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Freites-Nuñez D, Leon L, Toledano E, Candelas G, Martinez C, Rodriguez-Laguna M, Rubio D, Fernandez-Gutierrez B, Abasolo L. Switching related to inefficacy in biologics and targeted synthetic therapies for psoriatic arthritis: a comparative real-life study. Ther Adv Musculoskelet Dis 2024; 16:1759720X241273083. [PMID: 39219744 PMCID: PMC11366104 DOI: 10.1177/1759720x241273083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 07/12/2024] [Indexed: 09/04/2024] Open
Abstract
Background Switching between therapies is a recommended strategy for psoriatic arthritis (PsA) patients who experience treatment failure; however, studies including real-life data are scarce. Objectives To assess the incidence rate (IR) of switching between biologics and targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs) due to inefficacy in PsA, and to compare the risk of switching due to inefficacy across different b/tsDMARDs groups. Design A longitudinal retrospective study, spanning from 2007 to 2022, was conducted on patients with PsA treated with b/tsDMARDs at an outpatient rheumatology clinic. Methods The primary outcome was switching between b/tsDMARDs due to inefficacy. The independent variable was the exposure to b/tsDMARDs during follow-up. As covariates, clinical, treatment-related, and sociodemographic variables were considered. Survival techniques were run to estimate the IR of switching due to inefficacy per 100 patients*year and confidence interval at 95% (95% CI). Cox multivariate regression analyses were run to assess the risk of b/tsDMARDs switching due to inefficacy, expressed as hazard ratio (HR) and 95% CI. Results In all, 141 patients were included, with 893.09 patients*year follow-ups. 52.48% of them were females in their fifties. In total, 262 courses of treatment were recorded. During the study period, 56 patients presented 121 switches and 103 related to inefficacy (IR: 11.53 (9.51-13.98)). Tumor necrosis factor-alpha inhibitors (TNFi) showed the lowest IR. In the bivariate analysis, all b/tsDMARDs had more risk of switching compared to TNFi (HR: anti-lL-17 vs TNFi: 2.26 (1.17-4.36); others vs TNFi: 3.21 (1.59-6.45)); however, this statistical significance was no longer present in the multivariate analysis once adjustments were made for the covariates. Still, the final model achieved statistical significance in the following variables: gender, clinical symptoms, prescription year, therapy courses, glucocorticoids, and sulfasalazine. Conclusion In this study, we did not find differences in the rate of switching due to inefficacy among different groups of b/tsDMARDs. Other concomitant treatments, sociodemographic, and clinical variables were identified as risk factors for switching due to inefficacy.
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Affiliation(s)
| | - Leticia Leon
- Leon Musculoskeletal Pathology Group, Rheumatology Department, IdISSC, Hospital Clínico San Carlos, Madrid, Spain
- Faculty of Health Sciences - HM Hospitals, University Camilo José Cela, Calle Martín Lagos, s/n. Madrid 28040, Spain
| | - Esther Toledano
- Rheumatology Department, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Gloria Candelas
- Rheumatology Department, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Cristina Martinez
- Rheumatology Department, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | | | - Daniel Rubio
- Medicine Department, Universidad Complutense de Madrid, Madrid, Spain
| | - Benjamin Fernandez-Gutierrez
- Medicine Department, Universidad Complutense de Madrid, Madrid, Spain
- Musculoskeletal Pathology Group, Rheumatology Department, IdISSC, Hospital Clínico San Carlos, Madrid, Spain
| | - Lydia Abasolo
- Musculoskeletal Pathology Group, Rheumatology Department, IdISSC, Hospital Clínico San Carlos, Madrid, Spain
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Barros PO, Berthoud TK, Aloufi N, Angel JB. Soluble IL-7Rα/sCD127 in Health, Disease, and Its Potential Role as a Therapeutic Agent. Immunotargets Ther 2021; 10:47-62. [PMID: 33728276 PMCID: PMC7954429 DOI: 10.2147/itt.s264149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/16/2021] [Indexed: 01/05/2023] Open
Abstract
Soluble cytokine receptors can influence immune responses by modulating the biological functions of their respective ligands. These effects can be either agonistic or antagonistic and a number of soluble cytokine receptors have been shown to play critical roles in both maintenance of health and disease pathogenesis. Soluble IL-7Ra (sCD127) is one such example. With its impact on the IL-7/CD127 pathway, which is fundamental for the development and homeostasis of T cells, the role of sCD127 in health and disease has been extensively studied in recent years. Within this review, the role of sCD127 in maintaining host immune function is presented. Next, by addressing genetic factors affecting sCD127 expression and the associated levels of sCD127 production, the roles of sCD127 in autoimmune disease, infections and cancer are described. Finally, advances in the field of soluble cytokine therapy and the potential for sCD127 as a biomarker and therapeutic agent are discussed.
