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Bay LT, Nielsen DS, Flurey C, Giraldi A, Möller S, Graugaard C, Ellingsen T. Associations of gender with sexual functioning, loneliness, depression, fatigue and physical function amongst patients suffering from rheumatoid arthritis with a particular focus on methotrexate usage. Rheumatol Int 2024; 44:919-931. [PMID: 38483561 PMCID: PMC10980642 DOI: 10.1007/s00296-024-05555-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/31/2024] [Indexed: 04/01/2024]
Abstract
There is a lack of knowledge regarding methotrexate (MTX) usage in patients with rheumatoid arthritis (RA) and its possible links with gender, disease characterization and sexual functioning, loneliness, fatigue and depression. We, therefore, investigated the associations of gender with physical function, fatigue, depression, loneliness and sexual functioning with a particular focus on MTX usage. A cross-sectional study design was used. Inclusion criteria were RA diagnosis, age above 18 years and available data on MTX treatment 1 year after diagnosis. Data consisted of responses from validated questionnaires regarding physical function, fatigue, depression, loneliness and sexual functioning combined with evaluations from medical records. Data were analysed with linear regression models comparing numerical outcome measures between male and female patients and between MTX users and MTX non-users. Amongst 286 patients with RA (69 men and 217 women), 67.8% were MTX users 1 year after diagnosis. Comparing women and men, both overall and within subgroups of MTX usage, we found significantly more adverse outcomes for women than men in physical functioning at diagnosis and in sexual function, depression, fatigue and physical functioning at enrolment in the study. Gender differences were also present when comparing MTX users with MTX non-users divided by gender. There were only significant differences in the HAQ and loneliness scores when comparing MTX users with MTX non-users. Women with RA had more negative outcomes measured by the selected PROMs compared to men with RA, both overall and in subgroups of users and non-users of MTX. These findings call for sharpened attention to the importance of gender in the treatment and care of patients with RA, as well as in future clinical research.
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Affiliation(s)
- Laila T Bay
- Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital, 5000, Odense, Denmark.
- Department of Gynecology, University of Southern Denmark, 5000, Odense, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Dorthe S Nielsen
- Department of Geriatrics, Odense University Hospital, Odense, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Caroline Flurey
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Annamaria Giraldi
- Sexological Clinic, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Sören Möller
- OPEN, Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | - Christian Graugaard
- Center for Sexology Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Torkell Ellingsen
- Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital, 5000, Odense, Denmark
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Chua KJ, Kronstedt S, Kaldany A, Srivastava A, Doppalapudi SK, Liu H, Tarhini AA, Gatti‐Mays M, Gaughan E, Hu‐Lieskovan S, Aljumaily R, Nepple K, Schneider B, Sterling J, Singer EA. Comparing the rate of immunotherapy treatment change due to toxicity by sex. Cancer Rep (Hoboken) 2024; 7:e1932. [PMID: 38189893 PMCID: PMC10849926 DOI: 10.1002/cnr2.1932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 10/07/2023] [Accepted: 11/06/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND Immuno-oncology therapy (IO) is associated with a variety of treatment-related toxicities. However, the impact of toxicity on the treatment discontinuation rate between males and females is unknown. We hypothesized that immune-related adverse events would lead to more frequent treatment changes in females since autoimmune diseases occur more frequently in females. AIMS Our aim was to determine if there was a difference in the rate of immunotherapy treatment change due to toxicity between males and females. METHODS AND RESULTS The Oncology Research Information Exchange Network Avatar Database collected clinical data from 10 United States cancer centers. Of 1035 patients receiving IO, 447 were analyzed, excluding those who did not have documentation noting if a patient changed treatment (n = 573). Fifteen patients with unknown or gender-specific cancer were excluded. All cancer types and stages were included. The primary endpoint was documented treatment change due to toxicity. Four hundred and forty-seven patients (281 males and 166 females) received IO treatment. The most common cancers treated were kidney, skin, and lung for 99, 84, and 54 patients, respectively. Females had a shorter IO course than males (median 3.7 vs. 5.1 months, respectively, p = .02). Fifty-four patients changed treatment due to toxicity. There was no significant difference between females and males on chi-square test (11.4% vs. 12.5%, respectively, p = 0.75) and multivariable logistic regression (OR 0.924, 95% CI 0.453-1.885, p = .827). Significantly more patients with chronic obstructive pulmonary disease (COPD) changed therapy due to toxicity (OR 2.491, 95% CI 1.025-6.054, p = .044). CONCLUSION Females received a shorter course of IO than males. However, there was no significant difference in the treatment discontinuation rate due to toxicity between males and females receiving IO. Toxicity-related treatment change was associated with COPD.
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Affiliation(s)
- Kevin J. Chua
- Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical SchoolSection of Urologic OncologyNew BrunswickNew JerseyUSA
- Rutgers Robert Wood Johnson Medical SchoolPiscatawayNew JerseyUSA
| | - Shane Kronstedt
- Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical SchoolSection of Urologic OncologyNew BrunswickNew JerseyUSA
- Rutgers Robert Wood Johnson Medical SchoolPiscatawayNew JerseyUSA
| | - Alain Kaldany
- Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical SchoolSection of Urologic OncologyNew BrunswickNew JerseyUSA
- Rutgers Robert Wood Johnson Medical SchoolPiscatawayNew JerseyUSA
| | - Arnav Srivastava
- Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical SchoolSection of Urologic OncologyNew BrunswickNew JerseyUSA
- Rutgers Robert Wood Johnson Medical SchoolPiscatawayNew JerseyUSA
| | - Sai Krishnaraya Doppalapudi
- Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical SchoolSection of Urologic OncologyNew BrunswickNew JerseyUSA
- Rutgers Robert Wood Johnson Medical SchoolPiscatawayNew JerseyUSA
| | - Hao Liu
- Department of Biostatistics and EpidemiologyRutgers School of Public HealthPiscatawayNew JerseyUSA
| | - Ahmad A. Tarhini
- Departments of Cutaneous Oncology and ImmunologyMoffitt Cancer CenterTampaFloridaUSA
| | - Margaret Gatti‐Mays
- Division of Medical OncologyThe Ohio State University Comprehensive Cancer CenterColumbusOhioUSA
| | - Elizabeth Gaughan
- Division of Hematology/OncologyThe University of Virginia Health SystemCharlottesvilleVirginiaUSA
| | - Siwen Hu‐Lieskovan
- Department of Internal Medicine Division of OncologyUniversity of Utah School of Medicine and Huntsman Cancer InstituteSalt Lake CityUtahUSA
| | - Raid Aljumaily
- Department of Hematology/Oncology Stephenson Cancer CenterUniversity of Oklahoma Health Sciences CenterOklahoma CityOklahomaUSA
| | - Kenneth Nepple
- Department of UrologyUniversity of Iowa Holden Comprehensive Cancer CenterIowa CityIowaUSA
| | - Bryan Schneider
- Indiana University Melvin and Bren Simon Comprehensive Cancer CenterIndianapolisIndianaUSA
| | - Joshua Sterling
- Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical SchoolSection of Urologic OncologyNew BrunswickNew JerseyUSA
- Rutgers Robert Wood Johnson Medical SchoolPiscatawayNew JerseyUSA
| | - Eric A. Singer
- Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical SchoolSection of Urologic OncologyNew BrunswickNew JerseyUSA
- Division of Urologic OncologyThe Ohio State University Comprehensive Cancer CenterColumbusOhioUSA
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Cignarella A, Vegeto E, Bolego C, Trabace L, Conti L, Ortona E. Sex-oriented perspectives in immunopharmacology. Pharmacol Res 2023; 197:106956. [PMID: 37820857 DOI: 10.1016/j.phrs.2023.106956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/27/2023] [Accepted: 10/08/2023] [Indexed: 10/13/2023]
Abstract
Several immunopharmacological agents are effective in the treatment of cancer and immune-mediated conditions, with a favorable impact on life expectancy and clinical outcomes for a large number of patients. Nevertheless, response variation and undesirable effects of these drugs represent major issues, and overall efficacy remains unpredictable. Males and females show a distinct difference in immune system responses, with females generally mounting stronger responses to a variety of stimuli. Therefore, exploring sex differences in the efficacy and safety of immunopharmacological agents would strengthen the practice of precision medicine. As a pharmacological target highlight, programmed cell death 1 ligand 1 (PD-L1) is the first functionally characterized ligand of the coinhibitory programmed death receptor 1 (PD-1). The PD-L1/PD-1 crosstalk plays an important role in the immune response and is relevant in cancer, infectious and autoimmune disease. Sex differences in the response to immune checkpoint inhibitors are well documented, with male patients responding better than female patients. Similarly, higher efficacy of and adherence to tumor necrosis factor inhibitors in chronic inflammatory conditions including rheumatoid arthritis and Crohn's disease have been reported in male patients. The pharmacological basis of sex-specific responses to immune system modulating drugs is actively investigated in other settings such as stroke and type 1 diabetes. Advances in therapeutics targeting the endothelium could soon be wielded against autoimmunity and metabolic disorders. Based on the established sexual dimorphism in immune-related pathophysiology and disease presentation, sex-specific immunopharmacological protocols should be integrated into clinical guidelines.
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Affiliation(s)
| | - Elisabetta Vegeto
- Department of Pharmaceutical Sciences, University of Milan, Milan, Italy
| | - Chiara Bolego
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Padova, Italy
| | - Luigia Trabace
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Lucia Conti
- Center for Gender-Specific Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - Elena Ortona
- Center for Gender-Specific Medicine, Istituto Superiore di Sanità, Rome, Italy
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Corredores J, Vofo B, Amer R. Uveitis in Children: The Role of Biological Agents in Its Management. Biomedicines 2023; 11:biomedicines11020629. [PMID: 36831165 PMCID: PMC9953244 DOI: 10.3390/biomedicines11020629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/12/2023] [Accepted: 02/14/2023] [Indexed: 02/22/2023] Open
Abstract
We aimed to determine medium and long-term effects of TNF-α inhibitors in patients with pediatric uveitis. This was a retrospective review of medical charts. Included were 50 patients (84 eyes). Mean age at diagnosis was 7.22 ± 4.04 years. At baseline (time of initiation of biologic therapy), all patients had active uveitis. Complete control of uveitis was achieved in 84.52% (n = 71) of eyes, after a median of 3 months (IQR 2 months). Mean LogMAR BCVA at baseline was 0.23 ± 0.44; it remained stable at 12 and 24 months. At baseline, 64% of patients were treated with oral corticosteroids, this decreased to 29.5% at 12 months (p = 0.001) and to 21.9% at 24 months (p < 0.001). Mean time to prednisone dose of ≤0.2 mg/kg/day was 8.1 ± 2.02 months after baseline. A total of 40.5% of eyes were treated with topical steroids at baseline and this significantly decreased to 5.8% at 12 months. Multiple linear regression model was calculated to predict moderate and severe visual loss; only presenting visual acuity accounted for a unique variance in the model. In conclusion, TNF-α inhibitors achieved rapid disease control while enabling a remarkable steroid-sparing effect in children suffering from chronic uveitis. Presenting visual acuity was the sole predictor of moderate to severe visual loss.
