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Lima LDM, Aurilio RB, Fonseca AR, Parente AAAI, Sant’Anna MDFBP, Sant’Anna CC. Tuberculosis in children and adolescents with rheumatic diseases using biologic agents: an integrative review. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2023; 42:e2022084. [PMID: 37436237 PMCID: PMC10332438 DOI: 10.1590/1984-0462/2024/42/2022084] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 02/05/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVE To conduct a bibliographic review on tuberculosis (TB) disease in children and adolescents with rheumatic diseases, being managed with biologic therapy. DATA SOURCE An integrative review with a search in the U.S. National Library of Medicine and the National Institutes of Health (PubMed) using the following descriptors and Boolean operators: (["tuberculosis"] AND (["children"] OR ["adolescent"]) AND ["rheumatic diseases"] AND (["tumor necrosis factor-alpha"] OR ["etanercept"] OR ["adalimumab"] OR ["infliximab"] OR ["biological drugs"] OR ["rituximab"] OR ["belimumab"] OR ["tocilizumab"] OR ["canakinumab"] OR ["golimumab"] OR ["secukinumab"] OR ["ustekinumab"] OR ["tofacitinib"] OR ["baricitinib"] OR ["anakinra"] OR ["rilonacept"] OR ["abatacept"]), between January 2010 and October 2021. DATA SYNTHESIS Thirty-seven articles were included, with the total number of 36,198 patients. There were 81 cases of latent tuberculosis infection (LTBI), 80 cases of pulmonary tuberculosis (PTB), and four of extrapulmonary tuberculosis (EPTB). The main rheumatic disease was juvenile idiopathic arthritis. Among LTBI cases, most were diagnosed at screening and none progressed to TB disease during follow-up. Of the TB cases using biologics, most used tumor necrosis factor-alpha inhibitors (anti-TNFα) drugs. There was only one death. CONCLUSIONS The study revealed a low rate of active TB in pediatric patients using biologic therapy. Screening for LTBI before initiating biologics should be done in all patients, and treatment, in cases of positive screening, plays a critical role in preventing progression to TB disease.
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Affiliation(s)
- Lenita de Melo Lima
- Instituto de Puericultura e Pediatria Martagão Gesteira, Rio de Janeiro, RJ, Brazil
| | | | - Adriana Rodrigues Fonseca
- Instituto de Puericultura e Pediatria Martagão Gesteira, Rio de Janeiro, RJ, Brazil
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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2
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Golhen K, Winskill C, Yeh C, Zhang N, Welzel T, Pfister M. Value of Literature Review to Inform Development and Use of Biologics in Juvenile Idiopathic Arthritis. Front Pediatr 2022; 10:909118. [PMID: 35799700 PMCID: PMC9253535 DOI: 10.3389/fped.2022.909118] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 05/24/2022] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Juvenile idiopathic arthritis (JIA) is one of the most common pediatric inflammatory rheumatic diseases (PiRDs). Uncontrolled disease activity is associated with decreased quality of life and chronic morbidity. Biologic disease-modifying antirheumatic drugs (bDMARDs) and Janus kinase inhibitors (JAKi) have considerably improved clinical outcomes. For optimized patient care, understanding the efficacy-safety profile of biologics in subgroups of JIA is crucial. This systematic review based on published randomized controlled trials (RCTs) aims to assess efficacy and safety data for bDMARDs and JAKi with various JIA subgroups after 3 months of treatment. METHODS Data for American College of Rheumatology (ACR) pediatric (Pedi) 30, 50, and/or 70 responses after 3 months of treatment were selected from RCTs investigating bDMARDs or JAKi in JIA according to predefined inclusion/exclusion criteria. Treatment and control arms were compared by calculating risk ratios (RRs) with 95% confidence intervals (CIs), and proportions of overall, serious adverse events (AEs) and infections were analyzed. Forest plots were generated to summarize efficacy and safety endpoints across studies, JIA subgroups, and type of biologics. RESULTS Twenty-eight out of 41 PiRD RCTs investigated bDMARD or JAKi treatments in JIA. 9 parallel RCTs reported ACR Pedi 30, 50, and/or 70 responses 3 months after treatment initiation. All treatment arms showed improved ACR Pedi responses over controls. RRs ranged from 1.05 to 3.73 in ACR Pedi 30, from 1.20 to 7.90 in ACR Pedi 50, and from 1.19 to 8.73 in ACR Pedi 70. An enhanced effect for ACR Pedi 70 was observed with infliximab combined with methotrexate in PJIA vs. methotrexate monotherapy. A slightly higher risk of gastrointestinal AEs and infections was observed with treatment arms compared to placebo or methotrexate monotherapy. CONCLUSION Investigated bDMARDs and JAKi showed superior treatment responses compared to controls after 3 months of treatment, which were more pronounced in ACR Pedi 50 and 70 than in ACR Pedi 30. Higher susceptibility to infections associated with bDMARDs or JAKi vs. control arms must be weighed against efficacious treatment of the underlying disease and prevention of disease-related damage. Additional RCTs are warranted to further inform development and utilization of biologics in JIA.
