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Al-Shujairi A, Elbadawi F, Al-Saleh J, Hamouda M, Vasylyev A, Khamashta M. Literature review of lupus nephritis From the Arabian Gulf region. Lupus 2023; 32:155-165. [PMID: 36331103 PMCID: PMC9810828 DOI: 10.1177/09612033221137248] [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] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The severity of lupus nephritis (LN) varies between different ethnicities. However, there are limited data regarding disease severity for LN in patients from the Arabian Gulf region; moreover, there are no treatment guidelines developed specifically for this population. The objective of this review was to characterise the incidence of LN, current treatment practices, the severity of LN, and the pathophysiology and biomarkers associated with LN in the Arabian Gulf region. METHODS A literature search using EMBASE was conducted in October, 2021 to identify publications reporting on the incidence, treatment practices, severity, pathophysiology or biomarkers associated with LN, from countries in the Arabian Gulf region (including Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and the United Arab Emirates). Additional relevant publications were provided by collaborators. A manual review of the publications was conducted to determine their relevance and data on the outcomes of interest were extracted. RESULTS Of 3705 publications, 54 publications were identified as relevant. LN is one of the most commonly diagnosed renal diseases within the Arabian Gulf and approximately 10%-36% of all renal biopsies are for LN. Treatment patterns within the region appear to vary and generally follow treatment guidelines recommended by the Asia Pacific League of Associations for Rheumatology (APLAR), the European Alliance of Associations for Rheumatology (EULAR) and Kidney Disease Improving Global Outcomes (KDIGO). The majority of patients receive cyclophosphamide for induction therapy, whilst others receive mycophenolate mofetil. Most studies showed that the most frequently diagnosed class of LN within the Arabian Gulf region was Class IV (up to 63% of patients with LN). Sustained or increased levels of serum creatinine and proteinuria; and depressed levels of complement C3/C4 were commonly seen among patients with LN from the Arabian Gulf region. CONCLUSIONS This review identified that LN may manifest more severely among patients from the Arabian Gulf region than in other populations, such as Caucasian populations. A greater understanding of LN and the treatment practices within the region, as well as the development of more specific treatment guidelines for this population may help improve outcomes for patients with LN in the Arabian Gulf region.
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Affiliation(s)
| | - Faisal Elbadawi
- Department of Rheumatology,
Dubai
Hospital, Dubai, United Arab
Emirates
| | - Jamal Al-Saleh
- Department of Rheumatology,
Dubai
Hospital, Dubai, United Arab
Emirates
| | | | | | - Munther Khamashta
- GSK, Medical
Affairs, Dubai, United Arab Emirates,Department of Women and Children’s
Health, Kings College
London, St Thomas' Hospital, London,
UK,Munther Khamashta; GSK, Medical Affairs,
ARENCO Tower 19th Floor, Dubai Media City, United Arab Emirates, 50199, Dubai.
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Lorenzo-Vizcaya A, Isenberg DA. The use of anti-TNF-alpha therapies for patients with systemic lupus erythematosus. Where are we now? Expert Opin Biol Ther 2021; 21:639-647. [PMID: 33216641 DOI: 10.1080/14712598.2021.1853096] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Systemic lupus erythematosus (SLE) is an autoimmune rheumatic disease characterized by multiple pathologies in which sustained inflammatory activity leads to progressive tissue destruction and organ damage. One of the main proinflammatory cytokines playing a key role in autoimmune diseases such as rheumatoid arthritis (RA) or SLE, is tumor necrosis factor (TNF) alpha. AREAS COVERED The introduction of TNF-alpha inhibitors revolutionized the treatment of RA and other conditions including psoriatic arthritis and ankylosing spodylitis. We review here the efficacy and safety of TNF-alpha blockers in SLE focussing on why it has not been more widely used since TNF-alpha was reported to be increased in SLE patients and to correlate with disease activity. EXPERT OPINION We summarize the reported SLE cases that have received TNF-alpha blockers and the main results to date. We reflect on whether there is a case to reconsider the use of TNF-alpha blockade in SLE.