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Affiliation(s)
- Jamel Corredores
- Department of Ophthalmology, Hadassah Medical Center, Jerusalem 91120, Israel
| | - Brice Vofo
- Department of Ophthalmology, Hadassah Medical Center, Jerusalem 91120, Israel
| | - Radgonde Amer
- Faculty of Medicine, The Ophthalmology Department, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem 91120, Israel
- Correspondence: ; Tel.: +972-2-6778646; Fax: +972-2-6428896
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Personalized medicine in rheumatoid arthritis: Combining biomarkers and patient preferences to guide therapeutic decisions. Best Pract Res Clin Rheumatol 2023; 36:101812. [PMID: 36653230 DOI: 10.1016/j.berh.2022.101812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The last few decades have seen major therapeutic advancements in rheumatoid arthritis (RA) therapeutics. New disease-modifying antirheumatic drugs (DMARDs) have continued to emerge, creating more choices for people. However, no therapeutic works for all patients. Each has its own inherent benefits, risks, costs, dosing, and monitoring considerations. In parallel, there has been a focus on personalized medicine initiatives that tailor therapeutic decisions to patients based on their unique characteristics or biomarkers. Personalized effect estimates require an understanding of a patient's baseline probability of response to treatment and data on the comparative effectiveness of the available treatments. However, even if accurate risk prediction models are available, trade-offs often still need to be made between treatments. In this paper, we review the history of RA therapeutics and progress that has been made toward personalized risk predictive models for DMARDs, outlining where knowledge gaps still exist. We further review why patient preferences play a key role in a holistic view of personalized medicine and how this links with shared decision-making. We argue that a "preference misdiagnosis" may be equally important as a medical misdiagnosis but is often overlooked.
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Al-Saleh J, Almarzooqi A, Negm AA. Prevalence and Predictors of Remission and Sustained Remission in Patients with Rheumatoid Arthritis from the United Arab Emirates: A Two-Year Prospective Study. Open Access Rheumatol 2023; 15:51-63. [PMID: 37192954 PMCID: PMC10183195 DOI: 10.2147/oarrr.s408894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/05/2023] [Indexed: 05/18/2023] Open
Abstract
Aim To estimate the prevalence of remission and sustained remission for more than 12 months in a cohort of patients with rheumatoid arthritis in the United Arab Emirates and explore predictors of remission and sustained remission in these patients. Methods A two-year prospective study conducted in Dubai Hospital (January 1, 2018-December 31, 2019) included all consecutive patients with rheumatoid arthritis attending the rheumatology clinic. Patients with a Simplified Disease Activity Index ≤3.3 and/or Clinical Disease Activity Index ≤2.8 in December 2018 were considered in remission and followed until December 2019. Those who maintained remission through 2019 were considered in sustained remission. Results In this study, a total of 444 patients were followed for a 12-months period. The percentage of remission achieved in RA patients was 30.4% according to the Clinical Disease Activity Index, 31.1% according to Simplified Disease Activity Index, and 50.9% according to the Value of Disease Activity Score 28 (DAS28) remission criteria. The 12-months sustained remission rates ranged from 38.3% for the ACR-EULAR to 69.3% for the DAS28. Male gender, shorter disease duration, better functioning as evaluated by the Health Assessment Questionnaire Disability Index (lower HAQ scores), and higher compliance rates are among sustained remission predictors. Conclusion Establishing "real-world" data and understanding local predictors to sustained remission is principal for implementing timely and appropriate patient-tailored strategies. These strategies include early detection, close monitoring, and enhancing treatment adherence among UAE patients.
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Affiliation(s)
- Jamal Al-Saleh
- Rheumatology, Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates
- Correspondence: Jamal Al-Saleh, Rheumatology, Dubai Hospital, Dubai Health Authority, P.O. 7272, Dubai, United Arab Emirates, Tel +9714-219 5506, Fax +97142195788, Email
| | - Ahlam Almarzooqi
- Rheumatology, Al Qassimi Hospital, Emirates Health Services, Sharjah, United Arab Emirates
| | - Ahmed A Negm
- Rheumatology, Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates
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Lower odds of remission among women with rheumatoid arthritis: A cohort study in the Swiss Clinical Quality Management cohort. PLoS One 2022; 17:e0275026. [PMID: 36264948 PMCID: PMC9584448 DOI: 10.1371/journal.pone.0275026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 09/08/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To compare the likelihood of achieving remission between men and women with rheumatoid arthritis (RA) after starting their first biologic or targeted synthetic disease-modifying anti-rheumatic drug (b/tsDMARD). METHODS This cohort study in the Swiss Clinical Quality Management in Rheumatic Diseases (SCQM) registry included RA patients starting their first b/tsDMARD (1997-31/04/2018). The odds of achieving remission at ≤12-months, defined by disease activity score 28-joints (DAS28) <2.6, were compared between men and women. Secondary analyses were adjusted for age and seropositivity, and we investigated potential mediators or factors that could explain the main findings. RESULTS The study included 2839 (76.3%) women and 883 (23.7%) men with RA. Compared to women, men were older at diagnosis and b/tsDMARD start, but had shorter time from diagnosis to b/tsDMARD (3.4 versus 5.0 years, p<0.001), and they had lower DAS28 at b/tsDMARD start. Compared to women, men had 21% increased odds of achieving DAS28-remission, with odds ratio (OR) 1.21, 95% confidence interval (CI) 1.02-1.42. Adjusting for age and seropositivity yielded similar findings (adjusted OR 1.24, 95%CI 1.05-1.46). Analyses of potential mediators suggested that the observed effect may be explained by the shorter disease duration and lower DAS28 at treatment initiation in men versus women. CONCLUSION Men started b/tsDMARD earlier than women, particularly regarding disease duration and disease activity (DAS28), and had higher odds of reaching remission. This highlights the importance of early initiation of second line treatments, and suggests to target an earlier stage of disease in women to match the benefits observed in men.
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Jiang N, Li Q, Li H, Fang Y, Wu L, Duan X, Xu J, Zhao C, Jiang Z, Wang Y, Wang Q, Leng X, Li M, Tian X, Zeng X. Chinese registry of rheumatoid arthritis (CREDIT) V: sex impacts rheumatoid arthritis in Chinese patients. Chin Med J (Engl) 2022; 135:2210-2217. [PMID: 36103962 PMCID: PMC9771299 DOI: 10.1097/cm9.0000000000002110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The impact of sex on the clinical manifestations of rheumatoid arthritis (RA) were diversely reported in the literature. The Chinese Registry of rhEumatoiD arthrITis provides a platform for the investigation of this issue in Chinese patients. METHODS Demographic and clinical parameters were collected from all enrolled patients with RA and from patients with early RA (disease duration ≤6 months). The differences in data regarding disease activity, comorbidities, and medications for RA were compared between men and women. The proportions of patients who achieved remission and low disease activity were compared at enrollment and during 3-, 6-, and 12-month follow-up visits. RESULTS A total of 11,564 patients were enrolled, 83.6% of whom were female. In all the enrolled patients and patients with early RA, C-reactive protein (CRP, 12.0 vs . 6.7 mg/L), pain visual analogue scale (4.8 vs . 4.5), patient's and physician's global assessment (4.9 vs . 4.5 and 4.9 vs . 4.5), 28-joint disease activity score using DAS28-CRP (4.3 vs . 4.0) simplified disease activity index (21.9 vs . 19.9), and clinical disease activity index (19.3 vs . 18.0) were significantly higher in men than in women. Additionally, the swollen joint count/tender joint count and DAS28 using erythrocyte sedimentation rate were higher in male patients than in female patients with early RA. More female patients with early RA reached the treatment target at baseline than male patients (23.4% vs . 18.2%, assessed by CDAI). At 3 months, 6 months, and 12 months, the proportion of remission and treatment target achievement was similar in both sexes. Coronary artery disease (CAD) and stroke were more frequent in men than in women. CONCLUSIONS In Chinese patients with RA, men were found to have more active disease, as well as more cases of CAD and stroke. Therefore, sex should be carefully considered during the personalization of RA treatment.
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Affiliation(s)
- Nan Jiang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences and Peking Union Medical College; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science and Technology; State Key Laboratory of Complex Severe and Rare Diseases; Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China
| | - Qin Li
- Department of Rheumatology, the First People's Hospital of Yunnan Province, Kunming, Yunnan 650032, China
| | - Hongbin Li
- Department of Rheumatology, the Affiliated Hospital of Inner Mongolia Medical College, Hohhot, Inner Mongolia 010050, China
| | - Yongfei Fang
- Department of Rheumatology, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Lijun Wu
- Department of Rheumatology and Immunology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang 830001, China
| | - Xinwang Duan
- Department of Rheumatology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
| | - Jian Xu
- Department of Rheumatology and Immunology, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China
| | - Cheng Zhao
- Department of Rheumatology, The First Affiliated Hospital of Guangxi Medical University, Manning, Guangxi 530021, China
| | - Zhenyu Jiang
- Department of Rheumatology, The First Hospital of Jilin University, Changchun, Jilin 130021, China
| | - Yanhong Wang
- Department of Epidemiology and Bio-Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing 100005, China
| | - Qian Wang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences and Peking Union Medical College; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science and Technology; State Key Laboratory of Complex Severe and Rare Diseases; Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China
| | - Xiaomei Leng
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences and Peking Union Medical College; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science and Technology; State Key Laboratory of Complex Severe and Rare Diseases; Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China
| | - Mengtao Li
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences and Peking Union Medical College; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science and Technology; State Key Laboratory of Complex Severe and Rare Diseases; Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China
| | - Xinping Tian
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences and Peking Union Medical College; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science and Technology; State Key Laboratory of Complex Severe and Rare Diseases; Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China
| | - Xiaofeng Zeng
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences and Peking Union Medical College; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science and Technology; State Key Laboratory of Complex Severe and Rare Diseases; Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China
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Mu R, Li C, Li X, Ke Y, Zhao L, Chen L, Wu R, Wu Z, Zuo X, Xie Y, Chen J, Wei W, Liu Y, Li Z, Dai L, Sun L, Liu X, Li Z. Effectiveness and safety of iguratimod treatment in patients with active rheumatoid arthritis in Chinese: A nationwide, prospective real-world study. LANCET REGIONAL HEALTH-WESTERN PACIFIC 2021; 10:100128. [PMID: 34327344 PMCID: PMC8315426 DOI: 10.1016/j.lanwpc.2021.100128] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/07/2021] [Accepted: 02/28/2021] [Indexed: 02/08/2023]
Abstract
Background There is heterogeneity in the clinical manifestations and responses to drugs in RA patients due to variety of factors such as genes and environment. Despite advances in the treatment of rheumatoid arthritis (RA), approximately 40% of RA patients still do not achieve primary clinical outcomes in randomized trials, and its low remission rate and high economic consumption remain unresolved, especially in developing countries. Iguratimod (IGU) is a new disease-modifying anti-rheumatic drug (DMARD) with a low price that has demonstrated good efficacy and safety in clinical trials and was approved for active RA in China and Japan. As the most populous country in the Western Pacific region, it is warranted to conduct a study with a large scale of patients in a real-life setting. Our study confirms the new option for RA patients, which is potentially benificial for public health in developing countries. Methods This was a nationwide, prospective real-world study of IGU. Eligible subjects were active adult RA patients who aged 18 to 85 with or without multiple comorbidities such as hypertension and diabetes with DMARDs at a stable dosage for at least 12 weeks, or without ongoing DMARDs. A two-stage design was used for this study. In the first stage (the first 12 weeks), IGU 25 mg bid was added as monotherapy or to the background therapy, and in the second stage (the latter 12 weeks), adjustment of RA medicines other than IGU was allowed according to the participants’ disease activity. The primary endpoints were American College of Rheumatology 20% response (ACR20) 24 weeks and adverse events during 24 weeks. The secondary endpoints were ACR50 and ACR70 over 24 weeks, the changes of DAS28 and Health Assessment Questionnaire (HAQ) at week 12 and week 24 from baseline. The trial was registered with ClinicalTrials.gov, number NCT01554917. Findings Between March 2012 and January 2015, 1759 participants were enrolled, of whom 81•5% (1433/1759) completed the study. Notably, 1597 patients in the full analysis set were assessed for the effectiveness and 1751 patients were in the safety analysis set; 71•9% (1148/1597) of the patients achieved the primary endpoint of ACR20 response at week 24, and 51•7% (906/1751) patients had at least 1 adverse event (AE). The incidence of the clinical significant AE (grade≥3) of special interest was 3•4% (54 patients for grade 3 and 6 patients for grade 4), and 0•7% (13/1751) of patients developed SAEs associated with IGU. The most common clinical significant AEs were infection in 0•6% (10/1751) of the patients, abdominal discomfort in 0•5% (9/1751) of the patients including 0•2% (3/1751) gastric ulcer, fracture in 0•4% (7/1751), and increased alanine aminotransferase (ALT) in 0•2% (3/1751) of the patients. The secondary endpoint of ACR50 and ACR70 response rates at week 24 were 47•4% (757/1597) and 24•0% (384/1597). DAS28 was 4•11±1•27 and 3•75±1•32 at week 12 and 24, which was significantly decreased -1•40±1•10 and -1•75±1•26 compared with baseline (P<0•001) respectively. Changes in HAQ at week 12 and 24 from baseline were -7•4 ± 9•18 and -8•5 ± 9•97, respectively (all P<0•001). Stratified analysis results showed that the patients with shorter disease duration, male gender had better response to IGU. There was no significant difference in ACR20/50/70 responses between elderly patients(≥65 years) and younger patients(<65 years), IGU monotherapy or combined with other DMARDs. However, more fractures (1•1% vs 0•5%; P = 0•64) and infections (8•7% vs 7•9%; P = 0•69) were observed in elderly patients in our study. Interpretation Our results confirmed the effectiveness and safety of IGU as a new DMARD for active patients with RA as monotherapy or combination therapy. Funding This study was supported by “the 11th Five-Year-Plan for Science and Technology Support Program (2012ZX09104-103-01)”.
