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Oh TK, Song IA. Long-Term Glucocorticoid Use and Cancer Risk: A Population-Based Cohort Study in South Korea. Cancer Prev Res (Phila) 2020; 13:1017-1026. [PMID: 32839205 DOI: 10.1158/1940-6207.capr-20-0161] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/04/2020] [Accepted: 08/14/2020] [Indexed: 12/09/2022]
Abstract
Long-term glucocorticoid (GC) exposure causes immunosuppression; therefore, the risk of cancer may be increased in long-term GC users. We investigated whether long-term GC use is associated with a higher risk of cancer in the population without cancer. A population-based cohort study using data from the National Health Insurance Service was conducted among the South Korean adult population in 2010. Long-term GC users were defined as those who were prescribed a continuous supply of oral GC for ≥30 days. The primary endpoint was a new cancer diagnosis from January 1, 2011, to December 31, 2015. Among 770,880 individuals included in the analysis, 1,602 (0.2%) were long-term GC users and 36,157 (4.7%) were newly diagnosed with cancer from January 2011 to December 2015. In the multivariable Cox regression analysis, the risk of cancer among long-term GC users was 1.23-fold higher than that of the unexposed individuals [95% confidence interval (CI), 1.06-1.43; P = 0.007]. In the competing risk analyses, the risks of liver cancer and lung cancer were 1.46-fold (95% CI, 1.03-2.07; P = 0.034) and 1.52-fold (95% CI, 1.04-2.21; P = 0.029) higher in the long-term GC users than that of the unexposed individuals, respectively. We found that long-term GC exposure might be associated with a higher risk of overall cancer, and this association was more evident for lung and liver cancer risk. However, because there might be unmeasured and potential confounders in this study, the results should be interpreted carefully, and future studies should be performed to confirm these findings. IMPACT: Long-term glucocorticoid therapy might be associated with a higher cancer risk. This association was more evident for lung and liver cancer risk. Our findings suggest that long-term prescriptions of glucocorticoids should be administered carefully considering the risk of cancer.
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Affiliation(s)
- Tak Kyu Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - In-Ae Song
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
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Changes in Serum Cytokines May Predict Therapeutic Efficacy of Tofacitinib in Rheumatoid Arthritis. Mediators Inflamm 2019; 2019:5617431. [PMID: 31780862 PMCID: PMC6855066 DOI: 10.1155/2019/5617431] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 08/03/2019] [Accepted: 08/23/2019] [Indexed: 12/20/2022] Open
Abstract
Objective Tofacitinib is a novel therapy for rheumatoid arthritis (RA). The aim of this study was to measure various serum cytokines levels and to explore potential markers predictive of therapeutic efficacy of tofacitinib for RA patients. Methods Thirty-two patients with RA were given tofacitinib (5 mg bid). Serum cytokines levels of Th1 (IFN-γ), Th2 (IL-6), Th17 (IL-17), Tregs (IL-35), and TNF-α were detected by enzyme-linked immunosorbent assays. Results Disease activity was significantly decreased as early as week 4 after tofacitinib treatment. Serum IL-35 levels were significantly increased and serum levels of TNF-α, IL-17, IL-6, and IFN-γ were significantly reduced in response to tofacitinib since week 4. Conclusions After treatment with tofacitinib, RA patients may benefit from monitoring of disease activity as early as week 4. IL-35 also might be a predictive indicator of the disease activity and drug efficacy. Meanwhile, tofacitinib might be CS-sparing in RA.
