1990 to May 2013. All studies included were randomized, double-blind, controlled trials of patients with rheumatoid arthritis that evaluated adalimumab, certolizumab pegol, etanercept, golimumab, or infliximab treatment. The serious adverse events and discontinuation rates were abstracted, and risk estimates were calculated by Peto odds ratios (ORs). RESULTS Forty-four randomized controlled trials involving 11,700 subjects receiving tumor necrosis factor inhibitors and 5901 subjects receiving placebo or traditional disease-modifying antirheumatic drugs were included. Tumor necrosis factor inhibitor treatment as a group was associated with a higher risk of serious infection (OR, 1.42; 95% confidence interval [CI], 1.13-1.78) and treatment discontinuation due to adverse events (OR, 1.23; 95% CI, 1.06-1.43) compared with placebo and traditional disease-modifying antirheumatic drug treatments. Specifically, patients taking adalimumab, certolizumab pegol, and infliximab had an increased risk of serious infection (OR, 1.69, 1.98, and 1.63, respectively) and showed an increased risk of discontinuation due to adverse events (OR, 1.38, 1.67, and 2.04, respectively). In contrast, patients taking etanercept had a decreased risk of discontinuation due to adverse events (OR, 0.72; 95% CI, 0.55-0.93). Although ORs for malignancy varied across the different tumor necrosis factor inhibitors, none reached statistical significance. CONCLUSIONS These meta-analysis updates of the comparative safety of tumor necrosis factor inhibitors suggest a higher risk of serious infection associated with adalimumab, certolizumab pegol, and infliximab, which seems to contribute to higher rates of discontinuation. In contrast, etanercept use showed a lower rate of discontinuation. These data may help guide clinical comparative decision making in the management of rheumatoid arthritis.
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Affiliation(s)
- Tzeyu L Michaud
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis
| | - Young Hee Rho
- Section of Rheumatology and the Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Mass
| | - Tatyana Shamliyan
- Evidence-Based Medicine Quality Assurance Elsevier, Clinical Solutions, Philadelphia, PA
| | - Karen M Kuntz
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis
| | - Hyon K Choi
- Section of Rheumatology and the Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Mass.
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Costa JDO, Lemos LLPD, Machado MADÁ, Almeida AM, Kakehasi AM, Araújo VDE, Cherchiglia ML, Andrade EIG, Acurcio FDA. Infliximab, methotrexate and their combination for the treatment of rheumatoid arthritis: a systematic review and meta-analysis. REVISTA BRASILEIRA DE REUMATOLOGIA 2014; 55:146-58. [PMID: 25593074 DOI: 10.1016/j.rbr.2014.10.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 06/11/2014] [Accepted: 10/06/2014] [Indexed: 01/05/2023] Open
Abstract
We performed a systematic review to evaluate the efficacy and safety of infliximab + methotrexate (IFX + MTX) regimens versus MTX alone or in combination with other disease-modifying anti-rheumatic drugs (DMARDs). We searched through major databases, the grey literature and did a manual search. Two independent reviewers conducted the selection, data extraction and analysis of the quality of the studies. Meta-analysis was conducted using Review Manager(®) 5.1 software. Nine trials were included. The mean modified Jadad score was 4.4, but only one study showed low risk of bias. IFX + MTX regimen presented better responses in clinical outcomes of ACR and DAS28 by up to 54 weeks, and of radiographic progression by up to 104 weeks. Withdrawals due to lack of efficacy was lower in the IFX + MTX group. No significant difference in adverse events was observed. The IFX + MTX combination is more effective than treatment with MTX alone or DMARDs combination. This regimen presented good tolerability in patients previously treated with DMARDs, not treated with MTX or with insufficient responses to MTX. The efficacy of IFX + MTX is noted primarily during initial periods of treatment. High doses of IFX were as effective as the standard dose, but with possible higher risk of serious infections. Therefore, we advise clinicians to use the standard dose of IFX 3 mg/kg every 8 weeks.
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Affiliation(s)
- Juliana de Oliveira Costa
- Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil.
| | - Lívia Lovato Pires de Lemos
- Programa de Pós Graduação em Medicamentos e Assistência Farmacêutica, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | - Marina Amaral de Ávila Machado
- Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | - Alessandra Maciel Almeida
- Departamento de Farmácia Social, Faculdade de Farmácia, Universidade Federal de Belo Horizonte, Belo Horizonte, MG, Brasil
| | - Adriana Maria Kakehasi
- Departamento do Sistema Locomotor, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | - Vânia de Eloísa Araújo
- Medicina Baseada em Evidências/PGMIT, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Mariângela Leal Cherchiglia
- Departamento de Medicina Preventiva e Social, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | - Eli Iola Gurgel Andrade
- Departamento de Medicina Preventiva e Social, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | - Francisco de Assis Acurcio
- Departamento de Farmácia Social, Faculdade de Farmácia, Universidade Federal de Belo Horizonte, Belo Horizonte, MG, Brasil
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Barton JL, Koenig CJ, Evans-Young G, Trupin L, Anderson J, Ragouzeos D, Breslin M, Morse T, Schillinger D, Montori VM, Yelin EH. The design of a low literacy decision aid about rheumatoid arthritis medications developed in three languages for use during the clinical encounter. BMC Med Inform Decis Mak 2014; 14:104. [PMID: 25649726 PMCID: PMC4363399 DOI: 10.1186/s12911-014-0104-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Accepted: 11/03/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Shared decision-making in rheumatoid arthritis (RA) care is a priority among policy makers, clinicians and patients both nationally and internationally. Demands on patients to have basic knowledge of RA, treatment options, and details of risk and benefit when making medication decisions with clinicians can be overwhelming, especially for those with limited literacy or limited English language proficiency. The objective of this study is to describe the development of a medication choice decision aid for patients with rheumatoid arthritis (RA) in three languages using low literacy principles. METHODS Based on the development of a diabetes decision aid, the RA decision aid (RA Choice) was developed through a collaborative process involving patients, clinicians, designers, decision-aid and health literacy experts. A combination of evidence synthesis and direct observation of clinician-patient interactions generated content and guided an iterative process of prototype development. RESULTS Three iterations of RA Choice were developed and field-tested before completion. The final tool organized data using icons and plain language for 12 RA medications across 5 issues: frequency of administration, time to onset, cost, side effects, and special considerations. The tool successfully created a conversation between clinician and patient, and garnered high acceptability from clinicians. CONCLUSIONS The process of collaboratively developing an RA decision aid designed to promote shared decision making resulted in a graphically-enhanced, low literacy tool. The use of RA Choice in the clinical encounter has the potential to enhance communication for RA patients, including those with limited health literacy and limited English language proficiency.