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Affiliation(s)
- Rong Mu
- Department of Rheumatology and Immunology, Peking University People's Hospital, No. 11 Xizhimen South Street, Beijing, China.,Department of Rheumatology and Immunology, Peking University Third Hospital, No. 49 North Garden Road, Beijing, China
| | - Chun Li
- Department of Rheumatology and Immunology, Peking University People's Hospital, No. 11 Xizhimen South Street, Beijing, China
| | - Xiaomei Li
- Department of Rheumatology and Immunology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, No.17 Lujiang Road, Hefei, China
| | - Yao Ke
- Department of Rheumatology and Immunology, First Affiliated Hospital, Nanjing Medical University, 300 Guangzhou Road, Nanjing, China
| | - Ling Zhao
- Department of Rheumatological Immunology, First Hospital, Jilin University, 71 Xinmin Street, Changchun, China
| | - Lin Chen
- Department of Rheumatology and Immunology, Jilin Provincial People's Hospital, 1183 Industrial and Agricultural Road, Changchun, China
| | - Rui Wu
- Department of Rheumatology and Immunology, First Affiliated Hospital, Nanchang University, No.17 Yongwai main street, Nanchang, China
| | - Zhenbiao Wu
- Department of Clinical Immunology, Xijing Hospital, Fourth Military Medical University, No.127 Changle west road, Xi'an, China
| | - Xiaoxia Zuo
- Department of Rheumatology and Immunology, Xiangya Hospital Central South University, 87 Xiangya Road, Changsha, Hunan, China
| | - Yanli Xie
- Department of Rheumatology and Immunology, Xiangya Hospital Central South University, 87 Xiangya Road, Changsha, Hunan, China
| | - Jinwei Chen
- Department of Rheumatology and Immunology, Second Xiangya Hospital, Central South University, No.139 Ren Min Middle Road, Changsha, China
| | - Wei Wei
- Department of Rheumatology and Immunology, Tianjin Medical University General Hospital, 154 Anshan Street, Tianjin, China
| | - Yi Liu
- Department of Rheumatology and Immunology, West China Hospital, No.37 Guoxue Lane, Chengdu, China
| | - Zhijun Li
- Department of Rheumatology and Immunology, First Affiliated Hospital, Bengbu Medical College, 287 Changhuai Road, Bengbu, China
| | - Lie Dai
- Department of Rheumatology and Immunology, Sun Yat-Sen Memorial Hospital, 107 Yan Jiang West Road, Guangzhou, China
| | - Lingyun Sun
- Department of Rheumatology and Immunology, Nanjing Drum Tower Hospital Nanjing University Medical School, NO.321 Zhongshan Road, Nanjing, China
| | - Xiangyuan Liu
- Department of Rheumatology and Immunology, Peking University Third Hospital, No. 49 North Garden Road, Beijing, China
| | - Zhanguo Li
- Department of Rheumatology and Immunology, Peking University People's Hospital, No. 11 Xizhimen South Street, Beijing, China
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10
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Shin S, Park EH, Kang EH, Lee YJ, Song YW, Ha YJ. Sex differences in clinical characteristics and their influence on clinical outcomes in an observational cohort of patients with rheumatoid arthritis. Joint Bone Spine 2020; 88:105124. [PMID: 33346105 DOI: 10.1016/j.jbspin.2020.105124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 11/22/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Rheumatoid arthritis (RA) is more prevalent in women, but sex differences remain incompletely understood. This study aimed to elucidate sex differences in clinical characteristics and their potential impact on clinical outcomes in a large Korean cohort of patients with RA. METHODS In total, 5376 RA patients from the KORean Observational study Network for Arthritis (KORONA) database were examined at baseline and for 3 consecutive years using the disease activity score 28 (DAS28), health assessment questionnaire (HAQ), and patient-reported outcomes (PROs). Within a subgroup with active disease (DAS28≥3.2) at baseline, sex impacts on clinical outcome during follow-up were analyzed using generalized estimating equation (GEE) models. The factors related to achieving clinical remission were analyzed using Cox-proportional hazard regression. RESULTS At baseline, women (n=4574) were younger and had more erosive disease and longer disease duration than men (n=802) with higher scores in DAS28, HAQ, and PROs. The prevalence of interstitial lung disease, cardiovascular disease, and diabetes in men was higher than that of women. In a RA subgroup with active disease at baseline, GEE analyses demonstrated that women RA significantly influenced the rate of change of DAS28 over time. In that group, men are associated with achieving DAS28 sustained remission and point remission. CONCLUSIONS Women with RA in Korea report higher levels of disease activity and PROs compared to men, whereas most comorbidities were more prevalent in men. The longitudinal change in disease activity and the rate of achieving clinical remission were found to be worse in women with RA.
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Affiliation(s)
- Seunghwan Shin
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, 173Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Eun Hye Park
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, 173Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Eun Ha Kang
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, 173Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Yun Jong Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, 173Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Yeong Wook Song
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - You-Jung Ha
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, 173Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea.
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11
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Fang L, Song X, Ji P, Wang Y, Maynard J, Yim S, Sahajwalla C, Xu M, Kim M, Zhao L. Impact of Sex on Clinical Response in Rheumatoid Arthritis Patients Treated With Biologics at Approved Dosing Regimens. J Clin Pharmacol 2020; 60 Suppl 2:S103-S109. [DOI: 10.1002/jcph.1776] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 10/07/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Lanyan Fang
- Division of Quantitative Methods and Modeling Office of Research and Standards Office of Generic Drugs, US Food and Drug Administration Silver Spring Maryland USA
| | - Xuyang Song
- Division of Quantitative Methods and Modeling Office of Research and Standards Office of Generic Drugs, US Food and Drug Administration Silver Spring Maryland USA
| | - Ping Ji
- Division of Clinical Pharmacology II, Office of Translational Science, Center for Drug Evaluation and Research, US Food and Drug Administration Silver Spring Maryland USA
| | - Yaning Wang
- Division of Pharmacometrics Office of Clinical Pharmacology Office of Translational Science, Center for Drug Evaluation and Research, US Food and Drug Administration Silver Spring Maryland USA
| | - Janet Maynard
- Office of New Drugs Center for Drug Evaluation and Research US Food and Drug Administration Silver Spring Maryland USA
| | - Sarah Yim
- Office of New Drugs Center for Drug Evaluation and Research US Food and Drug Administration Silver Spring Maryland USA
| | - Chandrahas Sahajwalla
- Division of Clinical Pharmacology II, Office of Translational Science, Center for Drug Evaluation and Research, US Food and Drug Administration Silver Spring Maryland USA
| | - Mingjiang Xu
- Division of Quantitative Methods and Modeling Office of Research and Standards Office of Generic Drugs, US Food and Drug Administration Silver Spring Maryland USA
| | - Myong‐Jin Kim
- Division of Quantitative Methods and Modeling Office of Research and Standards Office of Generic Drugs, US Food and Drug Administration Silver Spring Maryland USA
| | - Liang Zhao
- Division of Quantitative Methods and Modeling Office of Research and Standards Office of Generic Drugs, US Food and Drug Administration Silver Spring Maryland USA
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12
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Hilliquin P, Barnetche T, Baillet A, Flipo RM, Lespessailles E, Roux C, Fardellone P, Gilbert-Marceau A, Idier I, Constantin A, Shipley E, Baudens G, Saraux A. Real-World 1-Year Retention Rate of Subcutaneous Tocilizumab Treatment in Patients with Moderate to Severe Active Rheumatoid Arthritis: TANDEM Study. Rheumatol Ther 2020; 8:95-108. [PMID: 33216287 PMCID: PMC7991027 DOI: 10.1007/s40744-020-00253-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/03/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction Drug retention is particularly relevant to assess long-term treatments. This real-world study mainly aimed to describe 1-year retention rate (RR) of subcutaneously administered tocilizumab (TCZ-SC) in patients with moderate to severe active rheumatoid arthritis (RA). Methods This non-interventional, prospective, multicenter study (NCT02608112) was conducted in patients with RA initiating TCZ-SC treatment, with an 18-month follow-up. RR was estimated at month 12 in the overall population and baseline subgroups (combination with a conventional synthetic disease-modifying antirheumatic drug (csDMARD) or not, age, body mass index, methotrexate dose), using the Kaplan–Meier method. Patient compliance to TCZ-SC was described using the 5-item Compliance Questionnaire for Rheumatology (CQR5). Results At inclusion 75% of the 285 analyzed patients were women, mean RA duration was 9 ± 9 years, previous RA treatments included biological agents (63%) and/or csDMARDs (94%), mean Disease Activity Score 28 joints-Erythrocyte Sedimentation Rate (DAS28-ESR) was 4.8 ± 1.2. TCZ-SC RR at month 12 was estimated to be 64% (95% CI 58%–69%) with no statistical differences between subgroups. Clinical results improved with TCZ-SC; the proportion of patients treated with combined glucocorticoids decreased from 49% to 22% at month 12. At each follow-up time, at least 80% of patients were high adherers to TCZ-SC (at least 80% of theoretical injections). Among the 286 patients with at least one TCZ-SC injection, 25 patients (9%) experienced serious adverse events related to TCZ-SC with no differences according to patient age. Conclusions This real-world study corroborates the RR at month 12 previously shown in interventional studies on TCZ-SC. Our data suggest there are no differences according to patient’s profile (age, BMI), methotrexate doses, and TCZ-SC use. Trial Registration NCT02608112.