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Affiliation(s)
- Klervi Golhen
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel (UKBB), University of Basel, Basel, Switzerland
| | - Carolyn Winskill
- Integrated Drug Development, Certara LP, Princeton, NJ, United States
| | - Cynthia Yeh
- Integrated Drug Development, Certara LP, Princeton, NJ, United States
| | - Nancy Zhang
- Integrated Drug Development, Certara LP, Princeton, NJ, United States
| | - Tatjana Welzel
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel (UKBB), University of Basel, Basel, Switzerland.,Pediatric Rheumatology, University Children's Hospital Basel (UKBB), University of Basel, Basel, Switzerland
| | - Marc Pfister
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel (UKBB), University of Basel, Basel, Switzerland.,Integrated Drug Development, Certara LP, Princeton, NJ, United States
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Udaondo C, Núñez Cuadros E, Murias S, Remesal A, Alcobendas R, Guerrero C, Guillen-Martin S, Escuredo M, Aleo E, Alonso D, Tagarro A, De Santiago E, Camacho-Lovillo M, Diaz F, Arenas D, Camacho P, Lirola MJ, Díaz Almirón M, Calvo C. Are infections in children with juvenile idiopathic arthritis more frequent than in healthy children? A prospective multicenter observational study. Front Pediatr 2022; 10:917731. [PMID: 36034561 PMCID: PMC9403004 DOI: 10.3389/fped.2022.917731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/26/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Children with juvenile idiopathic arthritis (JIA) might be at a higher risk of infection. Our objectives are to describe and compare infection rates in patients with JIA vs. healthy patients. METHODS A prospective, multicenter observational study was performed in Spain from January 2017 to June 2019. Patients with JIA from 7 participating hospitals and children without JIA (siblings of patients with JIA, and non-JIA children from primary health centers) were followed up with quarterly questionnaires to record infection episodes. Tuberculosis, herpes zoster, and infections requiring hospital admission were considered severe infections. Rates of infection (episodes/patient/year) were compared using a generalized estimating equations model. RESULTS A total of 371 children (181 with and 190 without JIA) were included. The median age was 8.8 years (IQR 5.5-11.3); 75% of the patients with JIA received immunosuppressive treatment (24% methotrexate, 22% biologic, 26% both). A total of 667 infections were recorded; 15 (2.2%) were considered severe. The infection rate was 1.31 (95%CI 1.1-1.5) in JIA and 1.12 (95%CI 0.9-1.3) in non-JIA participants (p = 0.19). Age <4 years increased the infection rate by 2.5 times (2.72 vs. 1.12, p < 0.001) in both groups. The most frequent infection sites were upper respiratory (62.6% vs. 74.5%) and gastrointestinal (18.8% vs. 11.4%). There were no differences in severe infections (2.5% vs. 2%, p = 0.65) between the groups. In children with JIA, younger age and higher disease activity (JADAS71) were associated with a higher infection rate. CONCLUSION We found no differences in the infection rate or infection severity between patients with and without JIA. Most infections were mild. An age younger than 4 years increased the infection risk in both groups. Higher disease activity was associated with a higher infection rate.