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Louveau B, De Rycke Y, Lafourcade A, Saraux A, Guillemin F, Tubach F, Fautrel B, Hajage D. Effect of cumulative exposure to corticosteroid and DMARD on radiographic progression in rheumatoid arthritis: results from the ESPOIR cohort. Rheumatology (Oxford) 2018; 57:1563-1573. [DOI: 10.1093/rheumatology/key122] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- Baptiste Louveau
- APHP, Centre de Pharmacoépidémiologie (Cephepi), Département de Biostatistique Santé Publique et Information Médicale, CIC 1421, Hôpital Pitié Salpêtrière, Paris, France
- INSERM, UMR 1123, ECEVE, CIC 1421, Paris, France
| | - Yann De Rycke
- APHP, Centre de Pharmacoépidémiologie (Cephepi), Département de Biostatistique Santé Publique et Information Médicale, CIC 1421, Hôpital Pitié Salpêtrière, Paris, France
- INSERM, UMR 1123, ECEVE, CIC 1421, Paris, France
| | - Alexandre Lafourcade
- APHP, Centre de Pharmacoépidémiologie (Cephepi), Département de Biostatistique Santé Publique et Information Médicale, CIC 1421, Hôpital Pitié Salpêtrière, Paris, France
| | - Alain Saraux
- Département de Rhumatologie, CHU Brest, INSERM 1227, UBO, Brest, France
| | - Francis Guillemin
- Université de Lorraine, Université Paris Descartes, EA 4360 APEMAC, Nancy, France
| | - Florence Tubach
- APHP, Centre de Pharmacoépidémiologie (Cephepi), Département de Biostatistique Santé Publique et Information Médicale, CIC 1421, Hôpital Pitié Salpêtrière, Paris, France
- INSERM, UMR 1123, ECEVE, CIC 1421, Paris, France
- Sorbonne Université, Faculté de médecine Sorbonne Université, Paris, France
| | - Bruno Fautrel
- Sorbonne Université, GRC-08 (EEMOIS), Paris, France
- Département de Rhumatologie, APHP, Hôpital Pitié Salpêtrière, Paris, France
| | - David Hajage
- APHP, Centre de Pharmacoépidémiologie (Cephepi), Département de Biostatistique Santé Publique et Information Médicale, CIC 1421, Hôpital Pitié Salpêtrière, Paris, France
- INSERM, UMR 1123, ECEVE, CIC 1421, Paris, France
- Sorbonne Université, Faculté de médecine Sorbonne Université, Paris, France
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Martin NH, Ibrahim F, Tom B, Galloway J, Wailoo A, Tosh J, Lempp H, Prothero L, Georgopoulou S, Sturt J, Scott DL. Does intensive management improve remission rates in patients with intermediate rheumatoid arthritis? (the TITRATE trial): study protocol for a randomised controlled trial. Trials 2017; 18:591. [PMID: 29221496 PMCID: PMC5723045 DOI: 10.1186/s13063-017-2330-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 11/16/2017] [Indexed: 01/26/2023] Open
Abstract
Background Uncontrolled active rheumatoid arthritis can lead to increasing disability and reduced quality of life over time. ‘Treating to target’ has been shown to be effective in active established disease and also in early disease. However, there is a lack of nationally agreed treatment protocols for patients with established rheumatoid arthritis who have intermediate disease activity. This trial is designed to investigate whether intensive management of disease leads to a greater number of remissions at 12 months. Levels of disability and quality of life, and acceptability and cost-effectiveness of the intervention will also be examined. Methods The trial is a 12-month, pragmatic, randomised, open-label, two-arm, parallel-group, multicentre trial undertaken at specialist rheumatology centres across England. Three hundred and ninety-eight patients with established rheumatoid arthritis will be recruited. They will currently have intermediate disease activity (disease activity score for 28 joints assessed using an erythrocyte sedimentation rate of 3.2 to 5.1 with at least three active joints) and will be taking at least one disease-modifying anti-rheumatic drug. Participants will be randomly selected to receive intensive management or standard care. Intensive management will involve monthly clinical reviews with a specialist health practitioner, where drug treatment will be optimised and an individualised treatment support programme delivered based on several principles of motivational interviewing to address identified problem areas, such as pain, fatigue and adherence. Standard care will follow standard local pathways and will be in line with current English guidelines from the National Institute for Health and Clinical Excellence. Patients will be assessed initially and at 6 and 12 months through self-completed questionnaires and clinical evaluation. Discussion The trial will establish whether the known benefits of intensive treatment strategies in active rheumatoid arthritis are also seen in patients with established rheumatoid arthritis who have moderately active disease. It will evaluate both the clinical and cost-effectiveness of intensive treatment. Trial registration Current Controlled Trials, ID: ISRCTN70160382. Registered on 16 January 2014. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2330-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Naomi H Martin
- Academic Department of Rheumatology, King's College London, Weston Education Centre, Cutcombe Road, Denmark Hill, London, SE5 9RJ, UK.
