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Ceban F, Xu J. The Evolution of TNF-α Blockade for the Treatment of Rheumatoid Arthritis. JOURNAL OF UNDERGRADUATE LIFE SCIENCES 2022. [DOI: 10.33137/juls.v16i1.39048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Tumor necrosis factor (TNF)-α is a potent trimeric cytokine which plays a fundamental role in the host immuno-inflammatory response, as well as in homeostasis and development. Although critical for canonical immune function, TNF-α has great destructive potential and is implicated in the development of multiple immune-mediated disorders. Within the context of rheumatoid arthritis (RA), TNF-α acts as a primary pathogenic driver by precipitating a pro-inflammatory cytokine cascade and coordinating the attraction and activation of immune cells, all of which culminate in damage to the synovium. The discovery of the paramount role of TNF-α in the pathophysiology of RA motivated studies to understand the effects of TNF blockade in vitro and in vivo. Promising preclinical results provided the impetus for clinical trials, spearheaded in the 1980s and 90s by Marc Feldmann, which revealed significant improvements across RA symptom scores and finally led to FDA approval in 1998. As of 2021, five TNF-α blocking agents have been widely applied clinically, including infliximab (IFX), etanercept (ETN), adalimumab (ADA), golimumab (GLM) and certolizumab pegol (CZP). All of them successfully ameliorated symptoms of RA and the associated tissue damage, especially in patients not responding to traditional treatment methods. Anti-TNFs are most often administered in combination with methotrexate (MTX) as part of Phase II treatment (i.e., second line). Although the general availability of anti-TNFs has dramatically improved patient outcomes, sustained remission is rare and the mechanism of RA remains incompletely understood. Thus, additional basic and translational research is warranted, towards the aim of developing novel RA treatments.
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Pandey P, Al Rumaih Z, Kels MJT, Ng E, Kc R, Chaudhri G, Karupiah G. Targeting ectromelia virus and TNF/NF-κB or STAT3 signaling for effective treatment of viral pneumonia. Proc Natl Acad Sci U S A 2022; 119:e2112725119. [PMID: 35177474 PMCID: PMC8872766 DOI: 10.1073/pnas.2112725119] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 01/13/2022] [Indexed: 12/14/2022] Open
Abstract
Viral causes of pneumonia pose constant threats to global public health, but there are no specific treatments currently available for the condition. Antivirals are ineffective when administered late after the onset of symptoms. Pneumonia is caused by an exaggerated inflammatory cytokine response to infection, but tissue necrosis and damage caused by virus also contribute to lung pathology. We hypothesized that viral pneumonia can be treated effectively if both virus and inflammation are simultaneously targeted. Combined treatment with the antiviral drug cidofovir and etanercept, which targets tumor necrosis factor (TNF), down-regulated nuclear factor kappa B-signaling and effectively reduced morbidity and mortality during respiratory ectromelia virus (ECTV) infection in mice even when treatment was initiated after onset of clinical signs. Treatment with cidofovir alone reduced viral load, but animals died from severe lung pathology. Treatment with etanercept had no effect on viral load but diminished levels of inflammatory cytokines and chemokines including TNF, IL-6, IL-1β, IL-12p40, TGF-β, and CCL5 and dampened activation of the STAT3 cytokine-signaling pathway, which transduces signals from multiple cytokines implicated in lung pathology. Consequently, combined treatment with a STAT3 inhibitor and cidofovir was effective in improving clinical disease and lung pathology in ECTV-infected mice. Thus, the simultaneous targeting of virus and a specific inflammatory cytokine or cytokine-signaling pathway is effective in the treatment of pneumonia. This approach might be applicable to pneumonia caused by emerging and re-emerging viruses, like seasonal and pandemic influenza A virus strains and severe acute respiratory syndrome coronavirus 2.
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Affiliation(s)
- Pratikshya Pandey
- Viral Immunology and Immunopathology Group, Tasmanian School of Medicine, University of Tasmania, Hobart, TAS 7000, Australia
| | - Zahrah Al Rumaih
- Department of Immunology, John Curtin School of Medical Research, Australian National University, Canberra, ACT 2601, Australia
| | - Ma Junaliah Tuazon Kels
- Department of Immunology, John Curtin School of Medical Research, Australian National University, Canberra, ACT 2601, Australia
| | - Esther Ng
- Department of Immunology, John Curtin School of Medical Research, Australian National University, Canberra, ACT 2601, Australia
| | - Rajendra Kc
- Viral Immunology and Immunopathology Group, Tasmanian School of Medicine, University of Tasmania, Hobart, TAS 7000, Australia
| | - Geeta Chaudhri
- Department of Immunology, John Curtin School of Medical Research, Australian National University, Canberra, ACT 2601, Australia
| | - Gunasegaran Karupiah
- Viral Immunology and Immunopathology Group, Tasmanian School of Medicine, University of Tasmania, Hobart, TAS 7000, Australia;
- Department of Immunology, John Curtin School of Medical Research, Australian National University, Canberra, ACT 2601, Australia
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Sellam J, Morel J, Tournadre A, Bouhnik Y, Cornec D, Devauchelle-Pensec V, Dieudé P, Goupille P, Jullien D, Kluger N, Lazaro E, Le Goff B, de Lédinghen V, Lequerré T, Nocturne G, Seror R, Truchetet ME, Verhoeven F, Pham T, Richez C. PRACTICAL MANAGEMENT of patients on anti-TNF therapy: Practical guidelines drawn up by the Club Rhumatismes et Inflammation (CRI). Joint Bone Spine 2021; 88:105174. [PMID: 33992225 DOI: 10.1016/j.jbspin.2021.105174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Jérémie Sellam
- Service de Rhumatologie, CHU Saint-Antoine, Paris, France
| | - Jacques Morel
- Service de Rhumatologie, CHU Montpellier, Montpellier, France
| | - Anne Tournadre
- Service de Rhumatologie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Yoram Bouhnik
- Service de Gastro-entérologie, CHU Hôpital Beaujon, Clichy, France
| | - Divi Cornec
- Service de Rhumatologie, CHRU La Cavale Blanche, Brest, France
| | | | - Philippe Dieudé
- Service de Rhumatologie, CHU Bichat-Claude Bernard, Paris, France
| | | | | | - Nicolas Kluger
- Dpt Dermatology, Helsinki, Finland; Service de Dermatologie, CHU Bichat-Claude Bernard, Paris, France
| | - Estibaliz Lazaro
- Service de Médecine interne, Hôpital Haut-Lévêque, CHU Bordeaux, Pessac, France
| | | | - Victor de Lédinghen
- Unité d'Hépatologie et transplantation hépatique, Hôpital Haut-Lévêque, CHU Bordeaux, Pessac, France
| | | | | | - Raphaèle Seror
- Service de Rhumatologie, Bicêtre, Le Kremlin-Bicêtre, France
| | | | | | - Thao Pham
- Service de Rhumatologie, CHU Sainte-Marguerite, Marseille, France
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Persistence on biologic DMARD monotherapy after achieving rheumatoid arthritis disease control on combination therapy: retrospective analysis of corrona registry data. Rheumatol Int 2020; 41:381-390. [PMID: 32876744 PMCID: PMC7835165 DOI: 10.1007/s00296-020-04667-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 07/28/2020] [Indexed: 02/07/2023]
Abstract
Biological disease-modifying antirheumatic drugs (bDMARDs) monotherapy may enhance adherence and decrease adverse events compared to combination therapy with conventional synthetic DMARDs (csDMARDs); however, persistence with bDMARD monotherapy has not been extensively studied. We explore persistence of etanercept monotherapy and monotherapy with other tumor necrosis factor inhibitors (TNFis) among patients first achieving remission/low disease activity (LDA) while on combination therapy with csDMARDs and a TNFi. Using Corrona registry data, the percentage of patients persistent with the index TNFi (etanercept versus other TNFis) over 6 and 12 months was determined. Factors influencing persistence and treatment patterns at 6 and 12 months were examined. Among 617 eligible patients, 56% of 182 patients on etanercept and 45% of 435 patients on other TNFis persisted with monotherapy at 6 months, 46% and 33%, respectively, at 12 months. Across first-line and subsequent biologic DMARDs, etanercept persistence was greater than other TNFi persistence by 10.8% (95% CI 2.1%, 19.6%) at 6 months and 11.4% (95% CI 0.9%, 21.9%) at 12 months. Patients on other TNFis were more likely to require reintroduction of csDMARD after 6 months (45% versus 35% for etanercept). Remission was the key predictor of persistence for both etanercept and other TNFi monotherapies. This retrospective, cohort study of registry data reflecting real-world practice indicates patients who achieve remission/LDA with combination csDMARD and TNFi therapy may successfully transition to TNFi monotherapy. Patients on etanercept monotherapy experienced greater persistence and less frequent reintroduction of a csDMARD than was observed for patients on other TNFi monotherapies.
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Bader-Meunier B, Krzysiek R, Lemelle I, Pajot C, Carbasse A, Poignant S, Melki I, Quartier P, Choupeaux L, Henry E, Treluyer JM, Belot A, Hacein-Bey-Abina S, Urien S. Etanercept concentration and immunogenicity do not influence the response to Etanercept in patients with juvenile idiopathic arthritis. Semin Arthritis Rheum 2018; 48:1014-1018. [PMID: 30396593 DOI: 10.1016/j.semarthrit.2018.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 08/23/2018] [Accepted: 09/07/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the relationship of clinical response of Juvenile Idiopathic Arthritis (JIA) to etanercept (ETN) with ETN levels, and the presence of anti-drug antibodies to ETN (ADAb). METHODS Prospective study of JIA patients under 18 years old. Clinical and pharmacological data were collected at two visits. JIA clinical inactivity and activity were assessed according to the Wallace criteria and to the Juvenile Arthritis Disease Activity Score (JADAS). ETN and ADAb serum levels assessments were determined using ELISA-based assays. RESULTS 126 patients were enrolled. The median duration of ETN treatment at inclusion was 569 days (range 53-2340). ADAb were undetectable (<10 ng/ml) in 171/218 (78%) samples and were > 25 ng/mL in 2/218 samples. No significant relationship between ETN concentration and the clinical inactivity status and JIA activity was found using either univariate logistic regression or multiple logistic regression analysis, adjusted on one individual descriptors, time since diagnosis, time of sampling, use of corticosteroids or methotrexate and classification of JIA. No correlation was found between the remission status and the detection of ADAb. CONCLUSION This study did not demonstrate any correlation between JIA activity and circulating ETN levels in a large population of patients with JIA previously treated with ETN for at least 1.5 months. As described for adults, our study confirms that ETN is marginally immunogenic in pediatric patients. These results do not support the clinical usefulness of a monitoring of ADAb or ETN concentrations for the management of this group of JIA patients if they fail to achieve clinical inactive disease.
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Affiliation(s)
- Brigitte Bader-Meunier
- Service d'Immunologie-hématologie et Rhumatologie pédiatrique, Institut Imagine, Hôpital Necker, Assistance Publique Hôpitaux de Paris, France & Centre National de Référence RAISE, 149 rue de Sèvres, 75015 Paris, France.
| | - Roman Krzysiek
- Service d'Immunologie Biologique, Groupe Hospitalier Universitaire Paris-Sud, Hôpital Kremlin Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), Le Kremlin Bicêtre, France; INSERM -UMR_S996, Université Paris-Saclay, Clamart, France
| | - Irène Lemelle
- Service d'Hémato-Onco Pédiatrie, CHRU Nancy, 54511 Vandoeuvre les Nancy, France
| | - Christine Pajot
- Service de Néphrologie et Rhumatologie pédiatrique, Hôpital Purpan, Toulouse, France
| | - Aurélia Carbasse
- Service de Pédi atrie générale, Hôpital A de Villeneuve, Montpellier, France
| | | | - Isabelle Melki
- Service de Pédiatrie générale, Hôpital Robert Debré, Paris, France
| | - Pierre Quartier
- Service d'Immunologie-hématologie et Rhumatologie pédiatrique, Institut Imagine, Hôpital Necker, Assistance Publique Hôpitaux de Paris, France & Centre National de Référence RAISE, 149 rue de Sèvres, 75015 Paris, France; Université Sorbonne Paris Cité, Paris, France
| | - Laure Choupeaux
- Unité de Recherche Clinique Paris Descartes Necker Cochin, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Tarnier, Paris, France
| | - Elodie Henry
- Unité de Recherche Clinique Paris Descartes Necker Cochin, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Tarnier, Paris, France
| | - Jean-Marc Treluyer
- Unité de Recherche Clinique Paris Descartes Necker Cochin, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Tarnier, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, EA 7323, Paris, France
| | - Alexandre Belot
- Service de Néphrologie, Rhumatologie et Dermatologie pédiatriques, Hôpital Femme-Mère-Enfants, Hospices Civils de Lyon, France & Centre National de Référence RAISE, Bron, France; INSERM U1111, Université de Lyon 1, France
| | - Salima Hacein-Bey-Abina
- Service d'Immunologie Biologique, Groupe Hospitalier Universitaire Paris-Sud, Hôpital Kremlin Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), Le Kremlin Bicêtre, France; UTCBS, CNRS UMR 8258, INSERM U1022, Faculté de Pharmacie de Paris, Université Sorbonne-Paris-Cité, Université Paris- Descartes, Paris, France
| | - Saik Urien
- Unité de Recherche Clinique Paris Descartes Necker Cochin, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Tarnier, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, EA 7323, Paris, France
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Naniwa T, Iwagaitsu S, Kajiura M. Long-term efficacy and safety of add-on tacrolimus for persistent, active rheumatoid arthritis despite treatment with methotrexate and tumor necrosis factor inhibitors. Int J Rheum Dis 2018; 21:673-687. [PMID: 29314738 DOI: 10.1111/1756-185x.13248] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
AIM To assess the long-term efficacy and safety of adding tacrolimus for patients with active rheumatoid arthritis (RA) despite anti-tumor necrosis factor (TNF) therapy with methotrexate. METHODS Consecutive patients who were treated with adding tacrolimus onto anti-TNF therapy with methotrexate for active RA despite anti-TNF therapy with methotrexate, were retrospectively analyzed in terms of treatment response, achieving remission, subsequent treatment tapering and adverse events. RESULTS Fifteen patients could be analyzed. Median symptom duration was 2.9 years and prior duration of anti-TNF therapy was 40 weeks. Median value of Disease Activity Score in 28 joints was 4.6. Five, eight and two were on infliximab, etanercept and adalimumab at the onset of tacrolimus, respectively. At 2 years, the proportions of patients achieving responses of American College of Rheumatology 50, 70 and 90, were 80%, 73% and 40%, respectively, and those achieving remission as defined by Simplified Disease Activity Index ≤ 3.3 were 67%. All patients could discontinue oral glucocorticoids and 10 had been successfully withdrawn from anti-TNF therapy for more than 1 year at the final observation. CONCLUSION Adding tacrolimus onto anti-TNF therapy is a promising therapeutic option with sustained benefit for refractory RA patients despite treatment with anti-TNF therapy combined with methotrexate.
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Affiliation(s)
- Taio Naniwa
- Division of Rheumatology, Department of Internal Medicine, Nagoya City University Hospital, Nagoya, Japan.,Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.,Rheumatology Clinic, Takeuchi Orthopedics & Internal Medicine, Aichi, Japan
| | - Shiho Iwagaitsu
- Division of Rheumatology, Department of Internal Medicine, Nagoya City University Hospital, Nagoya, Japan.,Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Mikiko Kajiura
- Rheumatology Clinic, Takeuchi Orthopedics & Internal Medicine, Aichi, Japan
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Favalli EG, Raimondo MG, Becciolini A, Crotti C, Biggioggero M, Caporali R. The management of first-line biologic therapy failures in rheumatoid arthritis: Current practice and future perspectives. Autoimmun Rev 2017; 16:1185-1195. [DOI: 10.1016/j.autrev.2017.10.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 07/31/2017] [Indexed: 12/20/2022]
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Rheumatoid arthritis patients treated in trial and real world settings: comparison of randomized trials with registries. Rheumatology (Oxford) 2017; 57:354-369. [DOI: 10.1093/rheumatology/kex394] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Indexed: 12/18/2022] Open
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Dubiel EA, Fülöp T, Vigier S, Vermette P. Quartz crystal microbalance as an assay to detect anti-drug antibodies for the immunogenicity assessment of therapeutic biologics. Anal Bioanal Chem 2017; 409:7153-7167. [PMID: 29026983 DOI: 10.1007/s00216-017-0674-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 09/02/2017] [Accepted: 09/25/2017] [Indexed: 10/18/2022]
Abstract
Because of their biological origins, therapeutic biologics can trigger an unwanted deleterious immune response with some patients. The immunogenicity of therapeutic biologics can affect drug efficacy and patient safety by the production of circulating anti-drug antibodies (ADA). In this study, quartz crystal microbalance (QCM) was developed as an assay to detect ADA. Etanercept (Enbrel®) was covalently grafted to dextran-modified QCM surfaces. Rabbits were immunized with etanercept to generate ADA. Results showed the QCM assay could detect purified ADA from rabbits at concentrations as low as 50 ng/mL, within the sensitivity range of ELISA. The QCM assay could also assess the ADA isotype. It was shown that the ADA were composed of the IgG isotype, but not IgM, as expected. Furthermore, it was shown that QCM surfaces that had been used to detect ADA could be regenerated in glycine-HCl solution and reused. The QCM assay was also demonstrated to detect ADA in crude serum samples. Serum was collected from the rabbits and analyzed before and after etanercept immunization. ADA were clearly detected in serum from rabbits after immunization, but not in serum before immunization. Serum from patients administered with etanercept for rheumatoid arthritis (RA) treatment was also analyzed and compared to serum from healthy donors. Sera from 10 RA patients were analyzed. Results showed one of the RA patient serum samples may have ADA present. In conclusion, QCM appears to be a viable assay to detect ADA for the immunogenicity assessment of therapeutic biologics.