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Affiliation(s)
- Clara Udaondo
- Pediatric Rheumatology Unit, University Hospital La Paz, Madrid, Spain.,La Paz Research Institute (IDIPaz), Madrid, Spain.,CIBERINFEC ISCIII, Madrid, Spain
| | - Esmeralda Núñez Cuadros
- Pediatric Rheumatology Unit, UCG Pediatría, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Sara Murias
- Pediatric Rheumatology Unit, University Hospital La Paz, Madrid, Spain
| | - Agustin Remesal
- Pediatric Rheumatology Unit, University Hospital La Paz, Madrid, Spain
| | - Rosa Alcobendas
- Pediatric Rheumatology Unit, University Hospital La Paz, Madrid, Spain
| | | | - Sara Guillen-Martin
- Pediatric Rheumatology Unit, UCG Pediatría, Hospital Regional Universitario de Málaga, Málaga, Spain.,Pediatrics, Hospital de Getafe, Madrid, Spain
| | | | - Esther Aleo
- Pediatrics, Fundación para la Investigación del Hospital Clínico San Carlos, Hospital Clinico San Carlos, Madrid, Spain
| | | | - Alfredo Tagarro
- Fundación de Investigación Biomédica Hospital 12 de Octubre. Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain.,Department of Pediatrics, Infanta Sofía University Hospital, Madrid, Spain.,Infanta Sofia University Hospital and Henares University Hospital Foundation for Biomedical Research and Innovation (FIIB HUIS HHEN), Madrid, Spain.,Facultad de Medicina, Universidad Europea de Madrid, Madrid, Spain
| | | | - Marisol Camacho-Lovillo
- Pediatric Immunology, Rheumatology and Infectious Diseases Department, Hospital Universitario Virgen del Rocío, Seville, Spain
| | | | | | - Pilar Camacho
- Pediatrics, Centro Alcala de Guadaira, Seville, Spain
| | - Maria Jose Lirola
- Pediatric Rheumatology, Grupo IHP - Instituto Hispalense de Pediatría, Seville, Spain
| | - Mariana Díaz Almirón
- CIBERINFEC ISCIII, Madrid, Spain.,Biostatistics, Investigation department, IDIPaz, University Hospital La Paz, Madrid, Spain
| | - Cristina Calvo
- CIBERINFEC ISCIII, Madrid, Spain.,Pediatric Rheumatology Unit, UCG Pediatría, Hospital Regional Universitario de Málaga, Málaga, Spain.,Pediatric Infectious Diseases Department, University Hospital La Paz, Madrid, Spain
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Welzel T, Kuemmerle-Deschner J, Sluka C, Carlomagno R, Cannizzaro Schneider E, Kaiser D, Hofer M, Hentgen V, Woerner A. Vaccination completeness in children with rheumatic diseases: A longitudinal, observational multicenter cohort study in Switzerland. Front Pediatr 2022; 10:993811. [PMID: 36160778 PMCID: PMC9493270 DOI: 10.3389/fped.2022.993811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 08/08/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Children with pediatric inflammatory rheumatic diseases (PRD) have an increased infection risk. Vaccinations are effective to avoid vaccine-preventable diseases. This study aimed to assess the vaccination completeness in Swiss PRD patients stratified by immunosuppressive treatment (IST). MATERIALS AND METHODS This multicenter observational cohort study of PRD patients was performed in Basel, Geneva, Lucerne, Lausanne, and Zurich in PRD patients aged < 18 years included in the Juvenile Inflammatory Rheumatism Cohort. Completeness was assessed for i) the overall vaccination status (Swiss national immunization program (NIP) and specific additional PRD-recommended vaccinations), ii) for all and each vaccination of the NIP at PRD diagnosis and reference date (RefD) and iii) all and each specific additional PRD-recommended vaccination at RefD. Completeness was assessed over the disease course and stratified by IST. RESULTS Of 616 eligible patients, 234 children were analyzed. Of these, 147 (63%) were girls. Median age at PRD diagnosis was 6.5 years (IQR 2.9-10.3) and 10.9 years at RefD (6.9-14.3). The median follow-up since PRD diagnosis was 3 years (1.1-5.5). 120/234 children received IST. At RefD, overall vaccination completeness was 3.8% (9/234 children), completeness for the NIP vaccinations was 70.1% (164/234 children; IST 65%, no IST: 75.4%) and for all specific additional PRD-recommended vaccinations was 3.8% (9/234 children; IST 2.5%; no IST 5.3%). Vaccination completeness against pneumococcal disease, hepatitis B virus, and human papilloma virus (HPV) was 50.4, 20, 37.9%, respectively. In 25/35 children with negative varicella zoster virus history vaccination status was complete (IST: 94.4%, no IST: 47%). Annual non-live influenza vaccination was complete in 24.2% of children during IST; adherence decreased over the disease course. DISCUSSION This study identified a low overall vaccination completeness in children with PRD. Particularly, the completeness of specific additional PRD-recommended vaccinations was low. If not performed early after PRD diagnosis, vaccination status remained frequently incomplete. Close collaboration between pediatrician and rheumatologist to improve vaccination completeness is essential. Exchange of vaccination records, standardized assessment of specific PRD-recommended vaccinations and those of the NIP, and annual reminder for influenza vaccination are crucial to improve vaccination completeness in this vulnerable pediatric population.
