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Teniou A, Rhouati A, Marty JL. Recent Advances in Biosensors for Diagnosis of Autoimmune Diseases. SENSORS (BASEL, SWITZERLAND) 2024; 24:1510. [PMID: 38475046 DOI: 10.3390/s24051510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 02/01/2024] [Accepted: 02/14/2024] [Indexed: 03/14/2024]
Abstract
Over the last decade, autoimmune diseases (ADs) have undergone a significant increase because of genetic and/or environmental factors; therefore, their simple and fast diagnosis is of high importance. The conventional diagnostic techniques for ADs require tedious sample preparation, sophisticated instruments, a dedicated laboratory, and qualified personnel. For these reasons, biosensors could represent a useful alternative to these methods. Biosensors are considered to be promising tools that can be used in clinical analysis for an early diagnosis due to their high sensitivity, simplicity, low cost, possible miniaturization (POCT), and potential ability for real-time analysis. In this review, recently developed biosensors for the detection of autoimmune disease biomarkers are discussed. In the first part, we focus on the main AD biomarkers and the current methods of their detection. Then, we discuss the principles and different types of biosensors. Finally, we overview the characteristics of biosensors based on different bioreceptors reported in the literature.
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Affiliation(s)
- Ahlem Teniou
- Bioengineering Laboratory, Higher National School of Biotechnology, Constantine 25100, Algeria
| | - Amina Rhouati
- Bioengineering Laboratory, Higher National School of Biotechnology, Constantine 25100, Algeria
| | - Jean-Louis Marty
- Laboratoire BAE, Université de Perpignan through Domitia, 66860 Perpignan, France
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Hassan WM, Othman N, Daghestani M, Warsy A, Omair MA, Alqurtas E, Amin S, Ismail A, El-Ansary A, Bhat RS, Omair MA. The Fidelity of Rheumatoid Arthritis Multivariate Diagnostic Biomarkers Using Discriminant Analysis and Binary Logistic Regression. Biomolecules 2023; 13:1305. [PMID: 37759705 PMCID: PMC10526504 DOI: 10.3390/biom13091305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/29/2023] Open
Abstract
Rheumatoid arthritis (RA) is an autoimmune inflammatory disease that causes multi-articular synovitis. The illness is characterized by worsening inflammatory synovitis, which causes joint swelling and pain. Synovitis erodes articular cartilage and marginal bone, resulting in joint deterioration. This bone injury is expected to be permanent. Cytokines play a prominent role in the etiology of RA and could be useful as early diagnostic biomarkers. This research was carried out at Riyadh's King Khalid University Hospital (KKUH). Patients were enrolled from the Rheumatology unit. Seventy-eight RA patients were recruited (67 (85.9%) females and 11 (14.1%) males). Patients were selected for participation by convenience sampling. Demographic data were collected, and disease activity measurements at 28 joints were recorded using the disease activity score (DAS-28). Age- and sex-matched controls from the general population were included in the study. A panel of 27 cytokines, chemokines, and growth factors was determined in patient and control sera. Binary logistic regression (BLR) and discriminant analysis (DA) were used to analyze the data. We show that multiple cytokine biomarker profiles successfully distinguished RA patients from healthy controls. IL-17, IL-4, and RANTES were among the most predictive variables and were the only biomarkers incorporated into both BLR and DA predictive models for pooled participants (men and women). In the women-only models, the significant cytokines incorporated in the model were IL-4, IL-17, MIP-1b, and RANTES for the BLR model and IL-4, IL-1Ra, GM-CSF, IL-17, and eotaxin for the DA model. The BLR and DA men-only models contained one cytokine each, eotaxin for BLR and platelet-derived growth factor-bb (PDGF-BB) for DA. We show that BLR has a higher fidelity in identifying RA patients than DA. We also found that the use of gender-specific models marginally improves detection fidelity, indicating a possible benefit in clinical diagnosis. More research is needed to determine whether this conclusion will hold true in various and larger patient populations.
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Affiliation(s)
- Wail M. Hassan
- Department of Biomedical Sciences, University of Missouri-Kansas City School of Medicine, Kansas City, MO 64108, USA;
| | - Nashwa Othman
- Central Research Laboratory, Center for Science and Medical Studies for Girls, King Saud University, Riyadh 11495, Saudi Arabia; (N.O.); (A.W.)
| | - Maha Daghestani
- Department of Zoology, College of Science, Center for Science and Medical Studies for Girls, King Saud University, Riyadh 11495, Saudi Arabia;
| | - Arjumand Warsy
- Central Research Laboratory, Center for Science and Medical Studies for Girls, King Saud University, Riyadh 11495, Saudi Arabia; (N.O.); (A.W.)
| | - Maha A. Omair
- Department of Statistics and Operations Research, College of Sciences, King Saud University, Riyadh 11495, Saudi Arabia;
| | - Eman Alqurtas
- Rheumatology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh 11495, Saudi Arabia; (E.A.); (S.A.); (M.A.O.)
| | - Shireen Amin
- Rheumatology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh 11495, Saudi Arabia; (E.A.); (S.A.); (M.A.O.)
| | - Abdulaziz Ismail
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh 11495, Saudi Arabia;
| | - Afaf El-Ansary
- Central Research Laboratory, Center for Science and Medical Studies for Girls, King Saud University, Riyadh 11495, Saudi Arabia; (N.O.); (A.W.)
| | - Ramesa Shafi Bhat
- Biochemistry Department, College of Science, Center for Science and Medical Studies for Girls, King Saud University, Riyadh 11495, Saudi Arabia;
| | - Mohammed A. Omair
- Rheumatology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh 11495, Saudi Arabia; (E.A.); (S.A.); (M.A.O.)
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Ross Y, Ballou S. Reliability of C-reactive protein as an inflammatory marker in patients with immune-mediated inflammatory diseases and liver dysfunction. Rheumatol Adv Pract 2023; 7:rkad045. [PMID: 37228508 PMCID: PMC10203543 DOI: 10.1093/rap/rkad045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 04/14/2023] [Indexed: 05/27/2023] Open
Abstract
Objectives CRP is an acute-phase reactant widely used clinically as a marker of inflammation. CRP is a protein synthesized by hepatocytes. Previous studies have shown lower CRP levels in response to infections in patients with chronic liver disease. We hypothesized that CRP levels would also be lower during active immune-mediated inflammatory diseases (IMIDs) in patients with liver dysfunction. Methods This retrospective cohort study used Slicer Dicer in Epic, our electronic medical record system, to search for patients with IMIDs both with and without concomitant liver disease. Patients with liver disease were excluded if there was no clear documentation of liver disease staging. Patients were also excluded if a CRP level was not available during disease flare or active disease. Arbitrarily, we considered normal CRP as ≤0.7 mg/dl, mild elevation of CRP as ≥0.8 and <3mg/dl, and elevated CRP as ≥3mg/dl. Results We identified 68 patients with both liver disease and IMIDs (RA, PsA and PMR) and 296 patients with autoimmune disease and without liver disease. Presence of liver disease had the lowest odds ratio (odds ratio = 0.25, P < 0.0001) of having an elevated CRP during flare. Each specific IMID, except SLE and IBD, had higher median CRP levels during active disease episodes in patients without liver disease than in those with liver disease. Discussion Overall, IMID patients with liver disease had lower serum CRP levels during active disease than their counterparts without liver dysfunction. This observation has implications for clinical use of CRP level as a reliable marker of disease activity in patients with IMIDs and liver dysfunction.
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Affiliation(s)
- Yael Ross
- Correspondence to: Yael Ross, Department of Rheumatology, WellStar Health System, 400 Tower Road Suite 160, Marietta, GA 30060, USA. E-mail:
| | - Stanley Ballou
- Case Western Reserve University at MetroHealth Medical Center, Cleveland, OH, USA
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Edes AN, Brown JL, Edwards KL. Evaluating individual biomarkers for predicting health risks in zoo-housed chimpanzees (Pan troglodytes) and bonobos (Pan paniscus). Am J Primatol 2023; 85:e23457. [PMID: 36537335 DOI: 10.1002/ajp.23457] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 11/15/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022]
Abstract
Although biomarkers are often used for predicting morbidity and mortality in humans, similar data are lacking in our closest relatives. This study analyzed 16 biomarkers in zoo-housed chimpanzees and bonobos from serum samples collected during both routine and nonroutine veterinary immobilizations. Generalized linear and generalized linear mixed models were used to determine the efficacy of each biomarker to predict all-cause morbidity, defined as the presence of at least one chronic condition, or cardiac disease as a subset of all-cause morbidity. Cox proportional hazards models were used to examine associations between biomarkers and mortality risk from any cause. Analyses were conducted using two data sets for each species, one with all values retained (chimpanzees: n = 148; bonobos: n = 33) and the other from samples collected during routine immobilizations only (chimpanzees: n = 95; bonobos: n = 23). Consistent results across both data sets in chimpanzees included associations of higher cortisol with all-cause morbidity risk, lower creatinine with cardiac disease risk, and higher creatinine with mortality risk, and in bonobos were increased cardiac disease risk with higher cortisol and lower dehydroepiandrosterone-sulfate, fructosamine, and triglycerides. However, there were some inconsistencies between data sets, such as tumor necrosis factor-α predicting mortality risk positively in chimpanzees when all values were retained, but negatively for routine values only. Despite the close evolutionary relationships between chimpanzees and bonobos, the only result observed in both species was a negative association between albumin and mortality risk in the all values retained data sets. Thus, data suggest some biomarkers may be useful predictors of future health outcomes, although a better understanding of both individual and species variation in biomarkers and their contribution to health risks is needed.
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Affiliation(s)
- Ashley N Edes
- Department of Reproductive and Behavioral Sciences, Saint Louis Zoo, Saint Louis, Missouri, USA.,Center for Species Survival, Smithsonian Conservation Biology Institute, Front Royal, Virginia, USA
| | - Janine L Brown
- Center for Species Survival, Smithsonian Conservation Biology Institute, Front Royal, Virginia, USA
| | - Katie L Edwards
- Center for Species Survival, Smithsonian Conservation Biology Institute, Front Royal, Virginia, USA.,Conservation Science and Policy, North of England Zoological Society, Chester Zoo, Upton by Chester, UK
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Analysis of Multiple Vitamins Serum Levels and Disease-Related Factors in Children with Acute Leukemia. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:5330563. [PMID: 35463661 PMCID: PMC9033379 DOI: 10.1155/2022/5330563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/22/2022] [Accepted: 03/25/2022] [Indexed: 11/17/2022]
Abstract
Objective To explore the relationship between vitamins levels and disease-related indicators in children with acute leukemia (AL). Methods A total of 107 hospitalized children with AL were enrolled in this study and assigned to one group in each of the following categories: infected group (n = 52) and noninfected group (n = 55); treatment remission group (n = 56) and nonremission group (n = 51); high-risk (HR) group (n = 44), intermediate risk (IR) group (n = 53), and slight risk (SR) group (n = 8); cyclophosphamide + cytosine arabinoside+6-mercaptopurine + pegaspargase group (CAML, n = 15); methotrexate group (MTX, n = 9); and vindesine + daunomycin + L-asparaginasum + prednisone (VALP, n = 38). Hematological and serological parameters, hepatic and renal function, and changes in vitamins A, B1, B2, B6, B9, B12, C, D, and E serum content in children with AL were analyzed to investigate their relationship with AL disease-related factors. Results The vitamin D level was significantly higher in the noninfected group than in the infected group (P < 0.05). Compared with the nonremission group, the level of vitamin B1 in the treatment remission group was significantly higher, while the levels of vitamin B6 and B12 were notably lower (P < 0.05). The levels of vitamins B6 and B12 were notably different among the treatment groups. Multivariate analysis showed that hemoglobin (Hb) and C-reactive protein (CRP) were predisposing factors of AL in children. The disease type (acute lymphoblastic leukemia/acute myelogenous leukemia) was the factor affecting remission in AL children. Abnormal kidney function and the occurrence of icterus were the influencing factors for the risk degree in AL children. Platelet (PLT) count, activated partial thromboplastin time (APTT), neutrophils (N), and immunophenotype were shown to affect the choice of therapeutic regimens. Conclusion There are notable vitamins imbalances in children with AL. The imbalances influence disease-related factors and therefore provide some references for the prognosis and treatment of AL.