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Affiliation(s)
- Ana Lorenzo-Vizcaya
- Department of Internal Medicine, Hospital Universitario De Ourense. Ourense, Spain
| | - David A Isenberg
- Department of Rheumatology, Division of Medicine, University College London. London, UK
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Sung SSJ, Fu SM. Interactions among glomerulus infiltrating macrophages and intrinsic cells via cytokines in chronic lupus glomerulonephritis. J Autoimmun 2019; 106:102331. [PMID: 31495649 DOI: 10.1016/j.jaut.2019.102331] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 08/23/2019] [Accepted: 08/25/2019] [Indexed: 10/26/2022]
Abstract
Inflammation plays a key role in the pathogenesis of lupus nephritis (LN) and inflammatory cytokines within the glomeruli are critical in this process. However, little information is available for the identities of the cell types that are primarily responsible for the production and function of the various cytokines. We have devised a novel method to visualize cytokine signals in the kidney by confocal microscopy and found that cytokine production within the glomerulus is cell type-specific and under translational control. In the lupus-prone NZM2328 mice with chronic glomerulonephritis, IL-6, IL-1β, and TNF-α in the glomerulus were produced predominantly by mesangial cells, podocytes, and glomerulus-infiltrating blood-derived macrophages, respectively. Microarray and RNASeq analyses showed that these cells expressed the receptors for these cytokines. Together the 3 cell types form a cytokine circuit in amplifying cytokine responses in LN. The intrinsic cells and infiltrating macrophages also produced other cytokines including M-CSF, SCF, and IL-34 that constituted within the enclosed glomerular space the soluble effector milieu which may mediate cellular damage and proliferation, and cytokine transcriptional and translation regulation. IL-10 and IL-1β were translationally regulated in the glomeruli in the intact kidney in a cell type-specific manner. The production of these 2 cytokines by infiltrating macrophages was undetectable in a visualization system for in situ protein accumulation despite high mRNA expression levels. However, these macrophages in isolated glomeruli which are released from Bowman's capsules produced large amounts of IL-10 and IL-1β. These data reveal the complexity of cytokine regulation, production, and function in the glomerulus and provide a model in which cytokine blocking may be beneficial in LN treatment.
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Affiliation(s)
- Sun-Sang J Sung
- Center for Immunity, Inflammation, and Regenerative Medicine, Departments of Medicine, University of Virginia School of Medicine, Charlottesville, VA, 22908, USA.
| | - Shu Man Fu
- Center for Immunity, Inflammation, and Regenerative Medicine, Departments of Medicine, University of Virginia School of Medicine, Charlottesville, VA, 22908, USA; Division of Rheumatology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, 22908, USA.
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Olaru F, Döbel T, Lonsdorf AS, Oehrl S, Maas M, Enk AH, Schmitz M, Gröne EF, Gröne HJ, Schäkel K. Intracapillary immune complexes recruit and activate slan-expressing CD16+ monocytes in human lupus nephritis. JCI Insight 2018; 3:96492. [PMID: 29875315 DOI: 10.1172/jci.insight.96492] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 04/24/2018] [Indexed: 12/30/2022] Open
Abstract
Lupus nephritis is a major cause of morbidity in patients with systemic lupus erythematosus. Among the different types of lupus nephritis, intracapillary immune complex (IC) deposition and accumulation of monocytes are hallmarks of lupus nephritis class III and IV. The relevance of intracapillary ICs in terms of monocyte recruitment and activation, as well as the nature and function of these monocytes are not well understood. For the early focal form of lupus nephritis (class III) we demonstrate a selective accumulation of the proinflammatory population of 6-sulfo LacNAc+ (slan) monocytes (slanMo), which locally expressed TNF-α. Immobilized ICs induced a direct recruitment of slanMo from the microcirculation via interaction with Fc γ receptor IIIA (CD16). Interestingly, intravenous immunoglobulins blocked CD16 and prevented cell recruitment. Engagement of immobilized ICs by slanMo induced the production of neutrophil-attracting chemokine CXCL2 as well as TNF-α, which in a forward feedback loop stimulated endothelial cells to produce the slanMo-recruiting chemokine CX3CL1 (fractalkine). In conclusion, we observed that expression of CD16 equips slanMo with a unique capacity to orchestrate early IC-induced inflammatory responses in glomeruli and identified slanMo as a pathogenic proinflammatory cell type in lupus nephritis.