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Affiliation(s)
- Evan A Dubiel
- Laboratoire de bio-ingénierie et de biophysique de l'Université de Sherbrooke, Department of Chemical and Biotechnological Engineering, Université de Sherbrooke, 2500 boulevard de l'Université, Sherbrooke, Québec, J1K 2R1, Canada.,Research Centre on Aging, Institut universitaire de gériatrie de Sherbrooke, 1036 rue Belvédère Sud, Sherbrooke, Québec, J1H 4C4, Canada.,Faculté de médecine et des sciences de la santé, Institut de pharmacologie de Sherbrooke, 3001 12ième Avenue Nord, Sherbrooke, Québec, J1H 5N4, Canada
| | - Tamás Fülöp
- Research Centre on Aging, Institut universitaire de gériatrie de Sherbrooke, 1036 rue Belvédère Sud, Sherbrooke, Québec, J1H 4C4, Canada
| | - Sylvain Vigier
- Laboratoire de bio-ingénierie et de biophysique de l'Université de Sherbrooke, Department of Chemical and Biotechnological Engineering, Université de Sherbrooke, 2500 boulevard de l'Université, Sherbrooke, Québec, J1K 2R1, Canada.,Research Centre on Aging, Institut universitaire de gériatrie de Sherbrooke, 1036 rue Belvédère Sud, Sherbrooke, Québec, J1H 4C4, Canada
| | - Patrick Vermette
- Laboratoire de bio-ingénierie et de biophysique de l'Université de Sherbrooke, Department of Chemical and Biotechnological Engineering, Université de Sherbrooke, 2500 boulevard de l'Université, Sherbrooke, Québec, J1K 2R1, Canada. .,Research Centre on Aging, Institut universitaire de gériatrie de Sherbrooke, 1036 rue Belvédère Sud, Sherbrooke, Québec, J1H 4C4, Canada. .,Faculté de médecine et des sciences de la santé, Institut de pharmacologie de Sherbrooke, 3001 12ième Avenue Nord, Sherbrooke, Québec, J1H 5N4, Canada.
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Emery P, Vencovský J, Sylwestrzak A, Leszczyński P, Porawska W, Stasiuk B, Hilt J, Mosterova Z, Cheong SY, Ghil J. Long-term efficacy and safety in patients with rheumatoid arthritis continuing on SB4 or switching from reference etanercept to SB4. Ann Rheum Dis 2017; 76:annrheumdis-2017-211591. [PMID: 28794078 PMCID: PMC5705842 DOI: 10.1136/annrheumdis-2017-211591] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 07/12/2017] [Accepted: 07/18/2017] [Indexed: 01/28/2023]
Abstract
OBJECTIVES SB4 (Benepali, Brenzys) is a biosimilar of reference etanercept (ETN). In a randomised, double-blind, 52-week study, SB4 demonstrated comparable efficacy and safety to ETN in patients with rheumatoid arthritis (RA). The open-label extension period evaluated long-term efficacy, safety and immunogenicity when continuing SB4 versus switching from ETN to SB4. METHODS In the randomised, double-blind phase, patients received weekly subcutaneous administration of 50 mg SB4 or ETN with background methotrexate for up to 52 weeks. Patients in the Czech Republic and Poland who completed the 52-week visit were enrolled in the open-label extension period and received SB4 for 48 additional weeks. Efficacy, safety and immunogenicity were assessed up to week 100. RESULTS Of 245 patients entering the extension period, 126 continued to receive SB4 (SB4/SB4) and 119 switched to SB4 (ETN/SB4). American College of Rheumatology (ACR) response rates were sustained and comparable between SB4/SB4 and ETN/SB4 with ACR20 response rates at week 100 of 77.9% and 79.1%, respectively. Other efficacy results, including radiographic progression, were also comparable between the groups. After week 52, rates of treatment-emergent adverse events were 47.6% (SB4/SB4) and 48.7% (ETN/SB4); one patient/group developed non-neutralising antidrug antibodies. No cases of active tuberculosis or injection-site reactions were reported during the extension period. One patient (SB4/SB4) died of hepatic cancer. CONCLUSIONS SB4 was effective and well tolerated over 2 years in patients with RA. Efficacy, safety and immunogenicity were comparable between the SB4/SB4 and ETN/SB4 groups, showing no risk associated with switching patients from ETN to SB4. TRIAL REGISTRATION NUMBER NCT01895309; 2012-005026-30.
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Affiliation(s)
- Paul Emery
- Arthritis Research, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Jiří Vencovský
- Rheumatology, Institute of Rheumatology, Prague, Czech Republic
| | - Anna Sylwestrzak
- Rheumatology, NZOZ Medica Pro Familia Sp. z o.o., Warsaw, Poland
| | | | | | | | - Joanna Hilt
- Rheumatology, Centrum Terapii Wspolczesnej J.M. Jasnorzewska sp. komandytowo-akcyjna, Bialystok, Poland
| | - Zdenka Mosterova
- Rheumatology, Revmacentrum MUDr. Mostera sro, Brno, Czech Republic
| | - Soo Yeon Cheong
- Clinical Sciences Division, Samsung Bioepis Co., Ltd., Incheon, Republic of Korea
| | - Jeehoon Ghil
- Clinical Sciences Division, Samsung Bioepis Co., Ltd., Incheon, Republic of Korea
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Singh JA, Hossain A, Mudano AS, Tanjong Ghogomu E, Suarez‐Almazor ME, Buchbinder R, Maxwell LJ, Tugwell P, Wells GA. Biologics or tofacitinib for people with rheumatoid arthritis naive to methotrexate: a systematic review and network meta-analysis. Cochrane Database Syst Rev 2017; 5:CD012657. [PMID: 28481462 PMCID: PMC6481641 DOI: 10.1002/14651858.cd012657] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Biologic disease-modifying anti-rheumatic drugs (biologics) are highly effective in treating rheumatoid arthritis (RA), however there are few head-to-head biologic comparison studies. We performed a systematic review, a standard meta-analysis and a network meta-analysis (NMA) to update the 2009 Cochrane Overview. This review is focused on the adults with RA who are naive to methotrexate (MTX) that is, receiving their first disease-modifying agent. OBJECTIVES To compare the benefits and harms of biologics (abatacept, adalimumab, anakinra, certolizumab pegol, etanercept, golimumab, infliximab, rituximab, tocilizumab) and small molecule tofacitinib versus comparator (methotrexate (MTX)/other DMARDs) in people with RA who are naive to methotrexate. METHODS In June 2015 we searched for randomized controlled trials (RCTs) in CENTRAL, MEDLINE and Embase; and trials registers. We used standard Cochrane methods. We calculated odds ratios (OR) and mean differences (MD) along with 95% confidence intervals (CI) for traditional meta-analyses and 95% credible intervals (CrI) using a Bayesian mixed treatment comparisons approach for network meta-analysis (NMA). We converted OR to risk ratios (RR) for ease of interpretation. We also present results in absolute measures as risk difference (RD) and number needed to treat for an additional beneficial or harmful outcome (NNTB/H). MAIN RESULTS Nineteen RCTs with 6485 participants met inclusion criteria (including five studies from the original 2009 review), and data were available for four TNF biologics (adalimumab (six studies; 1851 participants), etanercept (three studies; 678 participants), golimumab (one study; 637 participants) and infliximab (seven studies; 1363 participants)) and two non-TNF biologics (abatacept (one study; 509 participants) and rituximab (one study; 748 participants)).Less than 50% of the studies were judged to be at low risk of bias for allocation sequence generation, allocation concealment and blinding, 21% were at low risk for selective reporting, 53% had low risk of bias for attrition and 89% had low risk of bias for major baseline imbalance. Three trials used biologic monotherapy, that is, without MTX. There were no trials with placebo-only comparators and no trials of tofacitinib. Trial duration ranged from 6 to 24 months. Half of the trials contained participants with early RA (less than two years' duration) and the other half included participants with established RA (2 to 10 years). Biologic + MTX versus active comparator (MTX (17 trials (6344 participants)/MTX + methylprednisolone 2 trials (141 participants))In traditional meta-analyses, there was moderate-quality evidence downgraded for inconsistency that biologics with MTX were associated with statistically significant and clinically meaningful benefit versus comparator as demonstrated by ACR50 (American College of Rheumatology scale) and RA remission rates. For ACR50, biologics with MTX showed a risk ratio (RR) of 1.40 (95% CI 1.30 to 1.49), absolute difference of 16% (95% CI 13% to 20%) and NNTB = 7 (95% CI 6 to 8). For RA remission rates, biologics with MTX showed a RR of 1.62 (95% CI 1.33 to 1.98), absolute difference of 15% (95% CI 11% to 19%) and NNTB = 5 (95% CI 6 to 7). Biologics with MTX were also associated with a statistically significant, but not clinically meaningful, benefit in physical function (moderate-quality evidence downgraded for inconsistency), with an improvement of HAQ scores of -0.10 (95% CI -0.16 to -0.04 on a 0 to 3 scale), absolute difference -3.3% (95% CI -5.3% to -1.3%) and NNTB = 4 (95% CI 2 to 15).We did not observe evidence of differences between biologics with MTX compared to MTX for radiographic progression (low-quality evidence, downgraded for imprecision and inconsistency) or serious adverse events (moderate-quality evidence, downgraded for imprecision). Based on low-quality evidence, results were inconclusive for withdrawals due to adverse events (RR of 1.32, but 95% confidence interval included possibility of important harm, 0.89 to 1.97). Results for cancer were also inconclusive (Peto OR 0.71, 95% CI 0.38 to 1.33) and downgraded to low-quality evidence for serious imprecision. Biologic without MTX versus active comparator (MTX 3 trials (866 participants)There was no evidence of statistically significant or clinically important differences for ACR50, HAQ, remission, (moderate-quality evidence for these benefits, downgraded for imprecision), withdrawals due to adverse events,and serious adverse events (low-quality evidence for these harms, downgraded for serious imprecision). All studies were for TNF biologic monotherapy and none for non-TNF biologic monotherapy. Radiographic progression was not measured. AUTHORS' CONCLUSIONS In MTX-naive RA participants, there was moderate-quality evidence that, compared with MTX alone, biologics with MTX was associated with absolute and relative clinically meaningful benefits in three of the efficacy outcomes (ACR50, HAQ scores, and RA remission rates). A benefit regarding less radiographic progression with biologics with MTX was not evident (low-quality evidence). We found moderate- to low-quality evidence that biologic therapy with MTX was not associated with any higher risk of serious adverse events compared with MTX, but results were inconclusive for withdrawals due to adverse events and cancer to 24 months.TNF biologic monotherapy did not differ statistically significantly or clinically meaningfully from MTX for any of the outcomes (moderate-quality evidence), and no data were available for non-TNF biologic monotherapy.We conclude that biologic with MTX use in MTX-naive populations is beneficial and that there is little/inconclusive evidence of harms. More data are needed for tofacitinib, radiographic progression and harms in this patient population to fully assess comparative efficacy and safety.
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Affiliation(s)
- Jasvinder A Singh
- Birmingham VA Medical CenterDepartment of MedicineFaculty Office Tower 805B510 20th Street SouthBirminghamALUSA35294
| | - Alomgir Hossain
- University of Ottawa Heart InstituteCardiovascular Research Methods Centre40 Ruskin StreetRoom H‐2265OttawaONCanadaK1Y 4W7
| | - Amy S Mudano
- University of Alabama at BirminghamDepartment of Medicine ‐ RheumatologyBirminghamUSA
| | | | - Maria E Suarez‐Almazor
- The University of Texas, MD Anderson Cancer CenterDepartment of General Internal Medicine1515 Holcombe BlvdUnit 1465HoustonTexasUSA77030
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash UniversityMonash Department of Clinical Epidemiology, Cabrini HospitalSuite 41, Cabrini Medical Centre183 Wattletree RoadMalvernVictoriaAustralia3144
| | - Lara J Maxwell
- Ottawa Hospital Research Institute (OHRI), The Ottawa Hospital ‐ General CampusCentre for Practice‐Changing Research (CPCR)501 Smyth Road, Box 711OttawaONCanadaK1H 8L6
| | - Peter Tugwell
- Faculty of Medicine, University of OttawaDepartment of MedicineOttawaONCanadaK1H 8M5
| | - George A Wells
- University of OttawaDepartment of Epidemiology and Community MedicineRoom H128140 Ruskin StreetOttawaONCanadaK1Y 4W7
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Bouman CAM, van Herwaarden N, van den Hoogen FHJ, van der Maas A, van den Bemt BJF, den Broeder AA. Prediction of successful dose reduction or discontinuation of adalimumab, etanercept, or infliximab in rheumatoid arthritis patients using serum drug levels and antidrug antibody measurement. Expert Opin Drug Metab Toxicol 2017; 13:597-604. [DOI: 10.1080/17425255.2017.1320390] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- CAM Bouman
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - N van Herwaarden
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - FHJ van den Hoogen
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A van der Maas
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - BJF van den Bemt
- Department of Pharmacy, Sint Maartenskliniek, Nijmegen, The Netherlands
- Department of Pharmacy, Radboud University Medical Center, Nijmegen, The Netherlands
| | - AA den Broeder
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
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13
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Singh JA, Hossain A, Tanjong Ghogomu E, Mudano AS, Maxwell LJ, Buchbinder R, Lopez‐Olivo MA, Suarez‐Almazor ME, Tugwell P, Wells GA. Biologics or tofacitinib for people with rheumatoid arthritis unsuccessfully treated with biologics: a systematic review and network meta-analysis. Cochrane Database Syst Rev 2017; 3:CD012591. [PMID: 28282491 PMCID: PMC6472522 DOI: 10.1002/14651858.cd012591] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Biologic disease-modifying anti-rheumatic drugs (DMARDs: referred to as biologics) are effective in treating rheumatoid arthritis (RA), however there are few head-to-head comparison studies. Our systematic review, standard meta-analysis and network meta-analysis (NMA) updates the 2009 Cochrane overview, 'Biologics for rheumatoid arthritis (RA)' and adds new data. This review is focused on biologic or tofacitinib therapy in people with RA who had previously been treated unsuccessfully with biologics. OBJECTIVES To compare the benefits and harms of biologics (abatacept, adalimumab, anakinra, certolizumab pegol, etanercept, golimumab, infliximab, rituximab, tocilizumab) and small molecule tofacitinib versus comparator (placebo or methotrexate (MTX)/other DMARDs) in people with RA, previously unsuccessfully treated with biologics. METHODS On 22 June 2015 we searched for randomized controlled trials (RCTs) in CENTRAL, MEDLINE, and Embase; and trials registries (WHO trials register, Clinicaltrials.gov). We carried out article selection, data extraction, and risk of bias and GRADE assessments in duplicate. We calculated direct estimates with 95% confidence intervals (CI) using standard meta-analysis. We used a Bayesian mixed treatment comparison (MTC) approach for NMA estimates with 95% credible intervals (CrI). We converted odds ratios (OR) to risk ratios (RR) for ease of understanding. We have also presented results in absolute measures as risk difference (RD) and number needed to treat for an additional beneficial outcome (NNTB). Outcomes measured included four benefits (ACR50, function measured by Health Assessment Questionnaire (HAQ) score, remission defined as DAS < 1.6 or DAS28 < 2.6, slowing of radiographic progression) and three harms (withdrawals due to adverse events, serious adverse events, and cancer). MAIN RESULTS This update includes nine new RCTs for a total of 12 RCTs that included 3364 participants. The comparator was placebo only in three RCTs (548 participants), MTX or other traditional DMARD in six RCTs (2468 participants), and another biologic in three RCTs (348 participants). Data were available for four tumor necrosis factor (TNF)-biologics: (certolizumab pegol (1 study; 37 participants), etanercept (3 studies; 348 participants), golimumab (1 study; 461 participants), infliximab (1 study; 27 participants)), three non-TNF biologics (abatacept (3 studies; 632 participants), rituximab (2 studies; 1019 participants), and tocilizumab (2 studies; 589 participants)); there was only one study for tofacitinib (399 participants). The majority of the trials (10/12) lasted less than 12 months.We judged 33% of the studies at low risk of bias for allocation sequence generation, allocation concealment and blinding, 25% had low risk of bias for attrition, 92% were at unclear risk for selective reporting; and 92% had low risk of bias for major baseline imbalance. We downgraded the quality of the evidence for most outcomes to moderate or low due to study limitations, heterogeneity, or rarity of direct comparator trials. Biologic monotherapy versus placeboCompared to placebo, biologics were associated with clinically meaningful and statistically significant improvement in RA as demonstrated by higher ACR50 and RA remission rates. RR was 4.10 for ACR50 (95% CI 1.97 to 8.55; moderate-quality evidence); absolute benefit RD 14% (95% CI 6% to 21%); and NNTB = 8 (95% CI 4 to 23). RR for RA remission was 13.51 (95% CI 1.85 to 98.45, one study available; moderate-quality evidence); absolute benefit RD 9% (95% CI 5% to 13%); and NNTB = 11 (95% CI 3 to 136). Results for withdrawals due to adverse events and serious adverse events did not show any statistically significant or clinically meaningful differences. There were no studies available for analysis for function measured by HAQ, radiographic progression, or cancer outcomes. There were not enough data for any of the outcomes to look at subgroups. Biologic + MTX versus active comparator (MTX/other traditional DMARDs)Compared to MTX/other traditional DMARDs, biologic + MTX was associated with a clinically meaningful and statistically significant improvement in ACR50, function measured by HAQ, and RA remission rates in direct comparisons. RR for ACR50 was 4.07 (95% CI 2.76 to 5.99; high-quality evidence); absolute benefit RD 16% (10% to 21%); NNTB = 7 (95% CI 5 to 11). HAQ scores showed an improvement with a mean difference (MD) of 0.29 (95% CI 0.21 to 0.36; high-quality evidence); absolute benefit RD 9.7% improvement (95% CI 7% to 12%); and NNTB = 5 (95% CI 4 to 7). Remission rates showed an improved RR of 20.73 (95% CI 4.13 to 104.16; moderate-quality evidence); absolute benefit RD 10% (95% CI 8% to 13%); and NNTB = 17 (95% CI 4 to 96), among the biologic + MTX group compared to MTX/other DMARDs. There were no studies for radiographic progression. Results were not clinically meaningful or statistically significantly different for withdrawals due to adverse events or serious adverse events, and were inconclusive for cancer. Tofacitinib monotherapy versus placeboThere were no published data. Tofacitinib + MTX versus active comparator (MTX)In one study, compared to MTX, tofacitinib + MTX was associated with a clinically meaningful and statistically significant improvement in ACR50 (RR 3.24; 95% CI 1.78 to 5.89; absolute benefit RD 19% (95% CI 12% to 26%); NNTB = 6 (95% CI 3 to 14); moderate-quality evidence), and function measured by HAQ, MD 0.27 improvement (95% CI 0.14 to 0.39); absolute benefit RD 9% (95% CI 4.7% to 13%), NNTB = 5 (95% CI 4 to 10); high-quality evidence). RA remission rates were not statistically significantly different but the observed difference may be clinically meaningful (RR 15.44 (95% CI 0.93 to 256.1; high-quality evidence); absolute benefit RD 6% (95% CI 3% to 9%); NNTB could not be calculated. There were no studies for radiographic progression. There were no statistically significant or clinically meaningful differences for withdrawals due to adverse events and serious adverse events, and results were inconclusive for cancer. AUTHORS' CONCLUSIONS Biologic (with or without MTX) or tofacitinib (with MTX) use was associated with clinically meaningful and statistically significant benefits (ACR50, HAQ, remission) compared to placebo or an active comparator (MTX/other traditional DMARDs) among people with RA previously unsuccessfully treated with biologics.No studies examined radiographic progression. Results were not clinically meaningful or statistically significant for withdrawals due to adverse events and serious adverse events, and were inconclusive for cancer.