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Cost-Effectiveness Analysis of Biopharmaceuticals for Treating Rheumatoid Arthritis: Infliximab, Adalimumab, and Etanercept. BIOMED RESEARCH INTERNATIONAL 2021; 2021:4450162. [PMID: 34877355 PMCID: PMC8645365 DOI: 10.1155/2021/4450162] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 10/05/2021] [Accepted: 11/08/2021] [Indexed: 12/26/2022]
Abstract
Introduction Rheumatoid arthritis (RA) is a chronic progressive inflammatory disease that causes joint destruction. The condition imposes a significant economic burden on patients and societies. The present study is aimed at evaluating the cost-effectiveness of Infliximab, Adalimumab, and Etanercept in treating rheumatoid arthritis in Iran. Methods This is a cost-effectiveness study of economic evaluation in which the Markov model was used. The study was carried out on 154 patients with rheumatoid arthritis in Fars province taking Infliximab, Adalimumab, and Etanercept. The patients were selected through sampling. In this study, the cost data were collected from a community perspective, and the outcomes were the mean reductions in DAS-28 and QALY. The cost data collection form and the EQ-5D questionnaire were also used to collect the required data. The results were presented in the form of an incremental cost-effectiveness ratio, and the sensitivity analysis was used to measure the robustness of the study results. The TreeAge Pro and Excel softwares were used to analyze the collected data. Results The results showed that the mean costs and the QALY rates in the Infliximab, Adalimumab, and Etanercept arms were $ 79,518.33 and 12.34, $ 91,695.59 and 13.25, and $ 87,440.92 and 11.79, respectively. The one-way sensitivity analysis confirmed the robustness of the results. In addition, the results of the probabilistic sensitivity analysis (PSA) indicated that on the cost-effectiveness acceptability curve, Infliximab was in the acceptance area and below the threshold in 77% of simulations. The scatter plot was in the mentioned area in 81% and 91% of simulations compared with Adalimumab and Etanercept, respectively, implying lower costs and higher effectiveness than the other two alternatives. Therefore, the strategy was more cost-effective. Conclusion According to the results of this study, Infliximab was more cost-effective than the other two medications. Therefore, it is recommended that physicians use this medication as the priority in treating rheumatoid arthritis. It is also suggested that health policymakers consider the present study results in preparing treatment guidelines for RA.
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Edes AN, Brand CM. Age, sex, and inflammatory markers predict chronic conditions, cardiac disease, and mortality among captive western lowland gorillas (Gorilla gorilla gorilla). Primates 2021; 62:931-943. [PMID: 34460009 DOI: 10.1007/s10329-021-00942-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 08/12/2021] [Indexed: 01/22/2023]
Abstract
In humans, inflammatory markers predict health risks. As great apes experience many similar conditions, measuring inflammation may provide valuable health information. We examined four serum inflammatory markers in zoo-housed gorillas (n = 48): albumin, CRP, IL-6, and TNF-α. We first analyzed age- and sex-associated patterns, then used multimodel inference to evaluate models with age, sex, and inflammatory markers as predictors of all-cause morbidity, cardiac disease, and mortality. Older gorillas had lower albumin and higher IL-6, and males had higher albumin, lower CRP, and lower TNF-α. All-cause morbidity was best predicted by age, sex, and TNF-α, but the second model containing only age and sex was equivalent. Cardiac disease was best predicted by TNF-α alongside age and sex, with lower levels associated with increased risk. When outliers were removed, the model with TNF-α was second to the model containing only age and sex. Finally, mortality risk was best predicted by the model with only age and sex. Other models containing individual inflammatory markers were within top model sets for each health outcome. Our results indicate that age and sex are robust for predicting all-cause morbidity and mortality risk in gorillas; while models which include individual inflammatory markers also predict risk, they may not improve predictions over age and sex alone. However, given the prevalence of cardiac disease in great apes, these results suggest that TNF-α warrants further investigation. With their potential to provide valuable health information, data on inflammatory markers may contribute to the care and management of gorillas in human care.
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Affiliation(s)
- Ashley N Edes
- Center for Species Survival, Smithsonian Conservation Biology Institution, Front Royal, VA, USA.
- Department of Anthropology, The Ohio State University, Columbus, OH, USA.
- Department of Reproductive and Behavioral Sciences, Saint Louis Zoo, Saint Louis, MO, USA.
| | - Colin M Brand
- Department of Anthropology, University of Oregon, Eugene, OR, USA
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Abstract
The utilization and identification of biomarkers in rheumatoid arthritis (RA) to facilitate timely diagnosis and the optimal management of the disease is an area of active investigation. This review focuses on biomarkers available for routine clinical use, details potential investigational biomarkers, and raises outstanding clinical questions.
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Affiliation(s)
- Samantha C Shapiro
- Rheumatology, University of Texas at Austin, Dell Medical School, Austin, USA
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Pope JE, Choy EH. C-reactive protein and implications in rheumatoid arthritis and associated comorbidities. Semin Arthritis Rheum 2020; 51:219-229. [PMID: 33385862 DOI: 10.1016/j.semarthrit.2020.11.005] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 10/19/2020] [Accepted: 11/05/2020] [Indexed: 02/07/2023]
Abstract
C-reactive protein (CRP) is routinely assessed as a marker of systemic inflammation in rheumatoid arthritis (RA). However, it is also an immune regulator that plays an important role in inflammatory pathways associated with RA and promotes atherogenic effects. Comorbidities linked to systemic inflammation are common in RA, and CRP has been associated with the risk for cardiovascular disease, diabetes, metabolic syndrome, pulmonary diseases, and depression. The relationship between systemic inflammation, CRP, and comorbidities in RA is complex, and it is challenging to determine how changing CRP levels may affect the risk or progression of these comorbidities. We review the biological role of CRP in RA and its implications for disease activity and treatment response. We also discuss the impact of treatment on CRP levels and whether reducing systemic inflammation and inhibiting CRP-mediated inflammatory pathways may have an impact on conditions commonly comorbid with RA.
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Affiliation(s)
- Janet E Pope
- Janet E. Pope: Schulich School of Medicine, University of Western Ontario, St. Joseph's Health Care, London, ON, Canada
| | - Ernest H Choy
- Ernest H. Choy: Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, United Kingdom.
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Burmester G, Drescher E, Hrycaj P, Chien D, Pan Z, Cohen S. Efficacy and safety results from a randomized double-blind study comparing proposed biosimilar ABP 798 with rituximab reference product in subjects with moderate-to-severe rheumatoid arthritis. Clin Rheumatol 2020; 39:3341-3352. [PMID: 32876780 PMCID: PMC7567688 DOI: 10.1007/s10067-020-05305-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 07/03/2020] [Accepted: 07/21/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND/OBJECTIVES ABP 798 is a proposed biosimilar to the originator biologic rituximab, an anti-CD20 monoclonal antibody. This comparative clinical study evaluated the pharmacokinetics (PK), safety, and efficacy of ABP 798 versus rituximab reference product (RP) in patients with moderate-to-severe rheumatoid arthritis (RA). METHODS Adults with moderate-to-severe RA with an inadequate response or intolerance to other disease-modifying anti-rheumatic drugs including 1 or more tumor necrosis factor inhibitor therapies (n = 311) received ABP 798, US-sourced rituximab RP (rituximab US), or EU-sourced rituximab RP (rituximab EU) (1000 mg, 2 weeks apart). At week 24, ABP 798- or rituximab EU-treated subjects received a second dose of the same treatment, while rituximab US-treated subjects transitioned to receive ABP 798. The key efficacy endpoint was DAS28-CRP change from baseline at week 24. Other efficacy endpoints included DAS28-CRP at other time points; ACR20, ACR50, and ACR70 criteria; and hybrid ACR. The rituximab RP groups were pooled for all efficacy endpoints since PK equivalence had been established between rituximab US and rituximab EU. RESULTS Clinical equivalence between ABP 798 and rituximab RP was established as the 90% confidence interval for DAS28-CRP change from baseline at week 24 fell within the prespecified equivalence margin (- 0.6, 0.6). Safety and immunogenicity profiles of ABP 798 were comparable across treatment groups and not affected by single transition from RP to ABP 798. CONCLUSIONS Clinical equivalence in terms of efficacy, safety, and immunogenicity was established between ABP 798 and rituximab RP in this comparative clinical trial in patients with moderate-to-severe RA. Key Points • ABP 798 provided similar efficacy as rituximab reference product (RP) in patients with moderate-severe rheumatoid arthritis. • The safety and immunogenicity profiles for ABP 798 were similar to those for the rituximab RP. • The single transition from rituximab RP to ABP 798 did not show differences in efficacy, safety, or immunogenicity.
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Affiliation(s)
- Gerd Burmester
- Department of Rheumatology and Clinical Immunology, Free University and Humboldt University Berlin, Charité-University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Edit Drescher
- Veszprém Csolnoky Ferenc County Hospital, Veszprém, Hungary
| | - Pawel Hrycaj
- Rheumatology, Koscian Municipal Hospital, Koscian, Poland
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Shimony S, Rozovski U, Sudry N, Yeshurun M, Yahav D, Raanani P, Wolach O. Early detection of infectious complications during induction therapy for acute leukemia with serial C-reactive protein biomarker assessment. Leuk Lymphoma 2020; 61:2708-2713. [PMID: 32578463 DOI: 10.1080/10428194.2020.1779253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Febrile neutropenia (FN) and blood stream infections (BSI) are major complications of induction treatment for acute leukemia. We assessed the predictive utility of C-reactive protein (CRP), an acute phase reactant, for FN and BSI during induction. CRP levels and dynamics were analyzed in 138 consecutive patients. FN and BSI occurred in 110 (80.3%) and 10 (7.5%) patients, respectively. Median peak CRP level in the 24-hours preceding FN was 7.5 mg/dl (0.2-38.1) vs. median peak CRP level of 5.11 mg/dl (0.2-23.1, p = .009) in patients without FN. CRP levels preceding BSI were 13.1 mg/dl (6.9-27.9) vs. 6.3 mg/dl (0.16-38.14, p = .011). CRP increase prior to event (ΔCRP) was higher among patients with BSI vs. patients without BSI (p = .013). CRP was predictive for FN (p = .009) and BSI (p = .01) on ROC curve analysis and was also independently associated with FN on multivariate analysis. In conclusion, CRP is a sensitive biomarker that precedes FN and BSI.
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Affiliation(s)
- Shai Shimony
- Institute of Hematology, Davidoff Cancer Centre, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel
| | - Uri Rozovski
- Institute of Hematology, Davidoff Cancer Centre, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel
| | - Neta Sudry
- Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel
| | - Moshe Yeshurun
- Institute of Hematology, Davidoff Cancer Centre, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel
| | - Dafna Yahav
- Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel.,Infectious Disease Unit, Beilinson Hospital, Rabin Medical Centre, Petah-Tikva, Israel
| | - Pia Raanani
- Institute of Hematology, Davidoff Cancer Centre, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel
| | - Ofir Wolach
- Institute of Hematology, Davidoff Cancer Centre, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel
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McClellan JE, Conlon HD, Bolt MW, Kalfayan V, Palaparthy R, Rehman MI, Kirchhoff CF. The 'totality-of-the-evidence' approach in the development of PF-06438179/GP1111, an infliximab biosimilar, and in support of its use in all indications of the reference product. Therap Adv Gastroenterol 2019; 12:1756284819852535. [PMID: 31223341 PMCID: PMC6566480 DOI: 10.1177/1756284819852535] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 04/25/2019] [Indexed: 02/04/2023] Open
Abstract
The 'totality-of-the-evidence' biosimilarity concept requires that sufficient structural, functional, nonclinical, and clinical data are acquired in a stepwise manner, to demonstrate that no clinically meaningful differences in quality, safety, or efficacy are observed compared with the reference product. We describe the totality of the evidence for PF-06438179/GP1111 (PF-SZ-IFX; IXIFI™ [infliximab-qbtx]/Zessly®) that supported its approval as an infliximab (IFX) biosimilar for all eligible indications of reference IFX (ref-IFX; Remicade®) in Europe and in the US. Analytical similarity involving in vitro assays capable of distinguishing structural or functional differences between PF-SZ-IFX and ref-IFX formed a foundation for the biosimilarity exercise. Differences identified in N-glycosylation and charge heterogeneity were found not to impact the results in in vitro biological assays reflective of the pharmacology underlying the mechanisms of action (tumor necrosis factor binding, reverse signaling, antibody-dependent cell-mediated cytotoxicity and complement-dependent cytotoxicity) of IFX across disease indications. Similarity was assessed in a comparative clinical pharmacokinetic study and in a clinical efficacy and safety study in patients with rheumatoid arthritis, where therapeutic equivalence between PF-SZ-IFX and ref-IFX provided confirmatory evidence of biosimilarity, and, when coupled with the analytical similarity already established, supported extrapolation to all eligible disease indications of ref-IFX.