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Affiliation(s)
- Florina Olaru
- Department of Dermatology, Heidelberg University Hospital, Heidelberg, Germany
| | - Thomas Döbel
- Department of Dermatology, Heidelberg University Hospital, Heidelberg, Germany
| | - Anke S Lonsdorf
- Department of Dermatology, Heidelberg University Hospital, Heidelberg, Germany
| | - Stephanie Oehrl
- Department of Dermatology, Heidelberg University Hospital, Heidelberg, Germany
| | - Michael Maas
- Department of Dermatology, Heidelberg University Hospital, Heidelberg, Germany
| | - Alexander H Enk
- Department of Dermatology, Heidelberg University Hospital, Heidelberg, Germany
| | - Marc Schmitz
- Institute of Immunology, Medical Faculty, Technische Universität (TU) Dresden, Dresden, Germany.,National Center for Tumor Diseases, University Hospital Carl Gustav Carus, TU Dresden, Germany.,German Cancer Consortium (DKTK), Dresden, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,Center for Regenerative Therapies Dresden (CRTD), Medical Faculty, TU Dresden, Dresden, Germany
| | - Elisabeth F Gröne
- Department of Cellular and Molecular Pathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Hermann-J Gröne
- Department of Cellular and Molecular Pathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Knut Schäkel
- Department of Dermatology, Heidelberg University Hospital, Heidelberg, Germany
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Yeo SC, Liew A. Biologic agents in the treatment of glomerulonephritides. Nephrology (Carlton) 2016; 20:767-87. [PMID: 26040770 DOI: 10.1111/nep.12530] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2015] [Indexed: 12/17/2022]
Abstract
Current immunosuppression strategies in the treatment of glomerulonephritides remain unsatisfactory, especially in glomerular diseases that are frequently relapsing or are resistant to treatment. Toxicities associated with the use of drugs with non-specific targets for the immune response result in treatment non-compliance, and increase morbidity and mortality in these patients. Advances in our understanding of the immunopathogenesis of glomerulonephritis and the availability of biologics have led to their successful use in the treatment of immune-mediated glomerular diseases. Biologics are usually very large complex molecules, often produced using recombinant DNA technology and manufactured in a living system such as a microorganism, or plant or animal cells. They are novel agents that can target specific immune cell types, cytokines or immune pathways involved in the pathogenesis of these disorders. It is attractive to consider that, given their specific mode of action, these agents can potentially offer a more directed and effective immunosuppression, with side-effect profiles that are much more desirable. However, there have been few randomized controlled trials comparing biologic agents to conventional immunosuppression, and in many of these studies the side-effect profiles have been disappointingly similar. In this review, we will examine the rationale, efficacy and safety of some commonly used biologics in the treatment of primary and secondary glomerulonephritides. We will also discuss some of the key challenges that may be encountered with the use of biologics in treating glomerulonephritis in the future.
