1
|
Tichý Š, Nekvindová L, Baranová J, Vencovský J, Pavelka K, Horák P, Závada J. Drug survival analysis of etanercept compared with monoclonal antibody tumour necrosis factor-α inhibitors in rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis: a propensity score-matched analysis from the Czech ATTRA registry. Scand J Rheumatol 2024:1-8. [PMID: 39105330 DOI: 10.1080/03009742.2024.2381746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 07/15/2024] [Indexed: 08/07/2024]
Abstract
OBJECTIVES To compare the drug survival of etanercept to monoclonal tumour necrosis factor-α inhibitors in rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis. METHODS Patients initiating first line biological therapy with tumour necrosis factor-α were propensity score matched and compared for drug survival with a Kaplan-Meier analysis. RESULTS We matched 657 to 657 patients in rheumatoid arthritis, the median survival time on etanercept was 44.6 months vs. 36.8 months on monoclonal antibody tumour necrosis factor-α inhibitors, with a hazard ratio of 0.94, p = 0.416 We matched 187 to 356 patients in ankylosing spondylitis, the median survival time on etanercept was 75.1 compared to 68.0 months, hazard ratio of 0.78, p = 0.087 We matched 81 to 160 psoriatic arthritis patients, the median survival time on etanercept was 35.8. compared to 65.7 months, hazard ratio 1.61, p = 0.011. Patients treated with etanercept had significantly worse psoriasis scoring during follow up. CONCLUSIONS We found comparable survival in rheumatoid arthritis and ankylosing spondylitis. In psoriatic arthritis, we found significantly shorter survival on etanercept, possibly due to worse response of skin and nail manifestations.
Collapse
Affiliation(s)
- Š Tichý
- Institute of Rheumatology, Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - L Nekvindová
- Institute of Biostatistics and Analyses Ltd., Brno, Czech Republic
| | - J Baranová
- Institute of Biostatistics and Analyses Ltd., Brno, Czech Republic
| | - J Vencovský
- Institute of Rheumatology, Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - K Pavelka
- Institute of Rheumatology, Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - P Horák
- Third Department of Internal Medicine - Nephrology, Rheumatology and Endocrinology, University Hospital Olomouc, Olomouc, Czech Republic
| | - J Závada
- Institute of Rheumatology, Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| |
Collapse
|
2
|
Peng F, Chen F, Wen H, Bai J, Tian Y. Measurement of pre-treatment inflammatory cytokine levels is valuable for prediction of treatment efficacy to tumor necrosis factor inhibitor in axial spondyloarthritis patients. Int J Rheum Dis 2022; 25:844-850. [PMID: 35694730 PMCID: PMC9542033 DOI: 10.1111/1756-185x.14353] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 04/18/2022] [Accepted: 05/14/2022] [Indexed: 11/30/2022]
Abstract
Aim To evaluate the correlation of inflammatory cytokines with the treatment response to tumor necrosis factor inhibitor (TNFi) in axial spondyloarthritis (axSpA) patients. Methods This study enrolled 86 axSpA patients and 20 healthy controls (HCs). Inflammatory cytokines including tumor necrosis factor‐α (TNF‐α), interleukin (IL)‐1β, IL‐6, IL‐12, IL‐17A, IL‐21, IL‐23, and IL‐32 were determined in serum samples of axSpA patients before treatment and in HCs after enrollment. All patients received 40 mg adalimumab every 2 weeks for 12 weeks; meanwhile, ASAS40 (40 criteria of the Assessment by the SpondyloArthritis International Society) response rates were evaluated at weeks 2, 4, 8, and 12. Results Most inflammatory cytokines were elevated in axSpA patients compared with HCs (all P < 0.05) except for IL‐32 (P = 0.101). In axSpA patients, ASAS40 response rates were 0%, 19.5%, 34.5%, 47.1%, and 56.3% at weeks 0, 2, 4, 8, and 12, respectively. Baseline [interquartile range] IL‐6 (47.3 [32.5‐53.4] pg/mL vs 31.7 [23.0‐50.9] pg/mL, P = 0.005) and IL‐17A (127.9 [90.7‐149.5] pg/mL vs 96.6 [56.1‐112.6] pg/mL, P < 0.001) were higher in axSpA patients with ASAS40 response compared with those without ASAS40 response, while baseline TNF‐α, IL‐1β, IL‐12, IL‐21, IL‐23, and IL‐32 were not different between them (all P > 0.050). Multivariate logistic regression analysis disclosed that baseline IL‐17A (P = 0.037), C‐reactive protein (P = 0.012), and history of TNF inhibitor (P = 0.029) were independently associated with ASAS40 response. Furthermore, baseline IL‐17A, C‐reactive protein, history of TNFi, and their combination had an acceptable to good ability for predicting ASAS40 response. Conclusion Measurement of pre‐treatment inflammatory cytokine levels is valuable for predicting treatment efficacy of TNFi in axSpA patients.