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Affiliation(s)
- Jennifer L Barton
- Department of Medicine, University of California, San Francisco, CA, USA. .,Division of Hospital & Specialty Medicine, Portland Veterans Affairs Medical Center, 3710 SW US Veterans Hospital Road, Portland, OR, 97239, USA.
| | | | - Gina Evans-Young
- Department of Medicine, University of California, San Francisco, CA, USA. .,Phillip R. Lee Institute for Health Policy Studies, San Francisco, CA, USA.
| | - Laura Trupin
- Department of Medicine, University of California, San Francisco, CA, USA. .,Phillip R. Lee Institute for Health Policy Studies, San Francisco, CA, USA.
| | | | | | | | | | - Dean Schillinger
- Department of Medicine, University of California, San Francisco, CA, USA.
| | - Victor M Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, 55905, USA.
| | - Edward H Yelin
- Department of Medicine, University of California, San Francisco, CA, USA. .,Phillip R. Lee Institute for Health Policy Studies, San Francisco, CA, USA.
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Ruiz Garcia V, Jobanputra P, Burls A, Cabello JB, Vela Casasempere P, Bort-Marti S, Kynaston-Pearson FJB. Certolizumab pegol (CDP870) for rheumatoid arthritis in adults. Cochrane Database Syst Rev 2014:CD007649. [PMID: 25231904 DOI: 10.1002/14651858.cd007649.pub3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Tumour necrosis factor (TNF)-alpha inhibitors are beneficial for the treatment of rheumatoid arthritis (RA) in terms of reducing the risk of joint damage, improving physical function and improving quality of life. This Cochrane review is an update of a review of the treatment of RA with certolizumab pegol that was first published in 2011. OBJECTIVES To assess the clinical benefits and harms of certolizumab pegol (CDP870) in patients with RA who have not responded well to conventional disease-modifying anti-rheumatic drugs (DMARDs). SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library 2014, Issue 5), MEDLINE, EMBASE, Scopus, TOXLINE, Web of Knowledge; websites of the US Food and Drug Administration (FDA) and European Medicines Evaluation Agency (EMEA); reference lists of articles; and searched http/clinicaltrials.gov. The searches were updated from 2009 (date of last search for the original review) to 5 June 2014. SELECTION CRITERIA Randomised controlled trials that compared certolizumab pegol with any other agent including placebo or methotrexate (MTX) in adult patients with active RA despite current or prior treatment with conventional disease-modifying anti-rheumatic drugs (DMARDs), such as MTX. DATA COLLECTION AND ANALYSIS Two authors independently assessed search results, trial quality and extracted data. Disagreements were resolved by discussion or referral to a third author. MAIN RESULTS Eleven trials were included in this update. Ten (4324 patients) were included in the pooled analysis for benefits, five more than previously, and 10 (3711 patients) in the pooled analysis for harms, four more trials (1930 patients) than previously. The duration of follow-up varied from 12 to 52 weeks and the range of doses of certolizumab pegol varied from 50 to 400 mg given subcutaneously (sc). In phase III trials, the control was placebo plus MTX in five trials and placebo in four trials. The risk of bias of the included studies was assessed as low but there may have been a risk of attrition bias.Statistically significant improvements were observed at 24 weeks with the approved dose of 200 mg certolizumab pegol every other week, in 1) American College of Rheumatology (ACR) 50% improvement: 27% absolute improvement (95% CI 20% to 33%), NNT of 4 (95% CI 3 to 8), risk ratio (RR) 3.80 (95% CI 2.42 to 5.95); 2) the Health Assessment Questionnaire (HAQ): -12% absolute improvement (95% CI -9% to -14%), NNT of 6 (95% CI 5 to 8), mean difference (MD) - 0.35 (95% CI -0.43 to -0.26) (scale 0 to 3); 3) Disease Activity Score (DAS) remission improvement: absolute improvement 11% (95% CI 8% to 15%), NNT of 9 (95% CI 4 to 20), RR 8.47 (95% CI 4.15-17.28); and 4) radiological changes: erosion score (ES) absolute improvement -0.29% (95% CI -0.42% to -0.17%), NNT of 6 (95% CI 4 to 10), MD -0.67 (95% CI -0.96 to -0.38) (scale 0 to 230). Serious adverse events were statistically significantly more frequent for certolizumab pegol (200 mg every other week) with an absolute rate difference of 4% (95% CI 2% to 6%), NNTH of 32 (95% CI 17 to 88), Peto odds ratio (OR) 1.77 (95% CI 1.27 to 2.46). There was a statistically significant increase in all withdrawals in the placebo groups (for all doses and all follow-ups) with an absolute rate difference of -34% (95% CI -18% to -50%), NNTH of 4 (95% CI 3 to 5), NNTH of 4 (95% CI 3 to 5), RR 0.42 (95% CI 0.36 to 0.50); and there was a statistically significant increase in all withdrawals due to adverse events in the certolizumab groups (for all doses and all follow-up) with an absolute rate difference of 2% (95% CI 1% to 3%), NNTH of 55 (95% CI 27 to 238), Peto OR 1.66 (95% CI 1.15 to 2.37).The risk of bias was low and the quality of evidence was downgraded to moderate because of high rates of dropouts (> 20%) in most of the trials. We did not find any problems with inconsistency, indirectness, imprecision or publication bias. AUTHORS' CONCLUSIONS The results and conclusions did not change from the previous review. There is moderate-level evidence from randomised controlled trials that certolizumab pegol alone or combined with methotrexate is beneficial in the treatment of RA. Adverse events were more frequent with active treatment. We found a potential risk of serious adverse events.