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Affiliation(s)
- Jasvinder A Singh
- Birmingham VA Medical CenterDepartment of MedicineFaculty Office Tower 805B510 20th Street SouthBirminghamALUSA35294
| | - Alomgir Hossain
- University of Ottawa Heart InstituteCardiovascular Research Methods Centre40 Ruskin StreetRoom H‐2265OttawaONCanadaK1Y 4W7
| | | | - Amy S Mudano
- University of Alabama at BirminghamDepartment of Medicine ‐ RheumatologyBirminghamUSA
| | - Lara J Maxwell
- Ottawa Hospital Research Institute (OHRI), The Ottawa Hospital ‐ General CampusCentre for Practice‐Changing Research (CPCR)501 Smyth Road, Box 711OttawaONCanadaK1H 8L6
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash UniversityMonash Department of Clinical Epidemiology, Cabrini HospitalSuite 41, Cabrini Medical Centre183 Wattletree RoadMalvernVictoriaAustralia3144
| | - Maria Angeles Lopez‐Olivo
- The University of Texas, M.D. Anderson Cancer CenterDepartment of General Internal Medicine1515 Holcombe BlvdUnit 1465HoustonTexasUSA77030
| | - Maria E Suarez‐Almazor
- The University of Texas, M.D. Anderson Cancer CenterDepartment of General Internal Medicine1515 Holcombe BlvdUnit 1465HoustonTexasUSA77030
| | - Peter Tugwell
- Faculty of Medicine, University of OttawaDepartment of MedicineOttawaONCanadaK1H 8M5
| | - George A Wells
- University of OttawaDepartment of Epidemiology and Community MedicineRoom H128140 Ruskin StreetOttawaONCanadaK1Y 4W7
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Fleischmann R, Tongbram V, van Vollenhoven R, Tang DH, Chung J, Collier D, Urs S, Ndirangu K, Wells G, Pope J. Systematic review and network meta-analysis of the efficacy and safety of tumour necrosis factor inhibitor-methotrexate combination therapy versus triple therapy in rheumatoid arthritis. RMD Open 2017; 3:e000371. [PMID: 28123782 PMCID: PMC5237767 DOI: 10.1136/rmdopen-2016-000371] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 11/18/2016] [Accepted: 11/28/2016] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Clinical trials have not consistently demonstrated differences between tumour necrosis factor inhibitor (TNFi) plus methotrexate and triple therapy (methotrexate plus hydroxychloroquine plus sulfasalazine) in rheumatoid arthritis (RA). The study objective was to estimate the efficacy, radiographic benefits, safety and patient-reported outcomes of TNFi-methotrexate versus triple therapy in patients with RA. METHODS A systematic review and network meta-analysis (NMA) of randomised controlled trials of TNFi-methotrexate or triple therapy as one of the treatment arms in patients with an inadequate response to or who were naive to methotrexate was conducted. American College of Rheumatology 70% response criteria (ACR70) at 6 months was the prespecified primary endpoint to evaluate depth of response. Data from direct and indirect comparisons between TNFi-methotrexate and triple therapy were pooled and quantitatively analysed using fixed-effects and random-effects Bayesian models. RESULTS We analysed 33 studies in patients with inadequate response to methotrexate and 19 in patients naive to methotrexate. In inadequate responders, triple therapy was associated with lower odds of achieving ACR70 at 6 months compared with TNFi-methotrexate (OR 0.35, 95% credible interval (CrI) 0.19 to 0.64). Most secondary endpoints tended to favour TNFi-methotrexate in terms of OR direction; however, no clear increased likelihood of achieving these endpoints was observed for either therapy. The odds of infection were lower with triple therapy than with TNFi-methotrexate (OR 0.08, 95% CrI 0.00 to 0.57). There were no differences observed between the two regimens in patients naive to methotrexate. CONCLUSIONS In this NMA, triple therapy was associated with 65% lower odds of achieving ACR70 at 6 months compared with TNFi-methotrexate in patients with inadequate response to methotrexate. Although secondary endpoints numerically favoured TNFi-methotrexate, no clear differences were observed. The odds of infection were greater with TNFi-methotrexate. No differences were observed for patients naive to methotrexate. These results may help inform care of patients who fail methotrexate first-line therapy.
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Affiliation(s)
- Roy Fleischmann
- Department of Internal Medicine, University of Texas Southwestern Medical Center and Metroplex Clinical Research Center, Dallas, Texas, USA
| | | | | | - Derek H Tang
- Amgen Inc., Thousand Oaks, California, USA
- Novartis Pharmaceuticals, East Hanover, New Jersey, USA
| | | | | | - Shilpa Urs
- Oxford Outcomes, ICON plc, Morristown, New Jersey, USA
- Doctors’ Hospital of Michigan, Pontiac, Michigan, USA
| | | | - George Wells
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Janet Pope
- Department of Rheumatology, St. Joseph's Health Care, London, Ontario, Canada
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15
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Singh JA, Hossain A, Tanjong Ghogomu E, Mudano AS, Tugwell P, Wells GA. Biologic or tofacitinib monotherapy for rheumatoid arthritis in people with traditional disease-modifying anti-rheumatic drug (DMARD) failure: a Cochrane Systematic Review and network meta-analysis (NMA). Cochrane Database Syst Rev 2016; 11:CD012437. [PMID: 27855242 PMCID: PMC6469573 DOI: 10.1002/14651858.cd012437] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND We performed a systematic review, a standard meta-analysis and network meta-analysis (NMA), which updates the 2009 Cochrane Overview, 'Biologics for rheumatoid arthritis (RA)'. This review is focused on biologic monotherapy in people with RA in whom treatment with traditional disease-modifying anti-rheumatic drugs (DMARDs) including methotrexate (MTX) had failed (MTX/other DMARD-experienced). OBJECTIVES To assess the benefits and harms of biologic monotherapy (includes anti-tumor necrosis factor (TNF) (adalimumab, certolizumab pegol, etanercept, golimumab, infliximab) or non-TNF (abatacept, anakinra, rituximab, tocilizumab)) or tofacitinib monotherapy (oral small molecule) versus comparator (placebo or MTX/other DMARDs) in adults with RA who were MTX/other DMARD-experienced. METHODS We searched for randomized controlled trials (RCTs) in the Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library 2015, Issue 6, June), MEDLINE (via OVID 1946 to June 2015), and Embase (via OVID 1947 to June 2015). Article selection, data extraction and risk of bias and GRADE assessments were done in duplicate. We calculated direct estimates with 95% confidence intervals (CI) using standard meta-analysis. We used a Bayesian mixed treatment comparisons (MTC) approach for NMA estimates with 95% credible intervals (CrI). We converted odds ratios (OR) to risk ratios (RR) for ease of understanding. We calculated absolute measures as risk difference (RD) and number needed to treat for an additional beneficial outcome (NNTB). MAIN RESULTS This update includes 40 new RCTs for a total of 46 RCTs, of which 41 studies with 14,049 participants provided data. The comparator was placebo in 16 RCTs (4,532 patients), MTX or other DMARD in 13 RCTs (5,602 patients), and another biologic in 12 RCTs (3,915 patients). Monotherapy versus placeboBased on moderate-quality direct evidence, biologic monotherapy (without concurrent MTX/other DMARDs) was associated with a clinically meaningful and statistically significant improvement in American College of Rheumatology score (ACR50) and physical function, as measured by the Health Assessment Questionnaire (HAQ) versus placebo. RR was 4.68 for ACR50 (95% CI, 2.93 to 7.48); absolute benefit RD 23% (95% CI, 18% to 29%); and NNTB = 5 (95% CI, 3 to 8). The mean difference (MD) was -0.32 for HAQ (95% CI, -0.42 to -0.23; a negative sign represents greater HAQ improvement); absolute benefit of -10.7% (95% CI, -14% to -7.7%); and NNTB = 4 (95% CI, 3 to 5). Direct and NMA estimates for TNF biologic, non-TNF biologic or tofacitinib monotherapy showed similar results for ACR50 , downgraded to moderate-quality evidence. Direct and NMA estimates for TNF biologic, anakinra or tofacitinib monotherapy showed a similar results for HAQ versus placebo with mostly moderate quality evidence.Based on moderate-quality direct evidence, biologic monotherapy was associated with a clinically meaningful and statistically significant greater proportion of disease remission versus placebo with RR 1.12 (95% CI 1.03 to 1.22); absolute benefit 10% (95% CI, 3% to 17%; NNTB = 10 (95% CI, 8 to 21)).Based on low-quality direct evidence, results for biologic monotherapy for withdrawals due to adverse events and serious adverse events were inconclusive, with wide confidence intervals encompassing the null effect and evidence of an important increase. The direct estimate for TNF monotherapy for withdrawals due to adverse events showed a clinically meaningful and statistically significant result with RR 2.02 (95% CI, 1.08 to 3.78), absolute benefit RD 3% (95% CI,1% to 4%), based on moderate-quality evidence. The NMA estimates for TNF biologic, non-TNF biologic, anakinra, or tofacitinib monotherapy for withdrawals due to adverse events and for serious adverse events were all inconclusive and downgraded to low-quality evidence. Monotherapy versus active comparator (MTX/other DMARDs)Based on direct evidence of moderate quality, biologic monotherapy (without concurrent MTX/other DMARDs) was associated with a clinically meaningful and statistically significant improvement in ACR50 and HAQ scores versus MTX/other DMARDs with a RR of 1.54 (95% CI, 1.14 to 2.08); absolute benefit 13% (95% CI, 2% to 23%), NNTB = 7 (95% CI, 4 to 26) and a mean difference in HAQ of -0.27 (95% CI, -0.40 to -0.14); absolute benefit of -9% (95% CI, -13.3% to -4.7%), NNTB = 2 (95% CI, 2 to 4). Direct and NMA estimates for TNF monotherapy and NMA estimate for non-TNF biologic monotherapy for ACR50 showed similar results, based on moderate-quality evidence. Direct and NMA estimates for non-TNF biologic monotherapy, but not TNF monotherapy, showed similar HAQ improvements , based on mostly moderate-quality evidence.There were no statistically significant or clinically meaningful differences for direct estimates of biologic monotherapy versus active comparator for RA disease remission. NMA estimates showed a statistically significant and clinically meaningful difference versus active comparator for TNF monotherapy (absolute improvement 7% (95% CI, 2% to 14%)) and non-TNF monotherapy (absolute improvement 19% (95% CrI, 7% to 36%)), both downgraded to moderate quality.Based on moderate-quality direct evidence from a single study, radiographic progression (scale 0 to 448) was statistically significantly reduced in those on biologic monotherapy versus active comparator, MD -4.34 (95% CI, -7.56 to -1.12), though the absolute reduction was small, -0.97% (95% CI, -1.69% to -0.25%). We are not sure of the clinical relevance of this reduction.Direct and NMA evidence (downgraded to low quality), showed inconclusive results for withdrawals due to adverse events, serious adverse events and cancer, with wide confidence intervals encompassing the null effect and evidence of an important increase. AUTHORS' CONCLUSIONS Based mostly on RCTs of six to 12-month duration in people with RA who had previously experienced and failed treatment with MTX/other DMARDs, biologic monotherapy improved ACR50, function and RA remission rates compared to placebo or MTX/other DMARDs.Radiographic progression was reduced versus active comparator, although the clinical significance was unclear.Results were inconclusive for whether biologic monotherapy was associated with an increased risk of withdrawals due to adverse events, serious adverse events or cancer, versus placebo (no data on cancer) or MTX/other DMARDs.
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Affiliation(s)
- Jasvinder A Singh
- Birmingham VA Medical CenterDepartment of MedicineFaculty Office Tower 805B510 20th Street SouthBirminghamALUSA35294
| | - Alomgir Hossain
- University of Ottawa Heart InstituteCardiovascular Research Methods Centre40 Ruskin StreetRoom H‐2265OttawaONCanadaK1Y 4W7
| | | | - Amy S Mudano
- University of Alabama at BirminghamDepartment of Medicine ‐ RheumatologyBirminghamUSA
| | - Peter Tugwell
- Faculty of Medicine, University of OttawaDepartment of MedicineOttawaONCanadaK1H 8M5
| | - George A Wells
- University of OttawaDepartment of Epidemiology and Community MedicineRoom H128140 Ruskin StreetOttawaONCanadaK1Y 4W7
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Obeng JA, Amoruso A, Camaschella GLE, Sola D, Brunelleschi S, Fresu LG. Modulation of human monocyte/macrophage activity by tocilizumab, abatacept and etanercept: An in vitro study. Eur J Pharmacol 2016; 780:33-7. [PMID: 26997366 DOI: 10.1016/j.ejphar.2016.03.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 03/12/2016] [Accepted: 03/15/2016] [Indexed: 12/20/2022]
Abstract
Tocilizumab, etanercept and abatacept are biological drugs used in the therapy of Rheumatoid Arthritis (RA). Their mechanism of action is well documented but their direct effects on human monocytes/macrophages have not been fully investigated. The objective of this study was to evaluate in vitro the influence of these drugs on monocytes/macrophages from healthy volunteers. Human monocytes were isolated from healthy anonymous volunteers and cultured as such or differentiated to monocyte-derived macrophages (MDMs). The effect of tocilizumab, etanercept and abatacept (at concentrations similar to those in plasma of patients) on superoxide anion production, matrix metalloproteinase-9 (MMP-9) gene expression and activity, Peroxisome Proliferator-Activated Receptor (PPAR)γ expression and cell phenotype was evaluated. Exposure of monocytes/macrophages to tocilizumab, etanercept or abatacept resulted in a significant decrease of the PMA-induced superoxide anion production. Interestingly, the expression of PPARγ was significantly increased only by tocilizumab, while etanercept was the only one able to significantly reduce MMP-9 gene expression and inhibit the LPS-induced MMP-9 activity in monocytes. When etanercept and abatacept were added to the differentiating medium, both significantly reduced the amount of CD206(+)MDM. This study demonstrates that etanercept, abatacept and tocilizumab affect differently human monocytes/macrophages. In particular, the IL-6 antagonist tocilizumab seems to be more effective in inducing an anti-inflammatory phenotype of monocytes/macrophages compared to etanercept and abatacept, also in light of the up-regulation of PPARγ whose anti-inflammatory effects are well recognised.