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Affiliation(s)
- Pascal Hilliquin
- Rheumatology Department, C.H. Sud Francilien, Corbeil-Essonnes, France.
| | - Thomas Barnetche
- Rheumatology Department, University Hospital of Bordeaux, FHU ACRONIM, Bordeaux, France
| | - Athan Baillet
- Rheumatology Department, University Hospital of Grenoble, Grenoble, France
| | - René-Marc Flipo
- Rheumatology Department, University Hospital of Lille, Lille, France
| | | | - Christian Roux
- Rheumatology Department, University Hospital of Nice, Nice, France
| | | | | | - Isabelle Idier
- Medical Affairs, Chugai Pharma France, Paris La Défense, Puteaux, France
| | - Arnaud Constantin
- Rheumatology Department, University Hospital of Toulouse, Toulouse, France
| | - Emilie Shipley
- Rheumatology Department, General Hospital of Dax, Dax, France
| | - Guy Baudens
- Rheumatology, Private Practice, Valenciennes, France
| | - Alain Saraux
- Rheumatology Department, CHU de Brest, Univ Brest, Inserm UMR1227, Lymphocytes B et Autoimmunité, Brest, France
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13
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Maynard C, Mikuls TR, Cannon GW, England BR, Conaghan PG, Østergaard M, Baker DG, Kerr G, George MD, Barton JL, Baker JF. Sex Differences in the Achievement of Remission and Low Disease Activity in Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2020; 72:326-333. [PMID: 30875461 DOI: 10.1002/acr.23873] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 03/05/2019] [Indexed: 01/21/2023]
Abstract
OBJECTIVE In rheumatoid arthritis, whether women are less likely to achieve low disease activity is unclear. We evaluated sex differences in remission and low disease activity, comparing different clinical and imaging measures. METHODS We used data from the Veterans Affairs Rheumatoid Arthritis (VARA) registry and from 2 clinical trials. Remission and low disease activity were defined using composite scores, individual items (tender joints, swollen joints, erythrocyte sedimentation rate [ESR], C-reactive protein [CRP] level, and evaluator/patient global assessment), and magnetic resonance imaging (MRI). In the VARA registry, we assessed the likelihood of point remission at any time during follow-up using logistic regression, and time to sustained remission (2 consecutive visits) using Cox proportional hazards models. In the clinical trials, logistic regression models evaluated the likelihood of low clinical and MRI activity at 52 weeks. RESULTS Among 2,463 patients in VARA, women (10.2%) were less likely to be in Disease Activity Score in 28 joints (DAS28)-ESR remission in follow-up (odds ratio [OR] 0.71 [95% confidence interval (95% CI) 0.55-0.91]; P < 0.01) and had a longer time to sustained DAS28-ESR remission. This difference was not observed for DAS28-CRP, Clinical Disease Activity Index, or Routine Assessment of Patient Index Data 3. Women were more likely to achieve favorable individual components except for an ESR <30 mm/hour (OR 0.72 [95% CI 0.57-0.90]; P < 0.01). Among 353 trial participants (83.7% women), women had reduced rates of DAS28-ESR remission (OR 0.39 [95% CI 0.21-0.72]; P = 0.003) but similar rates of low MRI synovitis and osteitis. CONCLUSION The comparison of remission rates between men and women varies based on the disease activity measure, with sex-specific differences in ESR resulting in reliably lower rates of remission among women. There were no differences in MRI measures.
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Affiliation(s)
- Carson Maynard
- University of Pennsylvania, Perelman School of Medicine, Philadelphia
| | - Ted R Mikuls
- Veterans Affairs Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha
| | - Grant W Cannon
- Salt Lake City Veterans Affairs Medical Center and University of Utah, Salt Lake City
| | - Bryant R England
- Veterans Affairs Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha
| | - Philip G Conaghan
- University of Leeds and NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Rigshospitalet, Glostrup, and University of Copenhagen, Copenhagen, Denmark
| | - Daniel G Baker
- Janssen Research and Development, LLC, Horsham, Pennsylvania
| | - Gail Kerr
- Washington DC Veterans Affairs Medical Center, Georgetown University, and Howard University, Washington, DC
| | - Michael D George
- University of Pennsylvania, Perelman School of Medicine, Philadelphia
| | | | - Joshua F Baker
- Philadelphia Veterans Affairs Medical Center and University of Pennsylvania, Philadelphia
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14
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Bischof E, Wolfe J, Klein SL. Clinical trials for COVID-19 should include sex as a variable. J Clin Invest 2020; 130:3350-3352. [PMID: 32392184 DOI: 10.1172/jci139306] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Evelyne Bischof
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy.,College of Clinical Medicine, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Jeannette Wolfe
- Department of Emergency Medicine, UMass Medical School - Baystate Campus, Springfield, Massachusetts, USA
| | - Sabra L Klein
- W. Harry Feinstone Department of Molecular Microbiology and Immunology and.,Department of Biochemistry and Molecular Biology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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15
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Abstract
Immunotherapies are often used for the treatment, remission, and possible cure of autoimmune diseases, infectious diseases, and cancers. Empirical evidence illustrates that females and males differ in outcomes following the use of biologics for the treatment of autoimmune diseases, e.g., rheumatoid arthritis (RA), infectious diseases, e.g., influenza, and solid tumor cancers. Females tend to experience more adverse reactions than males following the use of a class of biologics referred to as immunotherapies. For immunotherapies aimed at stimulating an immune response, e.g., influenza vaccines, females develop greater responses and may experience greater efficacy than males. In contrast, for immunotherapies that repress an immune response, e.g., tumor necrosis factor (TNF) inhibitors for RA or checkpoint inhibitors for melanoma, the efficacy is reportedly greater for males than females. Despite these differences, discrepancies in reporting differences between females and males exist, with females have been historically excluded from biomedical and clinical studies. There is a critical need for research that addresses the biological (i.e., sex) as well as sociocultural (i.e., gender) causes of male-female disparities in immunotherapy responses, toxicities, and outcomes. One-size-fits-all approaches to immunotherapies will not work, and sex/gender may contribute to variable treatment success, including adherence, in clinical settings.
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16
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Lauper K, Mongin D, Alpizar-Rodriguez D, Codreanu C, Iannone F, Kristianslund EK, Kvien TK, Pavelka K, Pombo-Suarez M, Santos MJ, Gabay C, Finckh A, Courvoisier DS. Drug retention of biological DMARD in rheumatoid arthritis patients: the role of baseline characteristics and disease evolution. Rheumatology (Oxford) 2019; 58:2221-2229. [DOI: 10.1093/rheumatology/kez221] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 04/11/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objective
To examine the association of the evolution in physician-reported and patient-reported outcomes with decision to stop biological DMARDs (bDMARDs) in RA. The contribution of baseline characteristics is well established, but little is known about how the disease evolution influences the decision to discontinue therapy.
Methods
RA patients who initiated a bDMARD treatment from 2009 and with information on date of visit were pooled from seven European RA registers. Each outcome was divided into baseline assessments (capturing the inter-individual differences at drug initiation) and changes from baseline at subsequent visits (capturing the individual evolution). Cox regression models were used to examine their association with drug discontinuation, adjusting for baseline patient and co-therapy characteristics and stratifying by register and calendar year of drug initiation.
Results
A total of 25 077 patients initiated a bDMARDs (18 507 a TNF-inhibitor, 3863 tocilizumab and 2707 abatacept) contributing an amount of 46 456.8 patient-years. Overall, drug discontinuation was most strongly associated with a poor evolution of the DAS28, with a hazard ratio of 1.34 (95% CI 1.29, 1.40), followed by its baseline value. A change of Physician Global Assessment was the next strongest predictor of discontinuation, then the Patient Global Assessment.
Conclusions
The decision to discontinue treatments appears to be mostly influenced by DAS28 and particularly its evolution over time, followed by Physician Global Assessment evolution, suggesting that the decision to stop bDMARDs relies more on the physician’s than on the patient’s global assessment.
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Affiliation(s)
- Kim Lauper
- Division of Rheumatology, University Hospitals Geneva, Geneva, Switzerland
| | - Denis Mongin
- Division of Rheumatology, University Hospitals Geneva, Geneva, Switzerland
| | | | - Catalin Codreanu
- Center of Rheumatic Diseases, University of Medicine and Pharmacy, Bucharest, Romania, Italy
| | | | | | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Karel Pavelka
- Institute of Rheumatology, Prague and Clinic of Rheumatology, Charles University, Prague, Czech Republic
| | - Manuel Pombo-Suarez
- Rheumatology Unit, Clinical University Hospital, University of Santiago de Compostela, Santiago, Spain
| | - Maria J Santos
- Rheumatology Department, Hospital Garcia de Orta, Almada, Portugal, on behalf of Reuma.pt
| | - Cem Gabay
- Division of Rheumatology, University Hospitals Geneva, Geneva, Switzerland
| | - Axel Finckh
- Division of Rheumatology, University Hospitals Geneva, Geneva, Switzerland
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17
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Sung YK, Yoshida K, Prince FHM, Frits ML, Cho SK, Choe JY, Lee HS, Lee J, Lee SS, Yoo DH, Helfgott SM, Shadick NA, Weinblatt ME, Solomon DH, Bae SC. Prevalence and predictors for sustained remission in rheumatoid arthritis. PLoS One 2019; 14:e0214981. [PMID: 31002669 PMCID: PMC6474583 DOI: 10.1371/journal.pone.0214981] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 03/26/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Remission is a key goal in managing rheumatoid arthritis (RA), with sustained remission as the preferred sequelae of short-term remission. However little is known about the predictors of sustained remission for patients reaching remission. Using two independent cohorts, we aimed to evaluate the prevalence and predictors for sustained remission. METHODS The study cohort consisted of subjects with RA from the Brigham and Women's Hospital Rheumatoid Arthritis Sequential Study (BRASS) and the Korean Observational Study Network for Arthritis (KORONA). We analyzed subjects who reached remission in 2009 with follow up data for two consecutive years. Remission was defined by the Disease Activity Score 28- (DAS28-CRP) of less than 2.6. Sustained remission was defined as three consecutive annual visits in remission. Predictors for sustained remission were identified by multivariate logistic regression analysis. RESULTS A total of 465 subjects were in remission in 2009. Sustained remission was achieved by 53 of 92 (57.5%) in BRASS and by 198 of 373 (53.1%) in KORONA. In multivariate analyses, baseline predictors of sustained remission were: disease duration less than 5 years [odds ratio (OR) 1.96, 95% confidence interval (95% CI) 1.08-3.58], Modified Health Assessment Questionnaire (MHAQ) score of 0 (OR 1.80, 95% CI 1.18-2.74), and non-use of oral glucocorticoid (OR 1.58, 95% CI 1.01-2.47). CONCLUSION More than half of RA subjects in remission in 2009 remained in remission through 2011. Short disease duration, no disability, and non-use of oral glucocorticoid at baseline were associated with sustained remission.
