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Wendling D, Al Tabaa O, Chevet B, Fakih O, Ghossan R, Hecquet S, Dernis E, Maheu E, Saraux A, Besson FL, Alegria GC, Cortet B, Fautrel B, Felten R, Morel J, Ottaviani S, Querellou-Lefranc S, Ramon A, Ruyssen-Witrand A, Seror R, Tournadre A, Foulquier N, Verlhac B, Verhoeven F, Devauchelle-Pensec V. Recommendations of the French Society of Rheumatology for the management in current practice of patients with polymyalgia rheumatica. Joint Bone Spine 2024; 91:105730. [PMID: 38583691 DOI: 10.1016/j.jbspin.2024.105730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVE To develop recommendations for the routine management of patients with polymyalgia rheumatica (PMR). METHODS Following standard procedures, a systematic review of the literature by five supervised junior rheumatologists, based on the questions selected by the steering committee (5 senior rheumatologists), was used as the basis for working meetings, followed by a one-day plenary meeting with the working group (15 members), leading to the development of the wording and determination of the strength of the recommendations and the level of agreement of the experts. RESULTS Five general principles and 19 recommendations were drawn up. Three recommendations relate to diagnosis and the use of imaging, and five to the assessment of the disease, its activity and comorbidities. Non-pharmacological therapies are the subject of one recommendation. Three recommendations concern initial treatment based on general corticosteroid therapy, five concern the reduction of corticosteroid therapy and follow-up, and two concern corticosteroid dependence and steroid-sparing treatments (anti-IL-6). CONCLUSION These recommendations take account of current data on PMR, with the aim of reducing exposure to corticosteroid therapy and its side effects in a fragile population. They are intended to be practical, to help practitioners in the day-to-day management of patients with PMR.
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Affiliation(s)
- Daniel Wendling
- Rhumatologie, CHU de Besançon et Université de Franche-Comté, boulevard Fleming, 25030 Besançon, France.
| | - Omar Al Tabaa
- Rhumatologie, Hôpital Cochin, AP-HP, Paris, France; Rhumatologie, Hôpital NOVO, Pontoise, France
| | - Baptiste Chevet
- Department of Rheumatology, CHU Brest, Université de Bretagne Occidentale (University Brest), INSERM (U1227), LabEx IGO, 29200 Brest, France
| | - Olivier Fakih
- Rhumatologie, CHU de Besançon et Université de Franche-Comté, boulevard Fleming, 25030 Besançon, France
| | - Roba Ghossan
- Rhumatologie, Hôpital Cochin, AP-HP, Paris, France
| | | | | | - Emmanuel Maheu
- Service de rhumatologie, Hôpital St Antoine, AP-HP, et cabinet médical, Paris, France
| | - Alain Saraux
- Department of Rheumatology, CHU Brest, Université de Bretagne Occidentale (University Brest), INSERM (U1227), LabEx IGO, 29200 Brest, France
| | - Florent L Besson
- Service de médecine nucléaire-imagerie moléculaire, Hôpitaux universitaires Paris-Saclay AP-HP, CHU Bicêtre, DMU SMART IMAGING, Le Kremlin-Bicêtre, France
| | | | - Bernard Cortet
- Service de rhumatologie, CHU de Lille, 59037 Lille, France
| | - Bruno Fautrel
- Service de rhumatologie, GH Pitié Salpêtrière, AP-HP.Sorbonne Université, INSERM UMRS 1136-5, Réseau de recherche clinique CRI-IMIDIATE, 75013 Paris, France
| | - Renaud Felten
- Service de rhumatologie et centre d'investigation clinique 1434, Hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - Jacques Morel
- Service de rhumatologie. CHU et Université de Montpellier, Montpellier, France
| | | | - Solène Querellou-Lefranc
- Nuclear Medicine department, University Hospital, Brest, France, University of Western Brittany (UBO), Brest, France, Inserm, University of Brest, CHRU Brest, UMR 1304, GETBO, Brest cedex, France
| | - André Ramon
- Service de rhumatologie, CHU Dijon Bourgogne, Dijon, France
| | - Adeline Ruyssen-Witrand
- Centre de rhumatologie, CHU de Toulouse, Centre d'Investigation Clinique de Toulouse CIC1436, Inserm, Team PEPSS « Pharmacologie En Population cohorteS et biobanqueS », Université Paul Sabatier Toulouse 3, Toulouse, France
| | - Raphaèle Seror
- Service de rhumatologie, CHU Kremlin-Bicetre, AP-HP, Paris, France
| | - Anne Tournadre
- Rhumatologie CHU Clermont-Ferrand, Université Clermont Auvergne INRAe, Clermont-Ferrand, France
| | - Nathan Foulquier
- LBAI, UMR1227, University of Brest, Inserm, CHU de Brest, Brest, France
| | | | - Frank Verhoeven
- Rhumatologie, CHU de Besançon et Université de Franche-Comté, boulevard Fleming, 25030 Besançon, France
| | - Valérie Devauchelle-Pensec
- Department of Rheumatology, CHU Brest, Université de Bretagne Occidentale (University Brest), INSERM (U1227), LabEx IGO, 29200 Brest, France.
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Goupille P, Vuitton L, Wendling D. Axial spondyloarthritis and inflammatory bowel disease: Therapeutic implications. Joint Bone Spine 2024; 91:105720. [PMID: 38479580 DOI: 10.1016/j.jbspin.2024.105720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 02/24/2024] [Accepted: 02/27/2024] [Indexed: 04/01/2024]
Affiliation(s)
- Philippe Goupille
- Rheumatology Department, CHU de Tours; UPR CNRS 4301 CBM, NMNS, University of Tours, Tours, France.
| | - Lucine Vuitton
- Gastroenterology Department, CHU de Besançon; UMR RIGHT Inserm, University of Franche-Comté, Besançon, France
| | - Daniel Wendling
- Rheumatology Department, CHU de Besançon, EA 4266, University of Franche-Comté, Besançon, France
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Wendling D, Goupille P, Verhoeven F, Prati C. Can we consider a pre-clinical state of axial spondyloarthritis? Joint Bone Spine 2024; 91:105722. [PMID: 38582360 DOI: 10.1016/j.jbspin.2024.105722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 03/20/2024] [Indexed: 04/08/2024]
Affiliation(s)
- Daniel Wendling
- Service de rhumatologie, université de Franche-Comté, CHU de Besançon, boulevard Fleming, 25030 Besançon, France.
| | - Philippe Goupille
- Service de rhumatologie, UPR CNRS 4301 CBM, NMNS, université de Tours, CHU de Tours, Tours, France
| | - Frank Verhoeven
- Service de rhumatologie, université de Franche-Comté, CHU de Besançon, boulevard Fleming, 25030 Besançon, France
| | - Clément Prati
- Service de rhumatologie, université de Franche-Comté, CHU de Besançon, boulevard Fleming, 25030 Besançon, France
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López-Medina C, Ramiro S, van Durme C, Ez-Zaitouni Z, Toukap AN, Arends S, Spoorenberg A, Fogel O, Moltó A. Translation and cross-cultural adaptation of the modified Short Questionnaire to Assess Health-enhancing physical activity (mSQUASH) into French language. Joint Bone Spine 2024; 91:105749. [PMID: 38866097 DOI: 10.1016/j.jbspin.2024.105749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 05/07/2024] [Accepted: 05/22/2024] [Indexed: 06/14/2024]
Affiliation(s)
- Clementina López-Medina
- Rheumatology Department, Reina-Sofia University Hospital, IMIBIC, University of Cordoba, Menendez-Pidal Avenue, 14001 Cordoba, Spain.
| | - Sofia Ramiro
- Rheumatology Department, Leiden University Medical Center, Leiden and Zuyderland Medical Center, Heerlen, The Netherlands
| | - Caroline van Durme
- Rheumatology Department, Maastricht University Medical Centre, Maastricht, The Netherlands; Service de médecine de l'appareil locomoteur, CHC Liege, Liege, Belgium
| | - Zineb Ez-Zaitouni
- Department of Clinical Immunology and Rheumatology, Amsterdam, The Netherlands
| | - Adrien Nzeusseu Toukap
- Rheumatology Department/IREC/UCLouvain, Saint-Luc University Hospitals, Brussels, Belgium
| | - Suzanne Arends
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Anneke Spoorenberg
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Olivier Fogel
- Service de rhumatologie, centre de recherche épidémiologie et biostatistique de Sorbonne Paris Cité, hôpital Cochin, AP-HP, Paris Cité University, 75014 Paris, France
| | - Anna Moltó
- Service de rhumatologie, centre de recherche épidémiologie et biostatistique de Sorbonne Paris Cité, hôpital Cochin, AP-HP, Paris Cité University, 75014 Paris, France
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Gossec L, Kerschbaumer A, Ferreira RJO, Aletaha D, Baraliakos X, Bertheussen H, Boehncke WH, Esbensen BA, McInnes IB, McGonagle D, Winthrop KL, Balanescu A, Balint PV, Burmester GR, Cañete JD, Claudepierre P, Eder L, Hetland ML, Iagnocco A, Kristensen LE, Lories R, Queiro R, Mauro D, Marzo-Ortega H, Mease PJ, Nash P, Wagenaar W, Savage L, Schett G, Shoop-Worrall SJW, Tanaka Y, Van den Bosch FE, van der Helm-van Mil A, Zabotti A, van der Heijde D, Smolen JS. EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2023 update. Ann Rheum Dis 2024; 83:706-719. [PMID: 38499325 PMCID: PMC11103320 DOI: 10.1136/ard-2024-225531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 02/26/2024] [Indexed: 03/20/2024]
Abstract
OBJECTIVE New modes of action and more data on the efficacy and safety of existing drugs in psoriatic arthritis (PsA) required an update of the EULAR 2019 recommendations for the pharmacological treatment of PsA. METHODS Following EULAR standardised operating procedures, the process included a systematic literature review and a consensus meeting of 36 international experts in April 2023. Levels of evidence and grades of recommendations were determined. RESULTS The updated recommendations comprise 7 overarching principles and 11 recommendations, and provide a treatment strategy for pharmacological therapies. Non-steroidal anti-inflammatory drugs should be used in monotherapy only for mild PsA and in the short term; oral glucocorticoids are not recommended. In patients with peripheral arthritis, rapid initiation of conventional synthetic disease-modifying antirheumatic drugs is recommended and methotrexate preferred. If the treatment target is not achieved with this strategy, a biological disease-modifying antirheumatic drug (bDMARD) should be initiated, without preference among modes of action. Relevant skin psoriasis should orient towards bDMARDs targeting interleukin (IL)-23p40, IL-23p19, IL-17A and IL-17A/F inhibitors. In case of predominant axial or entheseal disease, an algorithm is also proposed. Use of Janus kinase inhibitors is proposed primarily after bDMARD failure, taking relevant risk factors into account, or in case bDMARDs are not an appropriate choice. Inflammatory bowel disease and uveitis, if present, should influence drug choices, with monoclonal tumour necrosis factor inhibitors proposed. Drug switches and tapering in sustained remission are also addressed. CONCLUSION These updated recommendations integrate all currently available drugs in a practical and progressive approach, which will be helpful in the pharmacological management of PsA.