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Affiliation(s)
- Joyce Afrakoma Obeng
- Department of Health Sciences, School of Medicine, University of Piemonte Orientale, Via Solaroli, 17, 28100 Novara, Italy
| | - Angela Amoruso
- Department of Health Sciences, School of Medicine, University of Piemonte Orientale, Via Solaroli, 17, 28100 Novara, Italy
| | | | - Daniele Sola
- Azienda Ospedaliera-Universitaria Maggiore della Carità, Novara, Italy
| | - Sandra Brunelleschi
- Department of Health Sciences, School of Medicine, University of Piemonte Orientale, Via Solaroli, 17, 28100 Novara, Italy
| | - Luigia Grazia Fresu
- Department of Health Sciences, School of Medicine, University of Piemonte Orientale, Via Solaroli, 17, 28100 Novara, Italy.
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Sangiorgi D, Benucci M, Nappi C, Perrone V, Buda S, Degli Esposti L. Drug usage analysis and health care resources consumption in naïve patients with rheumatoid arthritis. Biologics 2015; 9:119-27. [PMID: 26604680 PMCID: PMC4642803 DOI: 10.2147/btt.s89286] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The use of biologic agents has revolutionized the management of rheumatoid arthritis (RA) in the past 2 decades. These biologic agents directly target molecules and cells involved in the pathogenesis of RA. The purpose of this study was to assess the usage of biologic agents in terms of persistence to treatment, dose escalation, and consumption of health care resources (hospitalizations, drugs, and outpatients service) in the real clinical practice in naïve patients with RA. METHODS We conducted a real-world, retrospective, observational cohort study based on data obtained from administrative databases of three Local Health Units in Italy. The population included adults diagnosed with RA who had at least one prescription between January 1, 2009 and December 31, 2011, for a biologic that was approved for treatment of RA. The patients were followed for 12 months after enrollment. The clinical characteristics of the patients enrolled in this study were also investigated in the 1-year period before the index date. The main and secondary endpoints were evaluated only in biologic-naïve patients without switches. The overall health care costs for patients were evaluated. RESULTS A total of 594 patients met the study criteria (mean age 53.5±13.5, female:male ratio =3:1). Thirty-nine percent received etanercept, 25% adalimumab, 14% infliximab, 10% abatacept, 9% tocilizumab, and 3% golimumab. After 1 year of observation, patients showed similar use of other RA-related medication. For the naïve patients without switches, the persistence levels were: 78% for etanercept, 72% for tocilizumab, 71% for adalimumab, 69% for infliximab, and 64% for abatacept. For all agents, dose escalation was 21.4% for infliximab, 11.5% for adalimumab, 5.6% for abatacept, 4% for tocilizumab, and 3.8% for etanercept. The annual costs per treated patients were €12,803 for adalimumab, €11,924 for etanercept, €11,830 for tocilizumab, €11,201 for infliximab, and €10,943 for abatacept. CONCLUSION The role of biologic therapies in the treatment of RA continues to evolve; our study reflects real-world drug utilization data in adult patients with RA. These observations could be used by decision makers to support formulary decisions, although further research is needed using a larger sample to validate these results.
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Affiliation(s)
- Diego Sangiorgi
- CliCon S.r.l., Health, Economics and Outcomes Research, Ravenna, Italy
| | - Maurizio Benucci
- Unit of Rheumatology, S. Giovanni di Dio Hospital, Florence, Italy
| | | | - Valentina Perrone
- CliCon S.r.l., Health, Economics and Outcomes Research, Ravenna, Italy
| | - Stefano Buda
- CliCon S.r.l., Health, Economics and Outcomes Research, Ravenna, Italy
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Zhang J, Xie F, Delzell E, Yun H, Lewis JD, Haynes K, Chen L, Beukelman T, Saag KG, Curtis JR. Impact of biologic agents with and without concomitant methotrexate and at reduced doses in older rheumatoid arthritis patients. Arthritis Care Res (Hoboken) 2015; 67:624-32. [PMID: 25370912 DOI: 10.1002/acr.22510] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 10/28/2014] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To examine whether concomitant methotrexate (MTX) use is associated with better biologic persistence and whether self-administered anti-tumor necrosis factor (anti-TNF) therapies are used at reduced doses in real-world clinical care settings, not just clinical trials. METHODS We conducted a retrospective cohort study among rheumatoid arthritis (RA) patients using Medicare claims data from 2006 to 2012. Subjects were new initiators of etanercept, infliximab, adalimumab, abatacept, and tocilizumab with at least 12 months of continuous medical and pharmacy coverage after treatment initiation. We examined the association between concomitant MTX use and persistence on biologic agents using Cox proportional hazards regression, adjusting for demographics and baseline comorbidities. We further identified a subgroup of patients who initiated and were adherent on etanercept or adalimumab for at least 12 months and examined the proportion of patients who subsequently used these therapies at reduced doses continuously for an additional 12, 18, and 24 months. RESULTS Of 26,510 eligible RA patients, 10,511 initiated biologic monotherapy. Overall, patients who initiated biologic monotherapy were 1.4 (95% confidence interval [95% CI] 1.3-1.5) times more likely to discontinue at 1 year compared to those who initiated combination therapy, and 1.8 (95% CI 1.7-2.0) times more likely if starting infliximab monotherapy. Approximately 10-20% of patients who initiated and adhered to etanercept and adalimumab for ≥12 months subsequently received reduced-dose therapy for an 12 additional months and beyond. CONCLUSION In real-world practice, concomitant MTX was associated with improved persistence on biologic therapy, especially for infliximab users; reduced-dose injectable anti-TNF therapy was used by a substantial proportion of RA patients.
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Anti-TNF in rheumatoid arthritis: an overview. Wien Med Wochenschr 2015; 165:3-9. [DOI: 10.1007/s10354-015-0344-y] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 01/13/2015] [Indexed: 12/19/2022]
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Borrás-Blasco J, Navarro Ruiz A. Dose modification of anti-TNF in rheumatoid arthritis and estimated economical impact: a review of observational studies. Expert Rev Pharmacoecon Outcomes Res 2015; 15:71-9. [PMID: 25555555 DOI: 10.1586/14737167.2015.967219] [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: 11/08/2022]
Abstract
Anti-TNF drugs indicated for the treatment of moderate-to-severe active rheumatoid arthritis (RA) presents similar efficacy, safety and potential toxicity profiles, with more than 10 years' treatment experience. Several pharmacoeconomic evaluations had demonstrated their favorable cost-effectiveness profile in RA patients, based on pivotal clinical studies data from different countries and perspectives. However, in clinical practice, individual profiles of patients and drugs leads to dose modifications that may be associated with substantial cost deviations. Here, we further discuss the effect of dose titration of these biological drugs in clinical practice over their RA cost-effectiveness profiles.
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Affiliation(s)
- Joaquín Borrás-Blasco
- Specialist in Hospital Pharmacy, Pharmacy Service, Pharmacy Department, Hospital de Sagunto, Avda Ramon y Cajal s/n Sagunto E-46520 Valencia, Spain
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22
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Michaud TL, Rho YH, Shamliyan T, Kuntz KM, Choi HK. The comparative safety of tumor necrosis factor inhibitors in rheumatoid arthritis: a meta-analysis update of 44 trials. Am J Med 2014; 127:1208-32. [PMID: 24950486 DOI: 10.1016/j.amjmed.2014.06.012] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 05/22/2014] [Accepted: 06/09/2014] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The study objective was to evaluate and update the safety data from randomized controlled trials of tumor necrosis factor inhibitors in patients treated for rheumatoid arthritis. METHODS A systematic literature search was conducted from 1990 to May 2013. All studies included were randomized, double-blind, controlled trials of patients with rheumatoid arthritis that evaluated adalimumab, certolizumab pegol, etanercept, golimumab, or infliximab treatment. The serious adverse events and discontinuation rates were abstracted, and risk estimates were calculated by Peto odds ratios (ORs). RESULTS Forty-four randomized controlled trials involving 11,700 subjects receiving tumor necrosis factor inhibitors and 5901 subjects receiving placebo or traditional disease-modifying antirheumatic drugs were included. Tumor necrosis factor inhibitor treatment as a group was associated with a higher risk of serious infection (OR, 1.42; 95% confidence interval [CI], 1.13-1.78) and treatment discontinuation due to adverse events (OR, 1.23; 95% CI, 1.06-1.43) compared with placebo and traditional disease-modifying antirheumatic drug treatments. Specifically, patients taking adalimumab, certolizumab pegol, and infliximab had an increased risk of serious infection (OR, 1.69, 1.98, and 1.63, respectively) and showed an increased risk of discontinuation due to adverse events (OR, 1.38, 1.67, and 2.04, respectively). In contrast, patients taking etanercept had a decreased risk of discontinuation due to adverse events (OR, 0.72; 95% CI, 0.55-0.93). Although ORs for malignancy varied across the different tumor necrosis factor inhibitors, none reached statistical significance. CONCLUSIONS These meta-analysis updates of the comparative safety of tumor necrosis factor inhibitors suggest a higher risk of serious infection associated with adalimumab, certolizumab pegol, and infliximab, which seems to contribute to higher rates of discontinuation. In contrast, etanercept use showed a lower rate of discontinuation. These data may help guide clinical comparative decision making in the management of rheumatoid arthritis.
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Affiliation(s)
- Tzeyu L Michaud
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis
| | - Young Hee Rho
- Section of Rheumatology and the Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Mass
| | - Tatyana Shamliyan
- Evidence-Based Medicine Quality Assurance Elsevier, Clinical Solutions, Philadelphia, PA
| | - Karen M Kuntz
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis
| | - Hyon K Choi
- Section of Rheumatology and the Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Mass.
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23
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Cannon GW, DuVall SL, Haroldsen CL, Caplan L, Curtis JR, Michaud K, Mikuls TR, Reimold A, Collier DH, Harrison DJ, Joseph GJ, Sauer BC. Persistence and dose escalation of tumor necrosis factor inhibitors in US veterans with rheumatoid arthritis. J Rheumatol 2014; 41:1935-43. [PMID: 25128516 DOI: 10.3899/jrheum.140164] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Limited evidence exists comparing the persistence, effectiveness, and costs of biologic therapies for rheumatoid arthritis in clinical practice. Comparative effectiveness studies are needed to understand real-world experience with these agents. We evaluated treatment patterns, costs, and effectiveness of tumor necrosis factor inhibitor (TNFi) agents in patients enrolled in the Veterans Affairs Rheumatoid Arthritis (VARA) registry. METHODS Observational data from the VARA registry and linked administrative databases were analyzed. Longitudinal data from VARA patients initiating adalimumab (ADA), etanercept (ETN), or infliximab (IFX) from 2003 (the date all agents were available within the Veteran Affairs) to 2010 were analyzed. Outcomes included Disease Activity Score using 28 joints (DAS28), treatment persistence, dose escalation, and direct costs of drugs and drug administration. RESULTS For 563 eligible patients, baseline DAS28, DAS28 improvements, and persistence on initial treatment were similar across agents. Fewer patients receiving ETN (n = 5/290; 2%) underwent dose escalation than did patients taking ADA (n = 32/204; 16%) or IFX (n = 44/69; 64%). Annual costs for first course of TNFi therapy were lower for injectable ADA ($13,100 US) and ETN ($13,500 US) than for intravenously administered IFX ($16,900 US). CONCLUSION Despite similar persistence and clinical disease activity for these TNFi agents, rates of dose escalation were highest with ADA and IFX. Higher overall costs were noted for IFX without increases in effectiveness.
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Affiliation(s)
- Grant W Cannon
- From the Veterans Affairs Salt Lake City Health Care System; University of Utah School of Medicine, Salt Lake City, Utah; Denver Veterans Affairs (VA); University of Colorado, Denver, Colorado; University of Alabama at Birmingham, Birmingham, Alabama; the University of Nebraska Medical Center; Omaha VA, Omaha, Nebraska; the National Data Bank for Rheumatic Diseases, Wichita, Kansas; Dallas VA; University of Texas Southwestern, Dallas, Texas; Amgen Inc., Thousand Oaks, California, USA.G.W. Cannon, MD, Associate Chief of Staff of Academic Affiliations; S.L. DuVall, PhD, Associate Director, VA Informatics and Computing Infrastructure and Research Assistant Professor; C.L. Haroldsen, MSPH, Senior Programmer/Analyst; B.C. Sauer, PhD, MS, Associate Professor, Veterans Affairs Salt Lake City Health Care System, University of Utah School of Medicine; L. Caplan, MD, PhD, Associate Professor of Medicine/Rheumatology, Denver VA, University of Colorado; J.R. Curtis, MD, MS, MPH, William J. Koopman Endowed Professor in Rheumatology and Immunology, Director, University of Alabama Birmingham (UAB) Arthritis Clinical Intervention Program, Co-director, UAB Center for Education and Research on Therapeutics, Co-director, UAB PharmacoEpidemiology and Economic Research Group, University of Alabama at Birmingham; K. Michaud, PhD, Assistant Professor of Medicine, Co-director, University of Nebraska Medical Center, National Data Bank for Rheumatic Diseases; T.R. Mikuls, MD, Staff Physician and Researcher, Professor of Internal Medicine and Rheumatology, Omaha VA, University of Nebraska Medical Center; A. Reimold, MD, Chief, Rheumatology Section, Associate Professor of Medicine, Dallas VA, University of Texas Southwestern; D.H. Collier, MD, Clinical Research Medical Director; D.J. Harrison, PhD, Health Economics Director, Amgen Inc.; G.J. Joseph, PhD, Health Economics Senior Manager, former employee of Amgen Inc.