| | - Fowzia Ibrahim
- Academic Department of Rheumatology, King's College London, Weston Education Centre, Cutcombe Road, Denmark Hill, London, SE5 9RJ, UK
| | - Brian Tom
- MRC Biostatistics Unit, Institute of Public Health, University Forvie Site, Robinson Way, Cambridge, CB2 0SR, UK
| | - James Galloway
- Academic Department of Rheumatology, King's College London, Weston Education Centre, Cutcombe Road, Denmark Hill, London, SE5 9RJ, UK
| | - Allan Wailoo
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Jonathan Tosh
- DRG Abacus, Manchester One, 53 Portland Street, Manchester, M1 3LF, UK
| | - Heidi Lempp
- Academic Department of Rheumatology, King's College London, Weston Education Centre, Cutcombe Road, Denmark Hill, London, SE5 9RJ, UK
| | - Louise Prothero
- Academic Department of Rheumatology, King's College London, Weston Education Centre, Cutcombe Road, Denmark Hill, London, SE5 9RJ, UK
| | - Sofia Georgopoulou
- Department of Physiotherapy, King's College London, 5th Floor, Addison House, Guy's Campus, London, SE1 1UL, UK
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA, UK
| | - David L Scott
- Academic Department of Rheumatology, King's College London, Weston Education Centre, Cutcombe Road, Denmark Hill, London, SE5 9RJ, UK
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Bester FCJ, Bosch FJ, van Rensburg BJJ. The specialist physician's approach to rheumatoid arthritis in South Africa. Korean J Intern Med 2016; 31:219-36. [PMID: 26932399 PMCID: PMC4773728 DOI: 10.3904/kjim.2015.134] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 05/08/2015] [Indexed: 12/03/2022] Open
Abstract
Rheumatoid arthritis (RA) is expected to increase in Africa and South Africa. Due to the low numbers of rheumatologists in South Africa, specialist physicians also have to care for patients with RA. Furthermore several new developments have taken place in recent years which improved the management and outcome of RA. Classification criteria were updated, assessment follow-up tools were refined and above all, several new biological disease-modifying anti-rheumatic drugs were developed. Therefore it is imperative for specialist physicians to update themselves with the newest developments in the management of RA. This article provides an overview of the newest developments in the management of RA in the South African context. This approach may well apply to countries with similar specialist to patient ratios and disease profiles.
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Affiliation(s)
- Frederik C. J. Bester
- Department of Internal Medicine, Rosepark Life Health Care Hospital, Bloemfontein, South Africa
| | - Fredricka J. Bosch
- Department of Internal Medicine, Rosepark Life Health Care Hospital, Bloemfontein, South Africa
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Mok CC, Cha HS, Hidayat R, Nguyen LTN, Perez EC, Ramachandran R, Tsay GJ, Yoo DH. The importance of assessment and management of morning stiffness in Asian patients with rheumatoid arthritis: Recommendations from an expert panel. Int J Rheum Dis 2015; 19:30-7. [DOI: 10.1111/1756-185x.12755] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Chi Chiu Mok
- Department of Medicine; Tuen Mun Hospital; Hong Kong China
| | | | - Rudy Hidayat
- Dr Ciptomangunkusumo Hospital; Jakarta Indonesia
| | | | - Emmanuel C. Perez
- De la Salle University Medical Center; Health Science Institute; Cavite Philippines
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Lau CS, Chia F, Harrison A, Hsieh TY, Jain R, Jung SM, Kishimoto M, Kumar A, Leong KP, Li Z, Lichauco JJ, Louthrenoo W, Luo SF, Nash P, Ng CT, Park SH, Suryana BPP, Suwannalai P, Wijaya LK, Yamamoto K, Yang Y, Yeap SS. APLAR rheumatoid arthritis treatment recommendations. Int J Rheum Dis 2015; 18:685-713. [DOI: 10.1111/1756-185x.12754] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Chak Sing Lau