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Affiliation(s)
- Laure Gossec
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Universite, Paris, France
- APHP, Rheumatology Department, Hopital Universitaire Pitie Salpetriere, Paris, France
| | - Andreas Kerschbaumer
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Ricardo J O Ferreira
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Higher School of Nursing of Lisbon, Lisbon, Portugal
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Daniel Aletaha
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | | | | | | | - Bente Appel Esbensen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Iain B McInnes
- College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Dennis McGonagle
- LTHT, NIHR Leeds Biomedical Research Centre, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Kevin L Winthrop
- Division of Infectious Diseases, School of Medicine, School of Public Health, Oregon Health & Science University, Portland, Oregon, USA
| | - Andra Balanescu
- Sf Maria Hospital, University of Medicine and Pharmacy Carol Davila Bucharest, Bucharest, Romania
| | - Peter V Balint
- Medical Imaging Centre, Semmelweis University, 3rd Rheumatology Department, National Institute of Musculoskeletal Diseases, Budapest, Hungary
| | - Gerd R Burmester
- Department of Rheumatology and Clinical Immunology, Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Juan D Cañete
- Arthritis Unit, Department of Rheumatology, Hospital Clínic Barcelona, Barcelona, Spain
- FCRB, IDIBAPS, Barcelona, Spain
| | - Pascal Claudepierre
- Rheumatology, AP-HP, Henri Mondor University Hospital, Creteil, France
- EA Epiderme, UPEC, Creteil, France
| | - Lihi Eder
- Department of Medicine, University of Toronto, Women's College Hospital, Toronto, Toronto, Canada
| | - Merete Lund Hetland
- The Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet Glostrup, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Annamaria Iagnocco
- Academic Rheumatology Centre, Dipartimento Scienze Cliniche Biologiche, Università di Torino - AO Mauriziano Torino, Turin, Italy
| | - Lars Erik Kristensen
- The Parker Institute, Bispebjerg, Denmark
- Frederiksberg Hospital, Copenhagen University, Copenhagen, Denmark
| | - Rik Lories
- Laboratory of Tissue Homeostasis and Disease, Skeletal Biology and Engineering Research Center, KU Leuven, Leuven, Belgium
- Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium
| | - Rubén Queiro
- Rheumatology, Hospital Universitario Central de Asturias, Oviedo, Spain
- Translational Immunology Division, Biohealth Research Institute of the Principality of Asturias, Oviedo University School of Medicine, Oviedo, Spain
| | - Daniele Mauro
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Helena Marzo-Ortega
- LTHT, NIHR Leeds Biomedical Research Centre, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Philip J Mease
- Rheumatology Research, Providence Swedish, Seattle, Washington, USA
- University of Washington School of Medicine, Seattle, Washington, USA
| | - Peter Nash
- School of Medicine, Griffith University, Brisbane, Queensland, Australia
| | - Wendy Wagenaar
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
- Young PARE Patient Research Partner, EULAR, Zurich, Switzerland
| | - Laura Savage
- School of Medicine and Dermatology, Leeds Teaching Hospitals NHS Trust, University of Leeds, Leeds, UK
| | - Georg Schett
- Department of Internal Medicine 3, Rheumatology and Immunology and Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Stephanie J W Shoop-Worrall
- Children and Young Person's Rheumatology Research Programme, Centre for Musculoskeletal Research, The University of Manchester, Manchester, UK
| | - Yoshiya Tanaka
- First Department of Internal Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Filip E Van den Bosch
- Department of Internal Medicine and Pediatrics, VIB Center for Inflammation Research, Ghent University, Gent, Belgium
| | | | - Alen Zabotti
- Department of Medical and Biological Sciences, Azienda sanitaria universitaria Friuli Centrale, Udine, Italy
| | | | - Josef S Smolen
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
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Dougados M, Serrand C, Alonso S, Berenbaum F, Claudepierre P, Combe B, Gossec L, Ruyssen-Witrand A, Saraux A, Wendling D, Le Querré T, Molto A. Ten-year clinical outcome of recent-onset axial spondyloarthritis: Results from the DESIR inception Cohort. Joint Bone Spine 2024; 91:105678. [PMID: 38163581 DOI: 10.1016/j.jbspin.2023.105678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/01/2023] [Accepted: 12/11/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES This study aimed to evaluate the 10-year clinical outcome of patients with recent-onset axial spondyloarthritis (axSpA). METHODS STUDY DESIGN The DESIR cohort is an inception cohort of axSpA patients. METHODS DIAGNOSIS AND MANAGEMENT The diagnosis and management of patients were based on the decision of the treating rheumatologist. METHODS STATISTICAL ANALYSIS Both complete cases and imputed data analyses were conducted. RESULTS Of the 708 enrolled patients, 45 were excluded due to a change in the baseline diagnosis, 3 patients died, and 300 were lost to follow-up over the 10years. In the completer population, one patient required bilateral total hip replacement, and 56 patients received a pension due to invalidity. The prevalence of main extra-musculoskeletal features increased from baseline to year 10: psoriasis from 18% to 30%, acute anterior uveitis from 10% to 18%, and inflammatory bowel disease from 5% to 10%. The most frequent comorbidity was hypertension, with an increase from 5% to 15% from baseline to year 10. In the imputed data analysis the estimated proportions of patients with an acceptable status at year 10 were 70% [95% CI: 63; 77] for acceptable PASS, 43% [95% CI: 37; 49] for BASDAI<3, and 48% [95% CI: 41; 56] for ASDAS<2.1. CONCLUSION These findings suggest that despite a quite favorable 10-year outcome exists for severe outcomes, a large proportion of patients present with an important disease burden reflected by patient-reported outcomes. This information can be valuable for providing patients with information at the time of diagnosis.
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Affiliation(s)
- Maxime Dougados
- Inserm (U1153), Clinical Epidemiology and Biostatistics, Department of Rheumatology, Hôpital Cochin, Assistance publique-Hôpitaux de Paris, PRES Sorbonne Paris-Cité, University of Paris-Cité, Paris, France
| | - Chris Serrand
- Department of Biostatistics, Epidemiology, Public Health and Methodological Innovation, Nîmes University Hospital, Nîmes, France
| | - Sandrine Alonso
- Department of Biostatistics, Epidemiology, Public Health and Methodological Innovation, Nîmes University Hospital, Nîmes, France
| | - Francis Berenbaum
- Inserm, AP-HP Saint-Antoine Hospital, Sorbonne University, Paris, France
| | - Pascal Claudepierre
- EA 7379-EpiDermE, Service de rhumatologie, AP-HP, Hôpital Henri-Mondor, Université Paris Est Créteil, Paris, France
| | | | - Laure Gossec
- Rheumatology Department, Inserm, Institut Pierre-Louis d'épidémiologie et de santé publique, AP-HP, Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
| | - Adeline Ruyssen-Witrand
- Department of Rheumatology, Toulouse University Hospital, Centre d'investigation clinique de Toulouse CIC1436, Inserm, Paul-Sabatier University Toulouse III, Toulouse, France
| | - Alain Saraux
- Inserm, UMR1227, LabEx IGO, Department of Rheumatology, CHU Brest, Université de Bretagne Occidentale (UBO), Brest, France
| | - Daniel Wendling
- EA4266 EPILAB, Department of Rheumatology, CHU (University Hospital) Besançon, Université de Franche-Comté, Besançon, France
| | - Thierry Le Querré
- Inserm (U1234), Institut de Recherche et d'Innovations Biomédicales, CIC/CRB 1404, Department of Rheumatology, Rouen University, Rouen, France
| | - Anna Molto
- Inserm (U1153), Clinical Epidemiology and Biostatistics, Department of Rheumatology, Hôpital Cochin, Assistance publique-Hôpitaux de Paris, PRES Sorbonne Paris-Cité, University of Paris-Cité, Paris, France.
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Séauve M, Auréal M, Laplane S, Lega JC, Cabrera N, Coury F. Risk of infections in psoriatic arthritis or axial spondyloarthritis patients treated with targeted therapies: A meta-analysis of randomized controlled trials. Joint Bone Spine 2024; 91:105673. [PMID: 38042364 DOI: 10.1016/j.jbspin.2023.105673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 11/01/2023] [Accepted: 11/14/2023] [Indexed: 12/04/2023]
Abstract
OBJECTIVE To evaluate the risk of global infections in patients with psoriatic arthritis (PsA) and axial spondyloarthritis encompassing ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nr-axSpA) treated with targeted therapies. METHODS Medline and Cochrane databases were systematically searched up to March 2021 for randomized controlled trials (RCTs) performed in patients with PsA or axial spondyloarthritis treated with biologic or targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs). Global infections (any infections reported, including bacterial, viral and fungal infections, except serious infections) were the primary outcome. Secondary outcomes included serious infections defined as life-threatening infections or any infection requiring intravenous antibiotics or hospitalization. The relative risk of infections was determined by meta-analysis of RCTs. RESULTS A total of 60 RCTs were included (20,418 patients), encompassing 17 b/tsDMARDs, compared with placebo, conventional synthetic drugs (csDMARDs) or non-steroidal anti-inflammatory drugs (NSAIDs). An increased risk of any infection for patients exposed to these drugs was found (RR 1.15, 95% CI [1.06-1.25]), mainly with high doses and longer duration of treatment. Most infections were respiratory tract or ear, nose, and throat (ENT) infections. Subgroup analyses showed a statistically significant increased risk of infections for axial spondyloarthritis patients (RR 1.32, 95% CI [1.14-1.52]), but not for PsA patients (RR 1.05, 95% CI [0.97-1.14]). Infection risk was highest with TNF inhibitors (RR 1.23, 95% CI [1.11-1.37]) and IL-17 inhibitors (RR 1.30, 95% CI [1.07-1.59]). No increased risk of serious infections was shown. CONCLUSION In contrast to serious infections, the risk of global infections is moderately increased with b/tsDMARDs in spondyloarthritis, and is associated in particular with use of TNF and IL-17 inhibitors.
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Affiliation(s)
- Milène Séauve
- University of Lyon, University Lyon 1, 69100 Lyon, France; Department of Rheumatology, Lyon Sud Hospital, Hospices Civils de Lyon, 69495 Pierre-Bénite, France
| | - Mélanie Auréal
- University of Lyon, University Lyon 1, 69100 Lyon, France; Department of Rheumatology, Lyon Sud Hospital, Hospices Civils de Lyon, 69495 Pierre-Bénite, France
| | - Soline Laplane
- University of Lyon, University Lyon 1, 69100 Lyon, France; Department of Rheumatology, Lyon Sud Hospital, Hospices Civils de Lyon, 69495 Pierre-Bénite, France
| | - Jean-Christophe Lega
- University of Lyon, University Lyon 1, 69100 Lyon, France; Department of Internal and Vascular Medicine, Lyon Sud Hospital, Hospices Civils de Lyon, Pierre-Bénite, France; University of Lyon, UMR - CNRS 5558, Laboratoire de Biométrie et Biologie Évolutive, 69100 Lyon, France; Lyon Immunopathology Federation, Lyon, France
| | - Natalia Cabrera
- University of Lyon, UMR - CNRS 5558, Laboratoire de Biométrie et Biologie Évolutive, 69100 Lyon, France
| | - Fabienne Coury
- University of Lyon, University Lyon 1, 69100 Lyon, France; Department of Rheumatology, Lyon Sud Hospital, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; Lyon Immunopathology Federation, Lyon, France; University of Lyon, Inserm UMR 1033, 69100 Lyon, France.