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Affiliation(s)
| | - Hugh D. Conlon
- Analytical Research and Development, Pfizer Inc., Andover, MA, USA
| | - Michael W. Bolt
- Drug Safety Research and Development, Pfizer Inc., Cambridge, MA, USA
| | | | | | | | - Carol F. Kirchhoff
- Global Technology Services, Biotechnology and Aseptic Sciences Group, Pfizer Inc., Chesterfield, MO, USA
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Alex AM, Sayles H, Mikuls TR, Kerr GS. Evaluation of cytokine profiles in rheumatoid arthritis patients with clinically active disease and normal inflammatory indices. Clin Rheumatol 2018; 38:1075-1081. [PMID: 30506404 DOI: 10.1007/s10067-018-4379-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 10/31/2018] [Accepted: 11/26/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the potential utility of a cytokine measurement in rheumatoid arthritis (RA) patients with active joint disease but normal acute phase reactants (APR). METHODS RA patients in a longitudinal observational registry with available cytokine array data were included. Patients were categorized based on agreement/disagreement of physical examination and APR measurements: concordant high (CH) [high tender and/or swollen joint counts (TJC + SJC > 3) and APR (ESR ≥ 28 mm/h + CRP ≥ 1.5 mg/L)]; concordant low (CL) [TJC + SJC ≤ 3 and normal APR]. Discordant (D) [TJC + SJC > 3 and normal APR] patients were stratified into low, medium, and high-disease activity (DL, DM, DH). Weighted-average and log-transformed cytokine scores were calculated based on results of a cytokine array. Chi-square tests compared categorical variables by concordance status; t tests, Wilcoxon rank-sum tests, ANOVA models, and ordinary least squares (OLS) regressions were used to compare continuous measures. RESULTS RA patients (n = 1467) were predominantly male (91%). Compared to CH patients (n = 174), D (n = 434) were younger, less frequently seropositive, with lower TJC, SJC, and DAS28-3v scores (p < 0.001). Cytokine scores for DL, DM, and DH groups were lower than CH patients (p < 0.001) and did not differ between DL, DM, and DH subgroups and were similar to CL (n = 356) patients. In multivariable analyses including CH and D patients, log-cytokine score was associated with higher DAS28-3v scores (p = 0.029). In multivariable analyses including CL patients, concordance status (p = 0.011) and ACPA (p = 0.013) were predictors of higher log cytokine score. CONCLUSION In this study, cytokine scores did not identify active joint disease in RA patients with normal APR.
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Affiliation(s)
- Asha M Alex
- Medstar Georgetown University Hospital, Washington, DC, USA.,Washington DC Veteran Affairs Medical Center, Washington, DC, USA
| | - Harlan Sayles
- University of Nebraska Medical Center & VA Nebraska-Western Iowa Health Care System, Omaha, NE, USA
| | - Ted R Mikuls
- University of Nebraska Medical Center & VA Nebraska-Western Iowa Health Care System, Omaha, NE, USA
| | - Gail S Kerr
- Medstar Georgetown University Hospital, Washington, DC, USA. .,Washington DC Veteran Affairs Medical Center, Washington, DC, USA. .,Howard University, Washington, DC, USA. .,Rheumatology Section, 151K, Veterans Affairs Medical Center, 50 Irving St, NW, Washington, DC, 20422, USA.
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14
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Shrotriya S, Walsh D, Nowacki AS, Lorton C, Aktas A, Hullihen B, Benanni-Baiti N, Hauser K, Ayvaz S, Estfan B. Serum C-reactive protein is an important and powerful prognostic biomarker in most adult solid tumors. PLoS One 2018; 13:e0202555. [PMID: 30138391 PMCID: PMC6107177 DOI: 10.1371/journal.pone.0202555] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 08/06/2018] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Prognostication in cancer is challenging and inaccurate. C-Reactive Protein (CRP), a cheap and sensitive marker of inflammation may help. This study investigated the relationship between CRP and prognosis in a large cohort of solid tumors with mixed cancer diagnoses and stages. METHODS Electronic medical records of 4931 adults with solid tumors who attended the Taussig Cancer Institute from 2006-2012 were reviewed. Demographic and clinical characteristics were recorded. Maximum CRP (mCRP) was identified for each individual. CRP was analysed as a time-dependent, continuous and categorical variable for association with survival. RESULTS Two thirds of patients had a high mCRP. This was consistently associated with shorter survival, even after correction for time from diagnosis, and when analysed as a continuous or a categorical variable. When mCRP values above 10 mg/L were subcategorized, a higher mCRP was always worse. Even among those with normal values, statistically and clinically significant shorter survival was noted at mCRP levels >5 mg/L. CONCLUSIONS In a large representative cohort of consecutive solid tumor patients the risk of death was clinically and statistically significantly greater with a high mCRP. This was independent of other variables and regardless of statistical method from both dates of diagnosis and test. CRP appeared to be underutilized. Our results support the routine use of CRP as a universal cost-effective independent prognostic indicator in most solid tumors.
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Affiliation(s)
- Shiva Shrotriya
- Section of Palliative Medicine and Supportive Oncology, Department of Solid Tumor Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, United States of America
- The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, United States of America
- Department of Internal Medicine, Michigan State University, East Lansing, Michigan, United States of America
| | - Declan Walsh
- Section of Palliative Medicine and Supportive Oncology, Department of Solid Tumor Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, United States of America
- The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, United States of America
- Faculty of Health Sciences, Trinity College, Dublin, Ireland, United Kingdom
- School of Medicine and Medical Science, University College Dublin, Dublin, Ireland, United Kingdom
| | - Amy S. Nowacki
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Cliona Lorton
- Faculty of Health Sciences, Trinity College, Dublin, Ireland, United Kingdom
| | - Aynur Aktas
- Section of Palliative Medicine and Supportive Oncology, Department of Solid Tumor Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, United States of America
- The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, United States of America
| | - Barbara Hullihen
- Section of Palliative Medicine and Supportive Oncology, Department of Solid Tumor Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, United States of America
- The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, United States of America
| | - Nabila Benanni-Baiti
- Section of Palliative Medicine and Supportive Oncology, Department of Solid Tumor Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, United States of America
- The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, United States of America
| | - Katherine Hauser
- Section of Palliative Medicine and Supportive Oncology, Department of Solid Tumor Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, United States of America
- The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, United States of America
| | - Serkan Ayvaz
- ITD Analytics eResearch Department, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Bassam Estfan
- Section of Palliative Medicine and Supportive Oncology, Department of Solid Tumor Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, United States of America
- The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, United States of America
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15
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Lim SJ, Sun JH, Kekatpure AL, Chun JM, Jeon IH. Rotator cuff surgery in patients with rheumatoid arthritis: clinical outcome comparable to age, sex and tear size matched non-rheumatoid patients. Ann R Coll Surg Engl 2017; 99:579-583. [PMID: 28853601 PMCID: PMC5697045 DOI: 10.1308/rcsann.2017.0107] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2017] [Indexed: 11/22/2022] Open
Abstract
Aims This study aimed to compare the clinical outcomes of rotator cuff repair in patients with rheumatoid arthritis with those of patients who have no known history of the disease. We hypothesised that the functional outcomes are comparable between patients and without rheumatoid arthritis and may be affected by the level of disease activity, as assessed from C-reactive protein (CRP) level and history of systemic steroid intake. Patients and methods We conducted a retrospective review of the institutional surgical database from May 1995 to April 2012. Twenty-nine patients with rheumatoid arthritis who had rotator cuff repair were enrolled as the study group. Age, sex, and tear size matched patients with no disease who were selected as the control group. The mean duration of follow-up was 46 months (range 24-92 months). Clinical outcomes were assessed with the American Shoulder and Elbow Surgeons (ASES) questionnaire, Constant score and visual analogue scale (VAS). All data were recorded preoperatively and at regular postoperative follow-up visits. CRP was measured preoperatively as the disease activity marker for rheumatoid arthritis. Medication history was thoroughly reviewed in the study group. Results In patients with rheumatoid arthritis, all shoulder functional scores improved after surgery (ASES 56.1-78.1, Constant 50.8-70.5 and VAS 5.2-2.5; P < 0.001). The functional outcome of surgery in patients with rheumatoid arthritis was comparable to that of the control group (difference with control: ASES 78.1 vs. 85.5, P = 0.093; Constant 70.5 vs. 75.9, P = 0.366; VAS 2.5 vs. 1.8, P = 0.108). Patients with rheumatoid arthritis who had an elevated CRP level (> 1 mg/dl) showed inferior clinical outcomes than those with normal CRP levels. Patients with a history of systemic steroid intake showed inferior functional outcomes than those who had not taken steroids. Conclusions Surgical intervention for rotator cuff tear in patients with rheumatoid arthritis improved the shoulder functional outcome comparable to that in matched patients without rheumatoid arthritis. Elevated preoperative CRP level and history of systemic steroid intake portend inferior functional outcome in patients with rheumatoid arthritis.
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Affiliation(s)
- S J Lim
- Asan Medical Center, School of Medicine, University of Ulsan , Seoul , Korea
| | - J-H Sun
- Department of Orthopaedic Surgery, Hi Hospital , Incheon , Korea
| | - A L Kekatpure
- Department of Orthopaedic Surgery, Sterling Wockhardt Hospital Vashi , Navi Mumbai , India
| | - J-M Chun
- Asan Medical Center, School of Medicine, University of Ulsan , Seoul , Korea
| | - I-H Jeon
- Asan Medical Center, School of Medicine, University of Ulsan , Seoul , Korea
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16
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Asai S, Fujibayashi T, Oguchi T, Hanabayashi M, Hayashi M, Matsubara H, Ito T, Yabe Y, Watanabe T, Hirano Y, Kanayama Y, Kaneko A, Kato T, Takagi H, Takahashi N, Funahashi K, Takemoto T, Asai N, Watanabe T, Ishiguro N, Kojima T. Predictors of biologic discontinuation due to insufficient response in patients with rheumatoid arthritis who achieved clinical remission with biologic treatment: A multicenter observational cohort study. Mod Rheumatol 2017; 28:221-226. [DOI: 10.1080/14397595.2017.1332558] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Shuji Asai
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | | | - Takeshi Oguchi
- Department of Orthopedic Surgery, Anjo Kosei Hospital, Anjo, Aichi, Japan
| | - Masahiro Hanabayashi
- Department of Orthopedic Surgery, Ichinomiya Municipal Hospital, Ichinomiya, Aichi, Japan
| | - Masatoshi Hayashi
- Department of Rheumatology, Nagano Red Cross Hospital, Nagano, Japan
| | | | | | - Yuichiro Yabe
- Department of Rheumatology, Tokyo Shinjuku Medical Center, Tokyo, Japan
| | - Tsuyoshi Watanabe
- Department of Orthopedic Surgery, Kariya-Toyota General Hospital, Kariya, Aichi, Japan
| | - Yuji Hirano
- Department of Rheumatology, Toyohashi Municipal Hospital, Toyohashi, Aichi, Japan
| | - Yasuhide Kanayama
- Department of Rheumatology, Toyota Kosei Hospital, Toyota, Aichi, Japan
| | - Atsushi Kaneko
- Department of Orthopedic Surgery and Rheumatology, Nagoya Medical Center, Nagoya, Aichi, Japan
| | | | - Hideki Takagi
- Department of Orthopedic Surgery, Nagoya Central Hospital, Nagoya, Aichi, Japan
| | - Nobunori Takahashi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Koji Funahashi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Toki Takemoto
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Nobuyuki Asai
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Tatsuo Watanabe
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Naoki Ishiguro
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Toshihisa Kojima
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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Birtane M, Yavuz S, Taştekin N. Laboratory evaluation in rheumatic diseases. World J Methodol 2017; 7:1-8. [PMID: 28396844 PMCID: PMC5366934 DOI: 10.5662/wjm.v7.i1.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 12/21/2016] [Accepted: 01/18/2017] [Indexed: 02/06/2023] Open
Abstract
Autoantibodies can help clinicians to allow early detection of autoimmune diseases and their clinical manifestations, to determine effective monitoring of prognosis and the treatment response. From this point, they have a high impact in rheumatic disease management. When used carefully they allow rapid diagnosis and appropriate treatment. However, as they may be present in healthy population they may cause confusion for interpreting the situation. False positive test results may lead to wrong treatment and unnecessary anxiety for patients. Autoantibody positivity alone does not make a diagnosis. Similarly, the absence of autoantibodies alone does not exclude diagnosis. The success of the test is closely related to sensitivity, specificity and likelihood ratios. So, interpretation of these is very important for a proper laboratory evaluation. In conclusion, in spite of the remarkable advances in science and technology, a deeply investigated anamnesis and comprehensive physical examination still continue to be the best diagnostic method. The most correct approach is that clinicians apply laboratory tests to confirm or exclude preliminary diagnosis based on anamnesis and physical examination. This review will discuss these issues.