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Affiliation(s)
- Vicente Ruiz Garcia
- Unidad de Hospitalización a Domicilio Torre C planta 1 Despacho nº 5 & CASP Spain, Hospital Universitari i Politècnic La Fe, Avinguda de Fernando Abril Martorell nº 106, Valencia, Valencia, Spain, 46026
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TL1A increased the differentiation of peripheral Th17 in rheumatoid arthritis. Cytokine 2014; 69:125-30. [DOI: 10.1016/j.cyto.2014.04.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Revised: 03/01/2014] [Accepted: 04/18/2014] [Indexed: 01/29/2023]
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Furst DE, Emery P. Rheumatoid arthritis pathophysiology: update on emerging cytokine and cytokine-associated cell targets. Rheumatology (Oxford) 2014; 53:1560-9. [PMID: 24402580 PMCID: PMC4135582 DOI: 10.1093/rheumatology/ket414] [Citation(s) in RCA: 144] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 10/29/2013] [Indexed: 12/14/2022] Open
Abstract
Biologic therapies that target pathogenic cytokines such as TNF, IL-1β or IL-6 have greatly improved the treatment of RA. Unfortunately, not all RA patients respond to current biologic therapies and responses are not always maintained, suggesting that there are alternative drivers of RA pathogenesis that might serve as promising therapeutic targets. Discovery of the new Th17 subset of Th cells, and their role in autoimmune disease development, has implicated the proinflammatory IL-12 and IL-17 families of cytokines in RA disease pathogenesis. Members of these cytokine families are elevated in the blood and joints of RA patients and have been shown to remain elevated in patients who do not respond to current biologics. In addition, these cytokines have been shown to play roles in joint destruction and erosion. A new subclass of biologics that target the IL-12 and/or IL-17 signalling pathways are under development. Here we review evidence for a role of Th17 cells as well as IL-12 and IL-17 cytokines in RA pathogenesis as the rationale for a subsequent discussion of the ongoing and completed clinical trials of newly emerging biologic therapies directed at IL-12 or IL-17 pathway inhibition.
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Affiliation(s)
- Daniel E Furst
- Division of Rheumatology, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
| | - Paul Emery
- Division of Rheumatology, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK.Division of Rheumatology, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Abstract
The treatment of juvenile idiopathic arthritis (JIA) has substantially evolved over the past two decades. Research has been conducted and is ongoing on how therapies can best be utilized either as monotherapy or in combination for enhanced efficacy. The introduction of biologic therapies that selectively target specific cytokines has changed the acceptable clinical course of childhood arthritis. In addition to the development and utilization of new therapeutic agents, the pediatric rheumatology community has made vital progress toward defining disease activity, developing validated outcome measures, and establishing collaborative networks to assess both clinical outcomes and the long-term side effects related to therapeutics for juvenile arthritis. In this chapter, we will discuss the therapeutic evolution in JIA over the past two decades. Although the largest strides have been made with biologic agents, and these newer drugs have more rigorous data to support their use, select commonly used non-biologic therapies are included, with the discussion focused on more recent updated literature.
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Affiliation(s)
- Elizabeth A Kessler
- Division of Rheumatology, Department of Pediatrics, Children's Mercy Hospitals and Clinics, 2401 Gillham Road, Kansas City, MO 64108, USA.
| | - Mara L Becker
- Division of Rheumatology, Department of Pediatrics, Children's Mercy Hospitals and Clinics, 2401 Gillham Road, Kansas City, MO 64108, USA.
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Roeleveld DM, van Nieuwenhuijze AEM, van den Berg WB, Koenders MI. The Th17 pathway as a therapeutic target in rheumatoid arthritis and other autoimmune and inflammatory disorders. BioDrugs 2014; 27:439-52. [PMID: 23620106 DOI: 10.1007/s40259-013-0035-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Production of the pro-inflammatory cytokine interleukin (IL)-17 by Th17 cells and other cells of the immune system protects the host against bacterial and fungal infections, but also promotes the development of rheumatoid arthritis (RA) and other autoimmune and inflammatory disorders. Several biologicals targeting IL-17, the IL-17 receptor, or IL-17-related pathways are being tested in clinical trials, and might ultimately lead to better treatment for patients suffering from various IL-17-mediated disorders. In this review, we provide a clear overview of current knowledge on Th17 cell regulation and the main Th17 effector cytokines in relation to IL-17-mediated conditions, as well as on recent IL-17-related drug developments. We demonstrate that targeting the Th17 pathway is a promising treatment for rheumatoid arthritis and various other autoimmune and inflammatory diseases. However, improvements in technical developments assisting in the identification of patients suffering from IL-17-driven disease are needed to enable the application of tailor-made, personalized medicine.