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Affiliation(s)
- Yoon-Kyoung Sung
- Division of Rheumatology, Brigham and Women’s Hospital, Boston, Massachusetts, United States America
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea
- * E-mail:
| | - Kazuki Yoshida
- Division of Rheumatology, Brigham and Women’s Hospital, Boston, Massachusetts, United States America
| | - Femke H. M. Prince
- Division of Rheumatology, Brigham and Women’s Hospital, Boston, Massachusetts, United States America
- Department of Paediatrics/ Paediatric Rheumatology, Erasmus MC Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Michelle L. Frits
- Division of Rheumatology, Brigham and Women’s Hospital, Boston, Massachusetts, United States America
| | - Soo-Kyung Cho
- Division of Rheumatology, Brigham and Women’s Hospital, Boston, Massachusetts, United States America
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea
| | - Jung-Yoon Choe
- Department of Rheumatology, Catholic University of Daegu School of Medicine, Daegu, South Korea
| | - Hye-Soon Lee
- Department of Rheumatology, Hanyang University Guri Hospital, Guri, South Korea
| | - Jisoo Lee
- Division of Rheumatology, Ewha Womans University Mokdong Hospital, Seoul, South Korea
| | - Shin-Seok Lee
- Department of Rheumatology, Chonnam National University Hospital, Gwangju, South Korea
| | - Dae-Hyun Yoo
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea
| | - Simon M. Helfgott
- Division of Rheumatology, Brigham and Women’s Hospital, Boston, Massachusetts, United States America
| | - Nancy A. Shadick
- Division of Rheumatology, Brigham and Women’s Hospital, Boston, Massachusetts, United States America
| | - Michael E. Weinblatt
- Division of Rheumatology, Brigham and Women’s Hospital, Boston, Massachusetts, United States America
| | - Daniel H. Solomon
- Division of Rheumatology, Brigham and Women’s Hospital, Boston, Massachusetts, United States America
| | - Sang-Cheol Bae
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea
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18
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Prognostic Factors for Sustained Remission in a "Real Life" Cohort of Rheumatoid Arthritis Patients. ACTA ACUST UNITED AC 2018; 16:405-409. [PMID: 30482509 DOI: 10.1016/j.reuma.2018.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 09/06/2018] [Accepted: 10/19/2018] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Rheumatoid arthritis (RA) is the most frequent chronic polyarthritis. The current goal of RA treatment is to achieve clinical remission. OBJECTIVE The goal of this study was to determine the prevalence of remission in a cohort of patients from clinical practice, and to identify potentially modifiable factors associated with remission. METHODS A retrospective study was performed on a cohort of RA patients seen at the first consultation at the HUGC Rheumatology Service Dr. Negrín (HUGCDN) between first of January 2000 and thirtieth of April 2014. Sustained remission was defined as DAS28 less than 2.6 in the last two available visits in the medical history. RESULTS A total of 463 patients were consecutively included, most (75%) women, with a mean age at the onset of RA of 50 years and a mean duration of the disease at follow-up of 8 years. 46% of the patients achieved sustained remission. Multiple logistic regression analyses found male sex (P=.031, OR 1.7, 95% CI 1.05-2.82), diagnosis in the first year of symptoms (P=.023, OR 1.7, 95% CI 1.07-2.69) and the initial DAS28 (P=.035) to be independent predictors for sustained remission. CONCLUSIONS The 46% of the patients with RA followed in the HUGC Dr. Negrín are in persistent remission, being the early diagnosis a modifiable factor predictor of remission. Thus, an objective of the Rheumatology Service should be to improve the diagnostic delay of RA in the health area.
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19
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England BR. What Is Most Important in Rheumatoid Arthritis Treatment - Where You Are, Who You Are, or Where You Are Going? J Rheumatol 2018; 45:1341-1343. [PMID: 30275339 DOI: 10.3899/jrheum.180395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Bryant R England
- Division of Rheumatology and Immunology, Department of Internal Medicine, University of Nebraska Medical Center (UNMC), and Veterans Affairs Nebraska-Western IA Health Care System, Omaha, Nebraska, USA
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20
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Aldridge J, Pandya JM, Meurs L, Andersson K, Nordström I, Theander E, Lundell AC, Rudin A. Sex-based differences in association between circulating T cell subsets and disease activity in untreated early rheumatoid arthritis patients. Arthritis Res Ther 2018; 20:150. [PMID: 30029616 PMCID: PMC6053769 DOI: 10.1186/s13075-018-1648-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 06/18/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is not known if sex-based disparities in immunological factors contribute to the disease process in rheumatoid arthritis (RA). Hence, we examined whether circulating T cell subset proportions and their association with disease activity differed in male and female patients with untreated early rheumatoid arthritis (ueRA). METHODS Proportions of T cell subsets were analyzed in peripheral blood from 72 ueRA DMARD- and corticosteroid-naïve patients (50 females and 22 males) and in 31 healthy age- and sex-matched controls. Broad analysis of helper and regulatory CD4+ T cell subsets was done using flow cytometry. Disease activity in patients was assessed using DAS28, CDAI, swollen joint counts, tender joint counts, CRP, and ESR. RESULTS Multivariate factor analyses showed that male and female ueRA patients display distinct profiles of association between disease activity and circulating T cell subset proportions. In male, but not female, ueRA patients Th2 cells showed a positive association with disease activity and correlated significantly with DAS28-ESR, CDAI, and swollen and tender joint counts. Likewise, proportions of non-regulatory CTLA-4+ T cells associated positively with disease activity in male patients only, and correlated with DAS28-ESR. In contrast, there was a negative relation between Th1Th17 subset proportions and disease activity in males only. The proportions of Th17 cells correlated positively with DAS28-ESR in males only, while proportions of Th1 cells showed no relation to disease activity in either sex. There were no significant differences in proportions of T cell subsets between the sexes in patients with ueRA. CONCLUSIONS Our findings show sex-based differences in the association between T cell subsets and disease activity in ueRA patients, and that Th2 helper T cells may have a role in regulating disease activity in male patients.
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Affiliation(s)
- Jonathan Aldridge
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy of University of Gothenburg, Box 480, S-405 30, Gothenburg, Sweden.
| | - Jayesh M Pandya
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy of University of Gothenburg, Box 480, S-405 30, Gothenburg, Sweden
| | - Linda Meurs
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy of University of Gothenburg, Box 480, S-405 30, Gothenburg, Sweden
| | - Kerstin Andersson
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy of University of Gothenburg, Box 480, S-405 30, Gothenburg, Sweden
| | - Inger Nordström
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy of University of Gothenburg, Box 480, S-405 30, Gothenburg, Sweden
| | - Elke Theander
- Department of Rheumatology, Skåne University Hospital Lund and Malmö, Lund University, Lund, Sweden
| | - Anna-Carin Lundell
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy of University of Gothenburg, Box 480, S-405 30, Gothenburg, Sweden
| | - Anna Rudin
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy of University of Gothenburg, Box 480, S-405 30, Gothenburg, Sweden
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Bugatti S, Sakellariou G, Luvaro T, Greco MI, Manzo A. Clinical, Imaging, and Pathological Suppression of Synovitis in Rheumatoid Arthritis: Is the Disease Curable? Front Med (Lausanne) 2018; 5:140. [PMID: 29868592 PMCID: PMC5962817 DOI: 10.3389/fmed.2018.00140] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 04/24/2018] [Indexed: 12/18/2022] Open
Abstract
The management of patients with rheumatoid arthritis (RA) has witnessed a dramatic revolution in recent years, and disease remission has become an increasingly achievable outcome. Rheumatologists are now facing the urgent question of whether, once remission has been achieved and stably maintained, drugs can be tapered, and even discontinued. The concept of disease remission however encompasses progressive layers of complexity, all of which need to be disentangled before considering RA as a “curable” condition. As the synovial membrane represents the ultimate target of the pathological process of RA, a critical issue remains whether disease remission coincides with true suppression of inflammation and definitive tissue “healing.” In this short review, we will provide a critical summary of recent studies investigating the possibility of controlling RA synovitis at the clinical, imaging or pathological level. Potential advantages and limitations of these perspectives in the definition of remission are also discussed.
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Affiliation(s)
- Serena Bugatti
- Division of Rheumatology, Rheumatology and Translational Immunology Research Laboratories (LaRIT), IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - Garifallia Sakellariou
- Division of Rheumatology, Rheumatology and Translational Immunology Research Laboratories (LaRIT), IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - Terenzj Luvaro
- Division of Rheumatology, Rheumatology and Translational Immunology Research Laboratories (LaRIT), IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - Maria Immacolata Greco
- Division of Rheumatology, Rheumatology and Translational Immunology Research Laboratories (LaRIT), IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - Antonio Manzo
- Division of Rheumatology, Rheumatology and Translational Immunology Research Laboratories (LaRIT), IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
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23
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Nourisson C, Soubrier M, Mulliez A, Baillet A, Bardin T, Cantagrel A, Combe B, Dougados M, Flipo RM, Schaeverbeke T, Sibilia J, Vittecoq O, Ravaud P, Gottenberg JE, Mariette X, Tournadre A. Impact of gender on the response and tolerance to abatacept in patients with rheumatoid arthritis: results from the 'ORA' registry. RMD Open 2017; 3:e000515. [PMID: 29177081 PMCID: PMC5687529 DOI: 10.1136/rmdopen-2017-000515] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 10/04/2017] [Accepted: 10/05/2017] [Indexed: 11/19/2022] Open
Abstract
Objective The impact of gender on the response and tolerance to abatacept was assessed in a large prospective cohort during 2 years of follow-up. Methods From the 1017 patients included in the Orencia and Rheumatoid Arthritis registry, disease activity was assessed at baseline, 6, 12 and 24 months. The relationship between the European League Against Rheumatism (EULAR) response, Disease Activity Score 28 (DAS28) remission, rate of adverse events and gender was explored in multivariate analysis. Results 990 patients, 79.3%female, with at least one follow-up visit were analysed. At baseline, women had longer disease duration, higher disease activity and more often received antitumour necrosis factor (TNF) drugs. The remission was not different between men and women during the follow-up after adjustment on age, disease duration and activity, rheumatoid factor and anti-cyclic citrullinated pyeptide (CCP) positivity, and current disease-modifying antirheumatic drugs (DMARDs), previous TNF blockers and corticosteroids use. The proportion of men and women achieving EULAR good-or-moderate response at any endpoints was similar (52.4% vs 55.5%), as well as time to achieving EULAR response (5.4±4.9 vs 5.6±5.2 months). Moderate EULAR response was more frequent in women at 6 months (OR=1.80, p=0.02) but was no longer significant at 12 or 24 months. During the follow-up, the DAS28, the tender joint count score and the patient global assessment remained higher in women (p=0.001, 0.04 and 0.06, respectively). Drug retention and safety were comparable. Conclusion In this large daily practice cohort of established rheumatoid arthritis treated with abatacept, women achieved similar remission and EULAR response than men despite higher disease activity and tender joint count during the treatment course.
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Affiliation(s)
- Cynthia Nourisson
- Rheumatology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Martin Soubrier
- Rheumatology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France.,UNH-UMR 1019, INRA and University of Auvergne, Clermont-Ferrand, France
| | - Aurélien Mulliez
- Biostatistic Unit (DRCI), CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Athan Baillet
- Rheumatology Department, CHU Grenoble Sud Hospital, Grenoble, France
| | - Thomas Bardin
- Rheumatology Department, Hopital Lariboisiere, Paris, France
| | | | - Bernard Combe
- Rheumatology Department, Lapeyronie Hospital, Montpellier University, Montpellier, France
| | - Maxime Dougados
- Rhumatologie B, Cochin Hospital, René Descartes University INSERM (U1153), Paris, France
| | | | | | - Jean Sibilia
- Rheumatology Department, CHU Strasbourg, Strasbourg, France
| | - Olivier Vittecoq
- Rheumatology Department, Rouen University Hospital, Inserm U905, CIC/CRB 1404, Institute for Research and Innovation in Biomedicine (IRIB), University of Rouen, 76031, Rouen, France
| | - Philippe Ravaud
- Centre d'Epidémiologie Clinique, Hotel Dieu, Assistance Publique, Hopitaux de Paris, Paris, France
| | | | - Xavier Mariette
- Rheumatology Department, Université Paris-Sud, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, INSERM U1184, Center for Immunology of Viral Infections and Autoimmune Diseases, Le Kremlin Bicêtre, France
| | - Anne Tournadre
- Rheumatology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France.,UNH-UMR 1019, INRA and University of Auvergne, Clermont-Ferrand, France
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Moots RJ, Sebba A, Rigby W, Ostor A, Porter-Brown B, Donaldson F, Dimonaco S, Rubbert-Roth A, van Vollenhoven R, Genovese MC. Effect of tocilizumab on neutrophils in adult patients with rheumatoid arthritis: pooled analysis of data from phase 3 and 4 clinical trials. Rheumatology (Oxford) 2017; 56:541-549. [PMID: 28013198 PMCID: PMC5410975 DOI: 10.1093/rheumatology/kew370] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Indexed: 01/29/2023] Open
Abstract
Objectives To investigate changes in neutrophil count and occurrences of infection in RA patients treated with the IL-6 receptor-α inhibitor tocilizumab (TCZ). Methods Data were pooled from patients who received i.v. TCZ (4 mg/kg + MTX, 8 mg/kg ± DMARDs, 10 mg/kg) or placebo + DMARDs in phase 3/4 clinical trials, long-term extensions or a pharmacology study. Neutrophil counts were measured routinely according to the Common Toxicity Criteria for Adverse Events grades; TCZ dosing was adjusted if necessary. Covariates associated with decreased neutrophil counts were assessed with multivariate regression analysis. Infection rates within 30 days of neutrophil count changes were calculated per 100 patient-years of TCZ exposure. Results In placebo-controlled parts of trials, more TCZ-treated than placebo-treated patients had grade 1/2 or 3/4 neutrophil counts (TCZ: 28.2%/3.1%; placebo: 8.9%/0.2%). In placebo-controlled trials + long-term extensions, 4171 patients provided 16204.8 patient-years of TCZ exposure. Neutrophil counts decreased through week 6 from baseline [mean ( s . d .) change, -2.17 (2.16) × 10 9 /l) and remained stable thereafter. Rates (95% CI) of serious infections within 30 days of normal [4.66 (4.31, 5.03)], grade 1/2 [2.48 (1.79, 3.34)] and 3/4 [2.77 (0.34, 10.01)] neutrophil counts were similar. Baseline neutrophil count <2 × 10 9 /l and female gender were associated with grade 3/4 neutrophil counts [odds ratio (OR) (95% CI): 19.02 (6.76, 53.52), 2.55 (1.40, 4.66)]. Patients who stopped TCZ in response to decreased neutrophil count returned more quickly to normal levels than patients who reduced or continued their dose. Conclusion Decreases in neutrophil counts in patients taking TCZ do not appear to be associated with serious infections and are normalized by current risk mitigation guidelines.