- Division of Rheumatology and Clinical Immunology; Queen Mary Hospital; University of Hong Kong; Hong Kong
| | - Faith Chia
- Department of Rheumatology, Allergy and Immunology; Tan Tock Seng Hospital; Singapore City Singapore
| | - Andrew Harrison
- Department of Medicine; University of Otago Wellington; Wellington South New Zealand
| | - Tsu-Yi Hsieh
- Section of Allergy, Immunology and Rheumatology, and Section of Clinical Skills Training; Taichung Veterans General Hospital; Taichung Taiwan
| | | | - Seung Min Jung
- Division of Rheumatology; Department of Internal Medicine; The Catholic University of Korea; St. Mary's Hospital; Seoul South Korea
| | | | - Ashok Kumar
- Department of Rheumatology; Fortis Flt. Lt Rajan Dhall Hospital; New Delhi India
| | - Khai Pang Leong
- Department of Rheumatology, Allergy and Immunology; Tan Tock Seng Hospital; Singapore City Singapore
| | - Zhanguo Li
- Department of Rheumatology; Peking University People's Hospital; Beijing China
| | | | - Worawit Louthrenoo
- Division of Rheumatology; Department of Internal Medicine; Faculty of Medicine; Chiang Mai University; Chiang Mai Thailand
| | - Shue-Fen Luo
- Department of Rheumatology, Allergy and Immunology; Chang Gung Memorial Hospital and Chang Gung University; Tao-Yuan Taiwan
| | - Peter Nash
- Department of Medicine; University of Queensland; Brisbane Queensland Australia
| | - Chin Teck Ng
- Department of Rheumatology and Immunology; Singapore General Hospital; Singapore City Singapore
| | - Sung-Hwan Park
- Division of Rheumatology; Department of Internal Medicine; The Catholic University of Korea; St. Mary's Hospital; Seoul South Korea
| | - Bagus Putu Putra Suryana
- Rheumatology Division; Department of Internal Medicine; Brawijaya University; Saiful Anwar General Hospital; Malang Indonesia
| | - Parawee Suwannalai
- Allergy, Immunology and Rheumatology Division; Internal Medicine Department; Faculty of Medicine; Ramathibodi Hospital; Mahidol University; Bangkok Thailand
| | - Linda Kurniaty Wijaya
- Division of Rheumatology; Department of Internal Medicine; University of Indonesia; Jakarta Indonesia
| | - Kazuhiko Yamamoto
- Department of Allergy and Rheumatology; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Yue Yang
- Department of Rheumatology; Peking University People's Hospital; Beijing China
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Fortunet C, Pers YM, Lambert J, Godfrin-Valnet M, Constant E, Devilliers H, Gaudin P, Jorgensen C, Prades BP, Wendling D, Maillefert JF. Tocilizumab induces corticosteroid sparing in rheumatoid arthritis patients in clinical practice. Rheumatology (Oxford) 2014; 54:672-7. [DOI: 10.1093/rheumatology/keu339] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Trampisch US, Krause D, Trampisch HJ, Klaassen-Mielke R, Baraliakos X, Braun J. Comparison of the efficacy and safety of two starting dosages of prednisolone in early active rheumatoid arthritis (CORRA): study protocol for a randomized controlled trial. Trials 2014; 15:344. [PMID: 25181946 PMCID: PMC4247757 DOI: 10.1186/1745-6215-15-344] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 08/14/2014] [Indexed: 11/23/2022] Open
Abstract
Background Although glucocorticoids are widely used in the treatment of patients with early rheumatoid arthritis, the best dosage of glucocorticoids with regards to efficacy and safety is not known. The aim of the study ‘Comparison of the efficacy and safety of two starting dosages of prednisolone in early active rheumatoid arthritis’ (CORRA) is to compare two standard glucocorticoid starting dosages and the non-use of glucocorticoids in the treatment of patients with early active rheumatoid arthritis on the background of the established ‘anchor’ therapy with methotrexate. Methods/design CORRA is an