Collapse
Affiliation(s)
- Fei Peng
- Department of Traditional Chinese Medicine, Section of Western Medicine Foundation Teaching and Research, Baoji Vocational & Technical College, Baoji, China
| | - Fengyun Chen
- Department of Hematology and Rheumatology, Baoji Central Hospital, Baoji, China
| | - Huijun Wen
- Department Neurology, Baoji Central Hospital, Baoji, China
| | - Jie Bai
- Department of Rheumatology and Immunology, No.215 Hospital of Shaanxi Nuclear Industry, Xianyang, China
| | - Yuping Tian
- Department of Hematology and Rheumatology, Baoji Central Hospital, Baoji, China
| |
Collapse
|
3
|
Zhang K, Zheng Y, Han Q, Liu Y, Wang W, Ding J, Wang Y, Zhang B, Jia J, Zheng M, Zheng Z, Zhu P. The Clinical and MRI Effect of TNF-α Inhibitors in Spondyloarthritis Patients With Hip Involvement: A Real-World Observational Clinical Study. Front Immunol 2021; 12:740980. [PMID: 34659233 PMCID: PMC8511713 DOI: 10.3389/fimmu.2021.740980] [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: 07/14/2021] [Accepted: 09/03/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives Hip involvement is an important cause of disability and poor prognosis in patients with spondyloarthritis (SpA). Tumor necrosis factor (TNF)-α inhibitor treatment has been demonstrated to be effective in SpA patients with hip arthritis; however, quantitative assessment using MRI in long-term follow-up needs further application and observation. Methods A total of 239 patients were involved in this study. Methotrexate and sulfasalazine were given as basic treatment. In total, 165 patients received TNF-α inhibitors plus basic treatment, and 74 received basic treatment only, as controls. Clinical symptoms were assessed at baseline and at weeks 12, 24, and 52. MRI performances of hip arthritis, including bone marrow edema (BME) and synovitis, were quantitatively assessed using the Hip Inflammation MRI Scoring System (HIMRISS). Results The clinical values of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Harris hip score, and Ankylosing Spondylitis Disease Activity Score (ASDAS)-ESR in both groups showed significant clinical remission at week 52 (p < 0.001). However, the change in disease activity levels at week 52 in the control group was significantly worse than in the TNF-α inhibitor group. At week 52, MRI showed a significant remission trend in the TNF-α inhibitor group versus baseline, and total HIMRISS scores were significantly decreased (26.49 ± 10.37 vs. 20.59 ± 9.41, p < 0.001); the control group only had slight improvement (p < 0.05). Conclusions TNF-α inhibitors could significantly improve clinical and MRI manifestations of hip involvement in patients with SpA. Quantitative MRI assessment combined with clinical assessment can be used to accurately evaluate the treatment effect of TNF-α in SpA patients with hip involvement to help guide targeted treatment.