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Affiliation(s)
- See Cheng Yeo
- Department of Renal Medicine, Tan Tock Seng Hospital, Singapore
| | - Adrian Liew
- Department of Renal Medicine, Tan Tock Seng Hospital, Singapore
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Cortés-Hernández J, Egri N, Vilardell-Tarrés M, Ordi-Ros J. Etanercept in refractory lupus arthritis: An observational study. Semin Arthritis Rheum 2015; 44:672-9. [PMID: 25712812 DOI: 10.1016/j.semarthrit.2015.01.006] [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: 10/27/2014] [Revised: 12/22/2014] [Accepted: 01/16/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the long-term safety and preliminary efficacy of etanercept in patients with refractory lupus arthritis. METHODS We evaluated 43 patients in this observational cohort study. All received etanercept (50mg/week) in addition to concomitant immunosuppressive agents. Patient and disease characteristics were collected. Incidence of adverse events and the effect on autoantibody levels were evaluated. Clinical efficacy was measured by the 28-joint count and the SLEDAI-2K scores. Remission of lupus arthritis was defined by a 28-joint score = 0. Clinically inactive systemic disease was defined by a SLEDAI-2K score <4. RESULTS The total follow-up time was 93 patient-years (median: 2.3 years per patient; range: 0.4-6.8 years). Most side effects were minor and related to local reactions. Only 2 significant adverse events occurred (8%), both were of infectious nature. The rate of autoantibody production was low (18%). A mild increase in titres of ANA (2), IgG anti-dsDNA (3) and IgM anticardiolipin (aCL) (2) antibodies was observed. All anti-dsDNA antibody increments were transient and coincided with systemic flares. No vascular events occurred. In general, disease activity declined during therapy. Most patients (83%) with lupus arthritis achieved clinical remission by week 12. All patients with simultaneous serositis experienced clinical and radiological resolution of this condition. Relapses were frequent (23%), mostly mild and related to etanercept reduction. A total of 24 patients discontinued treatment, 12 of them due to clinical remission. CONCLUSIONS Long-term therapy with etanercept was relatively safe and had remarkable long-term efficacy for refractory lupus arthritis. In view of these results, further controlled trials are warranted.
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Affiliation(s)
- Josefina Cortés-Hernández
- Systemic Autoimmune Diseases Unit, Internal Medicine Department, Universitari Vall d´Hebron Hospital, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Passeig Vall- d´Hebron 119-129, Barcelona 08035, Spain
| | - Natalia Egri
- Systemic Autoimmune Diseases Unit, Internal Medicine Department, Universitari Vall d´Hebron Hospital, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Passeig Vall- d´Hebron 119-129, Barcelona 08035, Spain
| | - Miquel Vilardell-Tarrés
- Systemic Autoimmune Diseases Unit, Internal Medicine Department, Universitari Vall d´Hebron Hospital, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Passeig Vall- d´Hebron 119-129, Barcelona 08035, Spain
| | - Josep Ordi-Ros
- Systemic Autoimmune Diseases Unit, Internal Medicine Department, Universitari Vall d´Hebron Hospital, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Passeig Vall- d´Hebron 119-129, Barcelona 08035, Spain.
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Jung K, LePendu P, Chen WS, Iyer SV, Readhead B, Dudley JT, Shah NH. Automated detection of off-label drug use. PLoS One 2014; 9:e89324. [PMID: 24586689 PMCID: PMC3929699 DOI: 10.1371/journal.pone.0089324] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 01/17/2014] [Indexed: 01/30/2023] Open
Abstract
Off-label drug use, defined as use of a drug in a manner that deviates from its approved use defined by the drug's FDA label, is problematic because such uses have not been evaluated for safety and efficacy. Studies estimate that 21% of prescriptions are off-label, and only 27% of those have evidence of safety and efficacy. We describe a data-mining approach for systematically identifying off-label usages using features derived from free text clinical notes and features extracted from two databases on known usage (Medi-Span and DrugBank). We trained a highly accurate predictive model that detects novel off-label uses among 1,602 unique drugs and 1,472 unique indications. We validated 403 predicted uses across independent data sources. Finally, we prioritize well-supported novel usages for further investigation on the basis of drug safety and cost.