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18
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Zou J, Ji DN, Cai JF, Guan JL, Bao ZJ. Long-Term Outcomes and Predictors of Sustained Response in Patients with Intestinal Behcet's Disease Treated with Infliximab. Dig Dis Sci 2017; 62:441-447. [PMID: 28044230 DOI: 10.1007/s10620-016-4395-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 11/28/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Intestinal Behcet's disease (BD) is a specific subtype of BD. Effective drug therapy for intestinal BD remains elusive. AIMS To investigate long-term outcomes and identify predictors of sustained response in intestinal BD patients receiving infliximab (IFX) treatment. METHODS The medical records were reviewed of patients received IFX from September 2012 to March 2016. The cumulative probabilities of sustained response were calculated using the Kaplan-Meier. Predictor factors for sustained response were accessed by receiver operating characteristic curve. RESULTS Totally, 27 active intestinal BD patients were enrolled. Sustained responses were observed in 17 patients, after a median follow-up duration 24 months (interquartile range 9-37). The proportion of clinical remission at week 14, 30, and 52 had occurred in 84.6, 70, and 70%, respectively, with the proportion of clinical remission of 69.2, 40, and 55%. The mucosal healing (MH) rate at week 14 was 72%. Kaplan-Meier estimated patients with achievement of clinical and biological responses at week 14 or MH was likely to remain sustained clinical response. ROC curve analysis revealed CRP level (of 6.85 mg/L) at week 14 is a potential predictor for discriminating patients with sustained response from relapse, with an area under the curve values of 0.837. CONCLUSIONS IFX is effective and safe for induction and maintenance therapy in Chinese patients with moderate-to-severe active intestinal BD. Early achievement of clinical response and mucosal healing might associate long-term response. A lower CRP level seems to be associated with a more benign clinical course.
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Affiliation(s)
- Jun Zou
- Department of Immunology and Rheumatology, Huadong Hospital, Fudan University, No. 221 West Yan'an Road, Shanghai, 200040, China
| | - Da-Nian Ji
- Center of Gastrointestinal Endoscopy, Huadong Hospital, Fudan University, Shanghai, China
| | - Jian-Fei Cai
- Department of Immunology and Rheumatology, Huadong Hospital, Fudan University, No. 221 West Yan'an Road, Shanghai, 200040, China
| | - Jian-Long Guan
- Department of Immunology and Rheumatology, Huadong Hospital, Fudan University, No. 221 West Yan'an Road, Shanghai, 200040, China. .,Shanghai Key Laboratory of Clinical Geriatric Medicine, Research Center on Aging and Medicine, Fudan University, Shanghai, China.
| | - Zhi-Jun Bao
- Department of Gastroenterology, Huadong Hospital, Fudan University, Shanghai, China. .,Shanghai Key Laboratory of Clinical Geriatric Medicine, Research Center on Aging and Medicine, Fudan University, Shanghai, China.
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19
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Zhang Y, Xu YZ, Sun N, Liu JH, Chen FF, Guan XL, Li A, Wang F, Zhao QF, Wang HY, Song SS, Yu W, Zhao JN, Li XJ. Long noncoding RNA expression profile in fibroblast-like synoviocytes from patients with rheumatoid arthritis. Arthritis Res Ther 2016; 18:227. [PMID: 27716329 PMCID: PMC5053204 DOI: 10.1186/s13075-016-1129-4] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 09/20/2016] [Indexed: 01/07/2023] Open
Abstract
Background Long noncoding RNAs (lncRNAs) have recently received wide attention as key molecules that mediate a variety of physiological and pathological processes by regulating gene expression; however, knowledge of lncRNAs in rheumatoid arthritis (RA) is limited. Thus, we investigated the lncRNA expression profile in fibroblast-like synoviocytes (FLSs) from patients with RA and explored the function of abundantly expressed lncRNAs. Methods LncRNA and mRNA microarrays were performed to identify differentially expressed lncRNAs in RA FLSs compared with normal FLSs. Quantitative polymerase chain reaction (qPCR) was used to validate the results, and correlation analysis was used to analyze the relationship between these aberrantly expressed lncRNAs and clinical characteristics. A receiver operating characteristic (ROC) curve was constructed to evaluate the diagnostic value of the lncRNAs identified. Results According to the gene expression profiles, 135 lncRNAs were differentially expressed between RA and normal FLSs. Furthermore, qPCR data showed that lncRNA ENST00000483588 was up-regulated and that three lncRNAs (ENST00000438399, uc004afb.1, and ENST00000452247) were down-regulated in RA FLSs. The expression level of ENST00000483588 was positively correlated with the level of C-reactive protein and the Simplified Disease Activity Index score. Moreover, the areas under the ROC curve were 0.85, 0.92, 0.97, and 0.92 for ENST00000483588, ENST00000438399, uc004afb.1, and ENST00000452247, respectively. Conclusions The results indicate that the dysregulation of ENST00000483588, ENST00000438399, uc004afb.1, and ENST00000452247 may be involved in the pathological processes of RA and that these lncRNAs may have potential value for the diagnosis and assessment of the disease activity of RA. Electronic supplementary material The online version of this article (doi:10.1186/s13075-016-1129-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yu Zhang
- Department of Clinical Laboratory Science, Jinling Hospital, School of Medicine, Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, China
| | - Yu-Zhong Xu
- Department of Clinical Laboratory Science, Jinling Hospital, School of Medicine, Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, China
| | - Ning Sun
- Department of Clinical Laboratory Science, Jinling Hospital, School of Medicine, Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, China
| | - Jian-Hong Liu
- Department of Clinical Laboratory Science, Jinling Hospital, School of Medicine, Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, China
| | - Fang-Fang Chen
- Department of Clinical Laboratory Science, Jinling Hospital, School of Medicine, Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, China
| | - Xiao-Long Guan
- Department of Clinical Laboratory Science, Jinling Hospital, School of Medicine, Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, China
| | - Ang Li
- Department of Clinical Laboratory Science, Jinling Hospital, School of Medicine, Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, China
| | - Fei Wang
- Department of Clinical Laboratory Science, Jinling Hospital, School of Medicine, Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, China
| | - Qin-Fei Zhao
- Department of Clinical Laboratory Science, Jinling Hospital, School of Medicine, Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, China
| | - Hai-Yong Wang
- Department of Clinical Laboratory Science, Jinling Hospital, School of Medicine, Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, China
| | - Shu-Sheng Song
- Department of Clinical Laboratory Science, Jinling Hospital, School of Medicine, Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, China
| | - Wei Yu
- Department of Clinical Laboratory Science, Jinling Hospital, School of Medicine, Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, China
| | - Jian-Ning Zhao
- Department of Osteology, Jinling Hospital, School of Medicine, Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, China
| | - Xiao-Jun Li
- Department of Clinical Laboratory Science, Jinling Hospital, School of Medicine, Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, China. .,State Key Laboratory of Analytical Chemistry for Life Science, Department of Chemistry, Nanjing University, Nanjing, 210093, China.
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Shrotriya S, Walsh D, Bennani-Baiti N, Thomas S, Lorton C. C-Reactive Protein Is an Important Biomarker for Prognosis Tumor Recurrence and Treatment Response in Adult Solid Tumors: A Systematic Review. PLoS One 2015; 10:e0143080. [PMID: 26717416 PMCID: PMC4705106 DOI: 10.1371/journal.pone.0143080] [Citation(s) in RCA: 174] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 10/30/2015] [Indexed: 12/14/2022] Open
Abstract
PURPOSE A systematic literature review was done to determine the relationship between elevated CRP and prognosis in people with solid tumors. C-reactive protein (CRP) is a serum acute phase reactant and a well-established inflammatory marker. We also examined the role of CRP to predict treatment response and tumor recurrence. METHODS MeSH (Medical Subject Heading) terms were used to search multiple electronic databases (PubMed, EMBASE, Web of Science, SCOPUS, EBM-Cochrane). Two independent reviewers selected research papers. We also included a quality Assessment (QA) score. Reports with QA scores <50% were excluded. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) methodology was utilized for this review (S1 PRISMA Checklist). RESULTS 271 articles were identified for final review. There were 45% prospective studies and 52% retrospective. 264 had intermediate QA score (≥50% but <80%); Seven were adequate (80% -100%); A high CRP was predictive of prognosis in 90% (245/271) of studies-80% of the 245 studies by multivariate analysis, 20% by univariate analysis. Many (52%) of the articles were about gastrointestinal malignancies (GI) or kidney malignancies. A high CRP was prognostic in 90% (127 of 141) of the reports in those groups of tumors. CRP was also prognostic in most reports in other solid tumors primary sites. CONCLUSIONS A high CRP was associated with higher mortality in 90% of reports in people with solid tumors primary sites. This was particularly notable in GI malignancies and kidney malignancies. In other solid tumors (lung, pancreas, hepatocellular cancer, and bladder) an elevated CRP also predicted prognosis. In addition there is also evidence to support the use of CRP to help decide treatment response and identify tumor recurrence. Better designed large scale studies should be conducted to examine these issues more comprehensively.
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Affiliation(s)
- Shiva Shrotriya
- Department of Solid Tumor Oncology, The Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, United States of America
- The Harry R. Horvitz Center for Palliative Medicine, The Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, United States of America
| | - Declan Walsh
- Department of Solid Tumor Oncology, The Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, United States of America
- The Harry R. Horvitz Center for Palliative Medicine, The Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, United States of America
- * E-mail:
| | - Nabila Bennani-Baiti
- Department of Solid Tumor Oncology, The Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, United States of America
- The Harry R. Horvitz Center for Palliative Medicine, The Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, United States of America
| | - Shirley Thomas
- Department of Solid Tumor Oncology, The Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, United States of America
- The Harry R. Horvitz Center for Palliative Medicine, The Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, United States of America
| | - Cliona Lorton
- Our Lady’s Hospice & Care Services, Harold’s Cross, Dublin, Ireland
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Wang Y, Chen J, Luo X, Zhang Y, Si M, Wu H, Yan C, Wei W. Ginsenoside metabolite compound K exerts joint-protective effect by interfering with synoviocyte function mediated by TNF-α and Tumor necrosis factor receptor type 2. Eur J Pharmacol 2015; 771:48-55. [PMID: 26688568 DOI: 10.1016/j.ejphar.2015.12.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 12/08/2015] [Accepted: 12/09/2015] [Indexed: 01/15/2023]
Abstract
Ginsenoside metabolite compound K (CK), metabolite of the ginsenoside, is considered to exert numerous pharmacological efficacies of ginsenoside, including anti-inflammation and immunoregulatory effects. Rheumatoid arthritis (RA) is a multi-systemic autoimmune disease characterized by hyperplastic synovial membrane and systemic inflammation, which ultimately lead to progressive destructive inflammatory arthropathy. To evaluate the potential joint-protective effects of CK and the underlying mechanism, adjuvant arthritis (AA) was induced by complete Freund's adjuvant in rats. After the onset of arthritis, The effect of CK on AA rats was evaluated by histopathology of the joint. The proliferation of fibroblast-like synoviocyte(FLS) was assayed by the Cell Counting Kit-8.The migration of FLS was assayed by transwell migration assay. Cytokines in the supernatant from FLS were measured by ELISA kit. Expression of Tumor Necrosis Factor Receptor Type 1(TNFR1) and Tumor Necrosis Factor Receptor Type 2(TNFR2) were detected by immunostaining analysis and western blot analysis. CK (80mg/kg) significantly ameliorated the histopathological change of joint in AA rats, balanced the RANKL/OPG ratio and attenuated the proliferation and migration of AA-FLS. CK suppressed the secretion of proinflammatory cytokines TNF-α and downregulated the expression of TNFR2 on AA-FLS. In vitro CK also significantly suppressed proliferation, migration and secretion of AA-FLS mediated by TNF-α. Further studies showed that the effects of CK on AA-FLS were reversed by using glucocorticoid receptor (GR) antagonist (mifepristone). Our data suggest that CK exerts joint-protective effect by interfering with synoviocyte function mediated by TNF-α and TNFR2, and this effect may be mediated by GR.
