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Sparks JA, Harrold LR, Simon TA, Wittstock K, Kelly S, Lozenski K, Khaychuk V, Michaud K. Comparative effectiveness of treatments for rheumatoid arthritis in clinical practice: A systematic review. Semin Arthritis Rheum 2023; 62:152249. [PMID: 37573754 DOI: 10.1016/j.semarthrit.2023.152249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 07/11/2023] [Accepted: 07/24/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVE To assess real-world comparative effectiveness studies of biologic (b) and targeted synthetic (ts) disease-modifying antirheumatic drugs (DMARDs) in adults with rheumatoid arthritis (RA) through a systematic review. METHODS We searched Medline for journal articles (2001-2021) and Embase® for abstracts presented at the European Alliance of Associations for Rheumatology and American College of Rheumatology (ACR) 2020 and 2021 annual meetings on non-randomized studies comparing the effectiveness of b/tsDMARDs using ACR-recommended disease activity measures, measures of functional status, and patient-reported outcomes (HAQ, PROMIS PF, patient pain, Patient and Physician Global Assessment of disease activity). Methodological heterogeneity between studies precluded meta-analyses. Risk of bias was assessed using the Cochrane Risk Of Bias In Non-randomized Studies of Interventions-I tool. RESULTS Of 1283 records screened, 68 were selected for data extraction, of which 1 was excluded due to critical risk of bias. Most studies were multicenter observational cohort/registry studies (n = 60) and were published between 2011 and 2021 (n = 60). Mean or median reported RA duration was between 6 and 15 years. Disease Activity Score in 28 joints (46 studies), Clinical Disease Activity Index (37 studies), and Health Assessment Questionnaire-Disability Index (32 studies) were the most common outcomes used in clinical practice, with regional differences identified. The most common comparison was between tumor necrosis factor inhibitors (TNFis) and non-TNFi bDMARDs (35 studies). There were no evident differences between b/tsDMARDs in clinical effectiveness. CONCLUSION This systematic review summarizing real-world evidence from a very large number of global studies found there are many effective options for the treatment of RA, but relatively less evidence to support the use of any one b/tsDMARD or drug class over another. Treatment for patients with RA should be tailored to suit individual clinical profiles. Further research is needed to identify whether specific patient subgroups may benefit from specific drug classes.
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Affiliation(s)
- Jeffrey A Sparks
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Leslie R Harrold
- CorEvitas, LLC, Waltham, MA, USA; University of Massachusetts Medical School, Worcester, MA, USA
| | | | | | | | | | | | - Kaleb Michaud
- University of Nebraska Medical Center, Omaha, NE, USA; FORWARD, The National Databank for Rheumatic Diseases, Wichita, KS, USA.
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Michelsen B, Berget KT, Loge JH, Kavanaugh A, Haugeberg G. Sex difference in disease burden of inflammatory arthritis patients treated with tumor necrosis factor inhibitors as part of standard care. PLoS One 2022; 17:e0266816. [PMID: 35511905 PMCID: PMC9071161 DOI: 10.1371/journal.pone.0266816] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/29/2022] [Indexed: 11/18/2022] Open
Abstract
Objective Knowledge is needed on the total disease burden across the sexes in inflammatory arthritis (IA). We aimed to compare disease burden, including a broad range of health aspects, across men and women with IA treated with tumor necrosis factor inhibitors (TNFi). Methods Adult outpatients with IA (rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis) were included as part of standard care. Patient-reported outcomes, disease activity, TNFi trough levels, calprotectin, Work Productivity and Activity Impairment, comorbidities and cardiovascular risk profile were assessed. Unadjusted comparisons across sexes were done with independent t-test, Mann-Whitney U-test and X2-test and adjusted analyses with General Linear Models and logistic/ordinal logistic regression. Results A total of 305 IA patients were included (167 men, 138 women). A significantly lower proportion of women (45%) than men (59%) were in remission according to disease-specific composite scores (p = 0.02). Women had significantly worse scores on pain, joint pain, fatigue, enthesitis, Health Assessment Questionnaire and Short Form (SF)-36 vitality and social functioning (all p≤0.04). Both sexes had worse SF-36 scale scores than the general population. Women reported more absenteeism (work time missed) and activity impairment. TNFi trough levels, neutralizing antibodies and calprotectin were similar across sexes. A similar total number of comorbidities was seen. Self-reported hypothyroidism was more frequent in women. Men had higher 10-year calculated risk of fatal cardiovascular events. Conclusion Important differences in disease burden between men and women were seen. More attention to sex differences in the follow-up of IA patients is warranted.