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Affiliation(s)
- Kenneth Jung
- Program In Biomedical Informatics, Stanford University, Stanford, California, United States of America
| | - Paea LePendu
- Center for Biomedical Informatics Research, Stanford University, Stanford, California, United States of America
| | - William S. Chen
- Center for Biomedical Informatics Research, Stanford University, Stanford, California, United States of America
| | - Srinivasan V. Iyer
- Program In Biomedical Informatics, Stanford University, Stanford, California, United States of America
| | - Ben Readhead
- Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Joel T. Dudley
- Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Nigam H. Shah
- Center for Biomedical Informatics Research, Stanford University, Stanford, California, United States of America
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Yap DYH, Lai KN. The role of cytokines in the pathogenesis of systemic lupus erythematosus - from bench to bedside. Nephrology (Carlton) 2013; 18:243-55. [PMID: 23452295 DOI: 10.1111/nep.12047] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2013] [Indexed: 12/23/2022]
Abstract
The pathogenesis of systemic lupus erythematosus (SLE) entails a complex interaction between the different arms of the immune system. While autoantibodies production and immune complex deposition are cornered as hallmark features of SLE, there is growing evidence to propose the pathogenic role of cytokines in this disease. Examples of these cytokines include BLys, interleukin-6, interleukin-17, interleukin-18, type I interferons and tumour necrosis factor alpha. These cytokines all assume pivotal functions to orchestrate the differentiation, maturation and activation of various cell types, which would mediate local inflammatory process and tissue injury. The knowledge on these cytokines not only fosters our understanding of the disease, but also provides insights in devising biomarkers and targeted therapies. In this review, we focus on cytokines which have substantial pathogenic significance and also highlight the possible clinical applications of these cytokines.
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Affiliation(s)
- Desmond Yat Hin Yap
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR
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Calvo-Alén J, Silva-Fernández L, Úcar-Angulo E, Pego-Reigosa JM, Olivé A, Martínez-Fernández C, Martínez-Taboada V, Marenco JL, Loza E, López-Longo J, Gómez-Reino JJ, Galindo-Izquierdo M, Fernández-Nebro A, Cuadrado MJ, Aguirre-Zamorano MÁ, Zea-Mendoza A, Rúa-Figueroa Í. SER Consensus Statement on the Use of Biologic Therapy for Systemic Lupus Erythematosus. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.reumae.2013.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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10
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Consenso de la Sociedad Española de Reumatología sobre el uso de terapias biológicas en el lupus eritematoso sistémico. ACTA ACUST UNITED AC 2013; 9:281-96. [DOI: 10.1016/j.reuma.2013.04.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 04/03/2013] [Indexed: 12/23/2022]
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Aringer M, Smolen JS. Therapeutic blockade of TNF in patients with SLE—Promising or crazy? Autoimmun Rev 2012; 11:321-5. [PMID: 21619949 DOI: 10.1016/j.autrev.2011.05.001] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2011] [Indexed: 12/12/2022]
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12
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Beigel F, Schnitzler F, Paul Laubender R, Pfennig S, Weidinger M, Göke B, Seiderer J, Ochsenkühn T, Brand S. Formation of antinuclear and double-strand DNA antibodies and frequency of lupus-like syndrome in anti-TNF-α antibody-treated patients with inflammatory bowel disease. Inflamm Bowel Dis 2011; 17:91-8. [PMID: 20564536 DOI: 10.1002/ibd.21362] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Anti-tumor necrosis factor (TNF) therapy used in patients with inflammatory bowel disease (IBD) has been associated with induction of autoantibodies including antinuclear antibodies (ANA), double-strand (ds) DNA antibodies, and the occurrence of lupus-like syndrome (LLS). However, the clinical relevance of autoantibody formation and predictive factors are unclear. METHODS 180 IBD patients treated with anti-TNF antibodies (infliximab or adalimumab, or infliximab and adalimumab consecutively) were analyzed regarding ANA and dsDNA antibody values and the development of LLS, including factors predicting the development of LLS. RESULTS In all, 44.4% of anti-TNF-treated patients had ANA titers ≥1:240, while 15.6% had dsDNA serum levels ≥9 U/mL. However, only a minority of these patients experienced clinical symptoms of LLS; 8.9% presented with mild lupus-like symptoms with no need for intervention; 1.1% had severe symptoms consistent with LLS requiring immediate stop of anti-TNF therapy. Multivariate logistic regression analyses identified age as an independent risk factor for developing ANA ≥1:240 (P < 0.001) and LLS (P = 0.002), while concomitant immunosuppressive therapy was protective against autoantibody formation (ANA: P = 0.05) and LLS development (P = 0.04). There was a significant association between dsDNA antibody values ≥9 U/mL and LLS (P = 0.02) but not between ANA titers and LLS. CONCLUSIONS dsDNA antibody levels ≥9 U/mL, but not ANA titers ≥1:240, are associated with clinical symptoms of LLS. IBD patients of higher age treated with anti-TNF-α antibodies are at increased risk for development of ANA and LLS, while concomitant immunosuppressive therapy may have a protective effect.