Collapse
Affiliation(s)
- Kui Zhang
- Department of Clinical Immunology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China.,National Translational Science Center for Molecular Medicine, Xi'an, China
| | - Yan Zheng
- Department of Clinical Immunology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China.,National Translational Science Center for Molecular Medicine, Xi'an, China
| | - Qing Han
- Department of Clinical Immunology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China.,National Translational Science Center for Molecular Medicine, Xi'an, China
| | - Ying Liu
- Department of Radiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Weitao Wang
- Department of Clinical Immunology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China.,National Translational Science Center for Molecular Medicine, Xi'an, China
| | - Jin Ding
- Department of Clinical Immunology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China.,National Translational Science Center for Molecular Medicine, Xi'an, China
| | - Yan Wang
- Department of Clinical Immunology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China.,National Translational Science Center for Molecular Medicine, Xi'an, China
| | - Bei Zhang
- Department of Clinical Immunology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China.,National Translational Science Center for Molecular Medicine, Xi'an, China
| | - Junfeng Jia
- Department of Clinical Immunology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China.,National Translational Science Center for Molecular Medicine, Xi'an, China
| | - Minwen Zheng
- Department of Radiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Zhaohui Zheng
- Department of Clinical Immunology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China.,National Translational Science Center for Molecular Medicine, Xi'an, China
| | - Ping Zhu
- Department of Clinical Immunology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China.,National Translational Science Center for Molecular Medicine, Xi'an, China
| |
Collapse
|
4
|
Zhou X, Li M. JKAP serves as a potential biomarker for the evaluation of inflammatory condition, disease activity, and treatment response to TNF inhibitor in ankylosing spondylitis patients. Mod Rheumatol 2021; 32:613-618. [PMID: 34918117 DOI: 10.1093/mr/roab039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 07/05/2021] [Accepted: 07/09/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This study aimed to evaluate the value of JKAP as a biomarker in estimating treatment response to TNF inhibitor in AS patients. METHODS Totally, 63 AS patents who planned to receive adalimumab (TNF inhibitor) treatment were enrolled. Baseline JKAP level was determined in serum samples. All patients received 40 mg adalimumab every two weeks for 12 weeks. At W2, W4, W8, and W12, ASAS40 response rates were evaluated. RESULTS JKAP was negatively correlated with CRP (P = 0.032), BASDAI score (P = 0.021), BASFI score (P = 0.045), ASDASCRP score (P = 0.038), TNF-α (P = 0.031), IL-6 (P = 0.025) and IL-17A (P = 0.022). The ASAS40 response rates were 17.5%, 31.7%, 44.4% and 55.5% at W2, W4, W8 and W12, respectively. Baseline JKAP level was lower in patients with ASAS40 response than those without ASAS40 response (25.8 (13.2-42.7) pg/mL vs. 47.3 (26.7-71.2) pg/mL, P = 0.003). Multivariate logistic regression disclosed that JKAP level (P = 0.049) and CRP level (P = 0.014) independently correlated with ASAS40 response; further analyses disclosed that they exhibited acceptable to good ability in distinguishing patients with ASAS40 response from those without ASAS40 response. CONCLUSION JKAP serves as a potential biomarker for evaluation of inflammatory condition, disease activity, especially for assessing treatment response to TNF inhibitor in AS patients.