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Affiliation(s)
- Brigitte Michelsen
- Division of Rheumatology, Department of Medicine, Sørlandet Hospital Kristiansand, Kristiansand, Norway
- * E-mail:
| | - Kristine Thomassen Berget
- Department of Clinical Immunology and Transfusion Medicine, Sørlandet Hospital Kristiansand, Kristiansand, Norway
| | | | - Arthur Kavanaugh
- Division of Rheumatology, Allergy, Immunology, University of California San Diego, San Diego, California, United States of America
| | - Glenn Haugeberg
- Division of Rheumatology, Department of Medicine, Sørlandet Hospital Kristiansand, Kristiansand, Norway
- Faculty of Medicine and Health Sciences, Department of Neuromedicine and Movement Science, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
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Willers C, Lynch T, Chand V, Islam M, Lassere M, March L. A Versatile, Secure, and Sustainable All-in-One Biobank-Registry Data Solution: The A3BC REDCap Model. Biopreserv Biobank 2021; 20:244-259. [PMID: 34807733 DOI: 10.1089/bio.2021.0098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Introduction: A key element in the big data revolution is large-scale biobanking and the associated development of high-quality data collections and supporting informatics solutions. As such, in establishing the Australian Arthritis and Autoimmune Biobank Collaborative (A3BC), we sought to establish a low-cost, nation-scale data management system capable of managing a multisite biobank registry with complex longitudinal sample and data requirements. Materials and Methods: We assessed several international commercial and nonprofit software platforms using standardized system requirement criteria and follow-up interviews. Vendor compliance scoring was prioritized to meet our project-critical requirements. Consumer/end-user codesign was integral to refining our system requirements for optimized adoption. Customization of the selected software solution was performed to optimize field auto-population between participant timepoints and forms, using modules that are transferable and that do not impact core code. Institutional and independent testing was used to ensure data security. Results: We selected the widely used research web application Research Electronic Data Capture (REDCap), which is "free" (under nonprofit license agreement terms), highly configurable, and customizable to a variety of biobank and registry needs and can be developed/maintained by biobank users with modest IT skill, time, and cost. We created a secure, comprehensive participant-centric biobank-registry database that includes: (1) best practice data security measures (incl. multisite access login using institutional user credentials), (2) permission-to-contact and dynamic itemized electronic consent, (3) a complete chain of custody from consent to longitudinal biospecimen data collection to publication, (4) complex longitudinal patient-reported surveys, (5) integration of record-level extracted/linked participant data, (6) significant form auto-population for streamlined data capture, and (7) native dashboards for operational visualizations. Conclusion: We recommend the versatile, reusable, and sustainable informatics model we have developed in REDCap for prospective chronic disease biobanks or registry biobanks (of local to national complexity) supporting holistic research into disease prediction, precision medicine, and prevention strategies.
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Affiliation(s)
- Craig Willers
- Institute of Bone and Joint Research, The Australian Arthritis and Autoimmune Biobank Collaborative, Kolling Institute, University of Sydney, Sydney, Australia
| | - Tom Lynch
- Institute of Bone and Joint Research, The Australian Arthritis and Autoimmune Biobank Collaborative, Kolling Institute, University of Sydney, Sydney, Australia
| | - Vibhasha Chand
- Public Health and Preventive Medicine, Monash University, Clayton, Australia
| | - Mohammad Islam
- Information and Communications Technology, University of Sydney, Sydney, Australia
| | - Marissa Lassere
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Lyn March
- Institute of Bone and Joint Research, The Australian Arthritis and Autoimmune Biobank Collaborative, Kolling Institute, University of Sydney, Sydney, Australia
- Department of Rheumatology, Royal North Shore Hospital, St Leonards, Australia
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Shadick NA, Gerlanc NM, Frits ML, Stolshek BS, Brady BL, Iannaccone C, Collier D, Cui J, Mutebi A, Weinblatt ME. The longitudinal effect of biologic use on patient outcomes (disease activity, function, and disease severity) within a rheumatoid arthritis registry. Clin Rheumatol 2019; 38:3081-3092. [PMID: 31353421 DOI: 10.1007/s10067-019-04649-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 06/11/2019] [Accepted: 06/17/2019] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Biologics effectively manage symptoms and disease activity in rheumatoid arthritis (RA), but their long-term effects remain unclear. METHOD Longitudinal data were examined from the Brigham and Women's Rheumatoid Arthritis Sequential Study (BRASS) registry. Linear regression modeled the effect of biologic exposure on changes in disease activity (Disease Activity Score-28 with C-reactive protein [DAS28-CRP]), functional status (modified Health Assessment Questionnaire [mHAQ]), and RA severity (Routine Assessment of Patient Index Data [RAPID3]). Biologic exposure was the ratio of time on a biologic relative to time participating in the BRASS cohort. RESULTS The analysis included 1395 RA patients, 82.3% female, with 6783 unique study visits from 2003 to 2015. At the patient's first visit, mean (SD) age was 56.3 (14.2) years and mean (SD) duration of RA was 12.7 (11.9) years. Average follow-up duration was 5.59 years (range, 1-13). Over time, DAS28-CRP, mHAQ, and RAPID3 scores decreased as the biologic exposure ratio increased. In repeated measures regression models, increased biologic exposure was significantly associated with decreased DAS28-CRP score (β = - 0.647; P < 0.001), decreased mHAQ score (β = - 0.096; P < 0.001), and decreased RAPID3 score (β = - 0.724; P < 0.001) during follow-up. Methotrexate use at baseline predicted decreased DAS28-CRP, mHAQ, and RAPID3 scores during follow-up. Biologic use at baseline predicted increased DAS28-CRP or mHAQ during follow-up. CONCLUSIONS Increased biologic exposure is associated with decreased disease activity, function impairment, and RA severity. Future studies should examine whether earlier initiation of biologics improves patient outcomes in RA. TRIAL REGISTRATION ClinicalTrials.gov , NCT01793103 Key Points • Biologics effectively manage symptoms and disease activity in rheumatoid arthritis (RA), but their long-term effects remain unclear. • In this analysis of longitudinal annual population samples of 1395 RA patients in the Brigham and Women's Rheumatoid Arthritis Sequential Study (BRASS) registry, disease activity, function, and severity scores improved as time on biologic therapy increased. • In repeated measures regression models, time on biologic therapy was a significant predictor of improved outcomes for disease activity, function, and RA severity. • Further studies should examine whether earlier initiation of biologics limits the long-term effect of inflammation on RA outcomes.