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Affiliation(s)
- Robert J Moots
- Department of Musculoskeletal Biology, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Anthony Sebba
- Department of Rheumatology, University of South Florida, Tampa, FL
| | - William Rigby
- Medicine/Microbiology and Immunology, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Andrew Ostor
- Department of Rheumatology, Addenbrookes Hospital, Cambridge
| | | | | | | | | | | | - Mark C Genovese
- Division of Rheumatology, Stanford University Medical Center, Palo Alto, CA, USA
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Risk factors of flare in rheumatoid arthritis patients with both clinical and ultrasonographic remission: a retrospective study from China. Clin Rheumatol 2017. [DOI: 10.1007/s10067-017-3736-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Behrens M, Luckey D, Luthra H, David C, Taneja V. B cells influence sex specificity of arthritis via myeloid suppressors and chemokines in humanized mice. Clin Immunol 2017; 178:10-19. [DOI: 10.1016/j.clim.2015.05.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 05/15/2015] [Accepted: 05/31/2015] [Indexed: 12/15/2022]
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Sugiyama N, Kawahito Y, Fujii T, Atsumi T, Murata T, Morishima Y, Fukuma Y. Treatment Patterns, Direct Cost of Biologics, and Direct Medical Costs for Rheumatoid Arthritis Patients: A Real-world Analysis of Nationwide Japanese Claims Data. Clin Ther 2016; 38:1359-1375.e1. [PMID: 27101816 DOI: 10.1016/j.clinthera.2016.03.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 02/18/2016] [Accepted: 03/14/2016] [Indexed: 12/11/2022]
Abstract
PURPOSE The aims of this article were to characterize the patterns of treating rheumatoid arthritis with biologics and to evaluate costs using claims data from the Japan Medical Data Center Co, Ltd. METHODS Patients aged 16 to <75 years who were diagnosed with rheumatoid arthritis and prescribed adalimumab (ADA), etanercept (ETN), infliximab (IFX), tocilizumab (TCZ), abatacept, certolizumab, or golimumab between January 2005 and August 2014 were included. For the cross-sectional analysis, the annual costs of ETN, IFX, ADA, and TCZ from 2009 to 2013 were assessed. For the longitudinal analysis, patients prescribed these biologics as the first line of biologics, from January 2005 to August 2014, were included. The cost of biologic treatment over 1, 2, and 3 years (including prescription of subsequent biologics) and direct medical costs (including treatment of comorbidities) were compared between groups. Discontinuation and switching rates in each group were estimated, and multivariate analyses were conducted to estimate an adjusted hazard ratio of discontinuation and switching rates among each group. The dose of each first-line biologic treatment until discontinuation was analyzed to calculate relative dose intensity. FINDINGS The cross-sectional annual biologic costs of ETN, IFX, ADA, and TCZ were ~$8000 (2009 and 2013), $13,000 (2009) and $15,000 (2013), $10,000 (2009) and $11,000 (2013), and $9000 (2009) and $8000 (2013), respectively. In longitudinal analyses (n = 764), 276 (36%) initiated ETN; 242 (32%), IFX; 147 (19%), ADA; and 99 (13%), TCZ. The 1-year cumulative annual biologic costs per patient from the initial prescription of ETN, IFX, ADA, and TCZ as the first-line biologic treatment were ~$11,000, $19,000, $16,000, and $12,000. The corresponding direct medical costs over 1 year from the initial prescription were ~$17,000, $26,000, $22,000, and $22,000. Costs remained greatest in the IFX-initiation group at year 3. The discontinuation rates at 36 months with ETN, IFX, ADA, and TCZ were 37.7%, 52.3%, 55.8%, and 39.5%; the switching rates were 12.5%, 27.1%, 31.0%, and 16.7%. The mean (95% CI) relative dose intensities until discontinuation of ETN 25 mg, ETN 50 mg, IFX, ADA, and TCZ were 1.02 (0.95-1.10), 0.82 (0.79-0.85), 1.16 (1.12-1.20), 0.95 (0.90-0.99), and 0.96 (0.93-1.00). IMPLICATIONS Considered costs and discontinuation and switching event rates were lowest with ETN versus IFX, ADA, or TCZ used as the first-line biologic. Despite limitations, these findings imply clinical cost-reductive benefits of ETN as the first-line biologic treatment option for rheumatoid arthritis in Japan.
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Affiliation(s)
| | - Yutaka Kawahito
- Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takao Fujii
- Department of the Control for Rheumatic Disease, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tatsuya Atsumi
- Division of Rheumatology, Endocrinology and Nephrology, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Tatsunori Murata
- CRECON Medical Assessment Inc, The Pharmaceutical Society of Japan, Tokyo, Japan
| | | | - Yuri Fukuma
- Medical Affairs, Pfizer Japan Inc, Tokyo, Japan
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Kuriya B, Xiong J, Boire G, Haraoui B, Hitchon C, Pope J, Thorne JC, Tin D, Keystone EC, Bykerk V. Earlier time to remission predicts sustained clinical remission in early rheumatoid arthritis--results from the Canadian Early Arthritis Cohort (CATCH). J Rheumatol 2014; 41:2161-6. [PMID: 25274902 DOI: 10.3899/jrheum.140137] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate the prevalence and predictive factors of sustained remission in an early rheumatoid arthritis (ERA) population. Predictive factors of sustained remission in ERA are unknown. We hypothesized that a short time to remission is an important predictor of sustained clinical remission. METHODS Patients in the Canadian Early Arthritis Cohort were included. Remission was defined by Boolean-based American College of Rheumatology/European League Against Rheumatism clinical trial and clinical practice definitions and Simplified Disease Activity Index (SDAI). Logistic regression analysis identified predictors of sustained remission and influence of time to remission. RESULTS Of 1840 patients, 633 (34%) achieved clinical trial remission, 759 (41%) clinical practice remission, and 727 (39%) SDAI remission. Over half of those meeting remission criteria achieved sustained remission based on clinical trial (55%), clinical practice (60%), and/or SDAI (58%). Corticosteroid use and lack of initial disease-modifying antirheumatic drug (DMARD) were associated with decreased probability of sustained remission, while initial combination DMARD increased this probability. Female sex, greater pain, and longer time to first remission made sustained remission less likely. CONCLUSION Female sex, greater pain, and lack of initial DMARD therapy reduced the probability of sustained remission. A shorter time to remission is related to sustainability and supports striving for early remission.
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Affiliation(s)
- Bindee Kuriya
- From the Rheumatology Department, Mount Sinai Hospital, University of Toronto, Toronto, Ontario; Université de Sherbrooke, Sherbrooke; Rheumatic Disease Unit, Institut de Rhumatologie, Montreal, Quebec; Arthritis Centre, University of Manitoba, Winnipeg, Manitoba; Rheumatology Department, St. Joseph's Health Care, Western University, London; Southlake Regional Health Centre, Newmarket, Ontario, Canada; Hospital for Special Surgery, Cornell University, New York, New York, USA.B. Kuriya, MD, MS, FRCPC; J. Xiong, MSc, PhD, Rheumatology Department, Mount Sinai Hospital, University of Toronto; G. Boire, MD, MSc, FRCPC, Université de Sherbrooke; B. Haraoui, MD, FRCPC, Rheumatic Disease Unit, Institut de Rhumatologie; C. Hitchon, MD, MSc, FRCPC, Arthritis Centre, University of Manitoba; J. Pope, MD, MPH, FRCPC, Rheumatology Department, St. Joseph's Health Care, Western University; J.C. Thorne, MD, FRCP, FACP; D. Tin, BSc PHm, RPh, CDE, CGP, Southlake Regional Health Centre; E.C. Keystone, MD, FRCPC, Rheumatology Department, Mount Sinai Hospital, University of Toronto; V. Bykerk, MD, FRCPC, Rheumatology Department, Mount Sinai Hospital, University of Toronto, and Hospital for Special Surgery, Cornell University.