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Goupille P, Wendling D. Initial C-reactive protein level: Discriminating between anti-TNF and anti-IL-17 agents as the first biologic treatment for axial spondyloarthritis? Joint Bone Spine 2024; 91:105662. [PMID: 37977524 DOI: 10.1016/j.jbspin.2023.105662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/22/2023] [Accepted: 11/07/2023] [Indexed: 11/19/2023]
Affiliation(s)
- Philippe Goupille
- Rheumatology Department, Trousseau Hospital, CHU de Tours, EA 6295, University of Tours, avenue du la République, 37044 Tours cedex 9, France.
| | - Daniel Wendling
- Rheumatology Department, CHU de Besançon, EA 4266, University of Franche-Comté, Besançon, France
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Lee S, Kang S, Kim H, Lee J, Kim MJ, Cha HS. Sex-specific disparities in disease activity scores among patients with axial spondyloarthritis and their implications for evaluating the response to tumor necrosis factor alpha inhibitor therapy. Arthritis Res Ther 2024; 26:90. [PMID: 38664785 PMCID: PMC11044537 DOI: 10.1186/s13075-024-03320-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 04/04/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND We aimed to investigate whether there are sex differences in disease activity measures among patients with axial spondyloarthritis (axSpA) and to determine any potential impact on the assessment of treatment responses to tumor necrosis factor alpha inhibitors (TNFi). METHODS Using the Korean College of Rheumatology Biologics and Targeted Therapy (KOBIO) registry data, we compared sex differences in changes in the Bath Ankylosing Spondylitis Disease Activity Score (BASDAI) and Ankylosing Spondylitis Disease Activity Score (ASDAS) levels at baseline and one year after TNFi initiation in patients with axSpA. RESULTS This study included 1,753 patients with axSpA who started or changed TNFi, of whom 1,343 (76.6%) were male. At baseline, the mean BASDAI and ASDAS scores of all patients were 5.98 and 3.6, respectively. The BASDAI changes between baseline and the one-year follow-up were independently associated with sex (𝛽 = 0.343, p = 0.011), whereas ASDAS was not (𝛽 = 0.079, p = 0.235). When judging the effect of TNFi at one-year of treatment, male patients were more likely to be assessed as effective by the BASDAI-based criterion (ΔBASDAI ≥ 50% or ≥ 2; OR 1.700, 95% CI 1.200-2.406), while the ASDAS-based criterion (ΔASDAS ≥ 1.1) showed no significant difference between sexes (OR 0.993, 95% CI 0.678-1.455), after adjusting for other baseline characteristics. CONCLUSIONS The changes in disease activity before and after TNFi use were significantly different between sexes when measured by BASDAI, but not ASDAS. TNFi treatment effects may be interpreted differently between sexes depending on the disease activity measure used.
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Affiliation(s)
- Seulkee Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Seonyoung Kang
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Hyungjin Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Jaejoon Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Min-Ji Kim
- Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Hoon-Suk Cha
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
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10
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Ruyssen-Witrand A, Caillet-Portillo D, Najm A, Fogel O, Baillet A, Claudepierre P, Conort O, Dernis E, Fayet F, Gossec L, Goupille P, Hudry C, Letarouilly JG, Lukas C, Marotte H, Molto A, Pouplin S, Senbel E, Sordet C, Tournadre A, Truchetet ME, Wendling D, Dougados M. Standardized reporting for systematic global evaluation of axial spondyloarthritis: An evidence-based and consensus-driven initiative. Joint Bone Spine 2024; 91:105733. [PMID: 38604594 DOI: 10.1016/j.jbspin.2024.105733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/22/2024] [Accepted: 03/26/2024] [Indexed: 04/13/2024]
Abstract
INTRODUCTION National and international scientific societies advocate for a regular, systematic, and standardized global evaluation of axial spondyloarthritis (axSpA) patients. However, there are no recommendations specifying the content of this global evaluation. This initiative aimed to propose a standardized reporting framework, using evidence-based and consensus approaches, to collect data on all domains of axSpA. METHODS A literature review and consensus process involved a steering committee and an expert panel of 37 rheumatologists and health professionals. The first steering committee took place in March 2022 and identified the main domains for inclusion in the standardized report. A hierarchical literature review was conducted to identify items within these domains and tools for assessment. The items and tools for assessment were discussed and consensus was reached through a vote session during an expert meeting that took place in March 2023. RESULTS The steering committee identified four main domains to include in the standardized reporting framework: disease assessment, comorbidities, lifestyle, and quality of life. Items and tools for assessment were adopted after the expert meeting. Additionally, recommendations regarding digital tools (websites, apps, social media) were provided. CONCLUSION This initiative led to a consensus, based on evidence and expertise, on a reporting framework for use during periodic systematic global evaluations of axSpa in daily practice.
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Affiliation(s)
- Adeline Ruyssen-Witrand
- Rheumatology Centre, Toulouse University Hospital, Centre d'Investigation Clinique de Toulouse (CIC1436), Inserm, Team PEPSS "Pharmacologie En Population cohorteS et biobanqueS", University of Toulouse 3, Toulouse, France.
| | - Damien Caillet-Portillo
- Rheumatology Centre, Toulouse University Hospital, University of Toulouse 3, Toulouse, France
| | - Aurélie Najm
- Institute of Infection and Immunity, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Olivier Fogel
- Department of Rheumatology, Hôpital Cochin, Assistance publique-Hôpitaux de Paris, Paris, France
| | - Athan Baillet
- Université Grenoble-Alpes, TIMC, CNRS UMR5525, Grenoble, France
| | - Pascal Claudepierre
- AP-HP, Service de Rhumatologie, Hôpital Henri-Mondor, Université Paris Est Créteil, EA 7379, EpiDermE, Paris, France
| | - Orenella Conort
- Department Clinical Pharmacy, Hôpital Cochin, Assistance publique-Hôpitaux de Paris, Paris, France
| | - Emmanuelle Dernis
- Department of Rheumatology and Clinical Immunology, General hospital Le Mans, Le Mans, France
| | - Françoise Fayet
- Rheumatology Centre, Clermont University Hospital, Clermont-Ferrand, France
| | - Laure Gossec
- Sorbonne Université, Inserm, Institut Pierre-Louis d'Épidémiologie et de Santé Publique, AP-HP, Pitié-Salpêtrière Hospital, Rheumatology Department, Paris, France
| | - Philippe Goupille
- Université de Tours, EA 6295, Department of Rheumatology, University Hospital of Tours, Tours, France
| | | | | | - Cédric Lukas
- Department of Rheumatology, University Hospital of Montpellier, Inserm UA11 (IDESP), University of Montpellier, Montpellier, France
| | - Hubert Marotte
- Université Jean-Monnet Saint-Étienne, CHU de Saint-Étienne, Service de Rhumatologie, Mines Saint-Étienne, Inserm, SAINBIOSE U1059, 42023 Saint-Étienne, France
| | - Anna Molto
- ECAMO team (Inserm U1153), Center of Research in Epidemiology and Statistics (CRESS), Université Paris-Cité, Paris, France
| | - Sophie Pouplin
- Rheumatology Centre, Rouen University Hospital, Rouen, France
| | - Eric Senbel
- Centre de Rhumatologie de l'Eldorado, Marseille, France
| | - Christelle Sordet
- Rheumatology Center, Strasbourg University Hospital, University of Strasbourg, Strasbourg, France
| | - Anne Tournadre
- Rheumatology Centre, Clermont University Hospital, UNH INRAe University Clermont Auvergne, Clermont-Ferrand, France
| | - Marie-Elise Truchetet
- Department of Rheumatology, Hôpital Pellegrin, Bordeaux, France; Bordeaux University, CNRS, ImmunoConcept, UMR 5164, 33000 Bordeaux, France
| | - Daniel Wendling
- Rheumatology Centre, CHU de Besançon, University Hospital, EA4266, Université de Franche-Comté, Besançon, France
| | - Maxime Dougados
- University of Paris-Cité, Department of Rheumatology, Hôpital Cochin, Assistance publique-Hôpitaux de Paris, Inserm (U1153): Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité, Paris, France.
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11
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Portier E, Chevret S, Walter-Petrich A, Ruyssen-Witrand A, Dougados M, Moltó A. Factors Associated With Treatment Pathways in Early Axial Spondyloarthritis: A Multistate Analysis of the 10-Year Follow-Up of the DESIR Cohort. J Rheumatol 2024; 51:368-377. [PMID: 38359943 DOI: 10.3899/jrheum.2023-0933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 02/17/2024]
Abstract
OBJECTIVE Current recommendations for the management of patients with axial spondyloarthritis (axSpA) emphasize the need of an individualized strategy in therapeutic decision-making. The study objectives were to describe therapeutic strategies observed in axSpA, and to assess the factors associated with treatment intensification over time. METHODS We included patients with axSpA from the French prospective cohort DESIR (Devenir des Spondylarthropathies Indifférenciées Récentes), with a scheduled 10-year follow-up. A multistate model with 4 ordered treatment states (no treatment, nonsteroidal antiinflammatory drugs [NSAIDs], conventional synthetic disease-modifying antirheumatic drugs [csDMARDs], and tumor necrosis factor inhibitors [TNFi]) was defined, with 6 possible transitions. Restricted mean sojourn times in each state were estimated. Then, predictors of those transitions were assessed by multivariable Cox models. RESULTS A total of 686/708 (96.9%) patients who had > 1 visit were analyzed. At cohort entry, 199 (29%) were untreated, 427 (62.2%) were receiving NSAIDs, 60 (8.7%) csDMARDs, and none were receiving TNFi. Over the follow-up period, patients mostly (46.4% of the time) received NSAIDs, followed by TNFi (24.4% of the time). The presence of sacroiliitis on radiographs, inflammatory bowel disease, and articular index were jointly associated with the transition to NSAIDs. Longer duration in the previous state often decreased the hazard of the transition to csDMARDs or TNFi. Worse disease activity outcomes increased the hazard of most transitions. CONCLUSION To our knowledge, this was the first study using a multistate model to easily represent different treatment states, detailing the transitions across them and their associated factors. Different time profiles for the management of patients with axSpA were identified, including in those abstaining from treatment up to a significant proportion of patients treated with csDMARDs.