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De Keyser F, De Kock J, Leroi H, Durez P, Westhovens R. Ten-year Followup of Infliximab Therapy in Rheumatoid Arthritis Patients with Severe, Longstanding Refractory Disease: A Cohort Study. J Rheumatol 2014; 41:1276-81. [DOI: 10.3899/jrheum.131270] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Objective.Our study describes the 10-year followup data of the Belgian Expanded Access Program (EAP) for infliximab (IFX), which included patients with active rheumatoid arthritis who were refractory to methotrexate. The objectives of the study were to evaluate the continuation rate, reasons for discontinuation, and longterm disease control under IFX treatment, and to study baseline characteristics associated with longterm successful IFX therapy.Methods.Between February 2000 and September 2001, 511 patients were enrolled in the Belgian IFX EAP, and 507 effectively started IFX therapy. Previously reported data showed that 160 patients were still treated with IFX after 7 years of followup. We describe the therapy status, reasons for IFX discontinuation, and the level of disease activity of this subgroup after 10 years of followup. Baseline characteristics of the total EAP cohort were used to describe variables associated with longterm successful IFX treatment.Results.After 10 years of followup, 110 of the 507 patients (21.7%) were still receiving IFX treatment. In the 7-year to 10-year period, which is the focus of the current study, 16 patients were lost to followup and 34 patients discontinued IFX treatment, mainly because of loss of efficacy. Patients successfully treated with IFX for 10 years had lower baseline values for 28-joint Disease Activity Score (DAS28), patient pain scale, physician visual analog scale, and Health Assessment Questionnaire in comparison with the rest of the study cohort. The mean DAS28 level of the subgroup still taking IFX after 10 years was 2.55 ± 1.01.Conclusion.In the Belgian EAP, 21.7% of patients continued to receive maintenance IFX treatment after 10 years of followup. IFX provided good longterm disease control in these patients.
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Armuzzi A, Lionetti P, Blandizzi C, Caporali R, Chimenti S, Cimino L, Gionchetti P, Girolomoni G, Lapadula G, Marchesoni A, Marcellusi A, Mennini FS, Salvarani C, Cimaz R. anti-TNF agents as therapeutic choice in immune-mediated inflammatory diseases: focus on adalimumab. Int J Immunopathol Pharmacol 2014; 27:11-32. [PMID: 24774504 DOI: 10.1177/03946320140270s102] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The complex pathogenesis of immune-mediated inflammatory diseases (IMIDs) has been extensively investigated and dysregulation of cytokines, such as tumour necrosis factor (TNF) has been shown to play a dominant role in the pathogenesis of various IMIDs, such as rheumatoid arthritis, ankylosing spondylitis, Crohn's disease, ulcerative colitis, psoriasis and psoriatic arthritis. The subsequent development of biological agents capable of blocking TNF has led to important advances in the pharmacotherapy of such diseases and confirmed the concept of a common pathophysiology among IMIDs with TNF having a predominant role. Five TNF inhibitors have currently been approved for treatment of one or more IMIDs; these include infliximab, etanercept, adalimumab, golimumab and certolizumab pegol. Given the similarities in the pathogenic background of IMIDs, one could expect that anti-TNF agents be similarly effective and with comparable tolerability profiles; however, this may not be the case. Structural and pharmacological differences among the anti-TNF drugs are likely to result in differences in efficacy and tolerability among the agents in the different IMIDs, together with differences in potency, therapeutic dose ranges, dosing regimens, administration routes, and propensity for immunogenicity. Among the five TNF inhibitors approved for treatment of IMIDs, adalimumab has the widest range of indications. Data from controlled clinical trials of adalimumab, showing its excellent efficacy and tolerability in a wide range of indications, are supported by real-world long-term data from observational studies, which confirm the value of adalimumab as a suitable choice in the management of IMIDs.
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Affiliation(s)
- A Armuzzi
- IBD Unit, Complesso Integrato Columbus, Catholic University, Rome, Italy
| | - P Lionetti
- Gastroenterology Unit, Anna Meyer Childrens Hospital, Department of Paediatrics, University of Firenze, Firenze, Italy
| | - C Blandizzi
- Division of Pharmacology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - R Caporali
- Chair and Division of Rheumatology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - S Chimenti
- Department of Dermatology, University of Rome Tor Vergata, Rome, Italy
| | - L Cimino
- Ocular Immunology Unit, Ophthalmology, Unit, Arcispedale S Maria Nuova Reggio, Reggio, Emilia, Italy
| | - P Gionchetti
- IBD Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Italy
| | - G Girolomoni
- Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy
| | - G Lapadula
- Rheumatology Unit, Interdisciplinary Department of Medicine, Medical School, University of Bari, Bari, Italy
| | | | - A Marcellusi
- CEIS Economic Evaluation and HTA (EEHTA), IGF Department, University of Tor Vergata, Rome, Italy
| | - F S Mennini
- CEIS Economic Evaluation and HTA (EEHTA), IGF Department, University of Tor Vergata, Rome, Italy
| | - C Salvarani
- Rheumatology Unit, Department of Internal Medicine, Azienda Ospedaliera ASMN, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy
| | - R Cimaz
- Department of Paediatrics, Rheumatology Unit, Anna Meyer Childrens Hospital, University of Florence, Firenze, Italy
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Baji P, Péntek M, Czirják L, Szekanecz Z, Nagy G, Gulácsi L, Brodszky V. Efficacy and safety of infliximab-biosimilar compared to other biological drugs in rheumatoid arthritis: a mixed treatment comparison. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2014; 15 Suppl 1:S53-S64. [PMID: 24832836 PMCID: PMC4046078 DOI: 10.1007/s10198-014-0594-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 03/31/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE The aim of this meta-analysis was to compare the efficacy and safety of infliximab-biosimilar and other available biologicals for the treatment of rheumatoid arthritis (RA), namely abatacept, adalimumab, certolizumab pegol, etanercept, golimumab, infliximab, rituximab and tocilizumab. METHODS A systematic literature review of MEDLINE database until August 2013 was carried out to identify relevant randomized controlled trials (RCTs). Bayesian mixed treatment comparison method was applied for the pairwise comparison of treatments. Improvement rates by the American College of Rheumatology criteria (ACR20 and ACR50) at week 24 were used as efficacy endpoints, and the occurrence of serious adverse events was considered to assess the safety of the biologicals. RESULTS Thirty-six RCTs were included in the meta-analysis. All the biological agents proved to be superior to placebo. For ACR20 response, certolizumab pegol showed the highest odds ratio (OR) compared to placebo, OR 7.69 [95% CI 3.69-14.26], followed by abatacept OR 3.7 [95% CI 2.17-6.06], tocilizumab OR 3.69 [95% CI 1.87-6.62] and infliximab-biosimilar OR 3.47 [95% CI 0.85-9.7]. For ACR50 response, certolizumab pegol showed the highest OR compared to placebo OR 8.46 [3.74-16.82], followed by tocilizumab OR 5.57 [95% CI 2.77-10.09], and infliximab-biosimilar OR 4.06 [95% CI 1.01-11.54]. Regarding the occurrence of serious adverse events, the results show no statistically significant difference between infliximab-biosimilar and placebo, OR 1.87 [95% CI 0.74-3.84]. No significant difference regarding efficacy and safety was found between infliximab-biosimilar and the other biological treatments. CONCLUSION This is the first indirect meta-analysis in RA that compares the efficacy and safety of biosimilar-infliximab to the other biologicals indicated in RA. We found no significant difference between infliximab-biosimilar and other biological agents in terms of clinical efficacy and safety.