| | - Scott L DuVall
- From the Veterans Affairs Salt Lake City Health Care System; University of Utah School of Medicine, Salt Lake City, Utah; Denver Veterans Affairs (VA); University of Colorado, Denver, Colorado; University of Alabama at Birmingham, Birmingham, Alabama; the University of Nebraska Medical Center; Omaha VA, Omaha, Nebraska; the National Data Bank for Rheumatic Diseases, Wichita, Kansas; Dallas VA; University of Texas Southwestern, Dallas, Texas; Amgen Inc., Thousand Oaks, California, USA.G.W. Cannon, MD, Associate Chief of Staff of Academic Affiliations; S.L. DuVall, PhD, Associate Director, VA Informatics and Computing Infrastructure and Research Assistant Professor; C.L. Haroldsen, MSPH, Senior Programmer/Analyst; B.C. Sauer, PhD, MS, Associate Professor, Veterans Affairs Salt Lake City Health Care System, University of Utah School of Medicine; L. Caplan, MD, PhD, Associate Professor of Medicine/Rheumatology, Denver VA, University of Colorado; J.R. Curtis, MD, MS, MPH, William J. Koopman Endowed Professor in Rheumatology and Immunology, Director, University of Alabama Birmingham (UAB) Arthritis Clinical Intervention Program, Co-director, UAB Center for Education and Research on Therapeutics, Co-director, UAB PharmacoEpidemiology and Economic Research Group, University of Alabama at Birmingham; K. Michaud, PhD, Assistant Professor of Medicine, Co-director, University of Nebraska Medical Center, National Data Bank for Rheumatic Diseases; T.R. Mikuls, MD, Staff Physician and Researcher, Professor of Internal Medicine and Rheumatology, Omaha VA, University of Nebraska Medical Center; A. Reimold, MD, Chief, Rheumatology Section, Associate Professor of Medicine, Dallas VA, University of Texas Southwestern; D.H. Collier, MD, Clinical Research Medical Director; D.J. Harrison, PhD, Health Economics Director, Amgen Inc.; G.J. Joseph, PhD, Health Economics Senior Manager, former employee of Amgen Inc
| | - Candace L Haroldsen
- From the Veterans Affairs Salt Lake City Health Care System; University of Utah School of Medicine, Salt Lake City, Utah; Denver Veterans Affairs (VA); University of Colorado, Denver, Colorado; University of Alabama at Birmingham, Birmingham, Alabama; the University of Nebraska Medical Center; Omaha VA, Omaha, Nebraska; the National Data Bank for Rheumatic Diseases, Wichita, Kansas; Dallas VA; University of Texas Southwestern, Dallas, Texas; Amgen Inc., Thousand Oaks, California, USA.G.W. Cannon, MD, Associate Chief of Staff of Academic Affiliations; S.L. DuVall, PhD, Associate Director, VA Informatics and Computing Infrastructure and Research Assistant Professor; C.L. Haroldsen, MSPH, Senior Programmer/Analyst; B.C. Sauer, PhD, MS, Associate Professor, Veterans Affairs Salt Lake City Health Care System, University of Utah School of Medicine; L. Caplan, MD, PhD, Associate Professor of Medicine/Rheumatology, Denver VA, University of Colorado; J.R. Curtis, MD, MS, MPH, William J. Koopman Endowed Professor in Rheumatology and Immunology, Director, University of Alabama Birmingham (UAB) Arthritis Clinical Intervention Program, Co-director, UAB Center for Education and Research on Therapeutics, Co-director, UAB PharmacoEpidemiology and Economic Research Group, University of Alabama at Birmingham; K. Michaud, PhD, Assistant Professor of Medicine, Co-director, University of Nebraska Medical Center, National Data Bank for Rheumatic Diseases; T.R. Mikuls, MD, Staff Physician and Researcher, Professor of Internal Medicine and Rheumatology, Omaha VA, University of Nebraska Medical Center; A. Reimold, MD, Chief, Rheumatology Section, Associate Professor of Medicine, Dallas VA, University of Texas Southwestern; D.H. Collier, MD, Clinical Research Medical Director; D.J. Harrison, PhD, Health Economics Director, Amgen Inc.; G.J. Joseph, PhD, Health Economics Senior Manager, former employee of Amgen Inc
| | - Liron Caplan
- From the Veterans Affairs Salt Lake City Health Care System; University of Utah School of Medicine, Salt Lake City, Utah; Denver Veterans Affairs (VA); University of Colorado, Denver, Colorado; University of Alabama at Birmingham, Birmingham, Alabama; the University of Nebraska Medical Center; Omaha VA, Omaha, Nebraska; the National Data Bank for Rheumatic Diseases, Wichita, Kansas; Dallas VA; University of Texas Southwestern, Dallas, Texas; Amgen Inc., Thousand Oaks, California, USA.G.W. Cannon, MD, Associate Chief of Staff of Academic Affiliations; S.L. DuVall, PhD, Associate Director, VA Informatics and Computing Infrastructure and Research Assistant Professor; C.L. Haroldsen, MSPH, Senior Programmer/Analyst; B.C. Sauer, PhD, MS, Associate Professor, Veterans Affairs Salt Lake City Health Care System, University of Utah School of Medicine; L. Caplan, MD, PhD, Associate Professor of Medicine/Rheumatology, Denver VA, University of Colorado; J.R. Curtis, MD, MS, MPH, William J. Koopman Endowed Professor in Rheumatology and Immunology, Director, University of Alabama Birmingham (UAB) Arthritis Clinical Intervention Program, Co-director, UAB Center for Education and Research on Therapeutics, Co-director, UAB PharmacoEpidemiology and Economic Research Group, University of Alabama at Birmingham; K. Michaud, PhD, Assistant Professor of Medicine, Co-director, University of Nebraska Medical Center, National Data Bank for Rheumatic Diseases; T.R. Mikuls, MD, Staff Physician and Researcher, Professor of Internal Medicine and Rheumatology, Omaha VA, University of Nebraska Medical Center; A. Reimold, MD, Chief, Rheumatology Section, Associate Professor of Medicine, Dallas VA, University of Texas Southwestern; D.H. Collier, MD, Clinical Research Medical Director; D.J. Harrison, PhD, Health Economics Director, Amgen Inc.; G.J. Joseph, PhD, Health Economics Senior Manager, former employee of Amgen Inc
| | - Jeffrey R Curtis
- From the Veterans Affairs Salt Lake City Health Care System; University of Utah School of Medicine, Salt Lake City, Utah; Denver Veterans Affairs (VA); University of Colorado, Denver, Colorado; University of Alabama at Birmingham, Birmingham, Alabama; the University of Nebraska Medical Center; Omaha VA, Omaha, Nebraska; the National Data Bank for Rheumatic Diseases, Wichita, Kansas; Dallas VA; University of Texas Southwestern, Dallas, Texas; Amgen Inc., Thousand Oaks, California, USA.G.W. Cannon, MD, Associate Chief of Staff of Academic Affiliations; S.L. DuVall, PhD, Associate Director, VA Informatics and Computing Infrastructure and Research Assistant Professor; C.L. Haroldsen, MSPH, Senior Programmer/Analyst; B.C. Sauer, PhD, MS, Associate Professor, Veterans Affairs Salt Lake City Health Care System, University of Utah School of Medicine; L. Caplan, MD, PhD, Associate Professor of Medicine/Rheumatology, Denver VA, University of Colorado; J.R. Curtis, MD, MS, MPH, William J. Koopman Endowed Professor in Rheumatology and Immunology, Director, University of Alabama Birmingham (UAB) Arthritis Clinical Intervention Program, Co-director, UAB Center for Education and Research on Therapeutics, Co-director, UAB PharmacoEpidemiology and Economic Research Group, University of Alabama at Birmingham; K. Michaud, PhD, Assistant Professor of Medicine, Co-director, University of Nebraska Medical Center, National Data Bank for Rheumatic Diseases; T.R. Mikuls, MD, Staff Physician and Researcher, Professor of Internal Medicine and Rheumatology, Omaha VA, University of Nebraska Medical Center; A. Reimold, MD, Chief, Rheumatology Section, Associate Professor of Medicine, Dallas VA, University of Texas Southwestern; D.H. Collier, MD, Clinical Research Medical Director; D.J. Harrison, PhD, Health Economics Director, Amgen Inc.; G.J. Joseph, PhD, Health Economics Senior Manager, former employee of Amgen Inc
| | - Kaleb Michaud
- From the Veterans Affairs Salt Lake City Health Care System; University of Utah School of Medicine, Salt Lake City, Utah; Denver Veterans Affairs (VA); University of Colorado, Denver, Colorado; University of Alabama at Birmingham, Birmingham, Alabama; the University of Nebraska Medical Center; Omaha VA, Omaha, Nebraska; the National Data Bank for Rheumatic Diseases, Wichita, Kansas; Dallas VA; University of Texas Southwestern, Dallas, Texas; Amgen Inc., Thousand Oaks, California, USA.G.W. Cannon, MD, Associate Chief of Staff of Academic Affiliations; S.L. DuVall, PhD, Associate Director, VA Informatics and Computing Infrastructure and Research Assistant Professor; C.L. Haroldsen, MSPH, Senior Programmer/Analyst; B.C. Sauer, PhD, MS, Associate Professor, Veterans Affairs Salt Lake City Health Care System, University of Utah School of Medicine; L. Caplan, MD, PhD, Associate Professor of Medicine/Rheumatology, Denver VA, University of Colorado; J.R. Curtis, MD, MS, MPH, William J. Koopman Endowed Professor in Rheumatology and Immunology, Director, University of Alabama Birmingham (UAB) Arthritis Clinical Intervention Program, Co-director, UAB Center for Education and Research on Therapeutics, Co-director, UAB PharmacoEpidemiology and Economic Research Group, University of Alabama at Birmingham; K. Michaud, PhD, Assistant Professor of Medicine, Co-director, University of Nebraska Medical Center, National Data Bank for Rheumatic Diseases; T.R. Mikuls, MD, Staff Physician and Researcher, Professor of Internal Medicine and Rheumatology, Omaha VA, University of Nebraska Medical Center; A. Reimold, MD, Chief, Rheumatology Section, Associate Professor of Medicine, Dallas VA, University of Texas Southwestern; D.H. Collier, MD, Clinical Research Medical Director; D.J. Harrison, PhD, Health Economics Director, Amgen Inc.; G.J. Joseph, PhD, Health Economics Senior Manager, former employee of Amgen Inc
| | - Ted R Mikuls
- From the Veterans Affairs Salt Lake City Health Care System; University of Utah School of Medicine, Salt Lake City, Utah; Denver Veterans Affairs (VA); University of Colorado, Denver, Colorado; University of Alabama at Birmingham, Birmingham, Alabama; the University of Nebraska Medical Center; Omaha VA, Omaha, Nebraska; the National Data Bank for Rheumatic Diseases, Wichita, Kansas; Dallas VA; University of Texas Southwestern, Dallas, Texas; Amgen Inc., Thousand Oaks, California, USA.G.W. Cannon, MD, Associate Chief of Staff of Academic Affiliations; S.L. DuVall, PhD, Associate Director, VA Informatics and Computing Infrastructure and Research Assistant Professor; C.L. Haroldsen, MSPH, Senior Programmer/Analyst; B.C. Sauer, PhD, MS, Associate Professor, Veterans Affairs Salt Lake City Health Care System, University of Utah School of Medicine; L. Caplan, MD, PhD, Associate Professor of Medicine/Rheumatology, Denver VA, University of Colorado; J.R. Curtis, MD, MS, MPH, William J. Koopman Endowed Professor in Rheumatology and Immunology, Director, University of Alabama Birmingham (UAB) Arthritis Clinical Intervention Program, Co-director, UAB Center for Education and Research on Therapeutics, Co-director, UAB PharmacoEpidemiology and Economic Research Group, University of Alabama at Birmingham; K. Michaud, PhD, Assistant Professor of Medicine, Co-director, University of Nebraska Medical Center, National Data Bank for Rheumatic Diseases; T.R. Mikuls, MD, Staff Physician and Researcher, Professor of Internal Medicine and Rheumatology, Omaha VA, University of Nebraska Medical Center; A. Reimold, MD, Chief, Rheumatology Section, Associate Professor of Medicine, Dallas VA, University of Texas Southwestern; D.H. Collier, MD, Clinical Research Medical Director; D.J. Harrison, PhD, Health Economics Director, Amgen Inc.; G.J. Joseph, PhD, Health Economics Senior Manager, former employee of Amgen Inc
| | - Andreas Reimold
- From the Veterans Affairs Salt Lake City Health Care System; University of Utah School of Medicine, Salt Lake City, Utah; Denver Veterans Affairs (VA); University of Colorado, Denver, Colorado; University of Alabama at Birmingham, Birmingham, Alabama; the University of Nebraska Medical Center; Omaha VA, Omaha, Nebraska; the National Data Bank for Rheumatic Diseases, Wichita, Kansas; Dallas VA; University of Texas Southwestern, Dallas, Texas; Amgen Inc., Thousand Oaks, California, USA.G.W. Cannon, MD, Associate Chief of Staff of Academic Affiliations; S.L. DuVall, PhD, Associate Director, VA Informatics and Computing Infrastructure and Research Assistant Professor; C.L. Haroldsen, MSPH, Senior Programmer/Analyst; B.C. Sauer, PhD, MS, Associate Professor, Veterans Affairs Salt Lake City Health Care System, University of Utah School of Medicine; L. Caplan, MD, PhD, Associate Professor of Medicine/Rheumatology, Denver VA, University of Colorado; J.R. Curtis, MD, MS, MPH, William J. Koopman Endowed Professor in Rheumatology and Immunology, Director, University of Alabama Birmingham (UAB) Arthritis Clinical Intervention Program, Co-director, UAB Center for Education and Research on Therapeutics, Co-director, UAB PharmacoEpidemiology and Economic Research Group, University of Alabama at Birmingham; K. Michaud, PhD, Assistant Professor of Medicine, Co-director, University of Nebraska Medical Center, National Data Bank for Rheumatic Diseases; T.R. Mikuls, MD, Staff Physician and Researcher, Professor of Internal Medicine and Rheumatology, Omaha VA, University of Nebraska Medical Center; A. Reimold, MD, Chief, Rheumatology Section, Associate Professor of Medicine, Dallas VA, University of Texas Southwestern; D.H. Collier, MD, Clinical Research Medical Director; D.J. Harrison, PhD, Health Economics Director, Amgen Inc.; G.J. Joseph, PhD, Health Economics Senior Manager, former employee of Amgen Inc
| | - David H Collier
- From the Veterans Affairs Salt Lake City Health Care System; University of Utah School of Medicine, Salt Lake City, Utah; Denver Veterans Affairs (VA); University of Colorado, Denver, Colorado; University of Alabama at Birmingham, Birmingham, Alabama; the University of Nebraska Medical Center; Omaha VA, Omaha, Nebraska; the National Data Bank for Rheumatic Diseases, Wichita, Kansas; Dallas VA; University of Texas Southwestern, Dallas, Texas; Amgen Inc., Thousand Oaks, California, USA.G.W. Cannon, MD, Associate Chief of Staff of Academic Affiliations; S.L. DuVall, PhD, Associate Director, VA Informatics and Computing Infrastructure and Research Assistant Professor; C.L. Haroldsen, MSPH, Senior Programmer/Analyst; B.C. Sauer, PhD, MS, Associate Professor, Veterans Affairs Salt Lake City Health Care System, University of Utah School of Medicine; L. Caplan, MD, PhD, Associate Professor of Medicine/Rheumatology, Denver VA, University of Colorado; J.R. Curtis, MD, MS, MPH, William J. Koopman Endowed Professor in Rheumatology and Immunology, Director, University of Alabama Birmingham (UAB) Arthritis Clinical Intervention Program, Co-director, UAB Center for Education and Research on Therapeutics, Co-director, UAB PharmacoEpidemiology and Economic Research Group, University of Alabama at Birmingham; K. Michaud, PhD, Assistant Professor of Medicine, Co-director, University of Nebraska Medical Center, National Data Bank for Rheumatic Diseases; T.R. Mikuls, MD, Staff Physician and Researcher, Professor of Internal Medicine and Rheumatology, Omaha VA, University of Nebraska Medical Center; A. Reimold, MD, Chief, Rheumatology Section, Associate Professor of Medicine, Dallas VA, University of Texas Southwestern; D.H. Collier, MD, Clinical Research Medical Director; D.J. Harrison, PhD, Health Economics Director, Amgen Inc.; G.J. Joseph, PhD, Health Economics Senior Manager, former employee of Amgen Inc
| | - David J Harrison
- From the Veterans Affairs Salt Lake City Health Care System; University of Utah School of Medicine, Salt Lake City, Utah; Denver Veterans Affairs (VA); University of Colorado, Denver, Colorado; University of Alabama at Birmingham, Birmingham, Alabama; the University of Nebraska Medical Center; Omaha VA, Omaha, Nebraska; the National Data Bank for Rheumatic Diseases, Wichita, Kansas; Dallas VA; University of Texas Southwestern, Dallas, Texas; Amgen Inc., Thousand Oaks, California, USA.G.W. Cannon, MD, Associate Chief of Staff of Academic Affiliations; S.L. DuVall, PhD, Associate Director, VA Informatics and Computing Infrastructure and Research Assistant Professor; C.L. Haroldsen, MSPH, Senior Programmer/Analyst; B.C. Sauer, PhD, MS, Associate Professor, Veterans Affairs Salt Lake City Health Care System, University of Utah School of Medicine; L. Caplan, MD, PhD, Associate Professor of Medicine/Rheumatology, Denver VA, University of Colorado; J.R. Curtis, MD, MS, MPH, William J. Koopman Endowed Professor in Rheumatology and Immunology, Director, University of Alabama Birmingham (UAB) Arthritis Clinical Intervention Program, Co-director, UAB Center for Education and Research on Therapeutics, Co-director, UAB PharmacoEpidemiology and Economic Research Group, University of Alabama at Birmingham; K. Michaud, PhD, Assistant Professor of Medicine, Co-director, University of Nebraska Medical Center, National Data Bank for Rheumatic Diseases; T.R. Mikuls, MD, Staff Physician and Researcher, Professor of Internal Medicine and Rheumatology, Omaha VA, University of Nebraska Medical Center; A. Reimold, MD, Chief, Rheumatology Section, Associate Professor of Medicine, Dallas VA, University of Texas Southwestern; D.H. Collier, MD, Clinical Research Medical Director; D.J. Harrison, PhD, Health Economics Director, Amgen Inc.; G.J. Joseph, PhD, Health Economics Senior Manager, former employee of Amgen Inc
| | - George J Joseph
- From the Veterans Affairs Salt Lake City Health Care System; University of Utah School of Medicine, Salt Lake City, Utah; Denver Veterans Affairs (VA); University of Colorado, Denver, Colorado; University of Alabama at Birmingham, Birmingham, Alabama; the University of Nebraska Medical Center; Omaha VA, Omaha, Nebraska; the National Data Bank for Rheumatic Diseases, Wichita, Kansas; Dallas VA; University of Texas Southwestern, Dallas, Texas; Amgen Inc., Thousand Oaks, California, USA.G.W. Cannon, MD, Associate Chief of Staff of Academic Affiliations; S.L. DuVall, PhD, Associate Director, VA Informatics and Computing Infrastructure and Research Assistant Professor; C.L. Haroldsen, MSPH, Senior Programmer/Analyst; B.C. Sauer, PhD, MS, Associate Professor, Veterans Affairs Salt Lake City Health Care System, University of Utah School of Medicine; L. Caplan, MD, PhD, Associate Professor of Medicine/Rheumatology, Denver VA, University of Colorado; J.R. Curtis, MD, MS, MPH, William J. Koopman Endowed Professor in Rheumatology and Immunology, Director, University of Alabama Birmingham (UAB) Arthritis Clinical Intervention Program, Co-director, UAB Center for Education and Research on Therapeutics, Co-director, UAB PharmacoEpidemiology and Economic Research Group, University of Alabama at Birmingham; K. Michaud, PhD, Assistant Professor of Medicine, Co-director, University of Nebraska Medical Center, National Data Bank for Rheumatic Diseases; T.R. Mikuls, MD, Staff Physician and Researcher, Professor of Internal Medicine and Rheumatology, Omaha VA, University of Nebraska Medical Center; A. Reimold, MD, Chief, Rheumatology Section, Associate Professor of Medicine, Dallas VA, University of Texas Southwestern; D.H. Collier, MD, Clinical Research Medical Director; D.J. Harrison, PhD, Health Economics Director, Amgen Inc.; G.J. Joseph, PhD, Health Economics Senior Manager, former employee of Amgen Inc
| | - Brian C Sauer
- From the Veterans Affairs Salt Lake City Health Care System; University of Utah School of Medicine, Salt Lake City, Utah; Denver Veterans Affairs (VA); University of Colorado, Denver, Colorado; University of Alabama at Birmingham, Birmingham, Alabama; the University of Nebraska Medical Center; Omaha VA, Omaha, Nebraska; the National Data Bank for Rheumatic Diseases, Wichita, Kansas; Dallas VA; University of Texas Southwestern, Dallas, Texas; Amgen Inc., Thousand Oaks, California, USA.G.W. Cannon, MD, Associate Chief of Staff of Academic Affiliations; S.L. DuVall, PhD, Associate Director, VA Informatics and Computing Infrastructure and Research Assistant Professor; C.L. Haroldsen, MSPH, Senior Programmer/Analyst; B.C. Sauer, PhD, MS, Associate Professor, Veterans Affairs Salt Lake City Health Care System, University of Utah School of Medicine; L. Caplan, MD, PhD, Associate Professor of Medicine/Rheumatology, Denver VA, University of Colorado; J.R. Curtis, MD, MS, MPH, William J. Koopman Endowed Professor in Rheumatology and Immunology, Director, University of Alabama Birmingham (UAB) Arthritis Clinical Intervention Program, Co-director, UAB Center for Education and Research on Therapeutics, Co-director, UAB PharmacoEpidemiology and Economic Research Group, University of Alabama at Birmingham; K. Michaud, PhD, Assistant Professor of Medicine, Co-director, University of Nebraska Medical Center, National Data Bank for Rheumatic Diseases; T.R. Mikuls, MD, Staff Physician and Researcher, Professor of Internal Medicine and Rheumatology, Omaha VA, University of Nebraska Medical Center; A. Reimold, MD, Chief, Rheumatology Section, Associate Professor of Medicine, Dallas VA, University of Texas Southwestern; D.H. Collier, MD, Clinical Research Medical Director; D.J. Harrison, PhD, Health Economics Director, Amgen Inc.; G.J. Joseph, PhD, Health Economics Senior Manager, former employee of Amgen Inc
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Curtis EM, Marks JL. Optimal dose of etanercept in the treatment of rheumatoid arthritis. Open Access Rheumatol 2014; 6:27-38. [PMID: 27790032 PMCID: PMC5045112 DOI: 10.2147/oarrr.s41409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Etanercept (ETN) is one of a number of biological therapies targeting the proinflammatory cytokine tumor necrosis factor-alpha that have demonstrated efficacy in the management of rheumatoid arthritis (RA). As experience has grown, a number of different treatment strategies have been investigated to ascertain the optimal conditions for use of ETN in RA and maximize the clinical gains from therapy. These have included the use of higher- and lower-dose treatment regimens, ETN as a monotherapy or in combination with other nonbiologic disease-modifying antirheumatic drugs, the use of ETN in very early clinical disease, and intraarticular ETN administration for resistant synovitis. Recent trials have focused on phased dose reduction or withdrawal of ETN in patients achieving low disease activity states or clinical remission. This review summarizes existing data regarding the optimal timing of ETN initiation and dosing regimens and also evaluates more recent evidence regarding dose-reduction strategies that offer the possibility of biologic-free remission in RA.