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Affiliation(s)
- Nancy A Shadick
- Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA, 02115, USA.
| | | | - Michelle L Frits
- Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA, 02115, USA
| | | | | | | | | | - Jing Cui
- Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA, 02115, USA
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Huoponen S, Aaltonen KJ, Viikinkoski J, Rutanen J, Relas H, Taimen K, Puolakka K, Nordström D, Blom M. Cost-effectiveness of abatacept, tocilizumab and TNF-inhibitors compared with rituximab as second-line biologic drug in rheumatoid arthritis. PLoS One 2019; 14:e0220142. [PMID: 31339961 PMCID: PMC6656352 DOI: 10.1371/journal.pone.0220142] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 07/09/2019] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVES The objective of this study was to evaluate the cost-effectiveness of abatacept, tocilizumab, and tumor necrosis factor (TNF) inhibitors as compared with rituximab in Finnish rheumatoid arthritis patients, who have previously been treated with TNF inhibitors. METHODS A patient-level simulation model was developed to predict costs and outcomes associated with four biological drugs (abatacept, tocilizumab, rituximab and TNF inhibitors) in the treatment of rheumatoid arthritis. Following lack of efficacy or adverse events, the patients were switched to another biological drug until all four options were exhausted. After that, the patients were assumed to receive a 6th line treatment until death. The patients' baseline characteristics and regression models used in the simulation were based on observational data from the National Register for Biological Treatments in Finland. Direct costs comprised drug costs, administration costs, costs of switching, and outpatient and inpatient care, while indirect costs included disability pension and sick leaves due to rheumatoid arthritis. Several subgroup and deterministic sensitivity analyses were conducted. RESULTS Drug costs were the lowest for rituximab, but when administration costs and costs of switching were included, drug costs were the lowest for TNF inhibitors. Abatacept was associated with the highest drug costs, whereas rituximab was associated with the highest healthcare costs. In total, TNF inhibitors had the lowest direct costs, while rituximab had the highest direct costs. The amount of quality-adjusted life years (QALY) gained ranged from 9.405 for rituximab to 9.661 for TNF inhibitors. TNF inhibitors, abatacept, and tocilizumab were dominant in comparison to RTX. CONCLUSIONS TNF inhibitors, abatacept, and tocilizumab had lower costs and higher QALYs than rituximab, and therefore, they were dominant in comparison to rituximab. As TNF inhibitors had the lowest costs and highest QALYs, they were the most cost-effective treatment option.