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Affiliation(s)
- Elodie Portier
- E. Portier, MD, M. Dougados, MD, A. Moltó, MD, PhD, Rheumatology Department, Cochin Hospital, AP-HP, and ECAMO, INSERM U-1153: Clinical Epidemiology and Biostatistics, University Paris Cité, Paris
| | - Sylvie Chevret
- S. Chevret, MD, PhD, A. Walter-Petrich, PhD, Biostatistic Departement, Saint-Louis Hospital, AP-HP, University Paris Cité, Paris
| | - Anouk Walter-Petrich
- S. Chevret, MD, PhD, A. Walter-Petrich, PhD, Biostatistic Departement, Saint-Louis Hospital, AP-HP, University Paris Cité, Paris
| | - Adeline Ruyssen-Witrand
- A. Ruyssen-Witrand, MD, PhD, Rheumatology Department, CHU Toulouse, and CIC 1436 Inserm, University of Paul Sabatier Toulouse III, Toulouse, France
| | - Maxime Dougados
- E. Portier, MD, M. Dougados, MD, A. Moltó, MD, PhD, Rheumatology Department, Cochin Hospital, AP-HP, and ECAMO, INSERM U-1153: Clinical Epidemiology and Biostatistics, University Paris Cité, Paris
| | - Anna Moltó
- E. Portier, MD, M. Dougados, MD, A. Moltó, MD, PhD, Rheumatology Department, Cochin Hospital, AP-HP, and ECAMO, INSERM U-1153: Clinical Epidemiology and Biostatistics, University Paris Cité, Paris;
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12
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Bastard L, Claudepierre P, Penso L, Sbidian E, Pina Vegas L. Risk of serious infection associated with different classes of targeted therapies used in psoriatic arthritis: a nationwide cohort study from the French Health Insurance Database (SNDS). RMD Open 2024; 10:e003865. [PMID: 38485454 PMCID: PMC10941117 DOI: 10.1136/rmdopen-2023-003865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 02/20/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVE To assess the risk of serious infection associated with different targeted therapies for psoriatic arthritis (PsA) in real-world settings. METHODS This nationwide cohort study used the administrative healthcare database of the French health insurance scheme linked to the hospital discharge database to identify all adults with PsA who were new users of targeted therapies (adalimumab, etanercept, golimumab, certolizumab pegol, infliximab, secukinumab, ixekizumab, ustekinumab, and tofacitinib) from 1 January 2015 to 30 June 2021. The primary outcome was a serious infection (ie, requiring hospitalisation), in a time-to-event analysis using propensity score-weighted Cox models, with adalimumab as the comparator, estimating weighted HRs (wHRs) and their 95% CIs. RESULTS A total of 12 071 patients were included (mean age 48.7±12.7 years; 6965 (57.7%) women). We identified 367 serious infections (3.0% of patients), with a crude incidence rate of 17.0 per 1000 person-years (95% CI, 15.2 to 18.7). After inverse propensity score weighting and adjustment for time-dependent covariates and calendar year, risk of serious infection was significantly lower for new users of etanercept (wHR 0.72; 95% CI, 0.53 to 0.97) or ustekinumab (wHR, 0.57; 95% CI, 0.35 to 0.93) than adalimumab new users. This risk was not statistically modified with the other targeted therapies. CONCLUSIONS The incidence of serious infection was low for PsA patients who were new users of targeted therapies in real-world settings. Relative to adalimumab new users, this risk was lower among new users of etanercept and ustekinumab and unmodified for the other molecules.
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Affiliation(s)
- Léa Bastard
- Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE), University Paris-Est Créteil Val de Marne, Créteil, France
- Rheumatology, Hospital Henri Mondor, Créteil, France
| | - Pascal Claudepierre
- Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE), University Paris-Est Créteil Val de Marne, Créteil, France
- Rheumatology, Hospital Henri Mondor, Créteil, France
| | - Laetitia Penso
- Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE), University Paris-Est Créteil Val de Marne, Créteil, France
| | - Emilie Sbidian
- Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE), University Paris-Est Créteil Val de Marne, Créteil, France
- Dermatology, Hospital Henri Mondor, Créteil, France
- Clinical Investigation Center 1430, INSERM, Créteil, France
| | - Laura Pina Vegas
- Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE), University Paris-Est Créteil Val de Marne, Créteil, France
- Rheumatology, Hospital Henri Mondor, Créteil, France
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13
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Philippoteaux C, Delepine T, Cailliau E, Philippe P, Taisne N, Pascart T, Cortet B, Paccou J, Flipo RM, Letarouilly JG. Characteristics of difficult-to-treat axial spondyloarthritis: Results of a real-world multicentric study. Joint Bone Spine 2024; 91:105670. [PMID: 38036061 DOI: 10.1016/j.jbspin.2023.105670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/15/2023] [Accepted: 11/08/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVE The EULAR task force recently published the difficult-to-treat RA (D2T RA) definition, however, a definition of D2T axSpA is still lacking and limitations in this definition exist. The objectives were to study the characteristics of D2T axSpA patients using the EULAR definition and to study a subgroup of patients with a predefined more stringent definition including a temporal criterion. METHODS A multicentric retrospective study was performed. D2T axSpA was defined as failure of≥2 b/tsDMARDs with different mechanism of action. Very D2T axSpA was defined as failure of≥2 b/tsDMARDs in less than 2 years of follow-up. D2T and Very D2T axSpA patients were compared to non-D2T (nD2T) axSpA patients. RESULTS Three hundred and eleven axSpA patients were included: 88 D2T axSpA (28.3%) and 223 non-D2T (nD2T) axSpA (71.7%). Peripheral involvement was more prevalent in the D2T group (34.9 vs. 21.4%; P=0.015). BASDAI level at baseline was higher in the D2T group (63.7±16.5 vs. 58.8±14.7; P=0.015). Fibromyalgia was found to be more frequent in the D2T group vs nD2T group (P<0.001). Twelve patients (3.8%) were categorized as very D2T axSpA. Compared to nD2T, Very D2T patients had a higher CRP level at baseline (42.0±31.3 vs. 17.8±23.1; P=0.010). IBD prevalence at baseline was higher in the very D2T group (41.7 vs. 3.1%; P<0.001). None of the very D2T patients presented a fibromyalgia. CONCLUSION D2T axSpA was associated with higher disease activity, peripheral involvement, extra-musculoskeletal manifestations and fibromyalgia. Very D2T patients represented a minim proportion of patients after applying a more stringent definition including a temporal criterion of 2 years and might be independent from fibromyalgia.
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Affiliation(s)
| | - Thibaut Delepine
- Rheumatology Department, Valenciennes Hospital, Valenciennes, France
| | - Emeline Cailliau
- Biostatistics Department, Lille University Hospital, Lille, France
| | - Peggy Philippe
- Rheumatology Department, Lille University Hospital, Lille, France
| | - Nicolas Taisne
- Rheumatology Department, Valenciennes Hospital, Valenciennes, France
| | - Tristan Pascart
- Rheumatology Department, Saint-Philibert Catholic University Hospital, Lomme, France
| | - Bernard Cortet
- Rheumatology Department, Lille University Hospital, Lille, France
| | - Julien Paccou
- Rheumatology Department, Lille University Hospital, Lille, France
| | - René-Marc Flipo
- Rheumatology Department, Lille University Hospital, Lille, France
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14
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Hansmaennel A, Fakih O, Gerazime A, Prati C, Chouk M, Wendling D, Verhoeven F. Effects of disease-modifying anti-rheumatic drugs on sacroiliac MRI score in axial spondyloarthritis: a systematic review and meta-analysis. Clin Rheumatol 2024; 43:1045-1052. [PMID: 38158505 DOI: 10.1007/s10067-023-06849-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 12/12/2023] [Accepted: 12/16/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Sacroiliac bone marrow edema is an important factor in the diagnosis and management of axial spondyloarthritis (axSpA). The aim of this meta-analysis is to assess the effect of the different bDMARDs and tsDMARDs on the SPARCC score at 12-16 and 48-52 weeks. METHODS A systematic review, performed on PubMed (including Medline), Cochrane (CENTRAL) and DOAJ databases, included randomized controlled studies evaluating the sacroiliac joint (SIJ) SPARCC score at 12-16 or 48-52 weeks in patients with axSpA meeting the ASAS 2009 criteria or the modified New York criteria. We included studies evaluating the effects of the different treatments on the SPARCC score of SIJ in axial spondyloarthritis in comparison to a control group. RESULTS Eighteen studies were included in the meta-analysis. Nine studies evaluated the effect of TNFα inhibitors (TNFi), three for IL-17 inhibitors, and four for JAK inhibitors. At 12 and 16 weeks, SIJ SPARCC score was significantly improved by TNFi (WMD: - 3.29 [95% CI - 4.25; - 2, 34]), by IL-17 inhibitors (WMD: - 4.66 [95% CI - 6.22; - 3.09]), and by JAK inhibitors (JAKi) (WMD: - 3.06 [95% CI - 3.24; - 2.89]). There was no difference between the molecule subgroups. At 48-52 weeks, TNFα inhibitors reduced more SIJ SPARCC, but not significantly (WMD: - 2.26 [95% CI - 4.94; 0.42]), than placebo groups who began a TNFi treatment with delay. CONCLUSION Our meta-analysis shows a comparable improvement of the SIJ SPARCC score regarding TNFi, JAKi, and IL-17 inhibitors at three months and suggests the presence of an opportunity window. Key Points • Anti-TNF Ab, anti-IL17 Ab, and JAK inhibitor treatments reduce the sacroiliac joint SPARCC scores. • There is no difference between the different treatments in the reduction of the sacroiliac joint SPARCC score after 3 months in axial spondyloarthritis.
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Affiliation(s)
| | - Olivier Fakih
- Service de Rhumatologie, CHU de Besançon, Besançon, France
| | - Aurélie Gerazime
- Unité de méthodologie clinique, CHU de Besançon, Besançon, France
| | - Clément Prati
- Service de Rhumatologie, CHU de Besançon, Besançon, France
- EA 4267 "PEPITE", Université de Bourgogne Franche Comté, Besançon, France
| | - Mickaël Chouk
- Service de Rhumatologie, CHU de Besançon, Besançon, France
| | - Daniel Wendling
- Service de Rhumatologie, CHU de Besançon, Besançon, France
- EA 4266 "EPILAB", Université de Bourgogne Franche-Comté, Besançon, France
| | - Frank Verhoeven
- Service de Rhumatologie, CHU de Besançon, Besançon, France.
- EA 4267 "PEPITE", Université de Bourgogne Franche Comté, Besançon, France.
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15
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Dougados M, Lardy-Cléaud A, Desfleurs E, Claudepierre P, Goupille P, Ryussen-Witrand A, Saraux A, Tournadre A, Wendling D, Lukas C. Impact of the time of initiation and line of biologic therapy on the retention rate of secukinumab in axial spondyloarthritis (axSpA): data from the French multicentre retrospective FORSYA study. RMD Open 2024; 10:e003942. [PMID: 38428974 PMCID: PMC10910420 DOI: 10.1136/rmdopen-2023-003942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 02/05/2024] [Indexed: 03/03/2024] Open
Abstract
OBJECTIVE To compare the 1-year retention rate of secukinumab in axial spondyloarthritis (axSpA) and its predisposing factors with regard to its time of initiation (eg, right after or remotely from its launch). METHODS Study design: Retrospective multicentre French study of patients with axSpA. Study periods: Two cohorts were evaluated regarding the time of initiation of secukinumab: cohort 1 (C1)-between 16 August 2016 and 31 August 2018-and cohort 2 (C2)-between 1 September 2018 and 13 November 2020. STATISTICAL ANALYSIS The 1-year retention rate of secukinumab was estimated using the Kaplan-Meier method, and the log-rank test was used to compare the retention curves of the two cohorts. Preselected factors (eg, disease characterristics, line and time of secukinumab initiation) of secukinumab retention at 1 year were analysed by univariate and multivariate Cox model regression. RESULTS In total, 906 patients in C1 and 758 in C2 from 50 centres were included in the analysis. The 1-year retention rate was better in C2 (64% (61%-68%)) vs C1 (59% (55%-62%)) (HR=1.19 (1.02-1.39); p=0.0297). In the multivariate analysis, the line of biologic therapy was the single predictive factor of the 1-year retention rate of secukinumab picked up in both cohorts, with a better retention rate when prescribed as first-line biologic therapy. CONCLUSION The better secukinumab retention rate remotely from its launch is explained by its use at an earlier stage of the disease, suggesting a change in the behaviour of prescribing physicians. Our results emphasise the relevance of iterative evaluations of routine care treatments.