Collapse
Affiliation(s)
- Xianjie Zhou
- Department of Orthopedics, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Edong Healthcare Group, Huangshi, China
| | - Mingwu Li
- Department of Orthopedics, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Edong Healthcare Group, Huangshi, China
| |
Collapse
|
5
|
Yu CL, Yang CH, Chi CC. Drug Survival of Biologics in Treating Ankylosing Spondylitis: A Systematic Review and Meta-analysis of Real-World Evidence. BioDrugs 2021; 34:669-679. [PMID: 32946076 DOI: 10.1007/s40259-020-00442-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The last decade has witnessed the increasing use of biologics for the treatment of ankylosing spondylitis (AS). Drug survival is an outcome incorporating real-world effectiveness and safety. However, the drug survival of biologics in treating AS is unclear. OBJECTIVE The aim was to assess the drug survival of biologics (tumor necrosis factor inhibitors and anti-interleukin-17 monoclonal antibodies) in treating AS. METHODS We conducted a systematic review and meta-analysis and searched the PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and Embase databases up to 13th May 2020. Studies that analyzed the drug survival of biologics for AS and reported the respective annual data for each biologic for at least 1 year were included. Two authors independently screened and selected studies and assessed their risk of bias. A third author was available for arbitrating discrepancies. The Newcastle-Ottawa Scale was employed to evaluate the risk of bias of included studies. We conducted a random-effects model meta-analysis to obtain pooled drug survival from year 1 to 5. We performed subgroup analyses for biologic-naïve patients, first-line versus second- and third-line biologics, discontinuation due to loss of effectiveness and adverse effects, and high-quality studies. RESULTS We included 39 studies with 32,493 patients. The drug survival decreased from 76% at year 1 to 51% at year 5 for etanercept, from 75 to 51% for adalimumab, from 76 to 53% for infliximab, from 72 to 49% for golimumab, and from 63 to 57% for certolizumab pegol. The drug survival rate for secukinumab was 0.77 (95% confidence interval 0.64‒0.90) at year 1. Subgroup analyses on biologic-naïve patients and discontinuation due to adverse effects found no differences in the drug survival of various biologics except for a lower drug survival of infliximab in biologic-naïve patients. The drug survival for first-line biologics was higher than for second- and third-line biologics. CONCLUSION To the best of our knowledge, this study is the first systematic review and meta-analysis on the drug survival of biological therapies for AS patients. The drug survival of all biologics in treating AS appeared comparable, but is higher in first-line biologics than second- and third-line biologics. To date there are scarce data on the drug survival of newly available biologics, for example, anti-interleukin-17 biologics. PROSPERO REGISTRATION NO CRD42018114204.
Collapse
Affiliation(s)
- Chia-Ling Yu
- Department of Pharmacy, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Chung-Han Yang
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Ching-Chi Chi
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, 5, Fuxing St, Guishan Dist, Taoyuan, 33305, Taiwan. .,College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| |
Collapse
|
6
|
Resende GG, Meirelles EDS, Marques CDL, Chiereghin A, Lyrio AM, Ximenes AC, Saad CG, Gonçalves CR, Kohem CL, Schainberg CG, Campanholo CB, Bueno Filho JSDS, Pieruccetti LB, Keiserman MW, Yazbek MA, Palominos PE, Goncalves RSG, Lage RDC, Assad RL, Bonfiglioli R, Anti SMA, Carneiro S, Oliveira TL, Azevedo VF, Bianchi WA, Bernardo WM, Pinheiro MDM, Sampaio-Barros PD. The Brazilian Society of Rheumatology guidelines for axial spondyloarthritis - 2019. Adv Rheumatol 2020; 60:19. [PMID: 32171329 DOI: 10.1186/s42358-020-0116-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 01/22/2020] [Indexed: 12/13/2022] Open
Abstract
Spondyloarthritis is a group of chronic inflammatory systemic diseases characterized by axial and/or peripheral joints inflammation, as well as extra-articular manifestations. The classification axial spondyloarthritis is adopted when the spine and/or the sacroiliac joints are predominantly involved. This version of recommendations replaces the previous guidelines published in May 2013.A systematic literature review was performed, and two hundred thirty-seven studies were selected and used to formulate 29 recommendations answering 15 clinical questions, which were divided into four sections: diagnosis, non-pharmacological therapy, conventional drug therapy and biological therapy. For each recommendation the level of evidence supporting (highest available), the strength grade according to Oxford, and the degree of expert agreement (inter-rater reliability) is informed.These guidelines bring evidence-based information on clinical management of axial SpA patients, including, diagnosis, treatment, and prognosis.