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Affiliation(s)
- Saara Huoponen
- University of Helsinki, Helsinki, Finland
- ESiOR Oy, Kuopio, Finland
- * E-mail:
| | | | - Jaana Viikinkoski
- University of Helsinki, Helsinki, Finland
- Ministry of Social Affairs and Health, Helsinki, Finland
| | | | | | | | - Kari Puolakka
- South Karelia Central Hospital, Lappeenranta, Finland
| | - Dan Nordström
- University of Helsinki, Helsinki, Finland
- Helsinki University Hospital, Helsinki, Finland
| | - Marja Blom
- University of Helsinki, Helsinki, Finland
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Corbett M, Chehadah F, Biswas M, Moe-Byrne T, Palmer S, Soares M, Walton M, Harden M, Ho P, Woolacott N, Bojke L. Certolizumab pegol and secukinumab for treating active psoriatic arthritis following inadequate response to disease-modifying antirheumatic drugs: a systematic review and economic evaluation. Health Technol Assess 2018; 21:1-326. [PMID: 28976302 DOI: 10.3310/hta21560] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Several biologic therapies are approved by the National Institute for Health and Care Excellence (NICE) for psoriatic arthritis (PsA) patients who have had an inadequate response to two or more synthetic disease-modifying antirheumatic drugs (DMARDs). NICE does not specifically recommend switching from one biologic to another, and only ustekinumab (UST; STELARA®, Janssen Pharmaceuticals, Inc., Horsham, PA, USA) is recommended after anti-tumour necrosis factor failure. Secukinumab (SEC; COSENTYX®, Novartis International AG, Basel, Switzerland) and certolizumab pegol (CZP; CIMZIA®, UCB Pharma, Brussels, Belgium) have not previously been appraised by NICE. OBJECTIVE To determine the clinical effectiveness and cost-effectiveness of CZP and SEC for treating active PsA in adults in whom DMARDs have been inadequately effective. DESIGN Systematic review and economic model. DATA SOURCES Fourteen databases (including MEDLINE and EMBASE) were searched for relevant studies from inception to April 2016 for CZP and SEC studies; update searches were run to identify new comparator studies. REVIEW METHODS Clinical effectiveness data from randomised controlled trials (RCTs) were synthesised using Bayesian network meta-analysis (NMA) methods to investigate the relative efficacy of SEC and CZP compared with comparator therapies. A de novo model was developed to assess the cost-effectiveness of SEC and CZP compared with the other relevant comparators. The model was specified for three subpopulations, in accordance with the NICE scope (patients who have taken one prior DMARD, patients who have taken two or more prior DMARDs and biologic-experienced patients). The models were further classified according to the level of concomitant psoriasis. RESULTS Nineteen eligible RCTs were included in the systematic review of short-term efficacy. Most studies were well conducted and were rated as being at low risk of bias. Trials of SEC and CZP demonstrated clinically important efficacy in all key clinical outcomes. At 3 months, patients taking 150 mg of SEC [relative risk (RR) 6.27, 95% confidence interval (CI) 2.55 to 15.43] or CZP (RR 3.29, 95% CI 1.94 to 5.56) were more likely to be responders than patients taking placebo. The NMA results for the biologic-naive subpopulations indicated that the effectiveness of SEC and CZP relative to other biologics and each other was uncertain. Limited data were available for the biologic-experienced subpopulation. Longer-term evidence suggested that these newer biologics reduced disease progression, with the benefits being similar to those seen for older biologics. The de novo model generated incremental cost-effectiveness ratios (ICERs) for three subpopulations and three psoriasis subgroups. In subpopulation 1 (biologic-naive patients who had taken one prior DMARD), CZP was the optimal treatment in the moderate-severe psoriasis subgroup and 150 mg of SEC was optimal in the subgroups of patients with mild-moderate psoriasis or no concomitant psoriasis. In subpopulation 2 (biologic-naive patients who had taken two or more prior DMARDs), etanercept (ETN; ENBREL®, Pfizer Inc., New York City, NY, USA) is likely to be the optimal treatment in all subgroups. The ICERs for SEC and CZP versus best supportive care are in the region of £20,000-30,000 per quality-adjusted life-year (QALY). In subpopulation 3 (biologic-experienced patients or patients in whom biologics are contraindicated), UST is likely to be the optimal treatment (ICERs are in the region of £21,000-27,000 per QALY). The optimal treatment in subpopulation 2 was sensitive to the choice of evidence synthesis model. In subpopulations 2 and 3, results were sensitive to the algorithm for Health Assessment Questionnaire-Disability Index costs. The optimal treatment is not sensitive to the use of biosimilar prices for ETN and infliximab (REMICADE®, Merck Sharp & Dohme, Kenilworth, NJ, USA). CONCLUSIONS SEC and CZP may be an effective use of NHS resources, depending on the subpopulation and subgroup of psoriasis severity. There are a number of limitations to this assessment, driven mainly by data availability. FUTURE WORK Trials are needed to inform effectiveness of biologics in biologic-experienced populations. STUDY REGISTRATION This study is registered as PROSPERO CRD42016033357. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Mark Corbett
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Fadi Chehadah
- Centre for Health Economics, University of York, York, UK
| | - Mousumi Biswas
- Centre for Reviews and Dissemination, University of York, York, UK
| | | | - Stephen Palmer
- Centre for Health Economics, University of York, York, UK
| | - Marta Soares
- Centre for Health Economics, University of York, York, UK
| | - Matthew Walton
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Melissa Harden
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Pauline Ho