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Affiliation(s)
- Petra Baji
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8., Budapest, 1093, Hungary,
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Lemos LLPD, Costa JDO, Machado MADÁ, Almeida AM, Barbosa MM, Kakehasi AM, Araújo VED, Júnior AAG, Acurcio FDA. Rituximabe para o tratamento da artrite reumatoide: Revisão sistemática. REVISTA BRASILEIRA DE REUMATOLOGIA 2014. [DOI: 10.1016/j.rbr.2013.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Liu Y, Fan W, Chen H, Yu MX. Risk of Breast Cancer and Total Malignancies in Rheumatoid Arthritis Patients Undergoing TNF-α Antagonist Therapy: a Meta-analysis of Randomized Control Trials. Asian Pac J Cancer Prev 2014; 15:3403-10. [DOI: 10.7314/apjcp.2014.15.8.3403] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Timlin H, Bingham CO. Efficacy and safety implications of molecular constructs of biological agents for rheumatoid arthritis. Expert Opin Biol Ther 2014; 14:893-904. [PMID: 24720727 DOI: 10.1517/14712598.2014.900536] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Targeted biologic immunomodulatory therapies have had a major impact in rheumatoid arthritis (RA) treatment, including tumor necrosis factor (TNF)-α inhibition, B-cell depletion, interference in T-cell costimulation and interleukin (IL)-1 and IL-6 inhibition. Along with the recognition of the importance of early, aggressive disease-modifying antirheumatic drugs (DMARDs) grounded in the use of methotrexate, the introduction of biologic DMARDs (bDMARDs) has provided significantly improved outcomes in patients with RA with a goal of true remission, or at least a state of very low disease activity, now possible in many. There are a number of methods to inhibit cytokines, cellular receptors and pathways of signal transduction that have been used thus far and are in development. In some cases, the method of target inhibition and differences in molecular construct has impacted efficacy and/or safety; whereas, in other cases, similar safety and/or efficacy signals across compounds have demonstrated class- or target-related effects. As the development of targeted therapies moves forward, it is increasingly important to understand the role of the target both in RA disease pathogenesis and normal host defense and the mechanisms of target inhibition. AREAS COVERED This review covers the targets of therapy for biologic agents in rheumatic diseases, their molecular constructs and implications on efficacy and safety, with focus on approved treatments for RA. EXPERT OPINION Advances in molecular biology have provided a number of different ways to impact pathobiologically relevant pathways and targets in terms of the molecular construct of individual compounds. The use of these agents have provided important mechanistic insights into disease pathogenesis, and in some cases are associated with differences in efficacy and safety among agents even with the same downstream target. As bDMARDs identify promising mechanisms, oral agents that target or specifically regulate downstream pathways are made possible.
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Affiliation(s)
- Homa Timlin
- Johns Hopkins University, Division of Rheumatology, Department of Medicine , 5200 Eastern Avenue, Mason F. Lord Center Tower, Room 404, Baltimore, MD, 21224 , USA
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Aoki T, Fukuda M, Nishimura M, Nozaki K, Narumiya S. Critical role of TNF-alpha-TNFR1 signaling in intracranial aneurysm formation. Acta Neuropathol Commun 2014; 2:34. [PMID: 24685329 PMCID: PMC3974421 DOI: 10.1186/2051-5960-2-34] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 03/12/2014] [Indexed: 11/22/2022] Open
Abstract
Background Intracranial aneurysm (IA) is a socially important disease due to its high incidence in the general public and the severity of resultant subarachnoid hemorrhage that follows rupture. Despite the social importance of IA as a cause of subarachnoid hemorrhage, there is no medical treatment to prevent rupture, except for surgical procedures, because the mechanisms regulating IA formation are poorly understood. Therefore, these mechanisms should be elucidated to identify a therapeutic target for IA treatment. In human IAs, the presence of inflammatory responses, such as an increase of tumor necrosis factor (TNF)-alpha, have been observed, suggesting a role for inflammation in IA formation. Recent investigations using rodent models of IAs have revealed the crucial role of inflammatory responses in IA formation, supporting the results of human studies. Thus, we identified nuclear factor (NF)-kappaB as a critical mediator of inflammation regulating IA formation, by inducing downstream pro-inflammatory genes such as MCP-1, a chemoattractant for macrophages, and COX-2. In this study, we focused on TNF-alpha signaling as a potential cascade that regulates NF-kappaB-mediated IA formation. Results We first confirmed an increase in TNF-alpha content in IA walls during IA formation, as expected based on human studies. Consistently, the activity of TNF-alpha converting enzyme (TACE), an enzyme responsible for TNF-alpha release, was induced in the arterial walls after aneurysm induction in a rat model. Next, we subjected tumor necrosis factor receptor superfamily member 1a (TNFR1)-deficient mice to the IA model to clarify the contribution of TNF-alpha-TNFR1 signaling to pathogenesis, and confirmed significant suppression of IA formation in TNFR1-deficient mice. Furthermore, in the IA walls of TNFR1-deficient mice, inflammatory responses, including NF-kappaB activation, subsequent expression of MCP-1 and COX-2, and infiltration of macrophages into the IA lesion, were greatly suppressed compared with those in wild-type mice. Conclusions In this study, using rodent models of IAs, we clarified the crucial role of TNF-alpha-TNFR1 signaling in the pathogenesis of IAs by inducing inflammatory responses, and propose this signaling as a potential therapeutic target for IA treatment.