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Affiliation(s)
- Florian Beigel
- Department of Medicine II, University Hospital Munich-Grosshadern, Ludwig-Maximilians-University Munich, Germany.
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Cytokines and their roles in the pathogenesis of systemic lupus erythematosus: from basics to recent advances. J Biomed Biotechnol 2010; 2010:365083. [PMID: 20467470 PMCID: PMC2866250 DOI: 10.1155/2010/365083] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Accepted: 03/02/2010] [Indexed: 12/30/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is a complex auto-immune disorder which involves various facets of the immune system. In addition to autoantibody production and immune complex deposition, emerging evidences suggest that cytokines may act as key players in the immunopathogenesis of SLE. These cytokines assume a critical role in the differentiation, maturation and activation of cells and also participate in the local inflammatory processes that mediate tissue insults in SLE. Certain cytokines such as the IL-6, IL-10, IL-17, BLys, type I interferons (IFN) and tumor necrosis factor-α (TNF-α) are closely linked to pathogenesis of SLE. The delineation of the role played by these cytokines not only fosters our understanding of this disease but also provides a sound rationale for various therapeutic approaches. In this context, this review focuses on selected cytokines which exert significant effect in the pathogenesis of SLE and their possible clinical applications.
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Ponticelli C, Moroni G. Monoclonal Antibodies for Systemic Lupus Erythematosus (SLE). Pharmaceuticals (Basel) 2010; 3:300-322. [PMID: 27713252 PMCID: PMC3991031 DOI: 10.3390/ph3010300] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Revised: 01/12/2010] [Accepted: 01/15/2010] [Indexed: 12/18/2022] Open
Abstract
A number of monoclonal antibodies (mAb) are now under investigation in clinical trials to assess their potential role in Systemic Lupus Erythematosus (SLE). The most frequently used mAb is rituximab, which is directed against CD20, a membrane protein expressed on B lymphocytes. Uncontrolled trials reported an improvement of SLE activity in non-renal patients and other studies even reported an improvement of severe lupus nephritis unresponsive to conventional treatments. However two randomized trials failed to show the superiority of rituximab over conventional treatment in non renal SLE and in lupus nephritis. Preliminary trials reported promising results with epratuzumab, a humanized mAb directed against CD22, and with belimumab, a human mAb that specifically recognizes and inhibits the biological activity of BLyS a cytokine of the tumornecrosis-factor (TNF) ligand superfamily. Other clinical trials with mAb directed against TNF-alpha, interleukin-10 (Il-10), Il-6, CD154, CD40 ligand, IL-18 or complement component C5 are under way. At present, however, in spite of good results reported by some studies, no firm conclusion on the risk-benefit profile of these mAbs in patients with SLE can be drawn from the available studies.
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Affiliation(s)
- Claudio Ponticelli
- Division of Nephrology, Scientific Institute Humanitas, via Manzoni 56, 20089 Rozzano (Milano), Italy.
| | - Gabriella Moroni
- Division of Nephrology, Scientific Institute Ospedale Maggiore, Milano, Italy.
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15
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Régent A, Mouthon L. [Anti-TNFalpha therapy in systemic autoimmune and/or inflammatory diseases]. Presse Med 2009; 38:761-73. [PMID: 19349142 DOI: 10.1016/j.lpm.2009.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2009] [Accepted: 02/16/2009] [Indexed: 01/08/2023] Open
Abstract
TNFalpha plays a crucial role in the physiopathology of a large number of auto-immune and/or inflammatory systemic diseases. In addition to authorized indications including rheumatoid arthritis, ankylosing spondylitis, Crohn disease, ulcerative colitis, psoriatic arthritis and plaque psoriasis, TNFalpha blockers have been tested in a wide range of auto-immune and/or inflammatory diseases. TNFalpha blockers might be an option in refractory ANCA-associated vasculitis, sarcoïdosis, adult onset Still disease, Behçet disease, AA amyloïdosis and TRAPS. However, pertaining to the limited number of prospective randomized trails available, the small number of patients included and the poor methodology, it is difficult to define their place in the therapeutic strategy in these conditions. The therapeutic effect of TNFalpha blockers is often suspensive and disease flares are frequently observed during sustained treatment, as in the case of Behçet's disease. Published data do not support the use of TNFalpha blockers in connective tissue diseases.