| | - Juan Xiong
- From the Rheumatology Department, Mount Sinai Hospital, University of Toronto, Toronto, Ontario; Université de Sherbrooke, Sherbrooke; Rheumatic Disease Unit, Institut de Rhumatologie, Montreal, Quebec; Arthritis Centre, University of Manitoba, Winnipeg, Manitoba; Rheumatology Department, St. Joseph's Health Care, Western University, London; Southlake Regional Health Centre, Newmarket, Ontario, Canada; Hospital for Special Surgery, Cornell University, New York, New York, USA.B. Kuriya, MD, MS, FRCPC; J. Xiong, MSc, PhD, Rheumatology Department, Mount Sinai Hospital, University of Toronto; G. Boire, MD, MSc, FRCPC, Université de Sherbrooke; B. Haraoui, MD, FRCPC, Rheumatic Disease Unit, Institut de Rhumatologie; C. Hitchon, MD, MSc, FRCPC, Arthritis Centre, University of Manitoba; J. Pope, MD, MPH, FRCPC, Rheumatology Department, St. Joseph's Health Care, Western University; J.C. Thorne, MD, FRCP, FACP; D. Tin, BSc PHm, RPh, CDE, CGP, Southlake Regional Health Centre; E.C. Keystone, MD, FRCPC, Rheumatology Department, Mount Sinai Hospital, University of Toronto; V. Bykerk, MD, FRCPC, Rheumatology Department, Mount Sinai Hospital, University of Toronto, and Hospital for Special Surgery, Cornell University
| | - Gilles Boire
- From the Rheumatology Department, Mount Sinai Hospital, University of Toronto, Toronto, Ontario; Université de Sherbrooke, Sherbrooke; Rheumatic Disease Unit, Institut de Rhumatologie, Montreal, Quebec; Arthritis Centre, University of Manitoba, Winnipeg, Manitoba; Rheumatology Department, St. Joseph's Health Care, Western University, London; Southlake Regional Health Centre, Newmarket, Ontario, Canada; Hospital for Special Surgery, Cornell University, New York, New York, USA.B. Kuriya, MD, MS, FRCPC; J. Xiong, MSc, PhD, Rheumatology Department, Mount Sinai Hospital, University of Toronto; G. Boire, MD, MSc, FRCPC, Université de Sherbrooke; B. Haraoui, MD, FRCPC, Rheumatic Disease Unit, Institut de Rhumatologie; C. Hitchon, MD, MSc, FRCPC, Arthritis Centre, University of Manitoba; J. Pope, MD, MPH, FRCPC, Rheumatology Department, St. Joseph's Health Care, Western University; J.C. Thorne, MD, FRCP, FACP; D. Tin, BSc PHm, RPh, CDE, CGP, Southlake Regional Health Centre; E.C. Keystone, MD, FRCPC, Rheumatology Department, Mount Sinai Hospital, University of Toronto; V. Bykerk, MD, FRCPC, Rheumatology Department, Mount Sinai Hospital, University of Toronto, and Hospital for Special Surgery, Cornell University
| | - Boulos Haraoui
- From the Rheumatology Department, Mount Sinai Hospital, University of Toronto, Toronto, Ontario; Université de Sherbrooke, Sherbrooke; Rheumatic Disease Unit, Institut de Rhumatologie, Montreal, Quebec; Arthritis Centre, University of Manitoba, Winnipeg, Manitoba; Rheumatology Department, St. Joseph's Health Care, Western University, London; Southlake Regional Health Centre, Newmarket, Ontario, Canada; Hospital for Special Surgery, Cornell University, New York, New York, USA.B. Kuriya, MD, MS, FRCPC; J. Xiong, MSc, PhD, Rheumatology Department, Mount Sinai Hospital, University of Toronto; G. Boire, MD, MSc, FRCPC, Université de Sherbrooke; B. Haraoui, MD, FRCPC, Rheumatic Disease Unit, Institut de Rhumatologie; C. Hitchon, MD, MSc, FRCPC, Arthritis Centre, University of Manitoba; J. Pope, MD, MPH, FRCPC, Rheumatology Department, St. Joseph's Health Care, Western University; J.C. Thorne, MD, FRCP, FACP; D. Tin, BSc PHm, RPh, CDE, CGP, Southlake Regional Health Centre; E.C. Keystone, MD, FRCPC, Rheumatology Department, Mount Sinai Hospital, University of Toronto; V. Bykerk, MD, FRCPC, Rheumatology Department, Mount Sinai Hospital, University of Toronto, and Hospital for Special Surgery, Cornell University
| | - Carol Hitchon
- From the Rheumatology Department, Mount Sinai Hospital, University of Toronto, Toronto, Ontario; Université de Sherbrooke, Sherbrooke; Rheumatic Disease Unit, Institut de Rhumatologie, Montreal, Quebec; Arthritis Centre, University of Manitoba, Winnipeg, Manitoba; Rheumatology Department, St. Joseph's Health Care, Western University, London; Southlake Regional Health Centre, Newmarket, Ontario, Canada; Hospital for Special Surgery, Cornell University, New York, New York, USA.B. Kuriya, MD, MS, FRCPC; J. Xiong, MSc, PhD, Rheumatology Department, Mount Sinai Hospital, University of Toronto; G. Boire, MD, MSc, FRCPC, Université de Sherbrooke; B. Haraoui, MD, FRCPC, Rheumatic Disease Unit, Institut de Rhumatologie; C. Hitchon, MD, MSc, FRCPC, Arthritis Centre, University of Manitoba; J. Pope, MD, MPH, FRCPC, Rheumatology Department, St. Joseph's Health Care, Western University; J.C. Thorne, MD, FRCP, FACP; D. Tin, BSc PHm, RPh, CDE, CGP, Southlake Regional Health Centre; E.C. Keystone, MD, FRCPC, Rheumatology Department, Mount Sinai Hospital, University of Toronto; V. Bykerk, MD, FRCPC, Rheumatology Department, Mount Sinai Hospital, University of Toronto, and Hospital for Special Surgery, Cornell University
| | - Janet Pope
- From the Rheumatology Department, Mount Sinai Hospital, University of Toronto, Toronto, Ontario; Université de Sherbrooke, Sherbrooke; Rheumatic Disease Unit, Institut de Rhumatologie, Montreal, Quebec; Arthritis Centre, University of Manitoba, Winnipeg, Manitoba; Rheumatology Department, St. Joseph's Health Care, Western University, London; Southlake Regional Health Centre, Newmarket, Ontario, Canada; Hospital for Special Surgery, Cornell University, New York, New York, USA.B. Kuriya, MD, MS, FRCPC; J. Xiong, MSc, PhD, Rheumatology Department, Mount Sinai Hospital, University of Toronto; G. Boire, MD, MSc, FRCPC, Université de Sherbrooke; B. Haraoui, MD, FRCPC, Rheumatic Disease Unit, Institut de Rhumatologie; C. Hitchon, MD, MSc, FRCPC, Arthritis Centre, University of Manitoba; J. Pope, MD, MPH, FRCPC, Rheumatology Department, St. Joseph's Health Care, Western University; J.C. Thorne, MD, FRCP, FACP; D. Tin, BSc PHm, RPh, CDE, CGP, Southlake Regional Health Centre; E.C. Keystone, MD, FRCPC, Rheumatology Department, Mount Sinai Hospital, University of Toronto; V. Bykerk, MD, FRCPC, Rheumatology Department, Mount Sinai Hospital, University of Toronto, and Hospital for Special Surgery, Cornell University
| | - John Carter Thorne
- From the Rheumatology Department, Mount Sinai Hospital, University of Toronto, Toronto, Ontario; Université de Sherbrooke, Sherbrooke; Rheumatic Disease Unit, Institut de Rhumatologie, Montreal, Quebec; Arthritis Centre, University of Manitoba, Winnipeg, Manitoba; Rheumatology Department, St. Joseph's Health Care, Western University, London; Southlake Regional Health Centre, Newmarket, Ontario, Canada; Hospital for Special Surgery, Cornell University, New York, New York, USA.B. Kuriya, MD, MS, FRCPC; J. Xiong, MSc, PhD, Rheumatology Department, Mount Sinai Hospital, University of Toronto; G. Boire, MD, MSc, FRCPC, Université de Sherbrooke; B. Haraoui, MD, FRCPC, Rheumatic Disease Unit, Institut de Rhumatologie; C. Hitchon, MD, MSc, FRCPC, Arthritis Centre, University of Manitoba; J. Pope, MD, MPH, FRCPC, Rheumatology Department, St. Joseph's Health Care, Western University; J.C. Thorne, MD, FRCP, FACP; D. Tin, BSc PHm, RPh, CDE, CGP, Southlake Regional Health Centre; E.C. Keystone, MD, FRCPC, Rheumatology Department, Mount Sinai Hospital, University of Toronto; V. Bykerk, MD, FRCPC, Rheumatology Department, Mount Sinai Hospital, University of Toronto, and Hospital for Special Surgery, Cornell University
| | - Diane Tin
- From the Rheumatology Department, Mount Sinai Hospital, University of Toronto, Toronto, Ontario; Université de Sherbrooke, Sherbrooke; Rheumatic Disease Unit, Institut de Rhumatologie, Montreal, Quebec; Arthritis Centre, University of Manitoba, Winnipeg, Manitoba; Rheumatology Department, St. Joseph's Health Care, Western University, London; Southlake Regional Health Centre, Newmarket, Ontario, Canada; Hospital for Special Surgery, Cornell University, New York, New York, USA.B. Kuriya, MD, MS, FRCPC; J. Xiong, MSc, PhD, Rheumatology Department, Mount Sinai Hospital, University of Toronto; G. Boire, MD, MSc, FRCPC, Université de Sherbrooke; B. Haraoui, MD, FRCPC, Rheumatic Disease Unit, Institut de Rhumatologie; C. Hitchon, MD, MSc, FRCPC, Arthritis Centre, University of Manitoba; J. Pope, MD, MPH, FRCPC, Rheumatology Department, St. Joseph's Health Care, Western University; J.C. Thorne, MD, FRCP, FACP; D. Tin, BSc PHm, RPh, CDE, CGP, Southlake Regional Health Centre; E.C. Keystone, MD, FRCPC, Rheumatology Department, Mount Sinai Hospital, University of Toronto; V. Bykerk, MD, FRCPC, Rheumatology Department, Mount Sinai Hospital, University of Toronto, and Hospital for Special Surgery, Cornell University
| | - Edward C Keystone
- From the Rheumatology Department, Mount Sinai Hospital, University of Toronto, Toronto, Ontario; Université de Sherbrooke, Sherbrooke; Rheumatic Disease Unit, Institut de Rhumatologie, Montreal, Quebec; Arthritis Centre, University of Manitoba, Winnipeg, Manitoba; Rheumatology Department, St. Joseph's Health Care, Western University, London; Southlake Regional Health Centre, Newmarket, Ontario, Canada; Hospital for Special Surgery, Cornell University, New York, New York, USA.B. Kuriya, MD, MS, FRCPC; J. Xiong, MSc, PhD, Rheumatology Department, Mount Sinai Hospital, University of Toronto; G. Boire, MD, MSc, FRCPC, Université de Sherbrooke; B. Haraoui, MD, FRCPC, Rheumatic Disease Unit, Institut de Rhumatologie; C. Hitchon, MD, MSc, FRCPC, Arthritis Centre, University of Manitoba; J. Pope, MD, MPH, FRCPC, Rheumatology Department, St. Joseph's Health Care, Western University; J.C. Thorne, MD, FRCP, FACP; D. Tin, BSc PHm, RPh, CDE, CGP, Southlake Regional Health Centre; E.C. Keystone, MD, FRCPC, Rheumatology Department, Mount Sinai Hospital, University of Toronto; V. Bykerk, MD, FRCPC, Rheumatology Department, Mount Sinai Hospital, University of Toronto, and Hospital for Special Surgery, Cornell University
| | - Vivian Bykerk
- From the Rheumatology Department, Mount Sinai Hospital, University of Toronto, Toronto, Ontario; Université de Sherbrooke, Sherbrooke; Rheumatic Disease Unit, Institut de Rhumatologie, Montreal, Quebec; Arthritis Centre, University of Manitoba, Winnipeg, Manitoba; Rheumatology Department, St. Joseph's Health Care, Western University, London; Southlake Regional Health Centre, Newmarket, Ontario, Canada; Hospital for Special Surgery, Cornell University, New York, New York, USA.B. Kuriya, MD, MS, FRCPC; J. Xiong, MSc, PhD, Rheumatology Department, Mount Sinai Hospital, University of Toronto; G. Boire, MD, MSc, FRCPC, Université de Sherbrooke; B. Haraoui, MD, FRCPC, Rheumatic Disease Unit, Institut de Rhumatologie; C. Hitchon, MD, MSc, FRCPC, Arthritis Centre, University of Manitoba; J. Pope, MD, MPH, FRCPC, Rheumatology Department, St. Joseph's Health Care, Western University; J.C. Thorne, MD, FRCP, FACP; D. Tin, BSc PHm, RPh, CDE, CGP, Southlake Regional Health Centre; E.C. Keystone, MD, FRCPC, Rheumatology Department, Mount Sinai Hospital, University of Toronto; V. Bykerk, MD, FRCPC, Rheumatology Department, Mount Sinai Hospital, University of Toronto, and Hospital for Special Surgery, Cornell University
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Kojima T, Yabe Y, Kaneko A, Takahashi N, Funahashi K, Kato D, Hanabayashi M, Asai S, Hirabara S, Asai N, Hirano Y, Hayashi M, Miyake H, Kojima M, Ishiguro N. Importance of methotrexate therapy concomitant with tocilizumab treatment in achieving better clinical outcomes for rheumatoid arthritis patients with high disease activity: an observational cohort study. Rheumatology (Oxford) 2014; 54:113-20. [DOI: 10.1093/rheumatology/keu302] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Barnabe C, Thanh NX, Ohinmaa A, Homik J, Barr SG, Martin L, Maksymowych WP. Effect of remission definition on healthcare cost savings estimates for patients with rheumatoid arthritis treated with biologic therapies. J Rheumatol 2014; 41:1600-6. [PMID: 25028381 DOI: 10.3899/jrheum.131449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Sustained remission in rheumatoid arthritis (RA) results in healthcare utilization cost savings. We evaluated the variation in estimates of savings when different definitions of remission [2011 American College of Rheumatology/European League Against Rheumatism Boolean Definition, Simplified Disease Activity Index (SDAI) ≤ 3.3, Clinical Disease Activity Index (CDAI) ≤ 2.8, and Disease Activity Score-28 (DAS28) ≤ 2.6] are applied. METHODS The annual mean healthcare service utilization costs were estimated from provincial physician billing claims, outpatient visits, and hospitalizations, with linkage to clinical data from the Alberta Biologics Pharmacosurveillance Program (ABioPharm). Cost savings in patients who had a 1-year continuous period of remission were compared to those who did not, using 4 definitions of remission. RESULTS In 1086 patients, sustained remission rates were 16.1% for DAS28, 8.8% for Boolean, 5.5% for CDAI, and 4.2% for SDAI. The estimated mean annual healthcare cost savings per patient achieving remission (relative to not) were SDAI $1928 (95% CI 592, 3264), DAS28 $1676 (95% CI 987, 2365), and Boolean $1259 (95% CI 417, 2100). The annual savings by CDAI remission per patient were not significant at $423 (95% CI -1757, 2602). For patients in DAS28, Boolean, and SDAI remission, savings were seen both in costs directly related to RA and its comorbidities, and in costs for non-RA-related conditions. CONCLUSION The magnitude of the healthcare cost savings varies according to the remission definition used in classifying patient disease status. The highest point estimate for cost savings was observed in patients attaining SDAI remission and the least with the CDAI; confidence intervals for these estimates do overlap. Future pharmacoeconomic analyses should employ all response definitions in assessing the influence of treatment.