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Affiliation(s)
- Tatjana Welzel
- Pediatric Rheumatology, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Jasmin Kuemmerle-Deschner
- Department of Pediatrics, Division of Pediatric Rheumatology, Autoinflammation Reference Center Tuebingen (arcT), University Hospital Tuebingen, Tuebingen, Germany.,European Reference Network for Rare and Low Prevalence Complex Diseases, Network Immunodeficiency, Autoinflammatory and Autoimmune Diseases (ERN RITA), Tuebingen, Germany
| | - Constantin Sluka
- Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Raffaella Carlomagno
- Pediatric Rheumatology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.,Pediatric Rheumatology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | | | - Daniela Kaiser
- Pediatric Rheumatology, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Michael Hofer
- Pediatric Rheumatology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.,Pediatric Rheumatology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Veronique Hentgen
- Reference Center for Autoinflammatory Diseases CeRéMAIA, Versailles Hospital, Versailles, France
| | - Andreas Woerner
- Pediatric Rheumatology, University Children's Hospital Basel, University of Basel, Basel, Switzerland
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Ogstrup AK, Spannow AH, Holm M, Rubak S, Veirum JE, Glerup M, Herlin T. Serious Opportunistic Lower Respiratory Tract Infections in Pediatric Rheumatic Diseases During Treatment With Biologics. J Clin Rheumatol 2021; 27:S387-S391. [PMID: 32694355 DOI: 10.1097/rhu.0000000000001480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Nagy A, Mosdosi B, Simon D, Dergez T, Berki T. Peripheral Blood Lymphocyte Analysis in Oligo- and Polyarticular Juvenile Idiopathic Arthritis Patients Receiving Methotrexate or Adalimumab Therapy: A Cross-Sectional Study. Front Pediatr 2020; 8:614354. [PMID: 33363071 PMCID: PMC7758242 DOI: 10.3389/fped.2020.614354] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 11/16/2020] [Indexed: 12/14/2022] Open
Abstract
Juvenile idiopathic arthritis (JIA) is an umbrella term for seven distinct chronic immune-mediated diseases. Disease-modifying anti-rheumatic drugs (DMARD) are used to treat the underlying joint inflammation as well as extra-articular manifestations. Immunosuppression is a considerable side effect of the drugs. The main goal of this study was to investigate the effect of different JIA therapies on leukocyte subpopulations, which play a role in immune-defense. Three study groups were established. The first group consisted of JIA patients treated with methotrexate solely, the second one received a combination of methotrexate (MTX) and adalimumab (ADA). The control group was made up of the patients' healthy siblings. A total of 63 children were recruited. Fourty-one children with JIA and 22 healthy controls were included in the study. The absolute number of CD3+ T-cells was significantly elevated in patients treated with biological therapy compared to healthy controls (p2 = 0.017). In contrast, the number of CD56+ natural killer cells was significantly lower in children receiving biological therapy in comparison with healthy donors (p2 = 0.039). A significant alteration was also demonstrated between patients treated with MTX and MTX/ADA group concerning CD 19+ B-cells (p3 = 0.042). This is the first study that demonstrates significant alterations in the number of B-cells and T-cells with a relative decrease of NK-cell ratios in JIA patients receiving different DMARD therapy. Clinical Trial Registration: NCT03833271. 21.01.2019.