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Affiliation(s)
- Alexis Régent
- UPRES EA 4058, Université Paris Descartes, Faculté de Médecine, F-75005 Paris, France
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16
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Affiliation(s)
- M Aringer
- Division of Rheumatology, Department of Medicine III, University Clinical Center Carl Gustav Carus at the Technical University of Dresden, Germany
| | - JS Smolen
- Department of Rheumatology, Internal Medicine III, Medical University of Vienna, Austria
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Aringer M, Smolen JS. Efficacy and safety of TNF-blocker therapy in systemic lupus erythematosus. Expert Opin Drug Saf 2008; 7:411-9. [PMID: 18613805 DOI: 10.1517/14740338.7.4.411] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND There is still unmet medical need in the therapy of severe organ manifestations of patients with systemic lupus erythematosus (SLE). Therapeutic agents targeting pro-inflammatory cytokines may be an interesting option. OBJECTIVE To review available data on the efficacy and safety of tumour necrosis factor (TNF) blockade in SLE. METHODS A review of the literature was conducted. RESULTS/CONCLUSIONS Open-label experience suggests that TNF blockade is effective in SLE patients with arthritis, nephritis and skin disease. In particular, nephritis may remain in long-term remission after just four infusions of infliximab administered. Despite the induction of lupus-specific autoantibodies, short-term therapy with infliximab in combination with azathioprine appears feasible and relatively safe. The data call for controlled clinical trials, at least one of which has been initiated.
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Affiliation(s)
- Martin Aringer
- University Clinical Center Carl Gustav Carus, Technical University of Dresden, Division of Rheumatology, Department of Medicine III, Fetscherstrasse 74, 01307 Dresden, Germany.
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Aringer M, Smolen JS. The role of tumor necrosis factor-alpha in systemic lupus erythematosus. Arthritis Res Ther 2008; 10:202. [PMID: 18226185 PMCID: PMC2374473 DOI: 10.1186/ar2341] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Murine models of systemic lupus erythematosus (SLE) have shown apparently contradictory evidence in that either (a) tumor necrosis factor (TNF) expression was low and TNF administration helpful or (b) TNF was high and TNF blockade of therapeutic benefit, depending on the mouse model investigated. In fact, TNF apparently has both effects, checking autoimmunity, at least to some degree, and fostering inflammation. TNF blockade regularly, but transiently, induces or increases autoantibodies to chromatin and to phospholipids. At the same time, open-label data suggest that TNF blockade suppresses inflammatory manifestations of SLE, and long-term benefit was seen in patients with lupus nephritis. A controlled clinical trial is under way.
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Affiliation(s)
- Martin Aringer
- Division of Rheumatology, Department of Medicine III, University Clinical Center Carl Gustav Carus, Technical University of Dresden, Fetscherstrasse 74, 01307 Dresden, Germany.
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2008. [DOI: 10.1002/pds.1482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Díaz-Ley B, Guhl G, Fernández-Herrera J. Uso de fármacos biológicos en dermatosis fuera de la indicación aprobada. Primera parte: infliximab y adalimumab. ACTAS DERMO-SIFILIOGRAFICAS 2007. [DOI: 10.1016/s0001-7310(07)70159-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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Díaz-Ley B, Guhl G, Fernández-Herrera J. Off-Label Use of Biologic Agents in the Treatment of Dermatosis, Part 1: Infliximab and Adalimumab. ACTAS DERMO-SIFILIOGRAFICAS 2007. [DOI: 10.1016/s1578-2190(07)70539-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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