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Meier FMP, Frerix M, Hermann W, Müller-Ladner U. Current immunotherapy in rheumatoid arthritis. Immunotherapy 2014; 5:955-74. [PMID: 23998731 DOI: 10.2217/imt.13.94] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Rheumatoid arthritis is a common autoimmune disease primarily manifesting as chronic synovitis, subsequently leading to a change in joint integrity. Progressive disability and systemic complications are strongly associated with a decreased quality of life. To maintain function and health in patients with rheumatoid arthritis, early, aggressive and guided immunosuppressive therapy is required to induce clinical remission. Antirheumatic drugs are capable of controlling synovial inflammation and are therefore named 'disease-modifying antirheumatic drugs' (DMARDs). This article aims to bridge the beginning of DMARD therapy with agents such as methotrexate, leflunomide, sulfasalazine, injectable gold and (hydroxy)chloroquine with biological therapies, and with the new era of kinase inhibitors. Mechanisms of action, as well as advantages and disadvantages of DMARDs, are discussed with respect to the current literature and current recommendations.
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Affiliation(s)
- Florian M P Meier
- Department of Internal Medicine & Rheumatology, Justus-Liebig-University Giessen, Kerckhoff-Klinik, Bad Nauheim, Germany
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Aaltonen KJ, Sokka T, Möttönen T, Korpela M, Komulainen R, Uusitalo T, Salomaa S, Uutela T, Valleala H, for the RAMI study group. A nationwide cross-sectional overview of patients with rheumatoid arthritis followed in outpatient specialty clinics in Finland. Scand J Rheumatol 2014; 43:286-90. [DOI: 10.3109/03009742.2013.876512] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kourbeti IS, Ziakas PD, Mylonakis E. Biologic Therapies in Rheumatoid Arthritis and the Risk of Opportunistic Infections: A Meta-analysis. Clin Infect Dis 2014; 58:1649-57. [DOI: 10.1093/cid/ciu185] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
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Mendes D, Alves C, Batel-Marques F. Safety profiles of adalimumab, etanercept and infliximab: a pharmacovigilance study using a measure of disproportionality in a database of spontaneously reported adverse events. J Clin Pharm Ther 2014; 39:307-13. [DOI: 10.1111/jcpt.12148] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 02/06/2014] [Indexed: 11/29/2022]
Affiliation(s)
- D. Mendes
- CHAD - Centre for Health Technology Assessment and Drug Research; AIBILI - Association for Innovation and Biomedical Research on Light; Coimbra Portugal
- Central Portugal Regional Pharmacovigilance Unit; AIBILI - Association for Innovation and Biomedical Research on Light; Coimbra Portugal
- School of Pharmacy; University of Coimbra; Coimbra Portugal
| | - C. Alves
- CHAD - Centre for Health Technology Assessment and Drug Research; AIBILI - Association for Innovation and Biomedical Research on Light; Coimbra Portugal
- Central Portugal Regional Pharmacovigilance Unit; AIBILI - Association for Innovation and Biomedical Research on Light; Coimbra Portugal
- School of Pharmacy; University of Coimbra; Coimbra Portugal
- Health Sciences Research Centre; University of Beira Interior; Covilhã Portugal
| | - F. Batel-Marques
- CHAD - Centre for Health Technology Assessment and Drug Research; AIBILI - Association for Innovation and Biomedical Research on Light; Coimbra Portugal
- Central Portugal Regional Pharmacovigilance Unit; AIBILI - Association for Innovation and Biomedical Research on Light; Coimbra Portugal
- School of Pharmacy; University of Coimbra; Coimbra Portugal
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Why have clinical trials in sepsis failed? Trends Mol Med 2014; 20:195-203. [PMID: 24581450 DOI: 10.1016/j.molmed.2014.01.007] [Citation(s) in RCA: 486] [Impact Index Per Article: 48.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Revised: 01/16/2014] [Accepted: 01/22/2014] [Indexed: 12/17/2022]
Abstract
The systemic inflammatory response is biologically complex, redundant, and activated by both infectious and noninfectious triggers. Its manipulation can cause both benefit and harm. More than 100 randomized clinical trials have tested the hypothesis that modulating the septic response to infection can improve survival. With one short-lived exception, none of these has resulted in new treatments. The current challenge for sepsis research lies in a failure of concept and reluctance to abandon a demonstrably ineffectual research model. Future success will necessitate large studies of clinical and biochemical epidemiology to understand the course of illness, better integration of basic and clinical science, and the creation of stratification systems to target treatment towards those who are most likely to benefit.