investigator-initiated, randomized, multicenter, double-blind, placebo-controlled trial with two treatment arms, starting with 60 mg or 10 mg prednisolone per day, tapered down to 5 mg prednisolone within eight weeks, and one placebo arm, each arm comprising 150 patients. The duration of the intervention is 12 weeks. In parallel, all patients will be treated with methotrexate (usual dosage 15 mg/week). The primary efficacy endpoint is the progression of radiographic joint damage after one year compared to baseline. Important secondary endpoints are the percentage of patients in remission, patient global assessment of disease activity, and changes of functional capacity. Safety monitoring is performed. The statistical analysis is performed in three hierarchical steps. The first step is an analysis of covariance (α = 0.05) to compare the group with the initial prednisolone dosage of 60 mg and the placebo group. In case of a statistically significant result, the comparison of the group starting with 10 mg prednisolone with the placebo group will be performed as a second step (α = 0.05). In case of superiority of the 10 mg prednisolone group versus the placebo group, the third step will be a non-inferiority test for the 10 mg prednisolone group versus the 60 mg prednisolone group (α = 0.025). Discussion The CORRA trial will yield information concerning the optimal glucocorticoid dosage schedule in the treatment of patients with early rheumatoid arthritis. Trial registration This trial was registered on 19 November 2013 at ClinicalTrials.gov. Registration number: NCT02000336.
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Affiliation(s)
| | - Dietmar Krause
- Department of Medical Informatics, Biometry & Epidemiology, Ruhr-Universität Bochum, Universitätsstraße 150, D-44801 Bochum, Germany.
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Wailoo A, Hernández Alava M, Scott IC, Ibrahim F, Scott DL. Cost-effectiveness of treatment strategies using combination disease-modifying anti-rheumatic drugs and glucocorticoids in early rheumatoid arthritis. Rheumatology (Oxford) 2014; 53:1773-7. [PMID: 24771112 DOI: 10.1093/rheumatology/keu039] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE The aim of this study was to estimate the cost-effectiveness of combination DMARDs with short-term glucocorticoids in early active RA using data from the 2-year Combination of Anti-Rheumatic Drugs in Early RA (CARDERA) trial. METHODS CARDERA enrolled 467 patients with active RA of <24-months duration. All patients received MTX; half received step-down prednisolone and half ciclosporin in a placebo-controlled factorial design. Differences in mean costs and quality-adjusted life-years (QALYs) over 24-months follow-up were estimated using patient-level data from a UK health service perspective and 2011-12 costs. RESULTS Two-year costs for each treatment strategy showed primary care costs were negligible across all groups. Drug costs were lowest with MTX/ciclosporin and triple therapy. Hospital costs were lowest with MTX/prednisolone and triple therapy. Triple therapy was least costly and most effective; it dominated all other strategies. At positive values for a QALY in the typical UK range (£20 000-30 000) the probability that triple therapy was the most cost-effective strategy was 0.9. Results were robust to methods used to impute missing data. CONCLUSION Intensive treatment of early RA with triple therapy (two DMARDs and short-term glucocorticoids) is both clinically effective and cost effective.
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Affiliation(s)
- Allan Wailoo
- School of Health and Related Research, University of Sheffield, Sheffield, Academic Department of Rheumatology, Centre for Molecular and Cellular Biology of Inflammation and Department of Rheumatology, King's College Hospital, London, UK.