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Affiliation(s)
- Maxime Dougados
- Hopital Cochin, Rheumatology, Université Paris Descartes Faculté de Médecine, Paris, France
| | | | | | - Pascal Claudepierre
- Rheumatology, Hôpital Henri Mondor, Créteil, France
- EA EpidermE, Université Paris Est Créteil, Créteil, France
| | | | - Adeline Ryussen-Witrand
- Rheumatology, CHU Purpan, Toulouse, France
- UMR1027, INSERM/UPS Toulouse III, Toulouse, France
| | - Alain Saraux
- Université de Bretagne Occidentale (Univ Brest), Brest, France
| | - Anne Tournadre
- Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Cédric Lukas
- Rheumatology, University Hospital Lapeyronie, Montpellier, France
- EA2415, Montpellier University, Montpellier, France
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16
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Lioté F, Constantin A, Dahan É, Quiniou JB, Frazier A, Sibilia J. A prospective survey on therapeutic inertia in psoriatic arthritis (OPTI'PsA). Rheumatology (Oxford) 2024; 63:516-524. [PMID: 37261843 PMCID: PMC10836978 DOI: 10.1093/rheumatology/kead262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 04/27/2023] [Accepted: 05/19/2023] [Indexed: 06/02/2023] Open
Abstract
OBJECTIVES Clinical inertia, or therapeutic inertia (TI), is the medical behaviour of not initiating or intensifying treatment when recommended by clinical recommendations. To our knowledge, our survey is the first to assess TI around psoriatic arthritis (PsA). METHODS Eight hundred and twenty-five French rheumatologists were contacted via email between January and March 2021 and invited to complete an online questionnaire consisting of seven clinical vignettes: five cases ('oligoarthritis', 'enthesitis', 'polyarthritis', 'neoplastic history', 'cardiovascular risk') requiring treatment OPTImization, and two 'control' cases (distal interphalangeal arthritis, atypical axial involvement) not requiring any change of treatment-according to the most recent PsA recommendations. Rheumatologists were also questioned about their routine practice, continuing medical education and perception of PsA. RESULTS One hundred and one rheumatologists completed this OPTI'PsA survey. Almost half the respondents (47%) demonstrated TI on at least one of the five vignettes that warranted treatment optimization. The complex profiles inducing the most TI were 'oligoarthritis' and 'enthesitis' with 20% and 19% of respondents not modifying treatment, respectively. Conversely, clinical profiles for which there was the least uncertainty ('polyarthritis in relapse', 'neoplastic history' and 'cardiovascular risk') generated less TI with 11%, 8% and 6% of respondents, respectively, choosing not to change the current treatment. CONCLUSION The rate of TI we observed for PsA is similar to published data for other chronic diseases such as diabetes, hypertension, gout or multiple sclerosis. Our study is the first to show marked clinical inertia in PsA, and further research is warranted to ascertain the reasons behind this inertia.
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Affiliation(s)
- Frédéric Lioté
- Université Paris Cité, UFR de Médecine, Paris, France
- Rheumatology Department & INSERM U1132 Bioscar, Viggo Petersen Centre, Lariboisière Hospital, Paris, France
| | - Arnaud Constantin
- Rheumatology Department, Pierre-Paul Riquet Hospital, Toulouse, France
- Université Toulouse III—Paul Sabatier & INSERM, 1291 Infinity, Toulouse, France
| | - Étienne Dahan
- Rheumatology Department, UF 6501, Hautepierre Hospital, CHU Strasbourg, France
| | | | - Aline Frazier
- Rheumatology Department & INSERM U1132 Bioscar, Viggo Petersen Centre, Lariboisière Hospital, Paris, France
| | - Jean Sibilia
- Rheumatology Department, National Reference Centre for Rare Systemic Auto-immune Diseases East-South-West (RESO), CHU Strasbourg, France
- Molecular Immuno-Rhumatology Laboratory, GENOMAX platform, INSERM UMR-S1109, Faculty of Medicine, Interdisciplinary Thematic Institute (ITI) of Precision Medicine of Strasbourg, Transplantex NG, Federation of Translational Medicine of Strasbourg (FMTS), University of Strasbourg, Strasbourg, France
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17
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Pina Vegas L, Penso L, Sbidian E, Claudepierre P. Influence of sex on the persistence of different classes of targeted therapies for psoriatic arthritis: a cohort study of 14 778 patients from the French health insurance database (SNDS). RMD Open 2023; 9:e003570. [PMID: 38114199 DOI: 10.1136/rmdopen-2023-003570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/02/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Sex differences in phenotype presentation, disease trajectory and treatment response in psoriatic arthritis (PsA) have been reported. Nevertheless, whether classes of targeted therapies differentially affect men and women with PsA remains unclear. OBJECTIVES To assess the effect of sex on the long-term persistence of each class of targeted therapies in PsA. METHODS This nationwide cohort study involved the administrative healthcare database of the French health insurance scheme linked to the hospital discharge database. We included all adults with PsA who were new users of targeted therapies (not in the year before the index date) during 2015-2021 and studied all treatment lines during the study period. Persistence was defined as the time from treatment initiation to discontinuation and was estimated by the Kaplan-Meier method. Comparison of persistence by sex involved multivariate frailty models with conventional synthetic disease-modifying antirheumatic drugs and prednisone as time-dependant variables. RESULTS We included 14 778 patients with PsA who were new users of targeted therapies: 8475 (57%) women (mean age 50±13 years; 15 831 lines), 6303 (43%) men (mean age 51±13 years; 10 488 lines). Overall, 1-year persistence was 52% for women and 62% for men and at 3 years it was 27% and 39%, respectively. After adjustments, persistence was lower for women than men for inhibitors of tumour necrosis factor (TNFi) (adjusted HR (HRa) 1.4, 99% CI 1.3 to 1.5) and interleukin 17 inhibitor (IL17i) (HRa 1.2, 99% CI 1.1 to 1.3) but not IL12/23i (HRa 1.1, 99% CI 0.9 to 1.3), IL23i (HRa 1.1, 99% CI 0.7 to 1.5) or Janus kinase inhibitor (JAKi) (HRa 1.2, 99% CI 0.9 to 1.6). CONCLUSION The treatment persistence was lower for women than men for TNFi and IL17i but not for IL12/23i, IL23i or JAKi.
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Affiliation(s)
- Laura Pina Vegas
- EpiDermE, Université Paris-Est Créteil Val de Marne, Créteil, France
- Service de Rhumatologie, Hopital Henri Mondor, Créteil, France
| | - Laetitia Penso
- EpiDermE, Université Paris-Est Créteil Val de Marne, Créteil, France
| | - Emilie Sbidian
- EpiDermE, Université Paris-Est Créteil Val de Marne, Créteil, France
- Inserm, Centre d'investigation clinique 1430, Hopital Henri Mondor, Créteil, France
| | - Pascal Claudepierre
- EpiDermE, Université Paris-Est Créteil Val de Marne, Créteil, France
- Service de Rhumatologie, Hopital Henri Mondor, Créteil, France
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18
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Geoffroy M, Gozalo C, Konecki C, Pauvele L, Hittinger A, Theate N, Feliu C, Salmon JH, Djerada Z. A new pharmacokinetic model of urinary methotrexate to assess adherence in rheumatoid arthritis. Biomed Pharmacother 2023; 168:115620. [PMID: 37864897 DOI: 10.1016/j.biopha.2023.115620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/26/2023] [Accepted: 09/28/2023] [Indexed: 10/23/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Methotrexate (MTX) is the first-line therapy for rheumatoid arthritis (RA). While therapeutic adherence is essential to successful management, no objective MTX assay is currently available. Using population pharmacokinetic modelling (PopPK), our objective was to describe the urinary MTX (MTXu) kinetics in treated patients and to evaluate its abilities to assess the MTX-adherence. METHODS The association between urinary methotrexate level and methotrexate administration was assessed using a generalized linear model. Then, a population pharmacokinetic model was developed based on data from 59 patients using with Monolix 2021. R2. Simulations were run to establish a reference kinetic profile and evaluate the proportion of samples predicted as true positives. RESULTS Compared to the control group, multivariate analysis showed that MTXu was independently associated with methotrexate administration (p < 0.0001) with a sensitivity and specificity greater than 99%. The final PopPK model selected was a two-compartment model with first-order absorption and elimination. Internal and external validation of the model met all predefined criteria. When using an analytical assay with a LOQ equal to 1 nM, the proportion of samples predicted as true positives is over 90%, as a function of MTX dose (7.5-25 mg/week) and post-administration sampling days (1-7 days). CONCLUSION We developed a pharmacokinetic model able to describe expected patterns of urinary methotrexate. This allowed us to propose a new objective test of MTX adherence, which could help in routine practice to differentiate patients who are truly unresponsive to methotrexate from those who are unresponsive because of non-adherence.
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Affiliation(s)
| | - Claire Gozalo
- Reims University Hospital, Department of Pharmacology and Toxicology, 51100 Reims, France; University of Reims Champagne-Ardenne (URCA), Department of Medical Pharmacology, EA3801, 51097 Reims, France
| | - Céline Konecki
- Reims University Hospital, Department of Pharmacology and Toxicology, 51100 Reims, France; University of Reims Champagne-Ardenne (URCA), Department of Medical Pharmacology, EA3801, 51097 Reims, France
| | - Loic Pauvele
- Rheumatology, CHU Maison Blanche, Reims, Reims, France
| | | | - Noemie Theate
- Rheumatology, CHU Maison Blanche, Reims, Reims, France
| | - Catherine Feliu
- Reims University Hospital, Department of Pharmacology and Toxicology, 51100 Reims, France; University of Reims Champagne-Ardenne (URCA), Department of Medical Pharmacology, EA3801, 51097 Reims, France
| | | | - Zoubir Djerada
- Reims University Hospital, Department of Pharmacology and Toxicology, 51100 Reims, France; University of Reims Champagne-Ardenne (URCA), Department of Medical Pharmacology, EA3801, 51097 Reims, France.
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19
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Fakih O, Desmarets M, Martin B, Prati C, Wendling D, Monnet E, Verhoeven F. Impact of NSAIDs on 8-year cumulative incidence of major cardiovascular events in patients with ankylosing spondylitis: a nationwide study. Rheumatology (Oxford) 2023; 62:3317-3322. [PMID: 36752498 DOI: 10.1093/rheumatology/kead072] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/06/2023] [Accepted: 01/29/2023] [Indexed: 02/09/2023] Open
Abstract
OBJECTIVES The objectives of this study were to describe the incidence of major adverse cardiovascular events (MACEs) in French patients newly benefiting from the French Long-term Illness scheme (LTI) for AS and to evaluate the effect of various treatments on the risk of MACE occurrence. METHODS This national cohort study was based on the French national medico-administrative database SNDS containing data on hospitalization, the LTI, and outpatient care consumption. All French patients newly receiving LTI benefits for AS from 2010 to 2013 were included. The final follow-up date was 31 December 2018. The occurrences of MACEs [stroke and myocardial infarction (MI)] and comorbidities were identified from algorithms previously described in the literature. Competitive risk analysis using propensity score and inverse weighting was performed to calculate cumulative incidence functions and to determine subhazard ratios (SHRs) for the various treatments of interest. RESULTS Between 2010 and 2013, 22 929 patients were included [mean age 43.0 (s.d. 13.9) years, 44.9% mal]. The 8-year cumulative incidences of MACE, stroke, and MI were 1.81% (1.61-2.05), 0.97% (0.83-1.14), and 0.85% (0.71-1.04), respectively. NSAIDs [SHR: 0.39 (0.32-0.50), P < 0.001] and anti-TNF [SHR 0.61 (0.46-0.80), P < 0.001], but not anti-IL17 [2.10 (0.79-5.57)] were associated with a lower risk of MACE occurrence. CONCLUSION MACE incidence rates at 8 years are low in patients newly benefiting from LTI for AS. Our results support the hypothesis of a protective role of NSAIDs and anti-TNF in cardiovascular risk in these patients.