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Affiliation(s)
- Arnold Nagy
- Department of Paediatrics, University of Pecs, Medical School, Pecs, Hungary
| | - Bernadett Mosdosi
- Department of Paediatrics, University of Pecs, Medical School, Pecs, Hungary
| | - Diana Simon
- Department of Immunology and Biotechnology, University of Pecs, Medical School, Pecs, Hungary
| | - Timea Dergez
- Institute of Bioanalysis, University of Pecs, Medical School, Pecs, Hungary
| | - Timea Berki
- Department of Immunology and Biotechnology, University of Pecs, Medical School, Pecs, Hungary
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7
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Nagy A, Mátrai P, Hegyi P, Alizadeh H, Bajor J, Czopf L, Gyöngyi Z, Kiss Z, Márta K, Simon M, Szilágyi ÁL, Veres G, Mosdósi B. The effects of TNF-alpha inhibitor therapy on the incidence of infection in JIA children: a meta-analysis. Pediatr Rheumatol Online J 2019; 17:4. [PMID: 30658717 PMCID: PMC6339290 DOI: 10.1186/s12969-019-0305-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 01/08/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Juvenile Idiopathic arthritis (JIA) is the most common chronic rheumatic disease in childhood. The diagnosis is based on the underlying symptoms of arthritis with an exclusion of other diseases Biologic agents are increasingly used on the side of disease-modifying anti-rheumatic drugs (DMARD) in JIA treatment. MAIN BODY The aim of this meta-analysis was to investigate the observed infections in JIA children during tumor necrosis factor (TNF)-alpha inhibitor therapy. A systematic search of three databases (Medline via PubMed, Embase, Cochrane Library) was carried out up to May 2018. Published trials that evaluated the infectious adverse events in patients receiving TNF-alpha inhibitor vs. a control group were included in the analysis. Full-text data extraction was carried out independently by the investigators from ten relevant publications. 1434 patients received TNF-alpha inhibitor therapy; the control group consisted of 696 subjects. The analysis presented the risk of infection in the active treatment group (OR = 1.13; 95% CI: 0.76-1.69; p = 0.543). The majority of infections were upper respiratory tract infections (URTIs). Furthermore, the subgroup analysis demonstrated a higher infection rate in the observed localization. CONCLUSION Anti-TNF therapy slightly but not significantly increases the incidence of infection in JIA children compared to other therapies (GRADE: moderate evidence). The most common infections reported were mild URTIs. Further studies with larger patients number with a strong evidence level are crucially needed to finalize the answer whether anti-TNF therapy elevates and if yes on what extent the incidence of infection in JIA children. TRIAL REGISTRATION Prospero: CRD42017067873 .
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Affiliation(s)
- Arnold Nagy
- Department of Paediatrics, Medical School, University of Pécs, 7. József Attila street, Pécs, 7623, Hungary.
| | - Péter Mátrai
- 0000 0001 0663 9479grid.9679.1Institute of Bioanalysis, Medical School, University of Pécs, Pécs, Hungary
| | - Péter Hegyi
- 0000 0001 0663 9479grid.9679.1Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary ,0000 0001 0663 9479grid.9679.1Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary ,0000 0001 1016 9625grid.9008.1Momentum Gastroenterology Multidisciplinary Research Group, Hungarian Academy of Sciences - University of Szeged, Szeged, Hungary
| | - Hussain Alizadeh
- 0000 0001 0663 9479grid.9679.1Division of Haematology, First Department of Internal Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Judit Bajor
- 0000 0001 0663 9479grid.9679.1Division of Gastroenterology, First Department of Internal Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - László Czopf
- 0000 0001 0663 9479grid.9679.1Division of Cardiology, First Department of Internal Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Zoltán Gyöngyi
- 0000 0001 0663 9479grid.9679.1Department of Public Health Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Zoltán Kiss
- 0000 0001 0942 9821grid.11804.3cFirst Department of Paediatrics, Semmelweis University, Budapest, Hungary
| | - Katalin Márta
- 0000 0001 0663 9479grid.9679.1Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary ,0000 0001 0663 9479grid.9679.1Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Mária Simon
- 0000 0001 0663 9479grid.9679.1Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
| | - Ágnes Lilla Szilágyi
- 0000 0001 0663 9479grid.9679.1Department of Psychiatry and Psychotherapy, Medical School, University of Pécs, Pécs, Hungary
| | - Gábor Veres