- The Kellgren Centre for Rheumatology, Central Manchester and Manchester Children's University Hospitals Trust, Manchester, UK
| | - Nerys Woolacott
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Laura Bojke
- Centre for Health Economics, University of York, York, UK
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Gilmartin-Thomas JF, Liew D, Hopper I. Observational studies and their utility for practice. Aust Prescr 2018; 41:82-85. [PMID: 29922003 PMCID: PMC6003013 DOI: 10.18773/austprescr.2018.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
| | - Danny Liew
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne
| | - Ingrid Hopper
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne
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Okazaki M, Kobayashi H, Shimizu H, Ishii Y, Yajima T, Kanbori M. Safety, Effectiveness, and Treatment Persistence of Golimumab in Elderly Patients with Rheumatoid Arthritis in Real-World Clinical Practice in Japan. Rheumatol Ther 2018; 5:135-148. [PMID: 29500791 DOI: 10.1007/s40744-018-0101-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Golimumab has been proven as an effective treatment for rheumatoid arthritis in clinical trials. However, there is a scarcity of data regarding its use in elderly patients in a real-world setting. This study aims to evaluate the safety, effectiveness, and treatment persistence of golimumab in elderly Japanese patients (≥ 75 years) with rheumatoid arthritis. METHODS This study was a post hoc analysis of post-marketing surveillance data on 5137 Japanese patients with active rheumatoid arthritis who received golimumab for 24 weeks. The study population was divided into two age groups (younger: < 75 years and elderly: ≥ 75 years), and the safety, effectiveness, and treatment persistence of golimumab were assessed. Also, the reasons for discontinuing golimumab treatment were analyzed by multi-logistic regression. RESULTS During golimumab treatment over 24 weeks, younger and elderly groups exhibited comparable improvement of disease activity as measured by EULAR response criteria with similar overall rates of adverse events. However, the survival curve of golimumab for elderly patients was significantly different from that for younger patients due largely to the discontinuation at 4 weeks. The most common reason for discontinuation in elderly patients was patient choice, while it was disease progression in younger patients. Analysis of elderly patients who discontinued treatment by their own decision identified EULAR good response as a factor associated with continuation of golimumab treatment whereas no predictive factor associated with discontinuation was identified. CONCLUSIONS The safety and effectiveness of golimumab treatment in elderly Japanese patients aged 75 years or older were comparable to those in younger patients in real-world clinical practice. Analysis of the survival curves suggested that continuous use of golimumab might further improve clinical benefit of golimumab in elderly patients, underpinning the importance of effective communication between physicians and elderly patients based on the treat-to-target strategy. FUNDING Janssen Pharmaceutical K.K. and Mitsubishi Tanabe Pharma Corporation.
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Affiliation(s)
- Masateru Okazaki
- Immunology Department, Medical Affairs Division, Janssen Pharmaceutical K.K., Tokyo, Japan.
| | - Hisanori Kobayashi
- Immunology Department, Medical Affairs Division, Janssen Pharmaceutical K.K., Tokyo, Japan
| | - Hirohito Shimizu
- Immunology Department, Medical Affairs Division, Janssen Pharmaceutical K.K., Tokyo, Japan
| | - Yutaka Ishii
- Immunology Department, Medical Affairs Division, Janssen Pharmaceutical K.K., Tokyo, Japan
| | - Tsutomu Yajima
- Biostatistics Department, Research and Development Division, Janssen Pharmaceutical K.K., Tokyo, Japan
| | - Masayoshi Kanbori
- Japan Safety and Surveillance Division, Research and Development Division, Janssen Pharmaceutical K.K., Tokyo, Japan
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Smolen JS, Aletaha D, Barton A, Burmester GR, Emery P, Firestein GS, Kavanaugh A, McInnes IB, Solomon DH, Strand V, Yamamoto K. Rheumatoid arthritis. Nat Rev Dis Primers 2018; 4:18001. [PMID: 29417936 DOI: 10.1038/nrdp.2018.1] [Citation(s) in RCA: 1337] [Impact Index Per Article: 222.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Rheumatoid arthritis (RA) is a chronic, inflammatory, autoimmune disease that primarily affects the joints and is associated with autoantibodies that target various molecules including modified self-epitopes. The identification of novel autoantibodies has improved diagnostic accuracy, and newly developed classification criteria facilitate the recognition and study of the disease early in its course. New clinical assessment tools are able to better characterize disease activity states, which are correlated with progression of damage and disability, and permit improved follow-up. In addition, better understanding of the pathogenesis of RA through recognition of key cells and cytokines has led to the development of targeted disease-modifying antirheumatic drugs. Altogether, the improved understanding of the pathogenetic processes involved, rational use of established drugs and development of new drugs and reliable assessment tools have drastically altered the lives of individuals with RA over the past 2 decades. Current strategies strive for early referral, early diagnosis and early start of effective therapy aimed at remission or, at the least, low disease activity, with rapid adaptation of treatment if this target is not reached. This treat-to-target approach prevents progression of joint damage and optimizes physical functioning, work and social participation. In this Primer, we discuss the epidemiology, pathophysiology, diagnosis and management of RA.