Collapse
Affiliation(s)
- Gustavo Gomes Resende
- Universidade Federal de Minas Gerais (UFMG), Alameda Álvaro Celso, 175 / 2° Andar. Santa Efigênia. CEP 30.150-260, Belo Horizonte, MG, Brazil.
| | | | | | | | - Andre Marun Lyrio
- Pontifície Universidade Católica (PUC) de Campinas, Campinas, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | - Ricardo da Cruz Lage
- Universidade Federal de Minas Gerais (UFMG), Alameda Álvaro Celso, 175 / 2° Andar. Santa Efigênia. CEP 30.150-260, Belo Horizonte, MG, Brazil
| | | | | | | | - Sueli Carneiro
- Universidade Federal do Rio De Janeiro (UFRJ), Rio de Janeiro, Brazil
| | | | | | | | | | | | | |
Collapse
|
7
|
Svedbom A, Dalén J, Ivergård M, Borse RH, Black CM, Luttropp K, Kachroo S. The value of persistence in treatment with subcutaneous TNF-alpha inhibitors for ankylosing spondylitis. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2020; 21:45-54. [PMID: 31522361 DOI: 10.1007/s10198-019-01110-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 08/26/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To estimate the impact of persistence on cost-effectiveness of subcutaneous tumor necrosis factor-α inhibitors (SC-TNFis) from healthcare and societal perspectives in a United Kingdom ankylosing spondylitis (AS) population using a recently published Markov cohort model. METHODS A recently published cost-effectiveness model developed for a National Institute for health and Care Excellence appraisal was extended to fit the current study; in brief, it is a Markov cohort model where treatment responders continue from the trial period with maintenance SC-TNFi treatment, while non-responders transition to conventional care. Costs and effects were modeled for a hypothetical SC-TNFi with average efficacy and price. Model outcomes included quality-adjusted life-years (QALYs), total direct and indirect lifetime costs, and incremental cost-effectiveness ratios (ICERs). The cost-effectiveness of SC-TNFi persistence was estimated by decreasing the annual discontinuation probability in five percentage point increments from 25 to 5% per annum. RESULTS From a health care perspective, the ICERs for the modeled discontinuation rates compared to the baseline annual discontinuation rate (25%) ranged between GBP 17,277 and GBP 18,161. From a societal perspective, increased discontinuation rates resulted in decreased total costs and higher QALYs; hence, lower discontinuation rates dominated higher discontinuation rates from a societal perspective. CONCLUSION In conclusion, this study shows that, all else equal, higher SC-TNFi treatment persistence in AS is cost effective from a health care perspective and dominant from a societal perspective. Hence, all else equal, prescribing the SC-TNFi with the highest persistence may be considered a cost-effective strategy.
Collapse
Affiliation(s)
- Axel Svedbom
- Real-World Strategy and Analytics, ICON Clinical Research, Stockholm, Sweden
| | - Johan Dalén
- Real-World Strategy and Analytics, ICON Clinical Research, Stockholm, Sweden
| | - Moa Ivergård
- Real-World Strategy and Analytics, ICON Clinical Research, Stockholm, Sweden
| | - Rebekah H Borse
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
| | - Christopher M Black
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
| | - Karin Luttropp
- Real-World Strategy and Analytics, ICON Clinical Research, Stockholm, Sweden
| | - Sumesh Kachroo
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA.
| |
Collapse
|
8
|
Gai X, Li L. Overexpression of Long Noncoding RNAs (lncRNA) NF-κβ-Interacting Long Noncoding RNA (NKILA) in Ankylosing Spondylitis is Correlated with Transforming Growth Factor β1 (TGF-β1), Active Disease and Predicts Length of Treatment. Med Sci Monit 2019; 25:4244-4249. [PMID: 31173579 PMCID: PMC6570992 DOI: 10.12659/msm.913813] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background Long noncoding RNAs (lncRNA) NF-κβ-interacting long noncoding RNA (NKILA) is downregulated in various types of cancers, while its involvement in other diseases is unknown. In the present study we found that plasma lncRNA NKILA was expressed at higher levels in active ankylosing spondylitis patients than in healthy controls. Material/Methods According to Youden’s index, active disease patients were divided into high and low lncRNA NKILA groups. Results Patients in the high lncRNA NKILA level group had significantly longer length of treatment and higher re-hospitalization rate at 3 years after discharge. Plasma levels of TGF-β1 were also higher in active ankylosing spondylitis patients than in healthy controls. Levels of plasma lncRNA NKILA and TGF-β1 were significantly and positively correlated in ankylosing spondylitis patients but not in healthy controls. Conclusions Overexpression of lncRNA NKILA in ankylosing spondylitis is correlated with active disease and predicts length of treatment. LncRNA NKILA may participate in ankylosing spondylitis through the interaction with TGF-β1, which is a key player in this disease.