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Affiliation(s)
- Ying Wang
- Institute of Clinical Pharmacology of Anhui Medical University, key Laboratory of Antiinflammatory and Immune Medicine, Ministry of Education, Anhui Collaborative Innovation Center of Anti-inflammatory and Immune Medicine, Meishan Road 81, Hefei 230032, China
| | - Jingyu Chen
- Institute of Clinical Pharmacology of Anhui Medical University, key Laboratory of Antiinflammatory and Immune Medicine, Ministry of Education, Anhui Collaborative Innovation Center of Anti-inflammatory and Immune Medicine, Meishan Road 81, Hefei 230032, China
| | - Xuexia Luo
- Institute of Clinical Pharmacology of Anhui Medical University, key Laboratory of Antiinflammatory and Immune Medicine, Ministry of Education, Anhui Collaborative Innovation Center of Anti-inflammatory and Immune Medicine, Meishan Road 81, Hefei 230032, China
| | - Ying Zhang
- Institute of Clinical Pharmacology of Anhui Medical University, key Laboratory of Antiinflammatory and Immune Medicine, Ministry of Education, Anhui Collaborative Innovation Center of Anti-inflammatory and Immune Medicine, Meishan Road 81, Hefei 230032, China
| | - Ming Si
- Institute of Clinical Pharmacology of Anhui Medical University, key Laboratory of Antiinflammatory and Immune Medicine, Ministry of Education, Anhui Collaborative Innovation Center of Anti-inflammatory and Immune Medicine, Meishan Road 81, Hefei 230032, China
| | - Huaxun Wu
- Institute of Clinical Pharmacology of Anhui Medical University, key Laboratory of Antiinflammatory and Immune Medicine, Ministry of Education, Anhui Collaborative Innovation Center of Anti-inflammatory and Immune Medicine, Meishan Road 81, Hefei 230032, China
| | - Chang Yan
- Institute of Clinical Pharmacology of Anhui Medical University, key Laboratory of Antiinflammatory and Immune Medicine, Ministry of Education, Anhui Collaborative Innovation Center of Anti-inflammatory and Immune Medicine, Meishan Road 81, Hefei 230032, China
| | - Wei Wei
- Institute of Clinical Pharmacology of Anhui Medical University, key Laboratory of Antiinflammatory and Immune Medicine, Ministry of Education, Anhui Collaborative Innovation Center of Anti-inflammatory and Immune Medicine, Meishan Road 81, Hefei 230032, China.
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Van Roy M, Ververken C, Beirnaert E, Hoefman S, Kolkman J, Vierboom M, Breedveld E, 't Hart B, Poelmans S, Bontinck L, Hemeryck A, Jacobs S, Baumeister J, Ulrichts H. The preclinical pharmacology of the high affinity anti-IL-6R Nanobody® ALX-0061 supports its clinical development in rheumatoid arthritis. Arthritis Res Ther 2015; 17:135. [PMID: 25994180 PMCID: PMC4476083 DOI: 10.1186/s13075-015-0651-0] [Citation(s) in RCA: 125] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 05/11/2015] [Indexed: 12/21/2022] Open
Abstract
Introduction The pleiotropic cytokine interleukin-6 (IL-6) plays an important role in the pathogenesis of different diseases, including rheumatoid arthritis (RA). ALX-0061 is a bispecific Nanobody® with a high affinity and potency for IL-6 receptor (IL-6R), combined with an extended half-life by targeting human serum albumin. We describe here the relevant aspects of its in vitro and in vivo pharmacology. Methods ALX-0061 is composed of an affinity-matured IL-6R-targeting domain fused to an albumin-binding domain representing a minimized two-domain structure. A panel of different in vitro assays was used to characterize the biological activities of ALX-0061. The pharmacological properties of ALX-0061 were examined in cynomolgus monkeys, using plasma levels of total soluble (s)IL-6R as pharmacodynamic marker. Therapeutic effect was evaluated in a human IL-6-induced acute phase response model in the same species, and in a collagen-induced arthritis (CIA) model in rhesus monkeys, using tocilizumab as positive control. Results ALX-0061 was designed to confer the desired pharmacological properties. A 200-fold increase of target affinity was obtained through affinity maturation of the parental domain. The high affinity for sIL-6R (0.19 pM) translated to a concentration-dependent and complete neutralization of sIL-6R in vitro. In cynomolgus monkeys, ALX-0061 showed a dose-dependent and complete inhibition of hIL-6-induced inflammatory parameters, including plasma levels of C-reactive protein (CRP), fibrinogen and platelets. An apparent plasma half-life of 6.6 days was observed after a single intravenous administration of 10 mg/kg ALX-0061 in cynomolgus monkeys, similar to the estimated expected half-life of serum albumin. ALX-0061 and tocilizumab demonstrated a marked decrease in serum CRP levels in a non-human primate CIA model. Clinical effect was confirmed in animals with active drug exposure throughout the study duration. Conclusions ALX-0061 represents a minimized bispecific biotherapeutic of 26 kDa, nearly six times smaller than monoclonal antibodies. High in vitro affinity and potency was demonstrated. Albumin binding as a half-life extension technology resulted in describable and expected pharmacokinetics. Strong IL-6R engagement was shown to translate to in vivo effect in non-human primates, demonstrated via biomarker deregulation as well as clinical effect. Presented results on preclinical pharmacological properties of ALX-0061 are supportive of clinical development in RA. Electronic supplementary material The online version of this article (doi:10.1186/s13075-015-0651-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | - Els Beirnaert
- Ablynx NV, Technologiepark 21, 9052, Zwijnaarde, Belgium. .,VIB, Rijvisschestraat 120, 9052, Zwijnaarde, Belgium.
| | - Sven Hoefman
- Ablynx NV, Technologiepark 21, 9052, Zwijnaarde, Belgium.
| | - Joost Kolkman
- Ablynx NV, Technologiepark 21, 9052, Zwijnaarde, Belgium. .,Crucell, Archimedesweg 4-6, 2333, CA, Leiden, The Netherlands.
| | - Michel Vierboom
- Department of Immunobiology, Biomedical Primate Research Centre, Lange Kleiweg 161, 2288 GJ, Rijswijk, The Netherlands.
| | - Elia Breedveld
- Department of Immunobiology, Biomedical Primate Research Centre, Lange Kleiweg 161, 2288 GJ, Rijswijk, The Netherlands.
| | - Bert 't Hart
- Department of Immunobiology, Biomedical Primate Research Centre, Lange Kleiweg 161, 2288 GJ, Rijswijk, The Netherlands. .,Department of Neuroscience, University of Groningen, University Medical Center, Hanzeplein 1, 9700 RB, Groningen, The Netherlands.
| | - Sofie Poelmans
- Ablynx NV, Technologiepark 21, 9052, Zwijnaarde, Belgium.
| | | | - Alex Hemeryck
- Ablynx NV, Technologiepark 21, 9052, Zwijnaarde, Belgium.
| | - Sandy Jacobs
- Ablynx NV, Technologiepark 21, 9052, Zwijnaarde, Belgium.
| | | | - Hans Ulrichts
- Ablynx NV, Technologiepark 21, 9052, Zwijnaarde, Belgium.
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Warren MS, Hughes SG, Singleton W, Yamashita M, Genovese MC. Results of a proof of concept, double-blind, randomized trial of a second generation antisense oligonucleotide targeting high-sensitivity C-reactive protein (hs-CRP) in rheumatoid arthritis. Arthritis Res Ther 2015; 17:80. [PMID: 25885521 PMCID: PMC4415222 DOI: 10.1186/s13075-015-0578-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 02/20/2015] [Indexed: 11/17/2022] Open
Abstract
Introduction This randomized, double-blind, phase II study evaluated the pharmacodynamics, safety and tolerability of ISIS 329993 (ISIS-CRPRx), an antisense oligonucleotide, in patients with active rheumatoid arthritis (RA). Methods Patients with active RA of at least six months duration were randomized into three cohorts to receive ISIS-CRPRx (100 mg, 200 mg or 400 mg) or placebo (3 active:1 placebo within each cohort) via subcutaneous (SC) injection on Days 1, 3, 5 and 8 and then once weekly for the next 11 weeks. The effects of study treatment on high-sensitivity C-reactive protein (hs-CRP) level were evaluated. An exploratory analysis on disease activity was assessed via the American College of Rheumatology 20% improvement criteria (ACR20). Safety was evaluated via adverse events and laboratory measures. Results Fifty-one patients received one of the following treatments: ISIS-CRPRx 100 mg, n = 12; 200 mg, n = 13, 400 mg, n = 14; placebo n = 12. In the ISIS-CRPRx treatment groups there were dose-dependent reductions in hs-CRP. At Day 36 the mean percent change from baseline was: placebo: −14.4%; ISIS-CRPRx 100 mg: −19.5%; 200 mg: −56.6% and 400 mg: −76.7%, (P = 0.0015 placebo compared to 400 mg). There were no differences between treatment groups and placebo in the ACR20 at Day 36 or Day 92. There were no serious infections and no elevations in liver function tests, lipids, creatinine or other lab abnormalities related to ISIS-CRPRx. Conclusions In this study, ISIS-CRPRx selectively reduced hs-CRP in a dose-dependent manner, and was well-tolerated in patients with RA. Its utility as a therapy in RA remains unclear. Trial registration Clinicaltrials.gov NCT01414101. Registered 21 July 2011. Electronic supplementary material The online version of this article (doi:10.1186/s13075-015-0578-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marshelle S Warren
- Isis Pharmaceuticals, Inc, 2855 Gazelle Court, Carlsbad, CA, 92010, USA.
| | - Steven G Hughes
- Isis Pharmaceuticals, Inc, 2855 Gazelle Court, Carlsbad, CA, 92010, USA.
| | - Walter Singleton
- Isis Pharmaceuticals, Inc, 2855 Gazelle Court, Carlsbad, CA, 92010, USA.
| | - Mason Yamashita
- Isis Pharmaceuticals, Inc, 2855 Gazelle Court, Carlsbad, CA, 92010, USA.
| | - Mark C Genovese
- Stanford University, 1000 Welch Rd Palo, Alto, CA, 94304, USA.
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Lenski M, Scherer MA. Diagnostic potential of inflammatory markers in septic arthritis and periprosthetic joint infections: a clinical study with 719 patients. Infect Dis (Lond) 2015; 47:399-409. [DOI: 10.3109/00365548.2015.1006674] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Shrivastava AK, Singh HV, Raizada A, Singh SK, Pandey A, Singh N, Yadav DS, Sharma H. Inflammatory markers in patients with rheumatoid arthritis. Allergol Immunopathol (Madr) 2015; 43:81-7. [PMID: 24656623 DOI: 10.1016/j.aller.2013.11.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 10/30/2013] [Accepted: 11/07/2013] [Indexed: 01/13/2023]
Abstract
BACKGROUND Autoimmune diseases such as rheumatoid arthritis (RA) are the consequence of a persistent imbalance between pro- and anti-inflammatory immune mechanisms, leading to chronic inflammation. The objective of this study was to determine whether the high sensitive C-reactive protein (hs-CRP) and cytokines are elevated in RA patients and to investigate the relationship between these markers and disease activity in RA, measured by disease activity score 28 (DAS28). METHODS We studied 110 RA patients according to American College of Rheumatology revised criteria for RA, and 55 controls matched by age and sex. Serum levels of hs-CRP and cytokines interleukin (IL)-6, IL-10 and tumour necrosis factor-α (TNF-α) were estimated and correlated with the DAS28. Serum hs-CRP was assayed immunoturbidimetrically and cytokines were analysed by commercially available ELISA kit. RESULTS We found that RA patients had significantly higher levels of serum hs-CRP (p<0.001), IL-6 (p<0.001), TNF-α (p<0.001), and IL-10 (p<0.01) as compared to healthy controls. hs-CRP, IL-6 and TNF-α correlated positively (p<0.001) and IL-10 correlated negatively (p<0.01) with DAS28. CONCLUSIONS These results demonstrate that RA patients have high levels of inflammatory markers, and these levels are correlated with the DAS28. These findings suggest a possible role of these markers in the pathogenesis of RA. Moreover, these biomarkers can be used as markers of disease activity in the diagnosis and treatment of RA.