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Affiliation(s)
- Olivier Fakih
- Service de Rhumatologie, CHU de Besançon, Besançon, France
| | - Maxime Desmarets
- Centre d'investigation Clinique 1431, CHU de Besançon, Inserm, 2 place Saint Jacques, Besançon, France
- UMR 1098 Right, Inserm, Etablissement Français du Sang, Université Bourgogne Franche-Comté, Besançon, France
| | - Bérenger Martin
- Centre d'investigation Clinique 1431, CHU de Besançon, Inserm, 2 place Saint Jacques, Besançon, France
| | - Clément Prati
- Service de Rhumatologie, CHU de Besançon, Besançon, France
- EA 4267 "PEPITE", UFR Santé, Franche-Comté University, Besançon, France
| | - Daniel Wendling
- Service de Rhumatologie, CHU de Besançon, Besançon, France
- EA 4266 "EPILAB", UFR Santé, Franche-Comté University, Besançon, France
| | - Elisabeth Monnet
- Centre d'investigation Clinique 1431, CHU de Besançon, Inserm, 2 place Saint Jacques, Besançon, France
| | - Frank Verhoeven
- Service de Rhumatologie, CHU de Besançon, Besançon, France
- EA 4267 "PEPITE", UFR Santé, Franche-Comté University, Besançon, France
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20
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Kiefer D, Braun J, Kiltz U, Kolle N, Schneider L, Andreica I, Buehring B, Sewerin P, Herbold S, Baraliakos X. Patients' awareness towards physical activity in the treatment of axial spondyloarthritis. Joint Bone Spine 2023; 90:105585. [PMID: 37127259 DOI: 10.1016/j.jbspin.2023.105585] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 04/01/2023] [Accepted: 04/19/2023] [Indexed: 05/03/2023]
Abstract
INTRODUCTION The course of axial spondyloarthritis (axSpA) is often characterized by impairments in physical function and mobility. Regular physical activity (PA) is a cornerstone of axSpA management. Recent European League Against Rheumatism (EULAR) recommendations for PA have stressed the importance of their implementation. OBJECTIVE Cohort study to investigate the awareness on and individual implementation of axSpA patients towards PA. METHODS Patients with axSpA and impaired physical function (Bath AS Functional Index [BASFI] score≥2.0) were recruited consecutively. All patients underwent a clinical examination including assessments of disease activity, physical function, mobility and global functioning. Patients also had to fill out structured questionnaires on knowledge, awareness and individual attitudes to PA. RESULTS Out of a total of 100 patients enrolled, 96 were included. Most respondents (n=82, 85.4%) were aware that PA has significant health benefits for patients with axSpA. Even though less than half of the patients (n=44, 42.7%) were aware that actual EULAR recommendations do exist, 45 patients (46.9%) did already fulfill these in terms of frequency/week. The majority of patients (n=61, 67.7%) had been informed about the benefits of PA by their physician, and physiotherapy had often been prescribed (n=61, 63.3%). Many patients (n=51, 53.1%) reported to perform individual exercise programs, and some (n=22, 22.9) supervised PA. CONCLUSION Even though the majority of axSpA patients are not aware of the recent EULAR recommendations for PA, many understand and agree that PA is beneficial for their health status. Health care providers should concentrate on the patients who are not active and do not know about the benefits of PA.
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Affiliation(s)
- David Kiefer
- Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Bochum, Claudiusstrasse 45, 44649 Herne, Germany.
| | - Juergen Braun
- Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Bochum, Claudiusstrasse 45, 44649 Herne, Germany
| | - Uta Kiltz
- Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Bochum, Claudiusstrasse 45, 44649 Herne, Germany
| | - Niklas Kolle
- Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Bochum, Claudiusstrasse 45, 44649 Herne, Germany
| | - Lucia Schneider
- Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Bochum, Claudiusstrasse 45, 44649 Herne, Germany
| | - Ioana Andreica
- Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Bochum, Claudiusstrasse 45, 44649 Herne, Germany
| | - Bjoern Buehring
- Bergisches Rheuma-Zentrum Wuppertal, Ruhr-University Bochum, Wuppertal, Germany
| | - Philipp Sewerin
- Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Bochum, Claudiusstrasse 45, 44649 Herne, Germany; Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Susanne Herbold
- Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Bochum, Claudiusstrasse 45, 44649 Herne, Germany
| | - Xenofon Baraliakos
- Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Bochum, Claudiusstrasse 45, 44649 Herne, Germany
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21
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Avouac J, Fogel O, Hecquet S, Daien C, Elalamy I, Picard F, Prati C, Salmon JH, Truchetet ME, Sellam J, Molto A. Recommendations for assessing the risk of cardiovascular disease and venous thromboembolism before the initiation of targeted therapies for chronic inflammatory rheumatic diseases. Joint Bone Spine 2023; 90:105592. [PMID: 37201575 DOI: 10.1016/j.jbspin.2023.105592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/25/2023] [Accepted: 04/27/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Patients with rheumatoid arthritis (RA) and other chronic inflammatory rheumatic disorders have increased risk of cardiovascular disease (CVD) and venous thromboembolism (VTE) compared with the general population. Moreover, recent data have raised concerns around a possible increased risk of major CV events (MACE) and VTE in patients treated with JAK inhibitors (JAKi). In October 2022, the PRAC has recommended measures to minimize the risk of serious side effects, including CV conditions and VTE, associated with all approved in chronic inflammatory diseases. OBJECTIVE To provide an adequate and feasible strategy to evaluate, at the individual level, the risk of CVD and VTE in patients with chronic inflammatory rheumatic diseases. METHODS A multidisciplinary steering committee comprised 11 members including rheumatologists, a cardiologist, a hematologist expert in thrombophilia and fellows. Systematic literature searches were performed and evidence was categorized according to standard guidelines. The evidence was discussed and summarized by the experts in the course of a consensus finding and voting process. RESULTS Three overarching principles were defined. First, there is a higher risk of MACE and VTE in patients with chronic inflammatory rheumatic diseases compared with the general population. Second, the rheumatologist has a central role in the evaluation of the risk of CVD and VTE in patient with chronic inflammatory rheumatic diseases. Third, the risk of MACE and VTE should be regularly assessed in patients with chronic inflammatory rheumatic diseases, particularly before initiating targeted therapies. Eleven recommendations were defined to prevent potentially life-threatening complications of CVD and VTE in patients with chronic inflammatory rheumatic diseases, providing practical assessment of CVD and VTE before considering the prescription of targeted therapies, and especially JAKi. CONCLUSION These practical recommendations based on expert opinion and scientific evidence provide consensus for the prevention and the assessment of CVD and VTE.
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Affiliation(s)
- Jérôme Avouac
- Service de Rhumatologie, Hôpital Cochin, Centre - Université Paris Cité, Assistance publique-Hôpitaux de Paris (AP-HP), 75014 Paris, France.
| | - Olivier Fogel
- Service de Rhumatologie, Hôpital Cochin, Centre - Université Paris Cité, Assistance publique-Hôpitaux de Paris (AP-HP), 75014 Paris, France
| | - Sophie Hecquet
- Service de Rhumatologie, Hôpital Cochin, Centre - Université Paris Cité, Assistance publique-Hôpitaux de Paris (AP-HP), 75014 Paris, France
| | - Claire Daien
- Inserm U1046, CNRS UMR 9214, Montpellier University, CHU de Montpellier, Montpellier, France
| | - Ismail Elalamy
- Department Hematology and Thrombosis Center, Medicine, Sorbonne University, Paris, France
| | - Fabien Picard
- Service de Cardiologie, Hôpital Cochin, Centre - Université Paris Cité, AP-HP, 75014 Paris, France
| | - Clément Prati
- Service de Rhumatologie, Université de Franche-Comté, CHU de Besançon, boulevard Fleming, 25030 Besançon, France
| | - Jean Hugues Salmon
- Department of Rheumatology, Reims University Hospital, University of Reims Champagne-Ardenne (URCA), 51100 Reims, France
| | - Marie-Elise Truchetet
- CNRS, UMR5164 ImmunoConcept, Department of Rheumatology, Bordeaux University Hospital, Bordeaux University, Raba Leon, place Amélie, 33076 Bordeaux cedex, France
| | - Jérémie Sellam
- Paris Inserm UMRS 938, Department of Rheumatology, Centre de Recherche Saint-Antoine, Saint-Antoine Hospital, Sorbonne Université, AP-HP, Paris, France
| | - Anna Molto
- Service de Rhumatologie, Hôpital Cochin, Centre - Université Paris Cité, Assistance publique-Hôpitaux de Paris (AP-HP), 75014 Paris, France
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22
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Denis A, Sztejkowski C, Arnaud L, Becker G, Felten R. The 2023 pipeline of disease-modifying antirheumatic drugs (DMARDs) in clinical development for spondyloarthritis (including psoriatic arthritis): a systematic review of trials. RMD Open 2023; 9:e003279. [PMID: 37507210 PMCID: PMC10387652 DOI: 10.1136/rmdopen-2023-003279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/15/2023] [Indexed: 07/30/2023] Open
Abstract
OBJECTIVES The objective of this systematic review was to provide an overview of current developments and potentially available therapeutic options for spondyloarthritis (SpA) in the coming years. METHODS We conducted a systematic review of 17 national and international clinical trial databases for all disease-modifying antirheumatic drugs (DMARDs) for SpA that are already marketed, in clinical development or withdrawn. The search was performed on February 2023 with the keywords "spondyloarthritis", "ankylosing spondylitis" and "psoriatic arthritis". For each molecule, we only considered the study at the most advanced stage of clinical development. RESULTS Concerning axial SpA (axSpA), a total of 44 DMARDs were identified: 6 conventional synthetic DMARDs (csDMARDs), 27 biological DMARDs (bDMARDs) and 11 targeted synthetic DMARDs (tsDMARDs). Among the 18 targeted treatments (b+tsDMARDs) in current development, corresponding trials reached phase I (n=1), II (n=10) and III (n=7). Ten molecules are IL-17 inhibitors, two Janus kinase (JAK) inhibitors and two granulocyte-macrophage colony-stimulating factor inhibitors; four have another mode of action. Concerning psoriatic arthritis (PsA), 44 DMARDs were identified: 5 csDMARDs, 27 bDMARDs and 12 tsDMARDs. Among the 15 molecules in current development, corresponding trials reached phase II (n=8) and III (n=7). Six molecules are JAK inhibitors, six IL-17 inhibitors and one an IL-23 inhibitor; two have another mode of action. CONCLUSION This systematic review identified 18 and 15 molecules in clinical development for axSpA and PsA, respectively, which suggests a strengthening of the therapeutic arsenal in the coming years. However, with so many DMARDs but low target diversity, we will need to develop strategies or biomarkers to help clinicians make informed treatment decisions.