Collapse
Affiliation(s)
- Xuesong Gai
- Department of Rehabilitation Medicine, The First People's Hospital of Yunnan Province, Kunming, Yunnan, China (mainland)
| | - Li Li
- Department of Emergency Trauma Surgery, The First People's Hospital of Yunnan Province, Kunming, Yunnan, China (mainland)
| |
Collapse
|
9
|
Lindström U, Olofsson T, Wedrén S, Qirjazo I, Askling J. Biological treatment of ankylosing spondylitis: a nationwide study of treatment trajectories on a patient level in clinical practice. Arthritis Res Ther 2019; 21:128. [PMID: 31138285 PMCID: PMC6540538 DOI: 10.1186/s13075-019-1908-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 05/07/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND There is substantial evidence that patients with ankylosing spondylitis (AS) have high response rates to tumour necrosis factor inhibitors (TNFi), a low likelihood of successful treatment termination, but yet a limited drug retention. Whereas several reports have assessed drug retention rates for TNFi in AS, there are few, if any, studies investigating the actual treatment trajectories on a patient level, including subsequent therapy changes and dose reductions, of individual patients. The aim of this study was to describe 5-year treatment trajectories in patients with ankylosing spondylitis (AS) starting a first TNFi. METHODS Bio-naïve patients with AS starting a TNFi in 2006-2015 were identified in the nationwide Swedish Rheumatology Quality register and followed until 31 December 2015. All changes in their anti-rheumatic treatment during follow-up were recorded. To further increase precision, these data were complimented by information on the amount of prescribed subcutaneous TNFi collected from pharmacies during each year, retrieved from the Swedish Prescribed Drug Register. RESULTS Two thousand five hundred ninety patients started a first TNFi 2006-2015, and after 1 year, 74% remained on their first TNFi. However, after 5 years, this figure was only 46%, although at that time 63% were still on treatment with any biologic, while 30% had no anti-rheumatic treatment at all. After discontinuing the first TNFi, 46% switched directly to a second TNFi, but the drug retention for the second and third TNFi grew successively shorter compared to that for the first TNFi. In contrast, patients remaining on treatment with their first subcutaneous TNFi gradually reduced the dose, so that during the fifth year of treatment only 66% had collected ≥ 75% of the defined daily doses for that year. CONCLUSION Less than half of patients with AS will remain on their first TNFi after 5 years, but most are still on a biologic. While patients remaining on treatment with their first TNFi appear to be able to reduce the dose over time, a large proportion cycle through several biologics, and 1/3 have no anti-rheumatic treatment after 5 years. This indicates the importance of thorough follow-up programs as well as a need for alternative therapeutic options.
Collapse
Affiliation(s)
- Ulf Lindström
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Tor Olofsson
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Sara Wedrén
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ilia Qirjazo
- Rheumatology Department, Linköping University Hospital, Linköping, Sweden
| | - Johan Askling
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Clinical Epidemiology Unit, Karolinska University Hospital Solna, Stockholm, Sweden
| |
Collapse
|
10
|
Yang R, Liu H, Fan M. A quick decrease of bone marrow edema in sacroiliac joint could be served as a novel marker for dose tapering of etanercept in ankylosing spondylitis patients. Medicine (Baltimore) 2019; 98:e14620. [PMID: 30882628 PMCID: PMC6426528 DOI: 10.1097/md.0000000000014620] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
The purpose of this study was to investigate the correlation of bone marrow edema (BME) in sacroiliac joint (SIJ) with clinical characteristics and clinical response, and whether the quick decrease of BME could be served as a novel marker for dose tapering of etanercept in ankylosing spondylitis (AS) patients.Ninety active AS patients underwent etanercept treatment for 6 months were enrolled consecutively and classified into standard dose group (n = 37) and dose tapering group (n = 53). BME in SIJ and clinical response were assessed by SPARCC criteria and ASAS 40 response criteria, respectively. "Quick decrease of BME in SIJ" was defined as the decrease of SPARCC score≥50% from M0 to M1.BME in SIJ was positively correlated with pain VAS score, BASDAI score, CRP, IL-1β, IL-17, and TNF-α levels. ASAS 40 response rate at M6 was lower in dose tapering group than standard dose group, while higher in patients with a quick decrease of BME in SIJ than other patients. Besides, the ASAS 40 response rate in dose tapering group was similar to standard dose group in patients with a quick decrease of BME in SIJ but was lower than standard dose group in patients without a quick decrease of BME in SIJ at M6.A quick decrease of BME in SIJ predicts better treatment response to etanercept, and it might be served as a novel marker for dose tapering initiation of etanercept in AS patients.