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Affiliation(s)
- Josef S Smolen
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Daniel Aletaha
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Anne Barton
- Arthritis Research UK Centre for Genetics and Genomics and NIHR Manchester Biomedical Research Centre, Manchester Academic Health Sciences Centre, The University of Manchester and Central Manchester Foundation Trust, Manchester, UK
| | - Gerd R Burmester
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Paul Emery
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Gary S Firestein
- Division of Rheumatology, Allergy and Immunology, University of California-San Diego School of Medicine, La Jolla, CA, USA
| | - Arthur Kavanaugh
- Division of Rheumatology, Allergy and Immunology, University of California-San Diego School of Medicine, La Jolla, CA, USA
| | - Iain B McInnes
- Institute of Infection Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Daniel H Solomon
- Division of Rheumatology, Brigham and Women's Hospital, Boston, MA, USA
| | - Vibeke Strand
- Division of Immunology and Rheumatology, Stanford University, Palo Alto, CA, USA
| | - Kazuhiko Yamamoto
- Laboratory for Autoimmune Diseases, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
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Palazzi C, D’angelo S, Gilio M, Leccese P, Padula A, Olivieri I. Golimumab for the treatment of axial spondyloarthritis. Expert Opin Biol Ther 2016; 17:129-133. [DOI: 10.1080/14712598.2017.1256387] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Carlo Palazzi
- Rheumatology Department of Lucania, Madonna delle Grazie Hospital of Matera, Contrada Cattedra Ambulante, Matera, Italy
| | - Salvatore D’angelo
- Rheumatology Department of Lucania, San Carlo Hospital of Potenza, Potenza, Italy
| | - Michele Gilio
- Rheumatology Department of Lucania, San Carlo Hospital of Potenza, Potenza, Italy
| | - Pietro Leccese
- Rheumatology Department of Lucania, San Carlo Hospital of Potenza, Potenza, Italy
| | - Angela Padula
- Rheumatology Department of Lucania, San Carlo Hospital of Potenza, Potenza, Italy
| | - Ignazio Olivieri
- Rheumatology Department of Lucania, San Carlo Hospital of Potenza, Potenza, Italy
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Detection of adalimumab and anti-adalimumab antibodies in patients with rheumatoid arthritis: a comprehensive overview of methodology pitfalls and benefits. Immunol Res 2016; 65:172-185. [DOI: 10.1007/s12026-016-8824-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
The goals of therapy in inflammatory bowel disease (IBD) are the induction and maintenance of clinical and biological remission. Mucosal healing is desirable to prevent complications and reduce the need for surgery, hospitalizations, and steroid exposure. Therapeutic monoclonal antibodies (biologic agents) have revolutionized the treatment of IBD. The initial magnitude of the clinical/biologic response to these agents has been associated with a number of underlying phenotypic features in the recipient. In addition, the durability of the initial response often declines over time. This can occur due to low drug serum drug levels, anti-drug antibodies, and a shift to alternative inflammatory pathways. This review discusses strategies that may optimize the initial response to biologics and sustain this to improve patient outcomes.
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Affiliation(s)
- Aoibhlinn O'Toole
- Beth Israel Deaconess Medical Center & Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA
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Biologics Prescribing for Rheumatoid Arthritis in Older Patients: A Single-Center Retrospective Cross-Sectional Study. Rheumatol Ther 2015; 2:165-172. [PMID: 27747537 PMCID: PMC4883268 DOI: 10.1007/s40744-015-0021-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Indexed: 12/25/2022] Open
Abstract
Introduction Appropriate medical treatment can reduce the morbidity and mortality associated with rheumatoid arthritis (RA). Studies have shown that older patients with RA may be treated less aggressively than their younger counterparts, despite evidence suggesting that biologic treatments may be safe and efficacious in older age groups. The aim of this study was to assess whether patient age was associated with biologic treatment for RA in a single center in the United Kingdom. Methods This was a retrospective cross-sectional analysis of clinic records for all patients with RA reviewed over 1 year in our center. Data were also collected on healthcare use in patients aged 65 years and older as a surrogate marker of comorbidity. Results In total, 856 patients with RA were identified, of which 22.8% were on biologic treatment. Patients on biologics were younger (mean age 58.9 years) compared to the mean age of all patients (61.4 years). Of patients aged less than 65 years, 27.2% were receiving biologic treatment, while only 15.2% of patients aged 65 years or older were on biologics. Increasing age was significantly associated with a lower likelihood of receiving biologic treatment. However, in patients 65 years or older, there was no significant difference in overall healthcare use between those on biologic treatment and those not. Patients treated with prednisolone were found to have a greater number of admissions. Conclusion In our center, older patients are less likely to receive biologic treatment than younger patients. Among older patients we found no difference in healthcare use between those treated with biologics and those not, suggesting similar levels of comorbidity. Potential contributors are discussed, but further assessment is required to determine the reasons for this observation. Electronic supplementary material The online version of this article (doi:10.1007/s40744-015-0021-z) contains supplementary material, which is available to authorized users.