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Affiliation(s)
- Priscila O Barros
- Chronic Disease Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Tamara K Berthoud
- Chronic Disease Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Nawaf Aloufi
- Department of Biochemistry, Microbiology and Immunology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jonathan B Angel
- Division of Infectious Diseases, Department of Medicine, University of Ottawa and the Ottawa Hospital, Ottawa, Ontario, Canada
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López-Estebaranz J, de la Cueva-Dobao P, de la Torre Fraga C, Galán Gutiérrez M, González Guerra E, Mollet Sánchez J, Belinchón Romero I. Manejo de la psoriasis moderada-grave en condiciones de práctica habitual en el ámbito hospitalario español. ACTAS DERMO-SIFILIOGRAFICAS 2018; 109:631-642. [DOI: 10.1016/j.ad.2018.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 02/12/2018] [Accepted: 02/26/2018] [Indexed: 10/14/2022] Open
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López-Estebaranz J, de la Cueva-Dobao P, de la Torre Fraga C, Galán Gutiérrez M, González Guerra E, Mollet Sánchez J, Belinchón Romero I. Management of Moderate to Severe Psoriasis in Routine Clinical Practice in Spanish Hospitals. ACTAS DERMO-SIFILIOGRAFICAS 2018. [DOI: 10.1016/j.adengl.2018.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Carretero G, Puig L, Carrascosa JM, Ferrándiz L, Ruiz-Villaverde R, de la Cueva P, Belinchon I, Vilarrasa E, Del Rio R, Sánchez-Carazo JL, López-Ferrer A, Peral F, Armesto S, Eiris N, Mitxelena J, Vilar-Alejo J, A Martin M, Soria C. Redefining the therapeutic objective in psoriatic patients candidates for biological therapy. J DERMATOL TREAT 2017; 29:334-346. [PMID: 29099667 DOI: 10.1080/09546634.2017.1395794] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The advances in psoriasis management currently allow achieving a good control of the disease. In particular, with the latest developed molecules, available evidence suggests that it is possible to pose an ambitious therapeutic goal, such as a Dermatology Life Quality Index 0/1, a Physician Global Assessment 0/1, or a Psoriasis Area and Severity Index 90/100 response. However, patients often fail to achieve the complete clearance of their cutaneous lesions or the improvement of disease factors that impair their quality of life. To optimize the treatment of psoriasis, it is not enough to define precisely the therapeutic objective, but also to adapt the therapeutic strategy to make the necessary modifications in case of not achieving it at the time point (at the end of the induction phase, or every 3-6 months) to be agreed with the patient (the so-called treat-to-target approach). In the present report, based on the Delphi methodology, 11 dermatologists from the Spanish Psoriasis Group addressed key issues that could be involved in the achievement and maintenance of the therapeutic goals of patients with moderate to severe psoriasis. The document provides 27 consensus statements intended to support clinical decision-making by healthcare professionals for patients who might be candidates to receive biologic therapy.