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Affiliation(s)
- Elizabeth Mary Curtis
- Department of Rheumatology, University Hospital Southampton, Southampton, Hampshire, UK
| | - Jonathan Lewis Marks
- Department of Rheumatology, University Hospital Southampton, Southampton, Hampshire, UK
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Mahil SK, Arkir Z, Richards G, Lewis CM, Barker JN, Smith CH. Predicting treatment response in psoriasis using serum levels of adalimumab and etanercept: a single-centre, cohort study. Br J Dermatol 2014; 169:306-13. [PMID: 23550925 DOI: 10.1111/bjd.12341] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND A substantial proportion of patients with psoriasis do not respond, or lose initial response to tumour necrosis factor-α antagonists. One possible mechanism relates to subtherapeutic drug levels due to an immunogenic antibody response. OBJECTIVES To investigate the association between serum adalimumab and etanercept levels, antidrug antibody levels and clinical response in a cohort of patients with psoriasis using a commercially available enzyme-linked immunoassay. METHODS In a single-centre cohort of 56 adults with chronic plaque psoriasis initiated on adalimumab or etanercept monotherapy between 2009 and 2011, drug and antidrug antibody levels were measured at the patients' routine clinic reviews (4, 12 and 24 weeks of treatment and the last available observation). Patients' responses at 6 months were stratified into responders [75% reduction in Psoriasis Area and Severity Index from baseline (PASI 75) or Physician's Global Assessment score of 'clear' or 'nearly clear'] and nonresponders (failure to achieve PASI 50). RESULTS After 4 weeks, adalimumab levels were significantly higher in responders compared with nonresponders (P = 0·003) and these higher levels were sustained at 12 and 24 weeks. Anti adalimumab antibodies were detected in 25% of nonresponders (two of eight patients, average 22·5 weeks' follow-up) and none of the responders (n = 23, average 26·1 weeks' follow-up). There was no significant association between etanercept levels and clinical response at 4 weeks (P = 0·317) and no antietanercept antibodies were detected. Lack of serum trough levels may have resulted in underestimation of the prevalence of antidrug antibodies. CONCLUSIONS Early adalimumab drug level monitoring at 4 weeks may be useful in predicting treatment response and potentially reduce drug exposure (and associated cost) with earlier review of treatment in those with low levels. No conclusions about the value of etanercept drug monitoring can be made due to the paucity of data. Larger studies are now required to assess the clinical utility and cost-effectiveness of these assays in personalizing therapy in psoriasis.
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Affiliation(s)
- S K Mahil
- Division of Genetics and Molecular Medicine, King's College London, London, SE1 9RT, UK
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Zhang LL, Lu J, Li MT, Wang Q, Zeng XF. Preventive and remedial application of etanercept attenuate monocrotaline-induced pulmonary arterial hypertension. Int J Rheum Dis 2014; 19:192-8. [PMID: 24612527 DOI: 10.1111/1756-185x.12304] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Ling-ling Zhang
- Department of Rheumatology; Peking Union Medical College Hospital; Chinese Academy of Medical Science & Peking Union Medical College; Beijing China
| | - Jie Lu
- Department of Rheumatology; Peking Union Medical College Hospital; Chinese Academy of Medical Science & Peking Union Medical College; Beijing China
| | - Meng-tao Li
- Department of Rheumatology; Peking Union Medical College Hospital; Chinese Academy of Medical Science & Peking Union Medical College; Beijing China
| | - Qian Wang
- Department of Rheumatology; Peking Union Medical College Hospital; Chinese Academy of Medical Science & Peking Union Medical College; Beijing China
| | - Xiao-feng Zeng
- Department of Rheumatology; Peking Union Medical College Hospital; Chinese Academy of Medical Science & Peking Union Medical College; Beijing China
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Chen DY, Chen YM, Tsai WC, Tseng JC, Chen YH, Hsieh CW, Hung WT, Lan JL. Significant associations of antidrug antibody levels with serum drug trough levels and therapeutic response of adalimumab and etanercept treatment in rheumatoid arthritis. Ann Rheum Dis 2014; 74:e16. [PMID: 24442879 DOI: 10.1136/annrheumdis-2013-203893] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To evaluate the associations between (1) antidrug antibody (ADAb) and therapeutic response, (2) ADAb and serum drug trough levels and (3) serum drug levels and therapeutic responses in rheumatoid arthritis (RA) patients receiving adalimumab or etanercept. Secondarily, we aim (1) to evaluate the concordance between radioimmunoassay and bridging ELISA for ADAb assessment and to evaluate the correlation between two different ELISA methods for detecting drug levels, and (2) to determine the optimal cut-off drug levels for good European League Against Rheumatism (EULAR) response. METHODS ADAb levels were determined by bridging ELISA and radioimmunoassay, and drug levels evaluated using sandwich ELISA among 36 adalimumab-treated patients and 34 etanercept-treated patients at the 6th and 12th month. The optimal cut-off drug levels for EULAR responses were determined by receiver-operating characteristic curve analysis. RESULTS ADAb was detected in 10 (27.8%) and 13 (36.1%) of adalimumab-treated patients after 12-month therapy using bridging ELISA and radioimmunoassay respectively, but not detected in any of etanercept-treated patients. The presence of ADAb was associated with lower EULAR response and lower drug levels compared with those without ADAb (both p<0.001). Drug trough levels were positively associated with DAS28 decrement (ΔDAS28) (all p<0.001). The optimal cut-off trough levels for adalimumab were 1.274 μg/mL and 1.046 μg/mL, and those for etanercept were 1.242 μg/mL and 0.800 μg/mL for good EULAR response assessed at the 6th and 12th month, respectively. CONCLUSIONS ADAb levels were inversely correlated with therapeutic response and drug levels. The positive correlation between drug levels and ΔDAS28 indicates that drug monitoring would be useful to evaluate therapeutic response of TNF-α inhibitors.
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Affiliation(s)
- Der-Yuan Chen
- Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital and Faculty of Medicine, National Yang Ming University, Taichung, Taiwan Institute of Microbiology and Immunology, Chung Shan Medical University, Taichung, Taiwan Institute of Biomedical Science, National Chung Hsing University, Taichung, Taiwan
| | - Yi-Ming Chen
- Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital and Faculty of Medicine, National Yang Ming University, Taichung, Taiwan
| | - Wen-Chan Tsai
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jui-Cheng Tseng
- Division of Allergy, Immunology, and Rheumatology, College of Chinese Medicine, China Medical University, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yi-Hsing Chen
- Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital and Faculty of Medicine, National Yang Ming University, Taichung, Taiwan
| | - Chia-Wei Hsieh
- Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital and Faculty of Medicine, National Yang Ming University, Taichung, Taiwan Institute of Microbiology and Immunology, Chung Shan Medical University, Taichung, Taiwan
| | - Wei-Ting Hung
- Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital and Faculty of Medicine, National Yang Ming University, Taichung, Taiwan
| | - Joung-Liang Lan
- Division of Immunology and Rheumatology, College of Chinese Medicine, China Medical University Hospital, Taiwan
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Eng G, Stoltenberg MB, Szkudlarek M, Bouchelouche PN, Christensen R, Bliddal H, Marie Bartels E. Efficacy of treatment intensification with adalimumab, etanercept and infliximab in rheumatoid arthritis: A systematic review of cohort studies with focus on dose. Semin Arthritis Rheum 2013; 43:144-51. [DOI: 10.1016/j.semarthrit.2013.01.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 01/29/2013] [Accepted: 01/31/2013] [Indexed: 11/29/2022]
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Abstract
INTRODUCTION Biologic agents have transformed clinical outcomes in rheumatoid arthritis, and there are now several immune-modulating therapies available. Tumour necrosis factor-α (TNF-α) inhibitors were the first biologic drug class licensed for the treatment of rheumatoid arthritis. Etanercept is a fusion protein composed of two TNF receptors bound to the constant portion (Fc) of human immunoglobulin G (IgG). AREAS COVERED This article will consider the pharmacological properties of etanercept and the clinical efficacy data presented in clinical trials. Its safety in clinical practice will be reviewed. EXPERT OPINION There is overwhelming evidence to support the use of etanercept in rheumatoid arthritis. Trial data demonstrate etanercept's efficacy in reducing structural damage, improving clinical outcomes and inducing remission. Optimal response to therapy is seen when used in combination with methotrexate and when initiated early. Etanercept is an attractive therapeutic option given the excellent safety profile, reduced immunogenicity and ease of administration.
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Affiliation(s)
- Laura Hunt
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital , Chapeltown Road, LS7 4SA, Leeds , UK
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Comparison of patient satisfaction with two different etanercept delivery systems. A randomised controlled study in patients with rheumatoid arthritis. Z Rheumatol 2013; 71:890-9. [PMID: 22956167 DOI: 10.1007/s00393-012-1034-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The objective of this study was to investigate patients' perceptions of the acceptability of two devices delivering etanercept for rheumatoid arthritis (RA) treatment and to explore whether specific patients' attributes are associated with device preferences. Two similar multicenter, open-label, randomised, parallel-design studies were conducted in a total of 13 European countries. A total of 640 adult patients with RA were randomised to receive etanercept 50 mg once-weekly subcutaneously for 12 weeks in either a pre-filled syringe (PFS) or a pre-filled pen (PFP). Patient satisfaction at week 12 was measured on a 0- to 10-point Likert scale (primary endpoint). The study was powered to demonstrate non-inferiority of a PFP over PFS for the primary endpoint. At week 12, mean patient satisfaction was 8.3 (± 2.4) points in the pen group and 7.2 (± 2.6) points in the syringe group. Non-inferiority and even superiority of the pen over the syringe was demonstrated. In conclusion, this study showed higher patient satisfaction in the group of patients injecting etanercept with a PFP compared with the group of patients using a PFS.