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Affiliation(s)
- A K Shrivastava
- Department of Biochemistry, Sudha Rustagi College of Dental Sciences & Research, Faridabad 121001, India.
| | - H V Singh
- Biochemist, Department of Pathology, Hindu Rao Hospital, Delhi 110007, India
| | - A Raizada
- Department of Pathology and Laboratory Medicine, Medanta-The Medicity, Gurgaon 122001, India
| | - S K Singh
- Department of Biochemistry, G. R. Medical College, Gwalior 474009, India
| | - A Pandey
- Department of Biochemistry, Narsinhbhai Patel Dental College and Hospital, Visnagar 384315, India
| | - N Singh
- Department of Biochemistry, G. R. Medical College, Gwalior 474009, India
| | - D S Yadav
- Department of Pathology and Laboratory Medicine, Medanta-The Medicity, Gurgaon 122001, India
| | - H Sharma
- Department of Rheumatology, Hindu Rao Hospital, Delhi 110007, India
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Salter H, Holland R. Biomarkers: refining diagnosis and expediting drug development - reality, aspiration and the role of open innovation. J Intern Med 2014; 276:215-28. [PMID: 24605903 DOI: 10.1111/joim.12234] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
In the last decade, there have been intensive efforts to invent, qualify and use novel biomarkers as a means to improve success rates in drug discovery and development. The biomarkers field is maturing and this article considers whether these research efforts have brought about the expected benefits. The characteristics of a clinically useful biomarker are described and the impact this area of research has had is evaluated by reviewing a few, key examples of emerging biomarkers. There is evidence that the impact has been genuine and is increasing in both the drug and the diagnostic discovery and development processes. Beneficial impact on patient health outcomes seems relatively limited thus far, with the greatest impact in oncology (again, both in terms of novel drugs and in terms of more refined diagnoses and therefore more individualized treatment). However, the momentum of research would indicate that patient benefits are likely to increase substantially and to broaden across multiple therapeutic areas. Even though this research was originally driven by a desire to improve the drug discovery and development process, and was therefore funded with this aim in mind, it seems likely that the largest impact may actually come from more refined diagnosis. Refined diagnosis will facilitate both better allocation of healthcare resources and the use of treatment regimens which are optimized for the individual patient. This article also briefly reviews emerging technological approaches and how they relate to the challenges inherent in biomarker discovery and validation, and discusses the role of public/private partnerships in innovative biomarker research.
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Affiliation(s)
- H Salter
- AstraZeneca Translational Science Centre, Science for Life Laboratory, Solna, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
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Model-Based Optimal Design and Execution of the First-Inpatient Trial of the Anti-IL-6, Olokizumab. CPT-PHARMACOMETRICS & SYSTEMS PHARMACOLOGY 2014; 3:e119. [PMID: 24941311 PMCID: PMC4076804 DOI: 10.1038/psp.2014.17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 03/26/2014] [Indexed: 11/25/2022]
Abstract
The first-in-patient study for olokizumab (OKZ) employed model-based, optimal design and adaptive execution to define the concentration–C-reactive protein (CRP) suppression response. Modeling and exploratory statistics activities involved: reverse engineering of first-in-class (tocilizumab) pharmacokinetic/pharmacodynamic (PK/PD) models, adaptation of models to OKZ with a priori knowledge and preclinical data translation, application of multidimensional Desirability Index for optimal study design, sample size reestimation based on new information, optimization of second study part via Bayesian analysis of interim data, and interim and final analysis for PK/PD objective attainment. Design work defined a dose window (0.1–3 mg/kg) for CRP suppression exploration and suggested 72 patients in five single-dose levels would suffice. During execution, new information resulted in reestimating the study size to half. Halting the first part and conducting interim analysis for second part optimization followed. Second interim and final analyses confirmed attainment of study objective, illustrating efficiency and optimality of the study.
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Chang SH, Choi BY, Choi J, Yoo JJ, Ha YJ, Cho HJ, Kang EH, Song YW, Lee YJ. Baseline serum interleukin-34 levels independently predict radiographic progression in patients with rheumatoid arthritis. Rheumatol Int 2014; 35:71-9. [DOI: 10.1007/s00296-014-3056-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 05/25/2014] [Indexed: 01/22/2023]
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Kay J, Morgacheva O, Messing SP, Kremer JM, Greenberg JD, Reed GW, Gravallese EM, Furst DE. Clinical disease activity and acute phase reactant levels are discordant among patients with active rheumatoid arthritis: acute phase reactant levels contribute separately to predicting outcome at one year. Arthritis Res Ther 2014; 16:R40. [PMID: 24485007 PMCID: PMC3978994 DOI: 10.1186/ar4469] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 01/24/2014] [Indexed: 11/25/2022] Open
Abstract
Introduction Clinical trials of new treatments for rheumatoid arthritis (RA) typically require subjects to have an elevated acute phase reactant (APR), in addition to tender and swollen joints. However, despite the elevation of individual components of the Clinical Disease Activity Index (CDAI) (tender and swollen joint counts and patient and physician global assessment), some patients with active RA may have normal erythrocyte sedimentation rate (ESR) and/or C-reactive protein (CRP) levels and thus fail to meet entry criteria for clinical trials. We assessed the relationship between CDAI and APRs in the Consortium of Rheumatology Researchers of North America (CORRONA) registry by comparing baseline characteristics and one-year clinical outcomes of patients with active RA, grouped by baseline APR levels. Methods This was an observational study of 9,135 RA patients who had both ESR and CRP drawn and a visit at which CDAI was >2.8 (not in remission). Results Of 9,135 patients with active RA, 58% had neither elevated ESR nor CRP; only 16% had both elevated ESR and CRP and 26% had either ESR or CRP elevated. Among the 4,228 patients who had a one-year follow-up visit, both baseline and one-year follow-up modified Health Assessment Questionnaire (mHAQ) and CDAI scores were lowest for patients with active RA but with neither APR elevated; both mHAQ and CDAI scores increased sequentially with the increase in number of elevated APR levels at baseline. Each individual component of the CDAI followed the same trend, both at baseline and at one-year follow-up. The magnitude of improvement in both CDAI and mHAQ scores at one year was associated positively with the number of APRs elevated at baseline. Conclusions In a large United States registry of RA patients, APR levels often do not correlate with disease activity as measured by joint counts and global assessments. These data strongly suggest that it is appropriate to obtain both ESR and CRP from RA patients at the initial visit. Requiring an elevation in APR levels as a criterion for inclusion of RA patients in studies of experimental agents may exclude some patients with active disease.
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Abstract
Early diagnosis and initiation of therapy has become a primary objective in clinical rheumatology. As psoriatic arthritis causes deformities and joint damage leading to impaired quality of life and function as well as increased mortality risk, there was an urgent call for action aiming at inducing remission of the active inflammatory process. Until the year 2000 there were no treatments that led to a reduction in progression of joint damage. However, with the advent of anti-tumour necrosis factor agents, it is now possible to arrest the progression of damage in these patients. Therefore, the concept of window of opportunity, that is early assessment and management in specialist clinics, has been extended to psoriatic arthritis with successful outcomes among psoriatic arthritis patients similar to those with rheumatoid arthritis. Although all this sounds plausible, early psoriatic arthritis assessment remains limited to research as setting up this type of service in standard clinical practice faces several challenges that would need tackling. The objective of this article is to provide an overview of these challenges and suggest a paradigm for use in standard clinical practice to identify early psoriatic arthritis patients.
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Affiliation(s)
- Deborah Palmer
- Clinical Nurse Specialist at Rheumatology Department, North Middlesex University Hospital, London
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Kavanaugh A, McInnes IB, Krueger GG, Gladman D, Beutler A, Gathany T, Mack M, Tandon N, Han C, Mease P. Patient-reported outcomes and the association with clinical response in patients with active psoriatic arthritis treated with golimumab: findings through 2 years of a phase III, multicenter, randomized, double-blind, placebo-controlled trial. Arthritis Care Res (Hoboken) 2013; 65:1666-73. [PMID: 23666608 PMCID: PMC4282022 DOI: 10.1002/acr.22044] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 04/24/2013] [Indexed: 01/17/2023]
Abstract
Objective To evaluate the effect of golimumab on physical function, health-related quality of life (HRQOL), and productivity in psoriatic arthritis (PsA). Methods GO-REVEAL was a multicenter, randomized, placebo-controlled study. Adult patients with active PsA (n = 405) received golimumab (50 or 100 mg) or placebo every 4 weeks, with early escape at week 16 (placebo → 50 mg, 50 → 100 mg) or placebo crossover to golimumab 50 mg at week 24. Patient-reported outcomes included physical function (Health Assessment Questionnaire [HAQ] disability index [DI] score), HRQOL (36-item Short Form health survey [SF-36] mental component summary [MCS] and physical component summary [PCS] scores), and productivity (home/school/work). Clinical response was assessed using the 28-joint Disease Activity Score using the C-reactive protein level (DAS28-CRP) and the Psoriasis Area and Severity Index (PASI) score for arthritis and skin symptoms, respectively. Results At week 24, golimumab-treated patients had significant mean improvements in HAQ DI (0.36), SF-36 (PCS 7.83, MCS 3.84), and productivity (2.24) scores compared with placebo (−0.01, 0.67, −0.60, and 0.08, respectively; P <0.001 for all). Also, greater proportions of golimumab- than placebo-treated patients had clinically meaningful improvements in HAQ DI (≥0.30) and SF-36 PCS and MCS (≥5) scores at week 24 (P <0.05). Also at week 24, improvements in DAS28-CRP scores were significantly but moderately correlated with improvements in HAQ DI, SF-36 PCS, and productivity scores. Correlations between these patient-reported outcomes and improvements in PASI, enthesitis, and dactylitis scores were very weak. Improvements in HAQ DI, SF-36, and productivity scores were similar among all groups by week 52 and week 104 when including placebo → golimumab crossover patients. Conclusion Golimumab-treated patients had significant improvements in physical function, HRQOL, and productivity through week 24; these improvements correlated with clinical improvement in signs and symptoms of peripheral arthritis and were sustained through 2 years.
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Cost Effectiveness of TNF-α Inhibitors in Rheumatoid Arthritis. Int J Inflam 2013; 2013:581409. [PMID: 24324915 PMCID: PMC3845242 DOI: 10.1155/2013/581409] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 08/29/2013] [Accepted: 09/15/2013] [Indexed: 11/18/2022] Open
Abstract
Background. TNF-α inhibitors have shown to be effective in reducing disease activity and improving the quality of life. Due to the high costs associated with acquisition of this treatment, this study was undertaken to evaluate the ICER of TNF-α antagonists (etanercept, adalimumab, and infliximab) in improving the quality of life. Methods. The HAQ and SF-36 were administered at phases 1, 2, and 3, in order to assess the improvement in the QOL. Suppression of disease activity was assessed through the DAS-28. Results. Statistically significant improvements (P < 0.05) were noted for the SF-36 and HAQ after 3 months and for the DAS-28 after 6 months of TNF-α inhibitor therapy. The mean ICER per 10% improvement in the HAQ, DAS-28, and SF-6D were €1976.5, €2086.5, and €2316.4, respectively, following 6 months of TNF-α intervention. Most favorable ICERs were reported from a patient who had to undergo surgical intervention whilst on DMARD therapy. Conclusion. Significant improvement was observed in patients' quality of life, after a short timeframe of 6 months. Such data is useful information in the light of convincing policy makers, in terms of providing access to the medications to individual patients on national health service schemes.
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Havrdova E, Giovannoni G, Stefoski D, Forster S, Umans K, Mehta L, Greenberg S, Elkins J. Disease-activity-free status in patients with relapsing-remitting multiple sclerosis treated with daclizumab high-yield process in the SELECT study. Mult Scler 2013; 20:464-70. [PMID: 24022270 DOI: 10.1177/1352458513502113] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Daclizumab high-yield process (DAC HYP) is a humanized anti-CD25 monoclonal antibody that inhibits high-affinity interleukin-2 receptor signaling. OBJECTIVE The objective of this paper is to assess the proportion of DAC HYP- versus placebo-treated patients who were free from disease activity. METHODS SELECT was a randomized, double-blind, multicenter study of DAC HYP 150 mg or 300 mg, or placebo, administered subcutaneously every four weeks for 52 weeks. In this post-hoc analysis of the SELECT trial, 'disease-activity free' was defined as completion through week 52 without relapses or confirmed three-month disability progression (clinical), with no new/newly enlarging T2-hyperintense lesions and no new gadolinium-enhancing lesions at the week 52 scan (radiological). Primary analyses were based on logistic regression controlling for baseline characteristics. RESULTS More DAC HYP-treated (39%, n = 156) versus placebo-treated patients (11%, n = 22) were disease-activity free (odds ratio (95% confidence interval), 6.18 (3.71-10.32); p < 0.0001). Furthermore, 77% and 48% of DAC HYP-treated patients were free from clinical or radiological disease activity, respectively, compared with 60% and 18% of placebo-treated patients. CONCLUSION At one year, DAC HYP resulted in a meaningful increase in the proportion of relapsing-remitting MS patients who were disease-activity free versus placebo.