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Heather EM, Payne K, Harrison M, Symmons DPM. Including adverse drug events in economic evaluations of anti-tumour necrosis factor-α drugs for adult rheumatoid arthritis: a systematic review of economic decision analytic models. PHARMACOECONOMICS 2014; 32:109-134. [PMID: 24338344 DOI: 10.1007/s40273-013-0120-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Anti-tumour necrosis factor-α drugs (anti-TNFs) have revolutionised the treatment of rheumatoid arthritis (RA). More effective than standard non-biological disease-modifying anti-rheumatic drugs (nbDMARDs), anti-TNFs are also substantially more expensive. Consequently, a number of model-based economic evaluations have been conducted to establish the relative cost-effectiveness of anti-TNFs. However, anti-TNFs are associated with an increased risk of adverse drug events (ADEs) such as serious infections relative to nbDMARDs. Such ADEs will likely impact on both the costs and consequences of anti-TNFs, for example, through hospitalisations and forced withdrawal from treatment. OBJECTIVE The aim of this review was to identify and critically appraise if, and how, ADEs have been incorporated into model-based cost-effectiveness analyses of anti-TNFs for adult patients with RA. METHODS A systematic literature review was performed. Electronic databases (Ovid MEDLINE; Ovid EMBASE; Web of Science; NHS Economic Evaluations Database) were searched for literature published between January 1990 and October 2013 using electronic search strategies. The reference lists of retrieved studies were also hand searched. In addition, the National Institute for Health and Care Excellence technology appraisals were searched to identify economic models used to inform UK healthcare decision making. Only full economic evaluations that had used an economic model to evaluate biological DMARDs (bDMARDs) (including anti-TNFs) for adult patients with RA and had incorporated the direct costs and/or consequences of ADEs were critically appraised. To be included, studies also had to be available as a full text in English. Data extracted included general study characteristics and information concerning the methods used to incorporate ADEs and any associated assumptions made. The extracted data were synthesised using a tabular and narrative format. RESULTS A total of 43 model-based economic evaluations of bDMARDs for adult RA were identified from 2,483 initially identified studies (2,473 published; ten technology appraisals). Of these, nine studies had incorporated the incidence and costs of ADEs and were critically reviewed. One study also explicitly estimated the potential consequences for patient utility. There was a general lack of detail specifically reporting on how ADEs were included in the economic models. Furthermore, there was substantial heterogeneity amongst the nine studies concerning the (i) application of risk-related terminology; (ii) method of incorporating the incidence, costs and consequences of ADEs; and (iii) ADE-related assumptions. CONCLUSIONS Model-based economic evaluations have played an integral role in healthcare reimbursement and funding decisions relating to anti-TNFs for adult patients with RA. However, current economic models have not routinely or systematically considered the direct costs or consequences of ADEs, which may bias the estimates of the relative cost-effectiveness of anti-TNFs. Omitting information on relevant costs and consequences of interventions for RA will affect the validity of the associated recommendations for informed decision making. To improve current practice it is recommended that (i) greater efforts be made to provide appropriate long-term safety data on the use of anti-TNFs in adult RA; (ii) empirical research be undertaken to identify and quantify the impact of, and possible methods for, including ADEs in economic models to inform future good practice guidelines; and (iii) economic modelling guidelines and reference cases be updated to explicitly identify ADEs as an important treatment outcome and address how they might be incorporated into economic models. Improved consideration of the possible implications of ADEs in economic models will ensure that healthcare decision makers are provided with reliable and accurate information with which to make efficient reimbursement and financing decisions.
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Affiliation(s)
- Eleanor M Heather
- Manchester Centre for Health Economics, Institute of Population Health, Jean McFarlane Building, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK
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Chen YS, Yu HM, Shie JJ, Cheng TJR, Wu CY, Fang JM, Wong CH. Chemical constituents of Plectranthus amboinicus and the synthetic analogs possessing anti-inflammatory activity. Bioorg Med Chem 2014; 22:1766-72. [PMID: 24491635 DOI: 10.1016/j.bmc.2014.01.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 01/05/2014] [Accepted: 01/06/2014] [Indexed: 10/25/2022]
Abstract
This study demonstrates that compounds 1-4 from an extract of Plectranthus amboinicus inhibit the binding of AP-1 to its consensus DNA sequence. Thymoquinone (5) was further identified as a nonpolar ingredient from the hexane extract of P. amboinicus to suppress the expression of lipopolysaccharide-induced tumor necrosis factor-alpha (TNF-α). We then synthesized 2-alkylidenyl-4-cyclopentene-1,3-diones as the designed biomimetics of thymoquinone, and found that compounds 8a, 8b and 8d were more potent TNF-α inhibitors.
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Affiliation(s)
- Yuan-Siao Chen
- Graduate Institute of Life Science, National Defense Medical Center, Taipei 114, Taiwan; The Genomics Research Center, Academia Sinica, Taipei 115, Taiwan
| | - Hui-Ming Yu
- The Genomics Research Center, Academia Sinica, Taipei 115, Taiwan
| | - Jiun-Jie Shie
- The Genomics Research Center, Academia Sinica, Taipei 115, Taiwan
| | | | - Chung-Yi Wu
- The Genomics Research Center, Academia Sinica, Taipei 115, Taiwan.
| | - Jim-Min Fang
- Graduate Institute of Life Science, National Defense Medical Center, Taipei 114, Taiwan; Department of Chemistry, National Taiwan University, Taipei 106, Taiwan.
| | - Chi-Huey Wong
- Graduate Institute of Life Science, National Defense Medical Center, Taipei 114, Taiwan; The Genomics Research Center, Academia Sinica, Taipei 115, Taiwan.