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Affiliation(s)
- G Carretero
- a Hospital Universitario de Gran Canaria Doctor Negrín , Las Palmas de Gran Canaria , Spain
| | - L Puig
- b Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona , Barcelona , Spain
| | - J M Carrascosa
- c Hospital Universitari Germans Trias I Pujol, Universitat Autònoma de Barcelona , Badalona , Spain
| | - L Ferrándiz
- d Hospital Universitario Virgen Macarena , Sevilla , Spain
| | | | - P de la Cueva
- f Hospital Universitario Infanta Leonor , Madrid , Spain
| | - I Belinchon
- g Hospital General Universitario de Alicante-ISABIAL , Alicante , Spain
| | - E Vilarrasa
- b Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona , Barcelona , Spain
| | - R Del Rio
- h Fundació Hospital L'Esperit Sant , Santa Coloma de Gramenet , Spain
| | | | - A López-Ferrer
- b Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona , Barcelona , Spain
| | - F Peral
- j Hospital Universitario Infanta Cristina de Badajoz , Badajoz , Spain
| | - S Armesto
- k Hospital Universitario Marqués de Valdecilla , Santander , Spain
| | - N Eiris
- l Complejo Asistencial Universitario de León , Spain
| | | | - J Vilar-Alejo
- a Hospital Universitario de Gran Canaria Doctor Negrín , Las Palmas de Gran Canaria , Spain
| | - M A Martin
- n Hospital Clínico Universitario Lozano Blesa , Zaragoza , Spain
| | - C Soria
- o Hospital General Universitario Reina Sofia , Murcia , Spain
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Merola JF, Lockshin B, Mody EA. Switching biologics in the treatment of psoriatic arthritis. Semin Arthritis Rheum 2017; 47:29-37. [DOI: 10.1016/j.semarthrit.2017.02.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 12/15/2016] [Accepted: 02/04/2017] [Indexed: 01/13/2023]
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Carrascosa JM, Galán M, de Lucas R, Pérez-Ferriols A, Ribera M, Yanguas I. Expert Recommendations on Treating Psoriasis in Special Circumstances (Part II). ACTAS DERMO-SIFILIOGRAFICAS 2016; 107:712-729. [PMID: 27344068 DOI: 10.1016/j.ad.2016.04.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 04/15/2016] [Accepted: 04/19/2016] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND There is insufficient information on how best to treat moderate to severe psoriasis in difficult clinical circumstances. MATERIAL AND METHODS We considered 5 areas where there is conflicting or insufficient evidence: pediatric psoriasis, risk of infection in patients being treated with biologics, psoriasis in difficult locations, biologic drug survival, and impact of disease on quality of life. Following discussion of the issues by an expert panel of dermatologists specialized in the management of psoriasis, participants answered a questionnaire survey according to the Delphi method. RESULTS Consensus was reached on 66 (70.9%) of the 93 items analyzed; the experts agreed with 49 statements and disagreed with 17. It was agreed that body mass index, metabolic comorbidities, and quality of life should be monitored in children with psoriasis. The experts also agreed that the most appropriate systemic treatment for this age group was methotrexate, while the most appropriate biologic treatment was etanercept. Although it was recognized that the available evidence was inconsistent and difficult to extrapolate, the panel agreed that biologic drug survival could be increased by flexible, individualized dosing regimens, continuous treatment, and combination therapies. Finally, consensus was reached on using the Dermatology Quality of Life Index to assess treatment effectiveness and aid decision-making in clinical practice. CONCLUSIONS The structured opinion of experts guides decision-making regarding aspects of clinical practice for which there is incomplete or conflicting information.
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Affiliation(s)
- J M Carrascosa
- Servei de Dermatologia, Hospital Universitari GermansTrias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, España.
| | - M Galán
- Servicio de Dermatología, Hospital de Jaén, Jaén, España
| | - R de Lucas
- Servicio de Dermatología, Hospital Universitario La Paz, Madrid, España
| | - A Pérez-Ferriols
- Servicio de Dermatología, Hospital General de Valencia, Valencia, España
| | - M Ribera
- Servicio de Dermatología, Hospital Universitari Parc Taulí, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España
| | - I Yanguas
- Servicio de Dermatología, Hospital Universitario de Navarra, Pamplona, España
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Expert Recommendations on Treating Psoriasis in Special Circumstances (Part II). ACTAS DERMO-SIFILIOGRAFICAS 2016. [DOI: 10.1016/j.adengl.2016.08.018] [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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Prinz J, Puig L, Girolomoni G. Treatment of psoriasis with etanercept: the typical patient profile. J Eur Acad Dermatol Venereol 2016; 30:1092-9. [DOI: 10.1111/jdv.13662] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 02/22/2016] [Indexed: 01/06/2023]
Affiliation(s)
- J.C. Prinz
- Department of Dermatology University of Munich Munich Germany
| | - L. Puig
- Department of Dermatology Hospital de la Santa Creu i Sant Pau Universitat Autònoma de Barcelona Barcelona Catalonia Spain
| | - G. Girolomoni
- Section of Dermatology Department of Medicine University of Verona Piazzale A. Stefani, Verona Italy
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