- 0000 0001 1016 9625grid.9008.1Institute of Surgical Research, University of Szeged, Szeged, Hungary ,0000 0001 1088 8582grid.7122.6Department of Paediatrics, Medical School, University of Debrecen, Debrecen, Hungary
| | - Bernadett Mosdósi
- 0000 0001 0663 9479grid.9679.1Department of Paediatrics, Medical School, University of Pécs, 7. József Attila street, Pécs, 7623 Hungary
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The frequency of infections in patients with juvenile idiopathic arthritis on biologic agents: 1-year prospective study. Clin Rheumatol 2018; 38:1025-1030. [PMID: 30448935 DOI: 10.1007/s10067-018-4367-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 11/02/2018] [Accepted: 11/12/2018] [Indexed: 10/27/2022]
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Brunelli JB, Schmidt AR, Sallum AME, Goldenstein-Schainberg C, Bonfá E, Silva CA, Aikawa NE. High rate of serious infection in juvenile idiopathic arthritis patients under biologic therapy in a real-life setting. Mod Rheumatol 2017; 28:264-270. [PMID: 28949278 DOI: 10.1080/14397595.2017.1349059] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVES To assess the rate of serious and/or opportunistic infections in juvenile idiopathic arthritis (JIA) patients from a single tertiary center under biologic therapy and to identify possible risk factors associated to these complications. METHODS A total of 107 JIA patients followed at the biologic therapy center of our tertiary university hospital using a standardized electronic database protocol including demographic data, clinical and laboratorial findings and treatment at baseline and at the moment of infection. Opportunistic infections included tuberculosis, herpes zoster and systemic mycosis. RESULTS A total of 398 patient-yrs(py) were included. The median time of biologic exposure was 3.0 years (0.15-11.5). We observed 35 serious/opportunistic infectious events in 27 (25%) patients: 31(88.6%) were serious infections and four (11.4%) opportunistic infections. Serious/opportunistic infections rates were 10.6/100py for ETN, 10.9/100py for ADA, 2.6/100py for ABA and 14.8/100py for TCZ. Comparison of 27 patients with and 80 without infection showed a higher frequency of systemic-onset JIA, lower age at biologic therapy initiation and a history of previous serious infection (p < .05) in the former group. CONCLUSIONS This study demonstrated a high rate of serious infections in JIA patients under biologic therapy in a real-life setting. Systemic-onset JIA, lower age at biologic therapy start and history of previous serious infections were important risk factors for these complications. Also, higher rates of severe infections comparing to the former studies was possibly due to elevated MTX doses in our patients.
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Affiliation(s)
- Juliana Barbosa Brunelli
- a Pediatric Rheumatology Unit, Hospital das Clinicas HCFMUSP, Faculdade de Medicina , Universidade de Sao Paulo , São Paulo , Brazil
| | - Ana Renata Schmidt
- a Pediatric Rheumatology Unit, Hospital das Clinicas HCFMUSP, Faculdade de Medicina , Universidade de Sao Paulo , São Paulo , Brazil
| | - Adriana Maluf Elias Sallum
- a Pediatric Rheumatology Unit, Hospital das Clinicas HCFMUSP, Faculdade de Medicina , Universidade de Sao Paulo , São Paulo , Brazil
| | - Claudia Goldenstein-Schainberg
- b Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina , Universidade de Sao Paulo , São Paulo , Brazil
| | - Eloisa Bonfá
- b Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina , Universidade de Sao Paulo , São Paulo , Brazil
| | - Clovis A Silva
- a Pediatric Rheumatology Unit, Hospital das Clinicas HCFMUSP, Faculdade de Medicina , Universidade de Sao Paulo , São Paulo , Brazil
| | - Nádia Emi Aikawa
- a Pediatric Rheumatology Unit, Hospital das Clinicas HCFMUSP, Faculdade de Medicina , Universidade de Sao Paulo , São Paulo , Brazil.,b Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina , Universidade de Sao Paulo , São Paulo , Brazil
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Becker I, Horneff G. Risk of Serious Infection in Juvenile Idiopathic Arthritis Patients Associated With Tumor Necrosis Factor Inhibitors and Disease Activity in the German Biologics in Pediatric Rheumatology Registry. Arthritis Care Res (Hoboken) 2017; 69:552-560. [DOI: 10.1002/acr.22961] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 06/06/2016] [Accepted: 06/21/2016] [Indexed: 01/01/2023]
Affiliation(s)
| | - Gerd Horneff
- Asklepios Clinic Sankt AugustinSankt Augustin Germany
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Tragiannidis A, Kyriakidis I, Zündorf I, Groll AH. Invasive fungal infections in pediatric patients treated with tumor necrosis alpha (TNF-α) inhibitors. Mycoses 2016; 60:222-229. [DOI: 10.1111/myc.12576] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 09/17/2016] [Accepted: 09/17/2016] [Indexed: 01/09/2023]