| | - Mónica Hernández Alava
- School of Health and Related Research, University of Sheffield, Sheffield, Academic Department of Rheumatology, Centre for Molecular and Cellular Biology of Inflammation and Department of Rheumatology, King's College Hospital, London, UK
| | - Ian C Scott
- School of Health and Related Research, University of Sheffield, Sheffield, Academic Department of Rheumatology, Centre for Molecular and Cellular Biology of Inflammation and Department of Rheumatology, King's College Hospital, London, UK
| | - Fowzia Ibrahim
- School of Health and Related Research, University of Sheffield, Sheffield, Academic Department of Rheumatology, Centre for Molecular and Cellular Biology of Inflammation and Department of Rheumatology, King's College Hospital, London, UK
| | - David L Scott
- School of Health and Related Research, University of Sheffield, Sheffield, Academic Department of Rheumatology, Centre for Molecular and Cellular Biology of Inflammation and Department of Rheumatology, King's College Hospital, London, UK
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Lequerré T, Avenel G, Vittecoq O. [Therapeutic update in rheumatoid arthritis]. Rev Med Interne 2013; 34:754-62. [PMID: 24200099 DOI: 10.1016/j.revmed.2013.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 09/21/2013] [Indexed: 12/14/2022]
Abstract
The treatment of rheumatoid arthritis (RA) was revolutionized by the introduction of the biologics. Their power and their good safety profile have allowed to define new objectives and procedures to reach them; it is the "treat to target" concept. New recommendations were published by EULAR or ACR to obtain the remission as soon as possible. Disease-modifying antirheumatic drugs, in particular the methotrexate (MTX), remain the cornerstone of RA treatment in association with symptomatic treatments. The use of corticosteroids can be necessary to control the disease activity in the waiting time of the DMARDs efficiency or to control a flare. The absence of remission after 3months after initiation of MTX should prompt the rheumatologist to intensify the treatment with biologics. The increasing number of biologics targeting different mechanisms (5 anti-tumor necrosis factor-α, antagonist of interleukine-1 [IL-1] receptor, antagonist of IL-6 receptor, anti-CD20, anti-cytotoxic T-lymphocyte antigen 4) asks the question of the strategy in their prescription. Besides, all the registers or meta-analysis plead in favor of a good safety subject to a moderate prescription and to a greater vigilance. Except the opportunist infections, it is more the comorbidities or the associated treatments such as corticoids or MTX, which would favor the infections than anti-TNFα. There is no indication that biologics may increase the risk of solid cancer compared with a population of RA patients not exposed to anti-TNFα. However, biologics could increase the risk of cutaneous cancers, including melanoma.
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Affiliation(s)
- T Lequerré
- Inserm 905, institut de recherche et d'innovation biomédicales, service de rhumatologie, Pavillon la Colombière, hôpital de Bois-Guillaume, hôpitaux de Rouen, université de Rouen, CHU de Rouen, 76031 Rouen cedex, France.
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Xu Y, Zhan JM, Zheng YH, Han Y, Zhang ZG, Xi C. Computational synovial dynamics of a normal temporomandibular joint during jaw opening. J Formos Med Assoc 2013; 112:346-51. [DOI: 10.1016/j.jfma.2012.02.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2011] [Revised: 02/07/2012] [Accepted: 02/08/2012] [Indexed: 11/25/2022] Open
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Seymour MW, Kelly S, Beals CR, Malice MP, Bolognese JA, Dardzinski BJ, Cheng AS, Cummings CE, Smugar SS, McClinton C, Fox A, Dooley WM, Pitzalis C, Taylor PC. Ultrasound of metacarpophalangeal joints is a sensitive and reliable endpoint for drug therapies in rheumatoid arthritis: results of a randomized, two-center placebo-controlled study. Arthritis Res Ther 2012; 14:R198. [PMID: 22972032 PMCID: PMC3580508 DOI: 10.1186/ar4034] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Accepted: 09/12/2012] [Indexed: 11/10/2022] Open
Abstract