Collapse
Affiliation(s)
- Ruishan Yang
- Department of CT/MRI, The Second People's Hospital of Liaocheng, Linqing, Shandong
| | - Hongda Liu
- Foot and Ankle Surgery, The Second Hospital of Tangshan, Tangshan, Hebei
| | - Mengpo Fan
- Department of Orthopaedic Surgery, The Second People's Hospital of Liaocheng, Linqing, Shandong, China
| |
Collapse
|
11
|
Dong Y, Li P, Xu T, Bi L. Effective serum level of etanercept biosimilar and effect of antidrug antibodies on drug levels and clinical efficacy in Chinese patients with ankylosing spondylitis. Clin Rheumatol 2019; 38:1587-1594. [PMID: 30747393 DOI: 10.1007/s10067-018-04424-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 12/03/2018] [Accepted: 12/28/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To investigate the effective serum level of etanercept biosimilar in Chinese patients with ankylosing spondylitis (AS) who achieve AS Disease Activity Score-C-reactive protein (ASDAS-CRP) < 2.1, and the effect of antidrug antibodies on drug levels and clinical efficacy. METHODS Our study enrolled 60 patients with AS who were treated with etanercept biosimilar. Serum and clinical data were collected at baseline and treatment weeks 4, 12, and 24. Drug levels and antidrug antibody levels were measured using an enzyme-linked immunosorbent assay while tumour necrosis factor (TNF)-α levels were measured using cytometric bead array. A receiver operating characteristic (ROC) curve was used to analyse effective serum level of etanercept biosimilar. RESULTS Patients with ASDAS-CRP ≥ 2.1 exhibited significantly lower drug levels than those with ASDAS-CRP < 2.1 did. The cut-off values of effective serum level of patients with AS who achieved ASDAS-CRP < 2.1 at weeks 4, 12, and 24 were 2.32, 2.12, and 2.36 μg/mL, respectively. Patients with drug levels above the cut-off value had lower Bath AS Disease Activity Index (BASDAI) and TNF-α levels. Antidrug antibodies had no effect on the Assessment of Spondylosis Arthritis International Society (ASAS) remission rates, but patients with antidrug antibodies had lower drug levels and higher TNF-α levels. CONCLUSIONS Detecting serum drug levels and antidrug antibody levels might facilitate estimation of the clinical efficacy and adjustment of medication regimen during etanercept biosimilar therapy in Chinese patients with AS.
Collapse
Affiliation(s)
- Yidian Dong
- Department of Rheumatology and Immunology, China-Japan Union Hospital of Jilin University, 126 Xiantai Street, Changchun, 130033, China
| | - Ping Li
- Department of Rheumatology and Immunology, China-Japan Union Hospital of Jilin University, 126 Xiantai Street, Changchun, 130033, China
| | - Tingshuang Xu
- Department of Rheumatology and Immunology, China-Japan Union Hospital of Jilin University, 126 Xiantai Street, Changchun, 130033, China
| | - Liqi Bi
- Department of Rheumatology and Immunology, China-Japan Union Hospital of Jilin University, 126 Xiantai Street, Changchun, 130033, China.
| |
Collapse
|