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Affiliation(s)
- Agathe Denis
- Service de Rhumatologie de Hautepierre, RESO, Centre de Référence des Maladies Autoimmunes Systémiques Rares Est Sud-Ouest, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Cédric Sztejkowski
- Service de Rhumatologie de Hautepierre, RESO, Centre de Référence des Maladies Autoimmunes Systémiques Rares Est Sud-Ouest, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Laurent Arnaud
- Service de Rhumatologie de Hautepierre, RESO, Centre de Référence des Maladies Autoimmunes Systémiques Rares Est Sud-Ouest, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Guillaume Becker
- Pôle Pharmacie-Pharmacologie, Hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - Renaud Felten
- Service de Rhumatologie de Hautepierre, RESO, Centre de Référence des Maladies Autoimmunes Systémiques Rares Est Sud-Ouest, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- Centre d'Investigation Clinique, Inserm 1434, INSERM, Strasbourg, France
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Huang JX, Lee YH, Wei JCC. Patient-tailored dose reduction of tumor necrosis factor inhibitors in axial spondyloarthritis. Int Immunopharmacol 2023; 116:109804. [PMID: 36764276 DOI: 10.1016/j.intimp.2023.109804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/25/2023] [Accepted: 01/26/2023] [Indexed: 02/11/2023]
Abstract
Tumor necrosis factor inhibitors have been widely used in the field of axial spondyloarthritis, with current guidelines now recommending dose reduction instead of withdrawal of biologics. Systemic review and meta-analyses in literature have summarized present tapering strategies and principles in published heterogeneous studies. In this study, we reviewed and provided an update on present evidence based on prospective and retrospective studies from 2008 to 2022 by performing a literature review of related publications on remission or relapse from PubMed. We further stated the core issues concerning dose reduction, including the timing, optimization, intensity, maintenance, monitoring, factors associated with tapering and solutions to de-escalation failure. Remission/relapse should be the principal consideration in dose reduction implementation for individuals without comorbidities. As a treat-to-target scope of this multifaceted systemic disease, extra-articular manifestations such as uveitis, psoriasis, inflammatory bowel disease, cardiovascular complication, hip involvement and progressed structural damage influence patient-tailored dose reduction plans. Safety concerns and costs should be integrated into the decision-making schedule to optimize the individualized dose reduction paradigm.
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Affiliation(s)
- Jin-Xian Huang
- Division of Rheumatology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Yung-Heng Lee
- Department of Senior Services Industry Management, Minghsin University of Science and Technology, Hsinchu, Taiwan; Department of Recreation and Sport Management, Shu-Te University, Kaohsiung, Taiwan; Department of Orthopedics, Cishan Hospital, Ministry of Health and Welfare, Kaohsiung, Taiwan
| | - James Cheng-Chung Wei
- Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan.
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24
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Wendling D. Is psoriatic arthritis doomed to disappear? Joint Bone Spine 2023; 90:105477. [PMID: 36404487 DOI: 10.1016/j.jbspin.2022.105477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 09/26/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Daniel Wendling
- Service de rhumatologie, CHU de Besançon, boulevard Fleming, 25030 Besançon, France; EA 4266, EPILAB, université de Franche-Comté, rue A. Paré, 25030 Besançon, France.
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25
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Valero M, Bachiller-Corral FJ, Boris AB, Blázquez MA, Díaz-Miguel MC, García-Villanueva MJ, Larena MC, Morell JL, De la Puente C, Rodríguez-García A, Vázquez-Díaz M, Moltó A. Evaluating remission and low disease activity from the perspective of the patient with axial spondyloarthritis: The cross-sectional ConREspAx study. Joint Bone Spine 2023; 90:105505. [PMID: 36493989 DOI: 10.1016/j.jbspin.2022.105505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 11/16/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To evaluate the properties of a single question to determine patient perception of remission and disease activity; to compare this with existing definitions for remission and low disease activity (LDA). METHODS Single-center, cross-sectional study in a tertiary care hospital. Patients with axSpA (fulfilling ASAS criteria) were consecutively included. Both the patient's perception of remission and LDA and that of the physician were evaluated with a single question. Agreement between the patients' perception and other current definitions was tested using the prevalence-adjusted and bias-adjusted kappa (PABAK). The sensitivity (S) and specificity (Sp) of current definitions of disease states were tested against the patient's perception as the gold standard. RESULTS The study population included 105 axSpA patients (63.8% males; 67.6% with radiographic sacroiliitis). Patients considered themselves to be in remission in 21% of cases and in LDA in 51.4%; physicians considered patients to be in remission in 45.7% of cases and in LDA in 35.2%. The poorest agreement was recorded for the patient's and the physician's perception of remission. The best agreement for patients' perception of remission was for a BASDAI < 2 and normal C-reactive protein values. This definition was also the most sensitive (S=72.7%) and specific (Sp=83.1%) when the patient's perception was taken as the gold standard. CONCLUSION In a real-life setting, the evaluation of remission by the patient through a single question was the hardest criterion to achieve, although it did prove to be a feasible, valid, and specific way to assess remission.
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Affiliation(s)
- Marta Valero
- Rheumatology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | | | | | | | - María Carmen Larena
- Rheumatology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Jose Luis Morell
- Rheumatology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Carlos De la Puente
- Rheumatology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Mónica Vázquez-Díaz
- Rheumatology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Anna Moltó
- Rheumatology Department, Hôpital Cochin, AP-HP, Paris, France; Inserm U-1153, Université Paris-Cité, Paris, France.
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26
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Coates L, Gossec L. The updated GRAPPA and EULAR recommendations for the management of psoriatic arthritis: Similarities and differences. Joint Bone Spine 2023; 90:105469. [PMID: 36184036 DOI: 10.1016/j.jbspin.2022.105469] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/07/2022] [Accepted: 09/21/2022] [Indexed: 01/19/2023]
Affiliation(s)
- Laura Coates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
| | - Laure Gossec
- Sorbonne Université, Inserm, Institut Pierre Louis d'Epidémiologie et de Santé Publique, 75013 Paris, France; Rheumatology department, AP-HP, Pitié-Salpêtrière hospital, 75013 Paris, France
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Deng Z, Wang S, Wu C, Wang C. IL-17 inhibitor-associated inflammatory bowel disease: A study based on literature and database analysis. Front Pharmacol 2023; 14:1124628. [PMID: 37033665 PMCID: PMC10076642 DOI: 10.3389/fphar.2023.1124628] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 03/07/2023] [Indexed: 04/11/2023] Open
Abstract
Objective: Few real-world studies have shown clear association between interleukin (IL)-17 inhibitors and inflammatory bowel disease (IBD) onset. This study investigated the reporting prevalence and evaluated the clinical features and management of IL-17 inhibitor-related IBD events. Methods: We used the US FDA Adverse Event Reporting System database and retrieved data, from 2015 to 2022, on IL-17 inhibitors to identify gastrointestinal inflammatory events and conduct disproportionality analyses by estimating the reporting odds ratios (RORs) and corresponding 95% confidence intervals (CIs). Furthermore, case reports and case series, from 2015 to 30 November 2022, on IBD induced by IL-17 inhibitors were collected for retrospective analysis. Results: A total of 388 cases of primary suspected IL-17 inhibitor-associated gastrointestinal events were reported (268 IBD and 120 colitis), including 348 cases involving secukinumab (SEC), 36 cases involving ixekizumab (IXE), and 4 cases involving brodalumab (BRO). Statistically significant reporting rates of total IBD events were observed for SEC and IXE (ROR = 2.13, 95% CI [1.96-2.30] and ROR = 2.79, 95% CI [2.39-3.27], respectively), whereas BRO did not trigger a safety signal. Twenty-nine studies, which included 34 cases, showed evidence of IBD, following SEC (79.4%) and IXE (20.6%) treatment. The median age was 42 years; typical initial symptoms included diarrhea (90.9%), abdominal pain (57.6%), bloody diarrhea (51.5%), and fever (36.4%). The median time to onset of IBD symptoms was 2.9 months. Some cases were accompanied by elevated white blood cell (WBC) count (87.5%), erythrocyte sedimentation rate (ESR; 85.7%), C-reactive protein (CRP; 100%), and fecal calprotectin (FC; 100%). Cessation of IL-17 inhibitors plus treatment with corticosteroids and TNF antagonists, as either monotherapy or in combination, could lead to complete clinical remission. The median time to remission after IL-17 inhibitor discontinuation was 4 weeks. Conclusion: IL-17 inhibitor treatment is associated with exacerbation and new onset of IBD and colitis. Obtaining a detailed patient history before initiation of treatment and monitoring gastrointestinal symptoms and intestinal inflammatory biomarkers during IL-17 inhibitor treatment is important for safe use of these drugs.
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Webers C, Nikiphorou E, Boonen A, Ramiro S. Tapering or discontinuation of biological disease-modifying antirheumatic drugs in axial spondyloarthritis: A review of the literature and discussion on current practice. Joint Bone Spine 2023; 90:105482. [PMID: 36336291 DOI: 10.1016/j.jbspin.2022.105482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/24/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022]
Abstract
Biological disease-modifying antirheumatic drugs (bDMARDs) have taken up an important role in the management of axial spondyloarthritis. Once stable remission or low disease activity has been achieved with bDMARDs, it may be possible to maintain this state with lower levels of these drugs. Studies consistently demonstrate that tapering of tumor necrosis factor alpha inhibitors (TNFi) is not inferior to full-dose continuation in terms of maintaining treatment response, while data for tapering of interleukin-17 inhibitors (IL-17i) is lacking. Complete discontinuation of TNFi and IL-17i, however, often results in relapse and should not be recommended at this moment. Clear safety benefits of tapering or discontinuation have not been shown, although studies were typically not designed to address this. Current evidence does not support specific tapering or discontinuation strategies, although stepwise disease activity-guided regimens do allow for a more personalized approach and might be preferred. The definition of what constitutes an appropriate disease state to initiate tapering or discontinuation is unclear, and requires further study. Also, reliable predictors of successful tapering and discontinuation have not yet been identified. Fortunately, if tapering or discontinuation fails, most patients are able to regain disease control when reverted to the original bDMARD regimen. Finally, most patients indicate that, when asked, they would be willing to try tapering if the rationale is clear and if it is in their best interests. The decision to taper or discontinue should be made through shared decision-making, as this could improve the likelihood of success.