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Palazzi C, D’Angelo S, Gilio M, Leccese P, Padula A, Olivieri I. Pharmacological therapy of spondyloarthritis. Expert Opin Pharmacother 2015; 16:1495-504. [DOI: 10.1517/14656566.2015.1052744] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Chaabo K, Kirkham B. Rheumatoid Arthritis - Anti-TNF. Int Immunopharmacol 2015; 27:180-4. [PMID: 25962818 DOI: 10.1016/j.intimp.2015.04.051] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Revised: 04/24/2015] [Accepted: 04/27/2015] [Indexed: 01/01/2023]
Abstract
This review will focus on the recent information and strategies now informing best use of TNF inhibitor therapy in RA. These issues include the role of TNFi therapy in early RA management, anti-drug antibodies in TNFi therapy, updates on safety and optimal dosage regimens in long term management.
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Affiliation(s)
- Khaldoun Chaabo
- Rheumatology Department, Guy's & St Thomas' NHS Foundation Trust, London SE1 9RT, UK
| | - Bruce Kirkham
- Rheumatology Department, Guy's & St Thomas' NHS Foundation Trust, London SE1 9RT, UK.
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Affiliation(s)
- Aman Sharma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh
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Castro-Villegas C, Pérez-Sánchez C, Escudero A, Filipescu I, Verdu M, Ruiz-Limón P, Aguirre MA, Jiménez-Gomez Y, Font P, Rodriguez-Ariza A, Peinado JR, Collantes-Estévez E, González-Conejero R, Martinez C, Barbarroja N, López-Pedrera C. Circulating miRNAs as potential biomarkers of therapy effectiveness in rheumatoid arthritis patients treated with anti-TNFα. Arthritis Res Ther 2015; 17:49. [PMID: 25860297 PMCID: PMC4377058 DOI: 10.1186/s13075-015-0555-z] [Citation(s) in RCA: 137] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 02/13/2015] [Indexed: 12/31/2022] Open
Abstract
Introduction The advent of anti-tumor necrosis factor alpha (anti-TNFα) drugs has considerably improved medical management in rheumatoid arthritis (RA) patients, although it has been reported to be ineffective in a fraction of them. MicroRNAs (miRNAs) are small, non-coding RNAs that act as fine-tuning regulators of gene expression. Targeting miRNAs by gain or loss of function approaches have brought therapeutic effects in various disease models. The aim of this study was to investigate serum miRNA levels as predictive biomarkers of response to anti-TNFα therapy in RA patients. Methods In total, 95 RA patients undergoing anti-TNFα/disease-modifying antirheumatic drugs (anti-TNFα/DMARDs) combined treatments were enrolled. Serum samples were obtained at 0 and 6 months and therapeutic efficacy was assessed. miRNAs were isolated from the serum of 10 patients before and after anti-TNFα/DMARDs combination therapy, cDNA transcribed and pooled, and human serum miRNA polymerase chain reaction (PCR) arrays were performed. Subsequently, selected miRNAs were analyzed in a validation cohort consisting of 85 RA patients. Correlation studies with clinical and serological variables were also performed. Results Ninety percent of RA patients responded to anti-TNFα/DMARDs combination therapy according to European League Against Rheumatism (EULAR) criteria. Array analysis showed that 91% of miRNAS were overexpressed and 9% downregulated after therapy. Functional classification revealed a preponderance of target mRNAs involved in reduction of cells maturation - especially on chondrocytes - as well as in immune and inflammatory response, cardiovascular disease, connective tissue and musculoskeletal system. Six out of ten miRNAs selected for validation were found significantly upregulated by anti-TNFα/DMARDs combination therapy (miR-16-5p, miR-23-3p, miR125b-5p, miR-126-3p, miRN-146a-5p, miR-223-3p). Only responder patients showed an increase in those miRNAs after therapy, and paralleled the reduction of TNFα, interleukin (IL)-6, IL-17, rheumatoid factor (RF), and C-reactive protein (CRP). Correlation studies demonstrated associations between validated miRNAs and clinical and inflammatory parameters. Further, we identified a specific plasma miRNA signature (miR-23 and miR-223) that may serve both as predictor and biomarker of response to anti-TNFα/DMARDs combination therapy. Conclusions miRNA levels in the serum of RA patients before and after anti-TNFα/DMARDs combination therapy are potential novel biomarkers for predicting and monitoring therapy outcome. Electronic supplementary material The online version of this article (doi:10.1186/s13075-015-0555-z) contains supplementary material, which is available to authorized users.