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Affiliation(s)
- Cheryl Barnabe
- From the Department of Medicine, University of Calgary, Calgary; Department of Community Health Sciences, University of Calgary, Calgary; Institute of Health Economics, Edmonton; School of Public Health, University of Alberta, Edmonton; and Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.C. Barnabe, MD, MSc, FRCPC, Department of Medicine and Department of Community Health Sciences, University of Calgary; N.X. Thanh, MD, PhD, MPH, Institute of Health Economics and School of Public Health, University of Alberta; A. Ohinmaa, PhD, Institute of Health Economics and School of Public Health, University of Alberta; J. Homik, MD, MSc, FRCPC, Department of Medicine, University of Alberta; S.G. Barr, MD, MSc, FRCPC, Department of Medicine, and Department of Community Health Sciences, University of Calgary; L. Martin, MB, ChB, FRCPC, Department of Medicine, University of Calgary; W.P. Maksymowych, MB, ChB, FRCPC, Department of Medicine, University of Alberta.
| | - Nguyen Xuan Thanh
- From the Department of Medicine, University of Calgary, Calgary; Department of Community Health Sciences, University of Calgary, Calgary; Institute of Health Economics, Edmonton; School of Public Health, University of Alberta, Edmonton; and Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.C. Barnabe, MD, MSc, FRCPC, Department of Medicine and Department of Community Health Sciences, University of Calgary; N.X. Thanh, MD, PhD, MPH, Institute of Health Economics and School of Public Health, University of Alberta; A. Ohinmaa, PhD, Institute of Health Economics and School of Public Health, University of Alberta; J. Homik, MD, MSc, FRCPC, Department of Medicine, University of Alberta; S.G. Barr, MD, MSc, FRCPC, Department of Medicine, and Department of Community Health Sciences, University of Calgary; L. Martin, MB, ChB, FRCPC, Department of Medicine, University of Calgary; W.P. Maksymowych, MB, ChB, FRCPC, Department of Medicine, University of Alberta
| | - Arto Ohinmaa
- From the Department of Medicine, University of Calgary, Calgary; Department of Community Health Sciences, University of Calgary, Calgary; Institute of Health Economics, Edmonton; School of Public Health, University of Alberta, Edmonton; and Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.C. Barnabe, MD, MSc, FRCPC, Department of Medicine and Department of Community Health Sciences, University of Calgary; N.X. Thanh, MD, PhD, MPH, Institute of Health Economics and School of Public Health, University of Alberta; A. Ohinmaa, PhD, Institute of Health Economics and School of Public Health, University of Alberta; J. Homik, MD, MSc, FRCPC, Department of Medicine, University of Alberta; S.G. Barr, MD, MSc, FRCPC, Department of Medicine, and Department of Community Health Sciences, University of Calgary; L. Martin, MB, ChB, FRCPC, Department of Medicine, University of Calgary; W.P. Maksymowych, MB, ChB, FRCPC, Department of Medicine, University of Alberta
| | - Joanne Homik
- From the Department of Medicine, University of Calgary, Calgary; Department of Community Health Sciences, University of Calgary, Calgary; Institute of Health Economics, Edmonton; School of Public Health, University of Alberta, Edmonton; and Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.C. Barnabe, MD, MSc, FRCPC, Department of Medicine and Department of Community Health Sciences, University of Calgary; N.X. Thanh, MD, PhD, MPH, Institute of Health Economics and School of Public Health, University of Alberta; A. Ohinmaa, PhD, Institute of Health Economics and School of Public Health, University of Alberta; J. Homik, MD, MSc, FRCPC, Department of Medicine, University of Alberta; S.G. Barr, MD, MSc, FRCPC, Department of Medicine, and Department of Community Health Sciences, University of Calgary; L. Martin, MB, ChB, FRCPC, Department of Medicine, University of Calgary; W.P. Maksymowych, MB, ChB, FRCPC, Department of Medicine, University of Alberta
| | - Susan G Barr
- From the Department of Medicine, University of Calgary, Calgary; Department of Community Health Sciences, University of Calgary, Calgary; Institute of Health Economics, Edmonton; School of Public Health, University of Alberta, Edmonton; and Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.C. Barnabe, MD, MSc, FRCPC, Department of Medicine and Department of Community Health Sciences, University of Calgary; N.X. Thanh, MD, PhD, MPH, Institute of Health Economics and School of Public Health, University of Alberta; A. Ohinmaa, PhD, Institute of Health Economics and School of Public Health, University of Alberta; J. Homik, MD, MSc, FRCPC, Department of Medicine, University of Alberta; S.G. Barr, MD, MSc, FRCPC, Department of Medicine, and Department of Community Health Sciences, University of Calgary; L. Martin, MB, ChB, FRCPC, Department of Medicine, University of Calgary; W.P. Maksymowych, MB, ChB, FRCPC, Department of Medicine, University of Alberta
| | - Liam Martin
- From the Department of Medicine, University of Calgary, Calgary; Department of Community Health Sciences, University of Calgary, Calgary; Institute of Health Economics, Edmonton; School of Public Health, University of Alberta, Edmonton; and Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.C. Barnabe, MD, MSc, FRCPC, Department of Medicine and Department of Community Health Sciences, University of Calgary; N.X. Thanh, MD, PhD, MPH, Institute of Health Economics and School of Public Health, University of Alberta; A. Ohinmaa, PhD, Institute of Health Economics and School of Public Health, University of Alberta; J. Homik, MD, MSc, FRCPC, Department of Medicine, University of Alberta; S.G. Barr, MD, MSc, FRCPC, Department of Medicine, and Department of Community Health Sciences, University of Calgary; L. Martin, MB, ChB, FRCPC, Department of Medicine, University of Calgary; W.P. Maksymowych, MB, ChB, FRCPC, Department of Medicine, University of Alberta
| | - Walter P Maksymowych
- From the Department of Medicine, University of Calgary, Calgary; Department of Community Health Sciences, University of Calgary, Calgary; Institute of Health Economics, Edmonton; School of Public Health, University of Alberta, Edmonton; and Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.C. Barnabe, MD, MSc, FRCPC, Department of Medicine and Department of Community Health Sciences, University of Calgary; N.X. Thanh, MD, PhD, MPH, Institute of Health Economics and School of Public Health, University of Alberta; A. Ohinmaa, PhD, Institute of Health Economics and School of Public Health, University of Alberta; J. Homik, MD, MSc, FRCPC, Department of Medicine, University of Alberta; S.G. Barr, MD, MSc, FRCPC, Department of Medicine, and Department of Community Health Sciences, University of Calgary; L. Martin, MB, ChB, FRCPC, Department of Medicine, University of Calgary; W.P. Maksymowych, MB, ChB, FRCPC, Department of Medicine, University of Alberta
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Couderc M, Gottenberg JE, Mariette X, Pereira B, Bardin T, Cantagrel A, Combe B, Dougados M, Flipo RM, Le Loet X, Shaeverbeke T, Ravaud P, Soubrier M. Influence of gender on response to rituximab in patients with rheumatoid arthritis: results from the Autoimmunity and Rituximab registry. Rheumatology (Oxford) 2014; 53:1788-93. [DOI: 10.1093/rheumatology/keu176] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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Biologic therapy response and drug survival for females compared to males with rheumatoid arthritis: a cohort study. Rheumatol Int 2014; 34:1449-53. [DOI: 10.1007/s00296-014-2999-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 03/20/2014] [Indexed: 02/08/2023]
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Sexual disparities in the incidence and course of SLE and RA. Clin Immunol 2013; 149:211-8. [DOI: 10.1016/j.clim.2013.03.003] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 01/25/2013] [Accepted: 03/07/2013] [Indexed: 02/08/2023]
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Navarro-Millán IY, Chen L, Greenberg JD, Pappas DA, Curtis JR. Predictors and persistence of new-onset clinical remission in rheumatoid arthritis patients. Semin Arthritis Rheum 2013; 43:137-43. [PMID: 23742957 PMCID: PMC4184191 DOI: 10.1016/j.semarthrit.2013.02.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 02/07/2013] [Accepted: 02/15/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine the prevalence and persistence of new-onset clinical remission in rheumatoid arthritis (RA) patients. METHODS The Consortium of Rheumatology Researchers of North America (CORRONA) cohort was used to examine the prevalence of remission and associated comorbidities and RA therapies according to the 2011 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) remission criteria. Factors influencing the likelihood of remaining in remission were identified by logistic regression with generalized estimating equations. Analysis of variance and Tukey's test were used to determine differences in disability according to whether RA patients had been in remission or only low disease activity (LDA). RESULTS A total of 2105 individuals met ACR/EULAR remission criteria at the most recent visit within CORRONA, yielding an 8% point prevalence of remission. Patients with certain comorbidities (e.g., heart failure) were significantly less likely to achieve or remain in remission compared to those without these conditions (p < 0.001 for each). Among prednisone users, the prevalence of remission was 1-6% (depending on dose) higher compared to those not on prednisone (10%). More than 50% of patients who had consistently been in remission for ≥1 year were able to remain in remission over the next year. Patients consistently in remission had less disability than patients who achieved LDA or who fluctuated between remission and LDA. CONCLUSION Patients consistently in remission for at least 1 year had a high likelihood to remain in remission. These individuals might be considered the most likely candidates for de-escalation or withdrawal of RA treatments.
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Affiliation(s)
| | - Lang Chen
- University of Alabama at Birmingham; Birmingham, AL
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