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Bruno A, Pagani A, Magnani E, Rossi T, Noonan DM, Cantelmo AR, Albini A. Inflammatory angiogenesis and the tumor microenvironment as targets for cancer therapy and prevention. Cancer Treat Res 2014; 159:401-426. [PMID: 24114493 DOI: 10.1007/978-3-642-38007-5_23] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In addition to aberrant transformed cells, tumors are tissues that contain host components, including stromal cells, vascular cells (ECs) and their precursors, and immune cells. All these constituents interact with each other at the cellular and molecular levels, resulting in the production of an intricate and heterogeneous complex of cells and matrix defined as the tumor microenvironment. Several pathways involved in these interactions have been investigated both in pathological and physiological scenarios, and diverse molecules are currently targets of chemotherapeutic and preventive drugs. Many phytochemicals and their derivatives show the ability to inhibit tumor progression, angiogenesis, and metastasis, exerting effects on the tumor microenvironment. In this review, we will outline the principal players and mechanisms involved in the tumor microenvironment network and we will discuss some interesting compounds aimed at interrupting these interactions and blocking tumor insurgence and progression. The considerations provided will be crucial for the design of new preventive approaches to the reduction in cancer risk that need to be applied to large populations composed of apparently healthy individuals.
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Affiliation(s)
- Antonino Bruno
- Polo Scientifico e Tecnologico, MultiMedica Onlus, Milano, Italy
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Kiyonaga Y, Maeshima K, Imada C, Haranaka M, Ishii K, Shibata H. Steroid-sparing effects of etanercept in a patient with steroid-dependent adult-onset Still's disease. Intern Med 2014; 53:1209-13. [PMID: 24881751 DOI: 10.2169/internalmedicine.53.1488] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein report the case of an 84-year-old man with steroid-dependent adult-onset Still's disease (AOSD) whose daily steroid dose was successfully tapered after etanercept treatment. The corticosteroids worked well initially, and the patient went into remission promptly; however, he suffered a relapse due to steroid tapering. Because treatment with cyclosporine and methotrexate was ineffective, reducing the steroid dose was difficult, and the corticosteroids induced myopathy and diabetes. However, steroid tapering was accomplished in combination with etanercept therapy, and the patient's steroid-induced side effects disappeared. Etanercept should therefore be considered as a steroid-sparing treatment option in patients with steroid-responsive, steroid-dependent AOSD.
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Affiliation(s)
- Yasuhiro Kiyonaga
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Japan
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Huynh TK, Østergaard A, Egsmose C, Madsen OR. Preferences of patients and health professionals for route and frequency of administration of biologic agents in the treatment of rheumatoid arthritis. Patient Prefer Adherence 2014; 8:93-9. [PMID: 24470758 PMCID: PMC3901737 DOI: 10.2147/ppa.s55156] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVES To examine the preferences of rheumatoid arthritis (RA) patients and health professionals (HPs) for the route and frequency of administration of biologic drugs. METHODS One hundred and seven RA patients treated with biological agents for intravenous or subcutaneous use, 35 biologic-naïve RA patients treated with a disease-modifying antirheumatic drug and 30 rheumatology HPs (physicians and nurses) were recruited from two outpatient clinics in Copenhagen, Denmark. All subjects filled out a questionnaire interrogating their choice of preferred route and frequency of administration of a biologic corresponding to current available options, given that effects, adverse effects, and financial costs were identical for the different choices. The subjects were also asked to justify their preferences. The chi-square goodness-of-fit test was used to examine the distributions over different preferences. Proportions were compared using Fisher's exact test. RESULTS Forty-one patients were currently treated with subcutaneous self-injections at home (SCH) and 66 intravenously at the clinic (IVC). IVC was preferred by 85% of patients currently treated with IVC (P<0.0001). SCH was preferred by 71% of patients currently treated with SCH (P<0.001), by 77% of the biologic-naïve patients (P<0.01), and by 87% of HPs (P<0.0001). The proportion of patients favoring SCH was significantly higher for patients currently receiving SCH and for biologic-naïve RA patients than for those currently on IVC (P<0.0001). SCH once a month and IVC every 8 weeks were the most appealing treatment frequencies (P<0.01). The most frequent reason among patients for choosing IVC or SCH was a wish for safety, and a wish to minimize the time of transportation and treatment, respectively. CONCLUSION The majority of RA patients treated with biologics preferred their current route of administration. Most patients, those inexperienced with biologics, and HPs favored SCH. Low treatment frequencies were generally preferred.
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Affiliation(s)
- Tuan Khai Huynh
- Department of Rheumatology, Copenhagen University Hospital Frederiksberg, Frederiksberg, Denmark
- Department of Rheumatology, Copenhagen University Hospital Hillerød, Hillerød, Denmark
| | - Ann Østergaard
- Department of Rheumatology/C, Copenhagen University Hospital Gentofte, Hellerup, Denmark
| | - Charlotte Egsmose
- Department of Rheumatology/C, Copenhagen University Hospital Gentofte, Hellerup, Denmark
| | - Ole Rintek Madsen
- Department of Rheumatology/C, Copenhagen University Hospital Gentofte, Hellerup, Denmark
- Correspondence: Ole Rintek Madsen, Department of Rheumatology/C, Copenhagen University Hospital Gentofte, Copenhagen, Denmark, Tel +45 39 77 8382, Fax +45 39 77 7619, Email
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Abstract
INTRODUCTION With the introduction of biologic therapies, tremendous progress has been made in the treatment of rheumatoid arthritis (RA). However, up to 40% of patients do not respond to these treatments. AREAS COVERED Several new treatment strategies are discussed, with brief overview of currently performed clinical trials. The development of molecules targeting cytokines other than TNF is discussed, as well as chemokine-directed drugs. Finally, the area of small molecular inhibitors is explored. EXPERT OPINION Since RA is a life-long disease often evolving into disability, development of new treatment strategies remains crucial. Especially small molecules targeting JAK, Syk and PDE4 may provide novel therapeutic options.
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Affiliation(s)
- Peggy Jacques
- Ghent University Hospital, Department of Rheumatology, De Pintelaan 185, Gent, Belgium
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