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Kotsis K, Voulgari PV, Drosos AA, Carvalho AF, Hyphantis T. Health-related quality of life in patients with ankylosing spondylitis: a comprehensive review. Expert Rev Pharmacoecon Outcomes Res 2014; 14:857-72. [PMID: 25193010 DOI: 10.1586/14737167.2014.957679] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Ankylosing spondylitis (AS) is a complex systemic rheumatological disease which often causes severe disability and impaired quality of life (QoL). We searched the PubMed/MEDLINE electronic database for available literature on QoL and its predictors in patients with AS. Recent evidence indicates that AS patients have poorer QoL compared to the general population, but similar to that of patients with other rheumatological disorders. Disease activity is one of the most powerful predictors of QoL, however latest advances in pharmacological treatment (namely, anti-TNF-α) along with physical exercise can minimize the effects of AS on QoL. Psychological distress symptoms contribute to impaired QoL both directly and indirectly by influencing disease activity. The impact of other psychosocial variables, however, is less studied and more prospective investigations are necessary, which could eventually lead to the development of psychosocial interventions that are personalized to this patient population.
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Affiliation(s)
- Konstantinos Kotsis
- Department of Psychiatry, Division of Medicine, School of Health Sciences, University of Ioannina, Ioannina 45110, Greece
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Stidham RW, Lee TC, Higgins PD, Deshpande AR, Sussman DA, Singal AG, Elmunzer BJ, Saini SD, Vijan S, Waljee AK. Systematic review with network meta-analysis: the efficacy of anti-TNF agents for the treatment of Crohn's disease. Aliment Pharmacol Ther 2014; 39:1349-62. [PMID: 24749763 PMCID: PMC7006346 DOI: 10.1111/apt.12749] [Citation(s) in RCA: 148] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 03/12/2014] [Accepted: 03/24/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Anti-tumour necrosis factor-alpha agents (anti-TNF) are effective therapies for the treatment of Crohn's disease (CD), but their comparative efficacy is unknown. AIM To perform a network meta-analysis comparing the efficacy of anti-TNF therapies in CD. METHODS After screening 506 studies, reviewers extracted information on 10 studies. Traditional meta-analysis (TMA) was used to compare each anti-TNF agent to placebo. Bayesian network meta-analysis (NMA) was performed to compare the effects of anti-TNF agents to placebo. In addition, sample sizes for comparative efficacy trials were calculated. RESULTS Compared to placebo, TMA revealed that anti-TNF agents result in a higher likelihood of induction of remission and response (RR: 1.66, 95% CI: 1.17-2.36 and RR: 1.43, 95% CI: 1.17-1.73, respectively) as well as maintenance of remission and response (RR: 1.78, 95% CI: 1.51-2.09 and RR: 1.68, 95% CI: 1.46-1.93, respectively). NMA found nonsignificant trends between infliximab and adalimumab or certolizumab pegol. Among subcutaneous therapies, NMA demonstrated superiority of adalimumab to certolizumab pegol for induction of remission (RR: 2.93, 95% CrI: 1.21-7.75). Sample size calculations suggest that adequately powered head-to-head comparative efficacy trials would require greater than 3000 patients. CONCLUSIONS All anti-TNF agents are effective for induction and maintenance of response and remission in the treatment of CD. Although adalimumab is superior to certolizumab pegol for induction of remission, there is no evidence of clinical superiority among anti-TNF agents. Head-to-head trials among the anti-TNF agents are impractical in terms of size and cost.
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Affiliation(s)
- RW Stidham
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA
| | - TC Lee
- Division of General Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA
| | - PD Higgins
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA
| | - AR Deshpande
- Division of Gastroenterology, Department of Internal Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - DA Sussman
- Division of Gastroenterology, Department of Internal Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - AG Singal
- Division of Digestive and Liver Diseases, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - BJ Elmunzer
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA
| | - SD Saini
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA
| | - S Vijan
- Division of General Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA
| | - AK Waljee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA
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Konopka J, Richbourgh B, Liu C. The role of PGRN in musculoskeletal development and disease. Front Biosci (Landmark Ed) 2014; 19:662-71. [PMID: 24389211 DOI: 10.2741/4234] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Progranulin (PGRN) is a growth factor that has been implicated in wound healing, inflammation, infection, tumorigenesis, and is most known for its neuroprotective and proliferative properties in neurodegenerative disease. This pleiotropic growth factor has been found to be a key player and regulator of a diverse spectrum of multi-systemic functions. Its critical anti-inflammatory role in rheumatoid arthritis and other inflammatory disease models has allowed for the propulsion of research to establish its significance in musculoskeletal diseases, including inflammatory conditions involving bone and cartilage pathology. In this review, we aim to elaborate on the emerging role of PGRN in the musculoskeletal system, reviewing its particular mechanisms described in various musculoskeletal diseases, with special focus on osteoarthritis and inflammatory joint disease patho-mechanisms and potential therapeutic applications of PGRN and its derivatives in these and other musculoskeletal diseases.
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Affiliation(s)
- Jessica Konopka
- Department of Orthopaedic Surgery, New York University Medical Center, New York, NY, 10003
| | - Brendon Richbourgh
- Department of Orthopaedic Surgery, New York University Medical Center, 301 East 17th Street, New York, NY 10003
| | - Chuanju Liu
- Department of Orthopaedic Surgery, New York University Medical Center, 301 East 17th Street, New York, NY 10003
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