Introduction We aimed to investigate the sensitivity and reliability of two-dimensional ultrasonographic endpoints at the metacarpophalageal joints (MCPJs) and their potential to provide an early and objective indication of a therapeutic response to treatment intervention in rheumatoid arthritis (RA). Methods A randomized, double-blind, parallel-group, two-center, placebo-controlled trial investigated the effect on ultrasonographic measures of synovitis of repeat dose oral prednisone, 15mg or 7.5mg, each compared to placebo, in consecutive two-week studies; there were 18 subjects in a 1:1 ratio and 27 subjects in a 2:1 ratio, respectively. All subjects met the 1987 American College of Rheumatology criteria for the diagnosis of RA, were ≥18 years-old with RA disease duration ≥6 months, and had a Disease Activity Score 28 based on C-reactive protein (DAS28(CRP)) ≥3.2. Subjects underwent high-frequency (gray-scale) and power Doppler ultrasonography at Days 1 (baseline), 2, 8 and 15 in the dorsal transverse and longitudinal planes of all 10 MCPJs to obtain summated scores of quantitative and semi-quantitative measures of synovial thickness as well as vascularity. The primary endpoint was the summated score of power Doppler area measured quantitatively in all 10 MCPJs in the transverse plane at Day 15. Clinical efficacy was assessed at the same time points by DAS28(CRP). Results All randomized subjects completed the trial. The comparison between daily 15 mg prednisone and placebo at Day 15 yielded a statistically significant treatment effect (effect size = 1.17, P = 0.013) in change from baseline in the primary endpoint, but borderline for prednisone 7.5 mg daily versus placebo (effect size = 0.61, P = 0.071). A significant treatment effect for DAS28(CRP) was only observed at Day 15 in the prednisone 15 mg group (effect size = 0.95, P = 0.032). However, significant treatment effects at all time points for a variety of ultrasound (US) endpoints were detected with both prednisone doses; the largest observed effect size = 2.33. Combining US endpoints with DAS28(CRP) improved the registration of significant treatment effects. The parallel scan inter-reader reliability of summated 10 MCPJ scores were good to excellent (ICC values >0.61) for the majority of US measures. Conclusions Ultrasonography of MCPJs is an early, reliable indicator of therapeutic response in RA with potential to reduce patient numbers and length of trials designed to give preliminary indications of efficacy. Trial Registration Clinicaltrials.gov identifier: NCT00746512
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Ding CZ, Yao Y, Feng XB, Fang Y, Zhao C, Wang Y. Clinical analysis of chinese patients with rheumatoid arthritis treated with leflunomide and methotrexate combined with different dosages of glucocorticoid. CURRENT THERAPEUTIC RESEARCH 2012; 73:123-33. [PMID: 24653514 PMCID: PMC3954009 DOI: 10.1016/j.curtheres.2012.06.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/27/2012] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To analyze the safety of combined leflunomide (LEF), methotrexate (MTX), and glucocorticoid (GC) therapy, we investigated the adverse effects of such combination therapy in patients with early active rheumatoid arthritis (RA). METHODS Two hundred sixty-six patients with RA who were receiving LEF and MTX therapy were randomly assigned to 3 groups, as follows: group 1 received no GC, group 2 received 7.5 mg prednisone, and group 3 received 15 mg prednisone. Adverse effects were analyzed using the χ(2) test at week 4 or the Fisher exact test at week 12. RESULTS Patients in group 1 had a higher incidence of skin rash, oral ulcers, leukopenia, and liver damage than did those in groups 2 and 3 (all, P ≤ 0.05). However, the rates of osteoporosis, diabetes, hyperlipidemia, and hypertension in group 3 were statistically higher than in groups 1 and 2 (P ≤ 0.05). CONCLUSION In the treatment of RA, the incidence of skin rash, liver dysfunction, and oral ulcers may be decreased with combination therapy using LEF, MTX, and 7.5 mg prednisone, and blood pressure, blood glucose concentration, and bone density are not increased. Most important, 7.5 mg prednisone was synergistic with LEF and MTX, and such combination therapy could be a useful option as initial treatment of early active RA.