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Zhang X, Zhang F, Wu D, Bao C, Zhu P, Zhang X, Huang C, He D, Tao Y, Fang Y, Gu J, Wu H, Sun L, Yang X, Huang F, Xu H, Zhao D, Zhang M, Zheng Y, Li Z. Safety of infliximab therapy in rheumatoid arthritis patients with previous exposure to hepatitis B virus. Int J Rheum Dis 2013; 16:408-12. [PMID: 23992260 DOI: 10.1111/1756-185x.12125] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Xuewu Zhang
- Department of Rheumatology and Immunology; Peking University People's Hospital; Beijing China
| | - Fengchun Zhang
- Department of Rheumatology and Immunology; Peking Union Medical College Hospital; Beijing China
| | - Donghai Wu
- Department of Rheumatology and Immunology; China-Japan Friendship Hospital; Beijing China
| | - Chunde Bao
- Department of Rheumatology and Immunology; Shanghai Jiaotong University Renji Hospital; Shanghai China
| | - Ping Zhu
- Department of Rheumatology and Immunology; Xijing Hospital; the Fourth Military Medical University; Xian China
| | - Xiao Zhang
- Department of Rheumatology and Immunology; Guangdong Provincial People's Hospital; Guangzhou China
| | - Cibo Huang
- Department of Rheumatology and Immunology; Beijing Hospital; Beijing China
| | - DongYi He
- Department of Rheumatology and Immunology; Shanghai Guanghua Hospital; Shanghai China
| | - Yi Tao
- Department of Rheumatology and Immunology; Second Affiliated Hospital of Guangzhou Medical College; Guangzhou China
| | - Yongfei Fang
- Department of Rheumatology and Immunology; Xinan Affiliated Hospital of the Third Military Medical University; Chongqing China
| | - Jieruo Gu
- Department of Rheumatology and Immunology, the; Third Affiliated Hospital of Sun Yat-sen University; Guangzhou China
| | - Huaxiang Wu
- Department of Rheumatology and Immunology; Second Affiliated Hospital of Zhejiang University; Hangzhou China
| | - Lingyun Sun
- Department of Rheumatology and Immunology; Nanjing Drum Tower Hospital; the Affiliated Hospital of Nanjing University Medical School; Nanjing China
| | - Xiuyan Yang
- Department of Rheumatology and Immunology, the ; First Affiliated Hospital of Sun Yat-sen University; Guangzhou China
| | - Feng Huang
- Department of Rheumatology and Immunology; Chinese PLA General Hospital; Beijing China
| | - Huji Xu
- Department of Rheumatology and Immunology; Second Military Medical University; Shanghai China
| | - Dongbao Zhao
- Department of Rheumatology and Immunology; Changhai Hospital; the Second Military Medical University; Shanghai China
| | - Miaojia Zhang
- Department of Rheumatology and Immunology; Jiangsu Provincial People Hospital; Nanjing China
| | - Yi Zheng
- Department of Rheumatology and Immunology; Beijing Chaoyang Affiliated Hospital to Capital University of Medical Science; Beijing China
| | - Zhanguo Li
- Department of Rheumatology and Immunology; Peking University People's Hospital; Beijing China
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Lethaby A, Lopez‐Olivo MA, Maxwell LJ, Burls A, Tugwell P, Wells GA. Etanercept for the treatment of rheumatoid arthritis. Cochrane Database Syst Rev 2013; 2013:CD004525. [PMID: 23728649 PMCID: PMC10771320 DOI: 10.1002/14651858.cd004525.pub2] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Etanercept is a soluble tumour necrosis factor alpha-receptor disease-modifying anti-rheumatic drug (DMARD) for the treatment of rheumatoid arthritis (RA). OBJECTIVES The purpose of this review was to update the previous Cochrane systematic review published in 2003 assessing the benefits and harms of etanercept for the treatment of RA. In addition, we also evaluated the benefits and harms of etanercept plus DMARD compared with DMARD monotherapy in those people with RA who are partial responders to methotrexate (MTX) or any other traditional DMARD. SEARCH METHODS Five electronic databases were searched from 1966 to February 2003 with no language restriction. The search was updated to January 2012. Attempts were made to identify other studies by contact with experts, searching reference lists and searching trial registers. SELECTION CRITERIA All controlled trials (minimum 24 weeks' duration) comparing four possible combinations: 1) etanercept (10 mg or 25 mg twice weekly) plus a traditional DMARD (either MTX or sulphasalazine) versus a DMARD, 2) etanercept plus DMARD versus etanercept alone, 3) etanercept alone versus a DMARD or 4) etanercept versus placebo. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risk of bias of the trials. MAIN RESULTS Three trials were included in the original version of the review. An additional six trials, giving a total of 2842 participants, were added to the 2012 update of the review. The trials were generally of moderate to low risk of bias, the majority funded by pharmaceutical companies. Follow-up ranged from six months to 36 months.BenefitAt six to 36 months the American College of Rheumatology (ACR) 50 response rate was statistically significantly improved with etanercept plus DMARD treatment when compared with a DMARD in those people who had an inadequate response to any traditional DMARD (risk ratio (RR) 2.0; 95% confidence interval (CI) 1.3 to 2.9, absolute treatment benefit (ATB) 38%; 95% CI 13% to 59%) and in those people who were partial responders to MTX (RR 11.7; 95% CI 1.7 to 82.5, ATB 36%). Similar results were observed when pooling data from all participants (responders or not) (ACR 50 response rates at 24 months: RR 1.9; 95% CI 1.3 to 2.8, ATB 29%; 36 months: RR 1.6; 95% CI 1.3 to 1.9, ATB 24%). Statistically significant improvement in physical function and a higher proportion of disease remission were observed in combination-treated participants compared with DMARDs alone ((mean difference (MD) -0.36; 95% CI -0.43 to -0.28 in a 0-3 scale) and (RR 1.92; 95% CI 1.60 to 2.31), respectively) in those people who had an inadequate response to any traditional DMARD. All changes in radiographic scores were statistically significantly less with combination treatment (etanercept plus DMARD) compared with MTX alone for all participants (responders or not) (Total Sharp Score (TSS) (scale = 0 to 448): MD -2.2, 95% CI -3.0 to -1.4; Erosion Score (ES) (scale = 0 to 280): MD -1.6; 95% CI -2.4 to -0.9; Joint Space Narrowing Score (JSNS) (scale = 0 to 168): MD -0.7; 95% CI -1.1 to -0.2), and with combination treatment compared with etanercept alone (TSS: MD -1.1; 95% CI -1.8 to -0.5; ES: MD -0.7; 95% CI -1.1 to -0.2; JSNS: MD -0.5, 95% CI -0.7 to -0.2). The estimate of irreversible physical disability over 10 years given the radiographic findings was 0.45 out of 3.0.When etanercept monotherapy was compared with DMARD monotherapy, there was generally no evidence of a difference in ACR50 response rates when etanercept 10 mg or 25 mg was used; at six months etanercept 25 mg was significantly more likely to achieve ACR50 than DMARD monotherapy but this difference was not found at 12, 24 or 36 months. TSS and ES radiographic scores were statistically significantly improved with etanercept 25 mg monotherapy compared with DMARD (TSS: MD -0.7; 95% CI -1.4 to 0.1; ES: MD -0.7; 95% CI -1.0 to -0.3) but there was no evidence of a statistically significant difference between etanercept 10 mg monotherapy and MTX.HarmsThere was no evidence of statistically significant differences in infections or serious infections between etanercept plus DMARD and DMARD alone at any point in time. Infection rates were higher in people receiving etanercept monotherapy compared with DMARD; however, there were no differences regarding serious infections. For those participants who had an inadequate response to DMARDs, the rate of total withdrawals was lower for the etanercept plus DMARD group compared with DMARD alone (RR 0.53; 95% CI 0.36 to 0.77, ATB 18%). No other statistically significant differences were observed in any of the assessed comparisons. AUTHORS' CONCLUSIONS Etanercept 25 mg administered subcutaneously twice weekly together with MTX was more efficacious than either etanercept or MTX monotherapy for ACR50 and it slowed joint radiographic progression after up to three years of treatment for all participants (responders or not). There was no evidence of a difference in the rates of infections between groups.
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Affiliation(s)
- Anne Lethaby
- University of AucklandDepartment of Obstetrics and GynaecologyPrivate Bag 92019AucklandNew Zealand1142
| | - Maria Angeles Lopez‐Olivo
- The University of Texas, M.D. Anderson Cancer CenterDepartment of General Internal Medicine1515 Holcombe BlvdUnit 1465HoustonTexasUSA77030
| | - Lara J Maxwell
- University of OttawaCentre for Global Health, Institute of Population Health1 Stewart StreetOttawaOntarioCanadaK1N 6N5
| | - Amanda Burls
- City University LondonSchool of Health SciencesMyddleton StreetLondonUKEC1V 0HB
| | - Peter Tugwell
- Faculty of Medicine, University of OttawaDepartment of MedicineOttawaOntarioCanadaK1H 8M5
- Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaOntarioCanadaK1Y 4E9
- University of OttawaInstitute of Population Health & Department of Epidemiology and Community Medicine1 Stewart StreetOttawaOntarioCanadaK1N 6N5
| | - George A Wells
- University of OttawaDepartment of Epidemiology and Community MedicineRoom H128140 Ruskin StreetOttawaOntarioCanadaK1Y 4W7
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Krieckaert CL, Jamnitski A, Nurmohamed MT, Kostense PJ, Boers M, Wolbink G. Comparison of long-term clinical outcome with etanercept treatment and adalimumab treatment of rheumatoid arthritis with respect to immunogenicity. ACTA ACUST UNITED AC 2013; 64:3850-5. [PMID: 22933315 DOI: 10.1002/art.34680] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Accepted: 08/16/2012] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To compare rates of sustained low and minimal disease activity and remission according to the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) criteria during 3-year followup in rheumatoid arthritis (RA) patients treated with etanercept and adalimumab in routine care. METHODS Four hundred seven RA patients previously unexposed to tumor necrosis factor antagonists were treated with etanercept (n = 203) or adalimumab (n = 204) and assessed at 3- and later 6-month intervals. Treatment allocation was at the discretion of the treating rheumatologist. Clinical parameters were measured at each time point, as were anti-adalimumab antibodies in adalimumab-treated patients. Achievement of clinical outcome was defined as the occurrence of sustained (at least 12 consecutive months) low disease activity (28-joint Disease Activity Score [DAS28] <3.2), minimal disease activity (DAS28 <2.6), or ACR/EULAR remission based on the Simplified Disease Activity Index (SDAI). Non-overlapping response rates were calculated. RESULTS Among the adalimumab group, 13% reached sustained low disease activity but not sustained minimal disease activity, 15% reached sustained minimal disease activity but not sustained remission according to the SDAI, and 16% reached sustained ACR/EULAR remission. In the etanercept group the corresponding rates were 16%, 11%, and 12%, respectively (P = 0.42, overall test for linear trend). Adalimumab-treated patients without anti-adalimumab antibodies (n = 150 [74%]) had the best outcomes, and adalimumab-treated patients with anti-adalimumab antibodies the worst, with outcomes in etanercept-treated patients in between (P < 0.0001). Differences were most apparent in the sustained SDAI remission and sustained minimal disease activity categories. For example, 40% of anti-adalimumab antibody-negative patients, 23% of etanercept-treated patients, and 4% of anti-adalimumab antibody-positive patients achieved at least sustained minimal disease activity. CONCLUSION Overall, etanercept and adalimumab treatment appear similar in inducing a good long-term clinical outcome. However, in the case of adalimumab this is strongly dependent on the presence or absence of anti-adalimumab antibodies.
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Henrique da Mota LM, Afonso Cruz B, Viegas Brenol C, Alves Pereira I, Rezende-Fronza LS, Barros Bertolo M, Carioca Freitas MV, da Silva NA, Louzada-Junior P, Neubarth Giorgio RD, Corrêa Lima RA, Marques Bernardo W, Castelar Pinheiro GDR. Diretrizes para o tratamento da artrite reumatoide. REVISTA BRASILEIRA DE REUMATOLOGIA 2013. [DOI: 10.1590/s0482-50042013000200004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Ma X, Xu S. TNF inhibitor therapy for rheumatoid arthritis. Biomed Rep 2012; 1:177-184. [PMID: 24648915 DOI: 10.3892/br.2012.42] [Citation(s) in RCA: 139] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Accepted: 10/16/2012] [Indexed: 12/11/2022] Open
Abstract
Immunotherapy has markedly improved treatment outcomes in rheumatoid arthritis (RA). Tumor necrosis factor (TNF)-α antagonists, such as infliximab (IFX), etanercept (ETN), adalimumab (ADA), golimumab (GOLI) and certolizumab pegol (CZP) have been widely used for the treatment of RA. IFX provides significant, clinically relevant improvement in physical function and the quality of life, inhibits progressive joint damage and sustains improvement in the signs and symptoms of patients with RA. ETN is effective and safe for patients with RA. Combination therapy with ETN plus methotrexate (MTX) reduces disease activity, decreases total joint score progression, slows the pace of joint destruction and improves function more effectively compared to any of the monotherapies. ADA with or without MTX also relieves the signs and symptoms of RA. CZP and GOLI expand the therapeutic schedule for patients with RA. The TNF-α inhibitors have similar efficacy, but distinct clinical pharmacokinetic and -dynamic properties. The common adverse events of these TNF-α antagonists include adverse reactions, infections and injection-site reaction. Additionally, these adverse events are mostly mild or moderate and their incidence is low. Certain patients exhibit a lack of response to anti-TNF-α therapies. Some patients may discontinue the initial drug and switch to a second anti-TNF-α agent. The shortage of clinical response to one agent may not predict deficiency of response to another. This review mainly addresses the latest developments of these biological agents in the treatment of RA.
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Affiliation(s)
- Xixi Ma
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, P.R. China
| | - Shengqian Xu
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, P.R. China
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Tada M, Koike T, Okano T, Sugioka Y, Wakitani S, Fukushima K, Sakawa A, Uehara K, Inui K, Nakamura H. Comparison of joint destruction between standard- and low-dose etanercept in rheumatoid arthritis from the Prevention of Cartilage Destruction by Etanercept (PRECEPT) study. Rheumatology (Oxford) 2012; 51:2164-9. [PMID: 22829691 DOI: 10.1093/rheumatology/kes188] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To evaluate the prevention of joint destruction and clinical efficacy of low-dose etanercept (ETN) (25 mg/week) compared with standard-dose ETN (50 mg/week) in RA. METHODS In this prospective, randomized, open-label study, 70 patients were assigned to receive ETN at either 50 or 25 mg/week for 52 weeks. The primary endpoint was the variation in modified total Sharp score (mTSS), and secondary endpoints were variations in disease activity score in 28 joints (DAS-28), modified HAQ and adverse event rate. Values of mTSS were calculated at baseline and after 52 weeks. Non-progression was estimated as ΔmTSS ≤0.5, and the non-progression rate was compared between groups. RESULTS Mean values at baseline were as follows: disease duration 9.2 years; DAS-28 5.45; and annual progression of mTSS 26.1. No significant differences in background were seen between groups. At 52 weeks, the non-progression rate was significantly less in the 25 mg/week group (36.7%) than in the 50 mg/week group (67.7%) (P = 0.041). Mean ΔmTSS was higher at 25 mg/week (1.03) than at 50 mg/week (-0.13). DAS-28 was significantly improved at 4 weeks, and the effect of treatment lasted for 52 weeks in both groups. No differences in adverse event rates were seen between groups. CONCLUSION Low-dose ETN is not inferior to standard-dose ETN in terms of effects on clinical manifestations. However, in terms of the radiographic non-progression rate, the effects of low-dose ETN may be inferior to the effects of standard-dose ETN. TRIAL REGISTRATION UMIN Clinical Trials Registry, http://www.umin.ac.jp/ctr/, UMIN000001798.
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Affiliation(s)
- Masahiro Tada
- Department of Rheumatosurgery, Osaka City University Medical School, Osaka, Japan
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Hoshino M, Yoshio T, Onishi S, Minota S. Influence of antibodies against infliximab and etanercept on the treatment effectiveness of these agents in Japanese patients with rheumatoid arthritis. Mod Rheumatol 2011; 22:532-40. [PMID: 22173229 DOI: 10.1007/s10165-011-0567-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Accepted: 11/15/2011] [Indexed: 11/24/2022]
Abstract
We investigated the influence of antibodies against infliximab and etanercept on the serum trough levels of these agents and the influence of these antibodies on the effectiveness of treatment in patients with rheumatoid arthritis treated with these agents. Forty patients treated with infliximab for 54 weeks and 40 patients treated with etanercept for 32 weeks were enrolled. They were divided into responder and non-responder groups. Serum trough levels of and antibodies against these agents were measured by enzyme-linked immunosorbent assay or radioimmunoassay. Of the 40 patients treated with infliximab, 14 (35%) had anti-infliximab antibodies. Serum trough levels were significantly lower in the non-responder group (14 patients) than in the responder group (26 patients) 6 weeks after initiation of infliximab (p < 0.05). Conversely, titers of anti-infliximab antibody were significantly higher in the non-responder group than in the responder group between 6 and 38 weeks after initiation of infliximab (p < 0.05). Anti-etanercept antibodies were not detected in any patients on etanercept. Serum trough levels of etanercept were not significantly different between the responder (31 patients) and non-responder groups (9 patients). It seems that the appearance of anti-infliximab antibodies might decrease infliximab serum concentrations and, thereby, reduce the agent's effectiveness. The clinical efficacy of etanercept does not appear to be affected by the serum concentrations if it is administered at standard doses.
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Affiliation(s)
- Motoaki Hoshino
- Division of Rheumatology and Clinical Immunology, Jichi Medical University, 3311 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
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Curtis JR, Chen L, Luijtens K, Navarro-Millan I, Goel N, Gervitz L, Weinblatt M. Dose escalation of certolizumab pegol from 200 mg to 400 mg every other week provides no additional efficacy in rheumatoid arthritis: an analysis of individual patient-level data. ACTA ACUST UNITED AC 2011; 63:2203-8. [PMID: 21484766 DOI: 10.1002/art.30387] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To determine whether certolizumab pegol (CZP) dosage escalation from 200 mg to 400 mg every other week benefits some patients with rheumatoid arthritis (RA). METHODS In the extension of the Rheumatoid Arthritis Prevention of Structural Damage 1 (RAPID 1) study into an open-label study, all patients received CZP 400 mg every other week in combination with methotrexate (MTX). Before the open-label phase of the study, patients had received CZP 200 mg or 400 mg every other week, or placebo every other week, as add-on therapy to MTX. The open-label study included those who had completed the RAPID 1 study (to week 52) and also those who had been withdrawn from the study (at week 16, due to inadequate response). At 12 weeks and 48 weeks after enrollment in the open-label study, changes in the Disease Activity Score in 28 joints (DAS28) were compared in dose-escalation patients (200 mg increased to 400 mg every other week) versus stable-dosage patients (400 mg every other week), using cumulative probability plots of individual patient-level data. RESULTS In the group of patients who had completed the RAPID 1 study and had moderate or severe disease activity at entry into the open-label study, and in those who had been withdrawn early from the RAPID 1 study, the median DAS28 improvements 12 weeks after enrollment into the open-label study were similar in the dose-escalation and stable-dose groups. Individual patient-level data revealed no greater likelihood of response in the group of patients who received an increased dosage of CZP versus those in whom a stable dosage was maintained, whether they had completed the RAPID 1 study or had been withdrawn early. CONCLUSION Although patient heterogeneity in clinical settings is acknowledged, the present results indicate that increasing the dose of CZP from 200 mg to 400 mg offers little additional benefit in RA, even for selected patients.
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Affiliation(s)
- Jeffrey R Curtis
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, FOT 805D, 510 20th Street South, Birmingham, Alabama 35294, USA.