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Affiliation(s)
- Eva Havrdova
- Department of Neurology, Charles University in Prague, Czech Republic
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Ram R, Yeshurun M, Farbman L, Herscovici C, Shpilberg O, Paul M. Elevation of CRP precedes clinical suspicion of bloodstream infections in patients undergoing hematopoietic cell transplantation. J Infect 2013; 67:194-8. [PMID: 23707844 DOI: 10.1016/j.jinf.2013.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 05/06/2013] [Accepted: 05/17/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES We aimed to examine whether C-reactive protein (CRP) elevation precedes the clinical signs and symptoms of infection among patients undergoing allogeneic hematopoietic cell transplantation (HCT). METHODS Prospective cohort of patients undergoing allogeneic HCT in whom daily blood samples for CRP were taken. In a nested case-control study, cases were defined as patients with clinically-significant bloodstream infection (BSI). Controls were defined as afebrile patients without infection, matched by age, time after transplantation and GVHD status. We calculated the mean difference (MD) between CRP 1 day before clinical suspicion of infection (day -1) and days -2 and -3 (deltaM1M2 and delta M1M3, respectively) and compared cases vs. controls. RESULTS From January 2010 to April 2012 we identified 46 cases of BSIs. The difference between the mean delta M1M3 and delta M1M2 in cases and controls were significantly higher in patients with BSI compared to controls (MD = 5.9, 95% CI 3.5-8.3, p < .001 and MD = 4.2 mg/dl, 95% CI 2.2-6.2, p < .001, respectively). In the overall cohort, sensitivity, specificity, positive and negative predictive values of a daily delta value >4 mg/dl were 52%, 98%, 66% and 98%, respectively. CONCLUSIONS A daily increase of CRP blood levels of >4 mg/dl in afebrile HCT recipients should trigger an evaluation for infection.
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Affiliation(s)
- Ron Ram
- BMT Unit, Institute of Hematology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petah-Tiqva, Israel.
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Kuipers JG, Köhler L. [Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) : solo or duet?]. Z Rheumatol 2013; 72:420-1. [PMID: 23588923 DOI: 10.1007/s00393-013-1151-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- J G Kuipers
- Klinik für Internistische Rheumatologie, Rotes Kreuz Krankenhaus Bremen, St.-Pauli-Deich 24, 28199, Bremen, Deutschland.
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Bennett D, Eckersall PD, Waterston M, Marchetti V, Rota A, McCulloch E, Sbrana S. The effect of robenacoxib on the concentration of C-reactive protein in synovial fluid from dogs with osteoarthritis. BMC Vet Res 2013; 9:42. [PMID: 23452411 PMCID: PMC3610148 DOI: 10.1186/1746-6148-9-42] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 02/22/2013] [Indexed: 11/10/2022] Open
Abstract
Background Robenacoxib is a novel and highly selective inhibitor of COX-2 in dogs and cats and because of its acidic nature is regarded as being tissue-selective. Thirty four dogs with stifle osteoarthritis secondary to failure of the cranial cruciate ligament were recruited into this study. Lameness, radiographic features, synovial cytology and C-reactive protein concentrations in serum and synovial fluid were assessed before and 28 days after commencing a course of Robenacoxib at a dose of 1 mg/kg SID. Results There was a significant reduction in the lameness score (P < 0.01) and an increase in the radiographic score (P < 0.05) between pre- and post-treatment assessments. There was no difference between pre- (median 1.49 mg/l; Q1-Q3 0.56-4.24 mg/L) and post – (1.10 mg/L; 0.31-1.78 mg/L) treatment serum C-reactive protein levels although synovial fluid levels were significantly reduced (pre- : 0.44 mg/L; 0.23-1.62 mg/L; post- : 0.17 mg/L; 0.05-0.49 mg/L) (P < 0.05). There was no correlation between C-reactive protein concentrations in serum and matched synovial fluid samples. Conclusions Robenacoxib proved effective in reducing lameness in dogs with failure of the cranial cruciate ligament and osteoarthritis of the stifle joint. The drug also reduced levels of C-reactive protein in the synovial fluid taken from the affected stifle joint. Robenacoxib appears to reduce articular inflammation as assessed by C-reactive protein which supports the concept that Robenacoxib is a tissue-selective non-steroidal anti-inflammatory drug.
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Affiliation(s)
- David Bennett
- School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Bearsden Road, Bearsden, Glasgow G61 1QH, Scotland.
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Muangchan C, Harding S, Khimdas S, Bonner A, Baron M, Pope J. Association of C-reactive protein with high disease activity in systemic sclerosis: Results from the Canadian Scleroderma Research Group. Arthritis Care Res (Hoboken) 2012; 64:1405-14. [DOI: 10.1002/acr.21716] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Saber TP, Fearon U, Veale DJ. Is remission a more realistic goal in psoriatic arthritis? Ther Adv Musculoskelet Dis 2012; 3:3-7. [PMID: 22870461 DOI: 10.1177/1759720x10389847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Tajvur P Saber
- Dublin Academic Medical Centre, Department of Rheumatology, Bone and Joint Unit, St Vincent's University Hospital and the Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Ireland
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Reinisch W, Wang Y, Oddens BJ, Link R. C-reactive protein, an indicator for maintained response or remission to infliximab in patients with Crohn's disease: a post-hoc analysis from ACCENT I. Aliment Pharmacol Ther 2012; 35:568-76. [PMID: 22251435 DOI: 10.1111/j.1365-2036.2011.04987.x] [Citation(s) in RCA: 138] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Revised: 10/20/2011] [Accepted: 12/23/2011] [Indexed: 12/13/2022]
Abstract
BACKGROUND Secondary loss of response to anti-TNF-α therapy is observed in Crohn's disease patients. AIM Serum C-reactive protein (CRP) levels at baseline and after infliximab induction therapy at week 14 were assessed as predictors for maintained response or remission through 54 weeks of treatment in patients with Crohn's disease who responded to induction therapy. METHODS ACCENT I was a multicenter, randomised, placebo-controlled study. Patients who received infliximab induction (weeks 0, 2 and 6) and maintenance (5 or 10 mg/kg every 8 weeks beginning at week 14) therapy were considered. Patients in clinical response or remission to induction therapy at week 14 (n = 212 or n = 138 respectively) were analysed. Associations between CRP levels (cut-off points 0.5-3.0 mg/dL), baseline disease variables and maintained clinical response or remission during maintenance therapy were assessed. RESULTS A significant association was observed between baseline CRP levels and maintained remission. Forty-five percent of patients with baseline CRP ≥ 0.7 mg/dL vs. 22.0% with CRP < 0.7 mg/dL maintained remission (P = 0.012). CRP normalisation during infliximab treatment (decrease from 0.5 mg/dL at baseline to < 0.5 mg/dL at week 14) resulted in higher probability of maintained response (P < 0.001) or remission (P = 0.052). At week 14 low CRP levels were associated with maintained response (56.6% of patients with CRP < 0.5 mg/dL vs. 37.2% with higher CRP, P = 0.005). No optimal predictive CRP cut-off point was observed. CONCLUSIONS High baseline CRP levels increased the likelihood of maintained remission. Normalised CRP levels at week 14 increased the likelihood of maintained response or remission during 1 year of infliximab maintenance therapy ( CLINICAL TRIAL NCT00207662).
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Affiliation(s)
- W Reinisch
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Austria.
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Bugatti S, Manzo A, Benaglio F, Klersy C, Vitolo B, Todoerti M, Sakellariou G, Montecucco C, Caporali R. Serum levels of CXCL13 are associated with ultrasonographic synovitis and predict power Doppler persistence in early rheumatoid arthritis treated with non-biological disease-modifying anti-rheumatic drugs. Arthritis Res Ther 2012; 14:R34. [PMID: 22336440 PMCID: PMC3392832 DOI: 10.1186/ar3742] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Revised: 02/06/2012] [Accepted: 02/15/2012] [Indexed: 02/04/2023] Open
Abstract
Introduction Biological markers specifically reflecting pathological processes may add value in the assessment of inter-individual variations in the course of rheumatoid arthritis (RA). The current study was undertaken to investigate whether baseline serum levels of the chemokine CXCL13 might predict clinical and ultrasonographic (US) outcomes in patients with recent-onset RA. Methods The study included 161 early RA patients (disease duration < 12 months) treated according to a disease activity score (DAS) driven step-up protocol aiming at DAS < 2.4. Clinical disease activity measures were collected at baseline, 2, 4, 6, 9 and 12 months, and US examination of the hands was performed at baseline, 6 and 12 months. Grey-Scale (GS) and Power Doppler (PD) synovitis were scored (0 to 3), with overall scores as the sum of each joint score. CXCL13 levels were measured at baseline by enzyme-linked immunosorbent assay and evaluated in relation to the achievement of low disease activity (LDA, DAS < 2.4) and US residual inflammation (PD ≤ 1) at 12 months. Results Baseline levels of CXCL13 were significantly higher in RA compared to healthy controls (n = 19) (P = 0.03) and correlated with measures of synovitis, such as the swollen joint count (R 0.28, P < 0.001), the US-GS (R 0.27, P = 0.003) and US-PD (R 0.26, P = 0.005) score. Although CXCL13 did not predict the likelihood of achieving clinical LDA at 12 months within a structured treat-to-target protocol, elevated levels of CXCL13 were associated with more frequent increases of methotrexate dosage (P < 0.001). Using adjusted analyses, the highest levels of CXCL13 (> 100 pg/ml) were the only independent predictor of residual imaging inflammation (P = 0.005), irrespective of initial US-PD scores, disease activity status, acute phase reactants and autoantibodies. Among the patients in clinical LDA at 12 months, US-PD scores ≤ 1 were less frequently achieved in the high baseline CXCL13 (> 100 pg/ml) group, with an adjusted OR = 0.06 (95% CI 0.01 to 0.55, P = 0.01). Conclusions CXCL13 emerges as a new biological marker in early RA, accurate in assessing the severity of synovitis and the persistence of US-PD activity over time in response to conventional treatments.
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Affiliation(s)
- Serena Bugatti
- Division and Laboratory of Rheumatology, University of Pavia School of Medicine, IRCCS Policlinico San Matteo Foundation, Piazzale Golgi 2, 27100 Pavia, Italy
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Zhuang Y, Xu Z, Frederick B, de Vries DE, Ford JA, Keen M, Doyle MK, Petty KJ, Davis HM, Zhou H. Golimumab Pharmacokinetics After Repeated Subcutaneous and Intravenous Administrations in Patients with Rheumatoid Arthritis and the Effect of Concomitant Methotrexate: An Open-Label, Randomized Study. Clin Ther 2012; 34:77-90. [DOI: 10.1016/j.clinthera.2011.11.015] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Revised: 11/04/2011] [Accepted: 11/09/2011] [Indexed: 12/30/2022]
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Esalatmanesh K, Jamali R, Jamali A, Jamali B, Nikbakht M. Serum anti-cyclic citrullinated peptide antibodies may predict disease activity in rheumatoid arthritis. Rheumatol Int 2011; 32:3799-805. [PMID: 22187060 DOI: 10.1007/s00296-011-2282-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Accepted: 12/10/2011] [Indexed: 10/14/2022]
Abstract
To define the relationship between serum anti-cyclic citrullinated peptide antibodies (anti-CCP) and disease activity, and to construct a new disease activity index by using anti-CCP in rheumatoid arthritis (RA). One hundred and five RA patients were included. Disease activity based on DAS28-ESR and serum anti-CCP was measured. There was correlation between serum anti-CCP and DAS28-ESR. (R (2) = 0.71, P value < 0.01). New disease activity index was developed by replacing anti-CCP with ESR in DAS28-ESR. There was correlation between new model and DAS28-ESR. (R (2) = 0.91, P value < 0.01) The new composite index best cut-off values corresponding to DAS28-ESR values of 2.6, 3.2, and 5.1 were 3.21, 3.38, and 4.74, respectively. There was agreement between new model and DAS28-ESR for determination of patients in different disease activity categories. (Kappa = 0.71, P value < 0.01). The new disease activity index that applies serum anti-CCP may predict disease activity in RA.