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Affiliation(s)
- Cong-zhu Ding
- Department of Rheumatology and Immunology, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yao Yao
- Department of Pharmacy, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Xue-bing Feng
- Department of Rheumatology and Immunology, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yun Fang
- Department of Pharmacy, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Cheng Zhao
- Department of Rheumatology and Immunology, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yue Wang
- The First Clinical Medical School, Nanjing University of Chinese Medicine, Nanjing, China
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Reply to the letter by Jean-Marie Berthelot. Joint Bone Spine 2012. [DOI: 10.1016/j.jbspin.2011.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Berthelot JM. Comments about the article by Mouterde et al. entitled "Indications of glucocorticoids in early arthritis and rheumatoid arthritis: Recommendations for clinical practice based on data from the literature and expert opinions". Joint Bone Spine 2010;77:597-603. Low-dose prednisone and biologics: allies rather than competitors? Joint Bone Spine 2011; 79:103-4; author reply 104-6. [PMID: 22056758 DOI: 10.1016/j.jbspin.2011.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2011] [Indexed: 11/15/2022]
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André V, le Goff B, Leux C, Pot-Vaucel M, Maugars Y, Berthelot JM. Information on glucocorticoid therapy in the main studies of biological agents. Joint Bone Spine 2011; 78:478-83. [DOI: 10.1016/j.jbspin.2011.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2010] [Indexed: 02/07/2023]
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18
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The use of conventional disease-modifying anti-rheumatic drugs in established RA. Best Pract Res Clin Rheumatol 2011; 25:523-33. [DOI: 10.1016/j.berh.2011.10.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Accepted: 10/11/2011] [Indexed: 12/20/2022]
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19
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Blanco-Morales EA, Bravo-Ferrer Acosta JM, Rubio Romero E, Gil González E, Gantes Pedraza MÁ. [Glucocorticoids in rheumatoid arthritis: almost always or hardly ever?]. ACTA ACUST UNITED AC 2011; 7:407-11. [PMID: 22078702 DOI: 10.1016/j.reuma.2011.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Revised: 01/09/2011] [Accepted: 01/19/2011] [Indexed: 12/28/2022]
Abstract
The use of glucocorticoids in rheumatoid arthritis has been the source of frequent debate in the last decades. There is evidence on its anti-inflammatory capacity and its power to decrease radiologic progression, particularly if used in recent onset rheumatoid arthritis. However, there are still some voices questioning its use. Their arguments are its potential side-effects, especially when the glucocorticoids are used in high doses and/or for extended periods of time. In this review, we will try to summarize the evidence regarding this issue, from the beginning of the discussion in the fifties to the last releases.
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Dernis E, Ruyssen-Witrand A, Mouterde G, Maillefert JF, Tebib J, Cantagrel A, Claudepierre P, Fautrel B, Gaudin P, Pham T, Schaeverbeke T, Wendling D, Saraux A, Loët XL. Use of glucocorticoids in rheumatoid arthritis - pratical modalities of glucocorticoid therapy: recommendations for clinical practice based on data from the literature and expert opinion. Joint Bone Spine 2010; 77:451-7. [PMID: 20471886 DOI: 10.1016/j.jbspin.2009.12.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2009] [Accepted: 12/10/2009] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To develop recommendations about the use of glucocorticoids in patients with established rheumatoid arthritis (RA) managed in everyday practice, using the evidence-based approach and expert opinion. METHODS A three-step procedure was used: a scientific committee used a Delphi procedure to select five questions, which formed the basis for developing the recommendations; a systematic literature review was conducted by searching the Medline and Embase databases and the abstracts of meetings held by the Société Française de Rhumatologie (SFR), American College of Rheumatology (ACR), and European League Against Rheumatism (EULAR); and recommendations were developed and validated by a panel of experts based on the data from the literature review and on their experience. For each recommendation, the level of evidence and extent of agreement among experts were determined. RESULTS The five questions pertained to the use of glucocorticoids in RA patients: role for intravenous glucocorticoid bolus therapy, role for intraarticular injections, and practical modalities of glucocorticoid administration and discontinuation. From the literature search, 93 articles were selected based on their titles and abstracts. Of these, 50 were selected for the literature review. Eight recommendations about the use of glucocorticoid therapy in everyday practice in patients with established RA were validated by a vote among all participating experts: bolus glucocorticoid therapy should be reserved for highly selected situations; triamcinolone hexacetonide is the preferred glucocorticoid for intraarticular therapy, and the joint should be rested for about 24h after the injection; for oral glucocorticoid therapy, agents with a short half-life taken once daily should be preferred; and when discontinuing glucocorticoid therapy, the patient and usual physician should be informed of the risk of adrenal insufficiency.
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Affiliation(s)
- Emmanuelle Dernis
- Service de rhumatologie, centre hospitalier Le Mans, 72037 Le Mans, France
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