Affiliation(s)
- Athanasios Tragiannidis
- Second Department of Pediatrics; AHEPA University General Hospital; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Ioannis Kyriakidis
- Second Department of Pediatrics; AHEPA University General Hospital; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Ilse Zündorf
- Institute of Pharmaceutical Biology; Goethe-University of Frankfurt; Frankfurt am Main Germany
| | - Andreas H. Groll
- Department of Pediatric Hematology and Oncology; Center for Bone Marrow Transplantation; Infectious Disease Research Program; University Childrens Hospital; Muenster Germany
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12
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Walters HM, Pan N, Lehman TJA, Adams A, Kalliolias GD, Zhu YS, Santiago F, Nguyen J, Sitaras L, Cunningham-Rundles S, Walsh TJ, Toussi SS. The impact of disease activity and tumour necrosis factor-α inhibitor therapy on cytokine levels in juvenile idiopathic arthritis. Clin Exp Immunol 2016; 184:308-17. [PMID: 26934060 DOI: 10.1111/cei.12782] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2016] [Indexed: 12/31/2022] Open
Abstract
The aim of this study was to evaluate prospectively cytokine levels and disease activity in juvenile idiopathic arthritis (JIA) patients treated with and without tumour necrosis factor (TNF)-α inhibitors. TNF-α inhibitor-naive JIA subjects were followed prospectively for 6 months. Cytokine levels of TNF-α, interleukin (IL)-1β, IL-6, IL-8, IL-10 and IL-17 were measured at baseline for JIA subjects and healthy controls (HCs). Cytokine levels were then measured at four time-points after initiation of TNF-α inhibition for anti-TNF-α-treated (anti-TNF) JIA subjects, and at two subsequent time-points for other JIA (non-TNF) subjects. JIA disease activity by Childhood Health Assessment Questionnaire (CHAQ) disability index/pain score and physician joint count/global assessment was recorded. Sixteen anti-TNF, 31 non-TNF and 16 HCs were analysed. Among JIA subjects, those with higher baseline disease activity (subsequent anti-TNFs) had higher baseline TNF-α, IL-6 and IL-8 than those with lower disease activity (non-TNFs) (P < 0·05). TNF-α and IL-10 increased, and IL-6 and IL-8 no longer remained significantly higher after TNF-α inhibitor initiation in anti-TNF subjects. Subgroup analysis of etanercept versus adalimumab-treated subjects showed that TNF-α and IL-17 increased significantly in etanercept but not adalimumab-treated subjects, despite clinical improvement in both groups of subjects. JIA subjects with increased disease activity at baseline had higher serum proinflammatory cytokines. TNF-α inhibition resulted in suppression of IL-6 and IL-8 in parallel with clinical improvement in all anti-TNF-treated subjects, but was also associated with elevated TNF-α and IL-17 in etanercept-treated subjects.
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Affiliation(s)
- H M Walters
- Department of Pediatric Rheumatology, Cohen Children's Medical Center, North-Shore-Long Island Jewish Health System, Lake Success, NY
| | - N Pan
- Department of Rheumatology, Hospital for Special Surgery, New York, NY, USA
| | - T J A Lehman
- Department of Rheumatology, Hospital for Special Surgery, New York, NY, USA
| | - A Adams
- Department of Rheumatology, Hospital for Special Surgery, New York, NY, USA
| | - G D Kalliolias
- Department of Rheumatology, Hospital for Special Surgery, New York, NY, USA.,Arthritis and Tissue Degeneration Program, Hospital for Special Surgery, New York, NY, USA.,Department of Medicine, New York, NY, USA
| | - Y S Zhu
- Clinical and Translational Science Center, Weill Cornell Medical College, New York, NY, USA
| | - F Santiago
- Clinical and Translational Science Center, Weill Cornell Medical College, New York, NY, USA
| | - J Nguyen
- Department of Epidemiology and Biostatistics, Hospital for Special Surgery, New York, NY, USA
| | - L Sitaras
- Department of Pediatrics, New York, NY, USA
| | | | - T J Walsh
- Department of Pediatrics, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College/New York Presbyterian Hospital, New York, NY, USA
| | - S S Toussi
- Department of Pediatrics, New York, NY, USA
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13
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Taddio A, Cattalini M, Simonini G, Cimaz R. Recent advances in the use of Anti-TNFα therapy for the treatment of juvenile idiopathic arthritis. Expert Rev Clin Immunol 2016; 12:641-9. [DOI: 10.1586/1744666x.2016.1146132] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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