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Curtis JR, Singh JA. Use of biologics in rheumatoid arthritis: current and emerging paradigms of care. Clin Ther 2011; 33:679-707. [PMID: 21704234 DOI: 10.1016/j.clinthera.2011.05.044] [Citation(s) in RCA: 202] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2011] [Indexed: 02/08/2023]
Abstract
BACKGROUND Improved understanding of rheumatoid arthritis (RA) pathogenesis has led to the development of new biologic treatments that target specific elements of RA inflammatory response. OBJECTIVE Our aim was to provide a comprehensive review of biologic therapies currently used for the treatment of RA. METHODS A search of MEDLINE (up to October 2010) was conducted. Preference for article inclusion was given to English language meta-analyses and large, Phase III, randomized controlled trials (RCTs) of biologic treatments in patients with RA. RESULTS In large RCTs, significantly more patients treated with tumor necrosis factor-α (TNF-α) antagonists (as monotherapy, or as an adjunct to methotrexate) versus controls (35%-67% vs 9%-33% of patients; P ≤ 0.01) achieved an American College of Rheumatology 20 response as a primary study end point. However, safety concerns-especially the potential for serious infections and malignancy-remain for TNF-α blockade. For example, 1 meta-analysis (>5000 patients) reported a 2-fold increase (95% CI, 1.3-3.1) in the risk of serious infections and a 3.3-fold increase (95% CI, 1.2-9.1) in the risk of malignancy. Abatacept and rituximab (given in combination with methotrexate) may be useful clinical alternatives for RA patients with an inadequate response to TNF-α antagonists. These agents do not appear to increase the risk of serious infections (OR, 1.35-1.45; 95% CI, 0.56-3.73), although rituximab may rarely cause progressive multifocal leukoencephalopathy (0.4 cases per 100,000 hospitalizations). CONCLUSIONS Over the last decade, targeted biologic agents have transformed RA treatment. Although relatively expensive in the short term, the direct costs of these biologics may be offset by slowed disease progression and significant improvements in RA symptoms, physical function, and quality of life.
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Rahman MU, Buchanan J, Doyle MK, Hsia EC, Gathany T, Parasuraman S, Aletaha D, Matteson EL, Conaghan PG, Keystone E, van der Heijde D, Smolen JS. Changes in patient characteristics in anti-tumour necrosis factor clinical trials for rheumatoid arthritis: results of an analysis of the literature over the past 16 years. Ann Rheum Dis 2011; 70:1631-40. [PMID: 21708910 PMCID: PMC3147244 DOI: 10.1136/ard.2010.146043] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Objective To evaluate changes in baseline patient characteristics and entry criteria of randomised, controlled studies of tumour necrosis factor alpha (TNFα) inhibitors in rheumatoid arthritis (RA) patients. Methods A systematic literature review was performed using predefined inclusion criteria to identify randomised, double-blind, controlled trials that evaluated TNFα inhibitors in adult RA patients. Entry criteria and baseline clinical characteristics were evaluated over time for methotrexate-experienced and methotrexate-naive study populations. Enrolment start date for each trial was the time metric. The anchor time was the study with the earliest identifiable enrolment start date. Results 44 primary publications (reporting the primary study endpoint) from 1993 to 2008 met the inclusion criteria. Enrolment start dates of August 1993 and May 1997 were identified as time anchors for the 37 methotrexate-experienced studies and the seven methotrexate-naive studies, respectively. In methotrexate-experienced trials, no significant change was observed over the years included in this study in any inclusion criteria (including swollen joint counts and C-reactive protein (CRP)), but a significant decrease over time was observed in the baseline swollen joint count, CRP and total Sharp or van der Heijde modified Sharp score, but not in baseline tender joint counts. In the methotrexate-naive studies, significant decreases over the years were observed in swollen joint and tender joint inclusion criteria, but not in baseline tender joint count, baseline CRP, CRP inclusion criteria or baseline total Sharp or van der Heijde modified Sharp score. Conclusion Inclusion criteria and baseline characteristics of RA patients enrolled in studies of TNFα inhibitors have changed, with more recent trials enrolling cohorts with lower disease activity, especially in methotrexate-experienced trials.
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Navarro-Sarabia F, Fernandez-Sueiro JL, Torre-Alonso JC, Gratacos J, Queiro R, Gonzalez C, Loza E, Linares L, Zarco P, Juanola X, Roman-Ivorra J, Martin-Mola E, Sanmarti R, Mulero J, Diaz G, Armendariz Y, Collantes E. High-dose etanercept in ankylosing spondylitis: results of a 12-week randomized, double blind, controlled multicentre study (LOADET study). Rheumatology (Oxford) 2011; 50:1828-37. [DOI: 10.1093/rheumatology/ker083] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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Kavanaugh AF, Mayer LF, Cush JJ, Hanauer SB. Shared experiences and best practices in the management of rheumatoid arthritis and Crohn's disease. Am J Med 2011; 124:e1-18. [PMID: 21531240 DOI: 10.1016/j.amjmed.2011.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Arthur F Kavanaugh
- Center for Innovative Therapy, Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of California at San Diego, San Diego, California, USA
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van Vollenhoven RF. Unresolved issues in biologic therapy for rheumatoid arthritis. Nat Rev Rheumatol 2011; 7:205-15. [PMID: 21386796 DOI: 10.1038/nrrheum.2011.22] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The advent of biologic therapies for the treatment of rheumatoid arthritis (RA) has radically changed this therapeutic area. The currently available biologic agents have been studied extensively as part of their development and also during their subsequent years of use in clinical practice; as a result, the knowledge base regarding these therapeutics is very large. Nonetheless, a number of important questions remain and some key issues are still incompletely understood. In this Review, I discuss a number of these unresolved issues, including: the correct placement of biologic therapies in the long-term evolution of the RA disease process, and the expectations associated with such use; comparisons of therapeutic strategies that include conventional as well as biologic agents; optimal dosing of biologic agents; the elusive goal of personalized therapy; and an appraisal of the real impact of biologic therapy on patients' lives. It is concluded that, despite these unresolved issues, important progress has been made and many additional advances in our understanding can be expected during the coming years.
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Affiliation(s)
- Ronald F van Vollenhoven
- Unit for Clinical Therapy Research, Inflammatory Diseases, The Karolinska Institute, Karolinska University Hospital, S-171 76 Stockholm, Sweden.
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Malaviya AN, Haroon N. Infections associated with the use of biologic response modifiers in rheumatic diseases: a critical appraisal. INDIAN JOURNAL OF RHEUMATOLOGY 2011. [DOI: 10.1016/s0973-3698(11)60040-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Singh JA, Wells GA, Christensen R, Tanjong Ghogomu E, Maxwell LJ, MacDonald JK, Filippini G, Skoetz N, Francis DK, Lopes LC, Guyatt GH, Schmitt J, La Mantia L, Weberschock T, Roos JF, Siebert H, Hershan S, Cameron C, Lunn MPT, Tugwell P, Buchbinder R. Adverse effects of biologics: a network meta-analysis and Cochrane overview. Cochrane Database Syst Rev 2011; 2011:CD008794. [PMID: 21328309 PMCID: PMC7173749 DOI: 10.1002/14651858.cd008794.pub2] [Citation(s) in RCA: 352] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Biologics are used for the treatment of rheumatoid arthritis and many other conditions. While the efficacy of biologics has been established, there is uncertainty regarding the adverse effects of this treatment. Since serious risks such as tuberculosis (TB) reactivation, serious infections, and lymphomas may be common to the biologics but occur in small numbers across the various indications, we planned to combine the results from biologics used in many conditions to obtain the much needed risk estimates. OBJECTIVES To compare the adverse effects of tumor necrosis factor blocker (etanercept, adalimumab, infliximab, golimumab, certolizumab), interleukin (IL)-1 antagonist (anakinra), IL-6 antagonist (tocilizumab), anti-CD28 (abatacept), and anti-B cell (rituximab) therapy in patients with any disease condition except human immunodeficiency disease (HIV/AIDS). METHODS Randomized controlled trials (RCTs), controlled clinical trials (CCTs) and open-label extension (OLE) studies that studied one of the nine biologics for use in any indication (with the exception of HIV/AIDS) and that reported our pre-specified adverse outcomes were considered for inclusion. We searched The Cochrane Library, MEDLINE, and EMBASE (to January 2010). Identifying search results and data extraction were performed independently and in duplicate. For the network meta-analysis, we performed mixed-effects logistic regression using an arm-based, random-effects model within an empirical Bayes framework. MAIN RESULTS We included 163 RCTs with 50,010 participants and 46 extension studies with 11,954 participants. The median duration of RCTs was six months and 13 months for OLEs. Data were limited for tuberculosis (TB) reactivation, lymphoma, and congestive heart failure. Adjusted for dose, biologics as a group were associated with a statistically significant higher rate of total adverse events (odds ratio (OR) 1.19, 95% CI 1.09 to 1.30; number needed to treat to harm (NNTH) = 30, 95% CI 21 to 60) and withdrawals due to adverse events (OR 1.32, 95% CI 1.06 to 1.64; NNTH = 37, 95% CI 19 to 190) and an increased risk of TB reactivation (OR 4.68, 95% CI 1.18 to 18.60; NNTH = 681, 95% CI 143 to 14706) compared to control.The rate of serious adverse events, serious infections, lymphoma, and congestive heart failure were not statistically significantly different between biologics and control treatment. Certolizumab pegol was associated with significantly higher risk of serious infections compared to control treatment (OR 3.51, 95% CI 1.59 to 7.79; NNTH = 17, 95% CI 7 to 68). Infliximab was associated with significantly higher risk of withdrawals due to adverse events compared to control (OR 2.04, 95% CI 1.43 to 2.91; NNTH = 12, 95% CI 8 to 28). Indirect comparisons revealed that abatacept and anakinra were associated with a significantly lower risk of serious adverse events compared to most other biologics. Although the overall numbers are relatively small, certolizumab pegol was associated with significantly higher odds of serious infections compared to etanercept, adalimumab, abatacept, anakinra, golimumab, infliximab, and rituximab; abatacept was significantly less likely than infliximab and tocilizumab to be associated with serious infections. Abatacept, adalimumab, etanercept and golimumab were significantly less likely than infliximab to result in withdrawals due to adverse events. AUTHORS' CONCLUSIONS Overall, in the short term biologics were associated with significantly higher rates of total adverse events, withdrawals due to adverse events and TB reactivation. Some biologics had a statistically higher association with certain adverse outcomes compared to control, but there was no consistency across the outcomes so caution is needed in interpreting these results.There is an urgent need for more research regarding the long-term safety of biologics and the comparative safety of different biologics. National and international registries and other types of large databases are relevant sources for providing complementary evidence regarding the short- and longer-term safety of biologics.
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Affiliation(s)
- Jasvinder A Singh
- Birmingham VA Medical CenterDepartment of MedicineFaculty Office Tower 805B510 20th Street SouthBirminghamALUSA35294
| | - George A Wells
- University of OttawaDepartment of Epidemiology and Community MedicineRoom H128140 Ruskin StreetOttawaONCanadaK1Y 4W7
| | - Robin Christensen
- Copenhagen University Hospital, Bispebjerg og FrederiksbergMusculoskeletal Statistics Unit, The Parker InstituteNordre Fasanvej 57CopenhagenDenmarkDK‐2000
| | | | - Lara J Maxwell
- Ottawa Hospital Research Institute (OHRI), The Ottawa Hospital ‐ General CampusCentre for Practice‐Changing Research (CPCR)501 Smyth Road, Box 711OttawaONCanadaK1H 8L6
| | - John K MacDonald
- Robarts Clinical TrialsCochrane IBD Group100 Dundas Street, Suite 200LondonONCanadaN6A 5B6
| | - Graziella Filippini
- Fondazione I.R.C.C.S. Istituto Neurologico Carlo BestaScientific Directionvia Celoria, 11MilanoItaly20133
| | - Nicole Skoetz
- University Hospital of CologneCochrane Haematological Malignancies Group, Department I of Internal MedicineKerpener Str. 62CologneGermany50937
| | - Damian K Francis
- University of West IndiesEpidemiology Research UnitMona Kingston 7Jamaica
| | - Luciane C Lopes
- University of Sorocaba, São PauloSciences of Pharmaceutical ProgramRodovia Raposo Tavares, s/nSorocabaSão PauloBrazilCEP 18023‐000
| | - Gordon H Guyatt
- McMaster UniversityDepartment of Clinical Epidemiology and Biostatistics1200 Main Street WestHamiltonONCanadaL8N 3Z5
| | - Jochen Schmitt
- Faculty of Medicine Carl Gustav Carus, Technischen Universität (TU) DresdenCenter for Evidence‐Based HealthcareFetscherstr. 74DresdenGermany01307
| | - Loredana La Mantia
- I.R.C.C.S. Santa Maria Nascente ‐ Fondazione Don GnocchiUnit of Neurorehabilitation ‐ Multiple Sclerosis CenterVia Capecelatro, 66MilanoItaly20148
| | - Tobias Weberschock
- Goethe UniversityEvidence‐Based Medicine Frankfurt, Institute of General PracticeTheodor Stern Kai 7FrankfurtGermany60590
- J.W. Goethe‐University HospitalDepartment of Dermatology, Venereology, and AllergologyTheodor‐Stern‐Kai 7FrankfurtGermany60590
| | - Juliana F Roos
- Dubai Pharmacy CollegeDept of Clinical Pharmacy & Pharmacy PracticePo Box 19099AlMuhaisanah 1, Al mizharDubaiUnited Arab Emirates
| | - Hendrik Siebert
- University Hospital CologneCochrane Haematological Malignancies GroupKerpener Strasse 62CologneGermany50924
| | - Sarah Hershan
- Department of Epidemiology and Preventive Medicine, Monash UniversityMonash Department of Clinical Epidemiology at Cabrini HospitalSuite 41, Cabrini Medical Centre183 Wattletree RoadMalvernVictoriaAustralia3144
| | - Chris Cameron
- University of OttawaDepartment of Epidemiology and Community MedicineRoom H128140 Ruskin StreetOttawaONCanadaK1Y 4W7
| | - Michael PT Lunn
- National Hospital for Neurology and NeurosurgeryDepartment of Neurology and MRC Centre for Neuromuscular DiseasesQueen SquareLondonUKWC1N 3BG
| | - Peter Tugwell
- Faculty of Medicine, University of OttawaDepartment of MedicineOttawaONCanadaK1H 8M5
- Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaONCanadaK1Y 4E9
- Faculty of Medicine, University of OttawaDepartment of Epidemiology and Community MedicineOttawaONCanadaK1H 8M5
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash UniversityMonash Department of Clinical Epidemiology, Cabrini HospitalSuite 41, Cabrini Medical Centre183 Wattletree RoadMalvernVictoriaAustralia3144
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Giles JT, Bathon JM. Management of rheumatoid arthritis. Rheumatology (Oxford) 2011. [DOI: 10.1016/b978-0-323-06551-1.00094-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Papagoras C, Voulgari PV, Drosos AA. Strategies after the failure of the first anti-tumor necrosis factor α agent in rheumatoid arthritis. Autoimmun Rev 2010; 9:574-82. [DOI: 10.1016/j.autrev.2010.04.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2010] [Accepted: 04/22/2010] [Indexed: 12/17/2022]
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Biologic agents-a panacea for inflammatory arthritis or not? Int J Rheumatol 2009; 2009:420759. [PMID: 20130798 PMCID: PMC2814094 DOI: 10.1155/2009/420759] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2009] [Accepted: 08/21/2009] [Indexed: 11/17/2022] Open
Abstract
Aim. To describe the retention rates for biological therapies in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS) in a clinical setting. Methods. All patients managed in a dedicated biological therapy clinic in a teaching hospital in Australia were assessed for continuation on biological treatments and reasons for switching to an alternative biological agent or cessation of treatment. Results. There was a lower retention rate for RA patients on biological therapies compared to PsA and AS patients and the retention rate for RA patients was lower than that reported in RCTs. Conclusions. The retention rate on biological therapies for RA patients was lower in the clinic setting than what is reported in RCTs. The reasons for the lower retention rate in the clinical setting are discussed but no clear determinants for nonresponse to biological agents were identifiable. These agents have very limited steroid sparing effects.
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Abstract
PURPOSE OF REVIEW Although the remarkable efficacy of biological therapy has resulted in significant success in rheumatic disease management, susceptibility to infections remains a concern. Here we review the latest publications on infectious complications of biological therapy in rheumatic diseases. RECENT FINDINGS The recent data on anti-tumor necrosis factor agents show encouraging results in relation to infections. The majority of the infections are minor, and opportunistic infections including tuberculosis are rare. The incidence of infections decreases with time on biologic therapy. Vaccination is effective while on biological agents, although live vaccines should be avoided. Biologic therapy in the setting of HIV, HCV and HBV continues to be studied, but data are accumulating in support of a favorable safety profile. There are degrees of differential susceptibility to infection across the rheumatic diseases, which should be taken into account in weighing the infectious risks of biologics in the respective diseases. SUMMARY Biological medications have a favorable safety profile but continued vigilance is appropriate. Most infectious reported episodes are minor and the risk of infection appears to decrease with duration of treatment.
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Kremer JM. Etanercept for patients with RA: more is not always better. NATURE CLINICAL PRACTICE. RHEUMATOLOGY 2009; 5:10-11. [PMID: 18957946 DOI: 10.1038/ncprheum0936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2008] [Accepted: 09/05/2008] [Indexed: 05/27/2023]
Affiliation(s)
- Joel M Kremer
- Albany Medical College and Director of Research at The Center for Rheumatology in Albany, NY 12206, USA.
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