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Affiliation(s)
- Casper Webers
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, Maastricht, The Netherlands; Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.
| | - Elena Nikiphorou
- Department of Rheumatology, King's College Hospital, London, United Kingdom; Centre for Rheumatic Diseases, King's College London, London, United Kingdom; Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, Maastricht, The Netherlands; Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Sofia Ramiro
- Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands; Department of Rheumatology, Zuyderland Medical Centre, Heerlen, The Netherlands
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Wendling D, Verhoeven F, Prati C. Is the Difficult-to-Treat (D2T) concept applicable to axial spondyloarthritis? Joint Bone Spine 2022; 90:105512. [PMID: 36528335 DOI: 10.1016/j.jbspin.2022.105512] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 11/28/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Daniel Wendling
- Service de Rhumatologie, CHU de Besançon, Boulevard Fleming, 25030 Besançon, France; EA 4266, EPILAB, Université de Franche-Comté, Rue A. Paré, 25030 Besançon, France.
| | - Frank Verhoeven
- Service de Rhumatologie, CHU de Besançon, Boulevard Fleming, 25030 Besançon, France; EA 4267, PEPITE and UMR RIGHT 1098, Université de Franche-Comté, Rue A. Paré, 25030 Besançon, France
| | - Clément Prati
- Service de Rhumatologie, CHU de Besançon, Boulevard Fleming, 25030 Besançon, France; EA 4267, PEPITE and UMR RIGHT 1098, Université de Franche-Comté, Rue A. Paré, 25030 Besançon, France
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Turosz N, Chęcińska K, Chęciński M, Kamińska M, Nowak Z, Sikora M, Chlubek D. A Scoping Review of the Use of Pioglitazone in the Treatment of Temporo-Mandibular Joint Arthritis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192416518. [PMID: 36554400 PMCID: PMC9779153 DOI: 10.3390/ijerph192416518] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 12/01/2022] [Accepted: 12/05/2022] [Indexed: 05/27/2023]
Abstract
Thiazolidinediones (TZDs) are a group of diabetes medications currently being investigated for anti-arthritis effectiveness, one of which is pioglitazone. The purpose of this scoping review is to evaluate the potential use of pioglitazone in the treatment of temporomandibular joint (TMJ) arthritis. The criteria of eligibility were studies with the diagnosis of arthritis and pioglitazone treatment with a change in any inflammation index as an outcome. Of the 1169 records initially identified following the selection process, two animal studies and four clinical studies were included in the review. Improvements from the baseline were observed in each treatment group for each inflammation indicator. The results of the animal studies on the temporomandibular joints and on patients with rheumatoid and psoriatic arthritis indicate that the drug in question may have potential to treat arthritis, including within the temporomandibular joint.
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Affiliation(s)
- Natalia Turosz
- Ortomania, Bartosza Głowackiego 6/1, 30-085 Kraków, Poland
| | - Kamila Chęcińska
- Department of Glass Technology and Amorphous Coatings, Faculty of Materials Science and Ceramics, AGH University of Science and Technology, Mickiewicza 30, 30-059 Kraków, Poland
| | - Maciej Chęciński
- Department of Oral Surgery, Preventive Medicine Center, Komorowskiego 12, 30-106 Kraków, Poland
| | - Monika Kamińska
- Collegium Medicum, Jan Kochanowski University, aleja IX Wieków Kielc 19A, 25-317 Kielce, Poland
| | - Zuzanna Nowak
- Department of Temporomandibular Disorders, Medical University of Silesia in Katowice, Traugutta sq.2, 41-800 Zabrze, Poland
| | - Maciej Sikora
- Department of Maxillofacial Surgery, Hospital of the Ministry of Interior, Wojska Polskiego 51, 25-375 Kielce, Poland
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland
| | - Dariusz Chlubek
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland
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Pina Vegas L, Hoisnard L, Bastard L, Sbidian E, Claudepierre P. Long-term persistence of second-line biologics in psoriatic arthritis patients with prior TNF inhibitor exposure: a nationwide cohort study from the French health insurance database (SNDS). RMD Open 2022; 8:rmdopen-2022-002681. [PMID: 36597983 PMCID: PMC9730400 DOI: 10.1136/rmdopen-2022-002681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 11/02/2022] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Tumour necrosis factor inhibitor (TNFi) agents are most often the first-choice biological treatment for patients with psoriatic arthritis (PsA). When their discontinuation is needed, a switch to another TNFi or to another therapeutic class may be considered. However, data supporting one approach over another are lacking. OBJECTIVE To compare the long-term persistence of classes of biologics in PsA patients with prior TNFi exposure. METHODS This nationwide cohort study involved the administrative healthcare database of the French health insurance scheme linked to the hospital discharge database. We included all adults with PsA starting a second-line biological after discontinuing a TNFi during 2015-2020. Persistence was defined as the time from biological initiation to discontinuation and was estimated by the Kaplan-Meier method. Comparison of persistence by biological class was performed with Poisson regression models with time divided into 6-month intervals. RESULTS We included 2975 patients: 1580 (53%) initiating a second TNFi, 426 (14%) an interleukin 12/23 inhibitor (IL-12/23i) and 969 (33%) an IL-17 inhibitor (IL-17i). Overall, 1-year and 3-year persistence rates were 42% and 17%, respectively. After adjustment, persistence was associated with treatment with an IL-17i (adjusted relative risk (RRa) 0.79, 95% CI 0.71 to 0.87) or IL-12/23i (RRa 0.69, 95% CI 0.61 to 0.79) vs a TNFi, with no significant difference between IL-12/23 and IL-17 inhibitors (RRa 0.88, 95% CI 0.76 to 1.02). CONCLUSIONS Overall, this real-life study shows low persistence for all biologics at 3 years in PsA patients previously exposed to a TNFi. However, persistence was higher with an IL-17i or IL-12/23i than a TNFi.
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Affiliation(s)
- Laura Pina Vegas
- EpiDermE, Université Paris-Est Créteil Val de Marne, Créteil, France,Rhumatologie, Hôpital Henri Mondor, Creteil cedex, France
| | - Léa Hoisnard
- EpiDermE, Université Paris-Est Créteil Val de Marne, Créteil, France,Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Hôpital Henri Mondor, Créteil, France
| | - Léa Bastard
- EpiDermE, Université Paris-Est Créteil Val de Marne, Créteil, France,Rhumatologie, Hôpital Henri Mondor, Creteil cedex, France
| | - Emilie Sbidian
- EpiDermE, Université Paris-Est Créteil Val de Marne, Créteil, France,Inserm, Centre d’investigation clinique 1430, Hôpital Henri Mondor, Créteil, France,Dermatologie, Hôpital Henri Mondor, Créteil, France
| | - Pascal Claudepierre
- EpiDermE, Université Paris-Est Créteil Val de Marne, Créteil, France,Rhumatologie, Hôpital Henri Mondor, Creteil cedex, France
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Treatment persistence of tumour necrosis factors and IL-17 inhibitors in axial spondyloarthritis: A multi-center comparative analysis. Joint Bone Spine 2022; 89:105416. [PMID: 35636707 DOI: 10.1016/j.jbspin.2022.105416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/15/2022] [Accepted: 05/16/2022] [Indexed: 11/22/2022]
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Massy EF, Confavreux CB, Ammari K, Ramos J, Roger C, Villani AP, Chikh K. Untargeted metabolomics profiling identifies onycholysis-specific signature in psoriasis. Joint Bone Spine 2022; 89:105410. [PMID: 35577049 DOI: 10.1016/j.jbspin.2022.105410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/26/2022] [Accepted: 05/06/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Emmanuel F Massy
- Service de rhumatologie, centre hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France; Inserm UMR1033 - LYOS - Université de Lyon, Lyon, France.
| | - Cyrille B Confavreux
- Service de rhumatologie, centre hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France; Inserm UMR1033 - LYOS - Université de Lyon, Lyon, France
| | - Kamara Ammari
- Service de biochimie et biologie moléculaire, centre hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Jessica Ramos
- Service de biochimie et biologie moléculaire, centre hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Christelle Roger
- Service de biochimie et biologie moléculaire, centre hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Axel P Villani
- Service de dermatologie, hôpital Edouard-Herriot, Hospices Civils de Lyon, Lyon, France
| | - Karim Chikh
- Service de biochimie et biologie moléculaire, centre hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France; Service de dermatologie, hôpital Edouard-Herriot, Hospices Civils de Lyon, Lyon, France; Laboratoire CarMeN, Inserm U1060, INRAE U1397, Université de Lyon, Université Claude-Bernard Lyon1, 69600, Oullins, France
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Tapering biologics in axial spondyloarthritis: A systematic literature review. Int Immunopharmacol 2022; 112:109256. [PMID: 36150228 DOI: 10.1016/j.intimp.2022.109256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 09/10/2022] [Accepted: 09/12/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The emergence of biologics has improved the management of patients with rheumatic disease, mainly with spondyloarthritis (SpA). Sustained remission has become a reachable goal thanks to the treat to target strategy. Contrary to rheumatoid arthritis, data on biologic optimization among SpA patients in remission is scarce and still a subject of debate. The main objective of this systematic review was to provide the most up-to-date published literature regarding biologic tapering in axial spondyloarthritis. METHODS This systematic review followed the preferred reporting items for systematic reviews guidelines. Original articles from Pubmed and Scopus, published until December 20th 2021, and tackling tapering strategies of the biologics in patients with axial SpA were included RESULTS: Fourteen studies met the inclusion criteria. They were published between 2008 and 2020. The most studied molecules were Etanercept (ETN) (n = 13), Infliximab (IFX) (n = 6), Adalimumab (ADA) (n = 5), certolizumab pegol (CZP) (n = 2), Golimumab (n = 1) and ETN biosimilar. There are no studies published regarding anti-IL 17 tapering strategy. Patient-tailored dose reduction of anti TNF-α agents was successful in preserving stable low disease activity in most of the studies with remission rates ranging between 20.2 % and 93.7 %. Complete treatment discontinuation is associated with a high risk of flares. CONCLUSION To conclude, published data indicate that a progressive tapering strategy for anti TNF-α therapy is successful among axial SpA in sustained remission. However, further studies with more homogenized tapering strategies are needed in order to ascertain the specific implication of each subset for a better holistic approach.
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Abstract
PURPOSE OF REVIEW Flares correspond to fluctuations in disease activity or symptoms. They should be avoided in chronic inflammatory diseases. In axial spondyloarthritis (axSpA), work is ongoing to better conceptualise and treat flares. This review highlights recent data on the definition and management of flares in axSpA. RECENT FINDINGS Many definitions of flares have been used in clinical trials, limiting the interpretation and comparison of studies. The expert group Assessment of SpondyloArthritis International Society (ASAS) developed a data-driven definition of flares/disease worsening: an increase in Ankylosing Spondylitis Disease Activity Score-C-reactive protein (ASDAS-CRP) of at least 0.9 points, for use in axSpA clinical trials. Flares are more challenging to define in clinical practice because of their multifaceted nature. Qualitative studies have shown that flares from the patient's perspective are related not only to disease activity, but also to fatigue, mood, sleep and general well-being. The management of axSpA relies on a treat-to-target (T2T) strategy and aims at reaching clinical remission while monitoring closely disease activity to prevent and shorten flares. SUMMARY The concept of flares has been clarified, and definitions have been developed for use in trials. The T2T approach aims at minimising flares in axSpA. The early recognition of flares and their severity may lead to better management.
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Affiliation(s)
- Krystel Aouad
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
- Saint George Hospital University Medical Center, University of Balamand, Beirut, Lebanon
| | - Laure Gossec
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
- Pitié-Salpêtrière hospital, AP-HP, Rheumatology Department, Paris, France
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Wendling D, Verhoeven F, Claudepierre P, Goupille P, Pham T, Prati C. Axial psoriatic arthritis: new entity or simple clinical form? Joint Bone Spine 2022; 89:105409. [DOI: 10.1016/j.jbspin.2022.105409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/20/2022] [Accepted: 05/06/2022] [Indexed: 10/18/2022]
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Soumagnac T, Braganca A, Peyrony O. Spondyloarthrite axiale, un diagnostic difficile. ANNALES FRANCAISES DE MEDECINE D URGENCE 2022. [DOI: 10.3166/afmu-2022-0437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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