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Affiliation(s)
- Kamal Esalatmanesh
- Internal Medicine Ward, Division of Rheumatology, Shahid Beheshti Hospital, Kashan University of Medical Sciences, Kashan, Iran
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SELECTIONS FROM THE CURRENT LITERATURE. J Am Dent Assoc 2011. [DOI: 10.14219/jada.archive.2011.0116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Karagiozoglou-Lampoudi T, Trachana M, Agakidis C, Pratsidou-Gertsi P, Taparkou A, Lampoudi S, Kanakoudi-Tsakalidou F. Ghrelin levels in patients with juvenile idiopathic arthritis: relation to anti-tumor necrosis factor treatment and disease activity. Metabolism 2011; 60:1359-62. [PMID: 21550087 DOI: 10.1016/j.metabol.2011.03.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2010] [Revised: 03/09/2011] [Accepted: 03/10/2011] [Indexed: 11/19/2022]
Abstract
Studies in adults with rheumatoid arthritis reported low serum ghrelin that increased following anti-tumor necrosis factor (TNF) infusion. Data on juvenile idiopathic arthritis (JIA) are lacking. The aim of this pilot study was to explore serum ghrelin levels in patients with JIA and the possible association with anti-TNF treatment, disease activity, and nutritional status. Fifty-two patients with JIA (14/52 on anti-TNF treatment) were studied. Juvenile idiopathic arthritis was inactive in 3 of 14 anti-TNF-treated patients and in 11 of 38 non-anti-TNF-treated patients. The nutritional status, energy intake/requirements, appetite, and fasting serum ghrelin levels were assessed. Ghrelin control values were obtained from 50 individuals with minor illness matched for age, sex, and body mass index. Ghrelin levels in patients with JIA were significantly lower than in controls (P < .001, confidence interval [CI] = -101 to -331). Analysis according to anti-TNF treatment and disease activity showed that ghrelin levels were comparable to control values only in 3 patients with anti-TNF-induced remission. Ghrelin in non-anti-TNF-treated patients in remission was low. Multiple regression analysis showed that disease activity (P = .002, CI = -84.16 to -20.01) and anti-TNF treatment (P = .003, CI = -82.51 to -18.33) were significant independent predictors of ghrelin after adjusting for other potential confounders. Ghrelin did not correlate with nutritional status, energy balance, and appetite. Serum ghrelin is low in patients with JIA and is restored to values similar to those in controls following anti-TNF-induced remission. Our study provides evidence that TNF blockade is independently associated with serum ghrelin, which possibly contributes to anti-TNF-induced remission. These preliminary results could form the basis for future research.
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Affiliation(s)
- Thomais Karagiozoglou-Lampoudi
- Clinical Nutrition Laboratory, Department of Nutrition/Dietetics, Alexander Technological Education Institute of Thessaloniki, PO BOX 141 GR-574 00 Thessaloniki, Greece.
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Salaffi F, Carotti M, Ciapetti A, Gasparini S, Filippucci E, Grassi W. Relationship between time-integrated disease activity estimated by DAS28-CRP and radiographic progression of anatomical damage in patients with early rheumatoid arthritis. BMC Musculoskelet Disord 2011; 12:120. [PMID: 21624120 PMCID: PMC3123613 DOI: 10.1186/1471-2474-12-120] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Accepted: 05/30/2011] [Indexed: 11/29/2022] Open
Abstract
Background The main aim of the study was to investigate the relationship between persistent disease activity and radiographic progression of joint damage in early rheumatoid arthritis (ERA). Methods Forty-eight patients with active ERA was assessed every 3 months for disease activity for 3 years. Radiographic damage was measured by the Sharp/van der Heijde method (SHS). The cumulative inflammatory burden was estimated by the time-integrated values (area under the curve-AUC) of Disease Activity Score 28 joint based on C-reactive protein (DAS28-CRP) in rapid progressors versus non-progressors. Bland and Altman's 95% limits of agreement method were used to estimate the smallest detectable difference (SDD) of radiographic progression. The relationship between clinical and laboratory predictors of radiographic progression and their interactions with time was analysed by logistic regression model. Results After 3-years of follow-up, radiographic progression was observed in 54.2% (95%CI: 39.8% to 67.5%) of patients and SDD was 9.5 for total SHS. The percentage of patients with erosive disease increased from 33.3% at baseline to 76% at 36 months. The total SHS of the progressors worsened from a median (interquartile range) of 18.5 (15-20) at baseline to 38.5 (34-42) after 3 years (p < 0.0001) whereas non-progressors worsened from a median of 14.5 (13-20) at baseline to 22.5 (20-30) after 3 years (p < 0.001). In the regression model, time-integrated values of DAS28-CRP and anti-CCP positivity have the highest positive predictive value for progression (both at level of p < 0.0001). Radiographic progression was also predicted by a positive IgM-RF (p0.0009), and a high baseline joint damage (p = 0.0044). Conclusions These data indicate that the level of disease activity, as measured by time-integrated DAS28-CRP, anti-CCP and IgM-RF positivity and a high baseline joint damage, affects subsequent progression of radiographic damage in ERA.
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Affiliation(s)
- Fausto Salaffi
- Clinica Reumatologica, Università Politecnica delle Marche, Ancona, Italy, Ospedale C, Urbani, Via dei Colli, 52, 60035-Jesi (Ancona)-Italy.
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Circulating cytokine profiles and their relationships with autoantibodies, acute phase reactants, and disease activity in patients with rheumatoid arthritis. Mediators Inflamm 2011; 2010:158514. [PMID: 21437211 PMCID: PMC3061216 DOI: 10.1155/2010/158514] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Revised: 12/15/2010] [Accepted: 12/27/2010] [Indexed: 11/17/2022] Open
Abstract
Our objective was to analyse the relationship between circulating cytokines, autoantibodies, acute phase reactants, and disease activity in DMARDs-naïve rheumatoid arthritis (RA) patients (n = 140). All cytokines were significantly higher in the RA cohort than in healthy controls. Moderate-to-strong positive intercorrelations were observed between Th1/Th2/macrophage/fibroblast-derived cytokines. RF correlated significantly with IL-1β, IL-2, IL-4, IL-10, IL-12, G-CSF, GM-CSF, IFN-γ, and TNF (P < .0001), and aCCP and aMCV with IL-1β, IL-2, IL-4, and IL-10 (P < .0002), while IL-6 correlated best with the acute phase reactants, CRP, and SAA (P < .0001). In patients with a DAS28 score of ≥5.1, IFN-γ, IL-1β, IL-1Ra, TNF, GM-CSF, and VEGF were significantly correlated (P < .04–.001) with high disease activity (HDA). Circulating cytokines in RA reflect a multifaceted increase in immune reactivity encompassing Th1 and Th2 cells, monocytes/macrophages, and synovial fibroblasts, underscored by strong correlations between these cytokines, as well as their relationships with RF, aCCP, and aMCV, with some cytokines showing promise as biomarkers of HDA.
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Noninvasive quantitative assessment of synovial pannus angiogenesis by contrast-enhanced gray-scale sonography in antigen-induced arthritis in rabbits. Acad Radiol 2011; 18:359-68. [PMID: 21193334 DOI: 10.1016/j.acra.2010.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Revised: 10/18/2010] [Accepted: 10/20/2010] [Indexed: 12/29/2022]
Abstract
RATIONALE AND OBJECTIVES The aim of this study was to evaluate the value of contrast-enhanced gray-scale sonography in quantitative assessment of synovial pannus angiogenesis in antigen-induced arthritis in rabbits. MATERIALS AND METHODS Twenty-four adult New Zealand White rabbits were divided into two groups. Inflammatory arthritis was induced by intra-articular injection of ovalbumin into right knee joints with 4 mg in low-dose group (LD, n = 12) and 8 mg in high-dose group (HD, n = 12). The left side of the knee on each rabbit was used as normal control. Contrast-enhanced gray-scale sonography with time intensity curve (TIC) was performed on the synovia of suprapatellar bursa and posterior capsules 4 weeks after the injection. Immunohistochemical examinations of synovia were applied to assess the microvessel density and the expression of vascular endothelial growth factor. Correlation analysis between sonographic and immunohistochemical findings was performed. RESULTS Contrast-enhanced gray-scale sonography of all right knees demonstrated intra-articular hypoechoic lesions with enhanced blood flow and no abnormal findings on all left knees. Parameters of TIC, including ascending curve (A), derived peak intensity (DPI), and area under curve (AUC) on arthritis joints were significantly higher in HD group compared to LD group (P < .05). Positive correlation was found between immunohistochemical findings and parameters of A, DPI, and AUC (P < .05). However, no correlation was found between other parameters (slope of descending rate, time to peak, time to rise, and initial intensity) and immunohistochemical findings. CONCLUSIONS Contrast-enhanced gray-scale sonography with TIC measurement could provide reliable method for noninvasive quantitative assessment of synovial pannus angiogenesis of arthritis in clinical settings.
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Kang SY, Kim MH, Lee WI. [Measurement of inflammatory cytokines in patients with rheumatoid arthritis]. Korean J Lab Med 2010; 30:301-6. [PMID: 20603592 DOI: 10.3343/kjlm.2010.30.3.301] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Inflammatory cytokines such as tumor necrosis factor alpha (TNFalpha) and interleukin (IL)-6 play an important role in pathophysiology of rheumatoid arthritis (RA). We investigated the possibility whether TNFalpha and IL-6 could be used as an objective marker reflecting treatment response in RA. METHODS Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and rheumatoid factor (RF) together with TNFalpha and IL-6 were measured in 159 specimens obtained from 95 RA patients. RA patients were divided into pre-treatment, methotrexate (MTX) and non-MTX groups by treatment regimen and into inactive and active groups by disease activity. The agreement between changes in marker levels and treatment response, and the correlation between each marker were analyzed. RESULTS IL-6 was higher in active than in inactive group of patients in all three different treatment subgroups, but TNFalpha was not different between the two groups. IL-6 showed a better agreement with treatment response (MTX group, K=0.58; non-MTX group, K=0.21) than ESR or CRP, whereas TNFalpha did not show an agreement with treatment response. IL-6 was correlated with both ESR (r=0.22) and CRP (r=0.54), but TNFalpha was correlated only with ESR (r=0.21). CONCLUSIONS Unlike TNFalpha, IL-6 reflects disease activity of RA and shows a better agreement with treatment response than ESR or CRP, indicating that it has an association with clinical features of RA. Therefore IL-6 could be used as an additional marker in the evaluation of treatment response when markers like ESR or CRP show results discordant from clinical features.
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Affiliation(s)
- So Young Kang
- Department of Laboratory Medicine, Kyung Hee University School of Medicine, Seoul, Korea
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Shealy DJ, Cai A, Staquet K, Baker A, Lacy ER, Johns L, Vafa O, Gunn G, Tam S, Sague S, Wang D, Brigham-Burke M, Dalmonte P, Emmell E, Pikounis B, Bugelski PJ, Zhou H, Scallon BJ, Giles-Komar J. Characterization of golimumab, a human monoclonal antibody specific for human tumor necrosis factor α. MAbs 2010; 2:428-39. [PMID: 20519961 DOI: 10.4161/mabs.12304] [Citation(s) in RCA: 165] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
We prepared and characterized golimumab (CNTO148), a human IgG1 tumor necrosis factor alpha (TNFα) antagonist monoclonal antibody chosen for clinical development based on its molecular properties. Golimumab was compared with infliximab, adalimumab and etanercept for affinity and in vitro TNFα neutralization. The affinity of golimumab for soluble human TNFα, as determined by surface plasmon resonance, was similar to that of etanercept (18 pM versus 11 pM), greater than that of infliximab (44 pM) and significantly greater than that of adalimumab (127 pM, p=0.018). The concentration of golimumab necessary to neutralize TNFα-induced E-selectin expression on human endothelial cells by 50% was significantly less than those for infliximab (3.2 fold; p=0.017) and adalimumab (3.3-fold; p=0.008) and comparable to that for etanercept. The conformational stability of golimumab was greater than that of infliximab (primary melting temperature [Tm] 74.8 °C vs. 69.5 °C) as assessed by differential scanning calorimetry. In addition, golimumab showed minimal aggregation over the intended shelf life when formulated as a high concentration liquid product (100 mg/mL) for subcutaneous administration. In vivo, golimumab at doses of 1 and 10 mg/kg significantly delayed disease progression in a mouse model of human TNFα-induced arthritis when compared with untreated mice, while infliximab was effective only at 10 mg/kg. Golimumab also significantly reduced histological scores for arthritis severity and cartilage damage, as well as serum levels of pro-inflammatory cytokines and chemokines associated with arthritis. Thus, we have demonstrated that golimumab is a highly stable human monoclonal antibody with high affinity and capacity to neutralize human TNFα in vitro and in vivo.
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Affiliation(s)
| | - Ann Cai
- Centocor Research and Development, Radnor, PA
| | - Kim Staquet
- Centocor Research and Development, Radnor, PA
| | | | | | - Laura Johns
- Centocor Research and Development, Radnor, PA
| | - Omid Vafa
- Centocor Research and Development, Radnor, PA
| | - George Gunn
- Centocor Research and Development, Radnor, PA
| | - Susan Tam
- Centocor Research and Development, Radnor, PA
| | - Sarah Sague
- Centocor Research and Development, Radnor, PA
| | - Dana Wang
- Centocor Research and Development, Radnor, PA
| | | | | | - Eva Emmell
- Centocor Research and Development, Radnor, PA
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Bours MJL, Peeters RHRM, Landewé RBM, Beijer S, Arts ICW, Dagnelie PC. Adenosine 5'-triphosphate infusions reduced disease activity and inflammation in a patient with active rheumatoid arthritis. Rheumatology (Oxford) 2010; 49:2223-5. [PMID: 20547656 DOI: 10.1093/rheumatology/keq177] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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