1
|
Crossfield SSR, Marzo-Ortega H, Kingsbury SR, Pujades-Rodriguez M, Conaghan PG. Changes in ankylosing spondylitis incidence, prevalence and time to diagnosis over two decades. RMD Open 2021; 7:rmdopen-2021-001888. [PMID: 34887345 PMCID: PMC8663075 DOI: 10.1136/rmdopen-2021-001888] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/16/2021] [Indexed: 12/17/2022] Open
Abstract
Objectives To assess changes in ankylosing spondylitis (AS) incidence, prevalence and time to diagnosis, between 1998 and 2017. Methods Using UK GP data from the Clinical Practice Research Datalink, we identified patients diagnosed with AS between 1998 and 2017. We estimated the annual AS incidence, prevalence and length of time from first recorded symptom of back pain to rheumatology referral and diagnosis. Results We identified 12 333 patients with AS. The incidence declined from 0.72 (±0.14) per 10 000 patient-years in 1998 to 0.39 (±0.06) in 2007, with this decline significant only in men, then incidence rose to 0.57 (±0.11) in 2017. By contrast, prevalence increased between 1998 and 2017 (from 0.13%±0.006 to 0.18%±0.006), rising steeply among women (from 0.06%±0.05 to 0.10%±0.06) and patients aged ≥60 (from 0.14%±0.01 to 0.26%±0.01). The overall median time from first symptom to rheumatology referral was 4.87 years (IQR=1.42–10.23). The median time from first symptom to diagnosis rose between 1998 and 2017 (from 3.62 years (IQR=1.14–7.07) to 8.31 (IQR=3.77–15.89)) and was longer in women (6.71 (IQR=2.30–12.36)) than men (5.65 (IQR=1.66–11.20)). Conclusion AS incidence declined significantly between 1998 and 2007, with an increase between 2007 and 2017 that may be explained by an improvement in the recognition of AS or confidence in diagnosing AS over time, stemming from increased awareness of inflammatory back pain and the importance of early treatment. The rising AS prevalence may indicate improved patient survival. The persisting delay in rheumatology referral and diagnosis remains of concern, particularly in women.
Collapse
Affiliation(s)
- Samantha S R Crossfield
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK .,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Helena Marzo-Ortega
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Sarah R Kingsbury
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| |
Collapse
|
2
|
Jones GT, Dean LE, Pathan E, Hollick RJ, Macfarlane GJ. Real-world evidence of TNF inhibition in axial spondyloarthritis: can we generalise the results from clinical trials? Ann Rheum Dis 2020; 79:914-919. [PMID: 32327428 DOI: 10.1136/annrheumdis-2019-216841] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/14/2020] [Accepted: 04/05/2020] [Indexed: 11/04/2022]
Abstract
Management guidelines assume that results from clinical trials can be generalised, although seldom is data available to test this assumption. We aimed to determine the proportion of patients commencing tumour necrosis factor inhibition (TNFi) who would have been eligible for relevant clinical trials, and whether treatment response differs between these groups and the trials themselves. The British Society for Rheumatology Biologics Register for Ankylosing Spondylitis (BSRBR-AS) recruited a real-world cohort of TNFi-naïve spondyloarthritis patients with data collection from clinical records and patient questionnaires. Participant characteristics were extracted from trials identified from a recent Health Technology Assessment of TNFi for ankylosing spondylitis/non-radiographic axial spondyloarthritis. Descriptive statistics were used to determine the differences, including treatment response, between BSRBR-AS participants who would/would not have been eligible for the clinical trials and with trial participants. Among 2420 BSRBR-AS participants, those commencing TNFi (34%) had shorter symptom duration (15 vs 22 years) but more active disease (Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) 6.4 vs 4.0; Bath Ankylosing Spondylitis Disease Functional Index (BASFI) 6.2 vs 3.8). Of those commencing TNFi, 41% met eligibility criteria for ≥1 of fourteen relevant trials; they reported higher disease activity (BASDAI 6.9 vs 6.1) and poorer function (BASFI 6.6 vs 6.0). 61.7% of trial participants reported a positive treatment response, vs 51.3% of BSRBR-AS patients (difference: 10.4%; 95% CI 4.4% to 16.5%). Potential eligibility for trials did not influence treatment response (difference 2.0%; -9.4% to 13.4%). Fewer patients in the real world respond to TNFi than is reported in the trial literature. This has important implications for the generalisability of trial results, and the cost-effectiveness of TNFi agents.
Collapse
Affiliation(s)
- Gareth T Jones
- Epidemiology Group, Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Linda E Dean
- Epidemiology Group, Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Ejaz Pathan
- Department of Rheumatology, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Rosemary J Hollick
- Epidemiology Group, Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Gary J Macfarlane
- Epidemiology Group, Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| |
Collapse
|
3
|
Purmonen T, Puolakka K, Mishra D, Gunda P, Martikainen J. Cost-effectiveness of secukinumab compared to other biologics in the treatment of ankylosing spondylitis in Finland. CLINICOECONOMICS AND OUTCOMES RESEARCH 2019; 11:159-168. [PMID: 30858713 PMCID: PMC6386207 DOI: 10.2147/ceor.s192235] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
AIM This study assesses the cost-effectiveness of secukinumab vs currently licensed biologics for the treatment of ankylosing spondylitis (AS) from the Finnish health care system perspective. METHODS A semi-Markov model compared secukinumab with adalimumab, adalimumab biosimilar, certolizumab pegol, etanercept, etanercept biosimilar, golimumab, and infliximab in a biologic-naïve population over a lifetime horizon. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) was used to assess the treatment response. Efficacy inputs were obtained from the network meta-analysis, and other model inputs were obtained from the published literature and Finnish sources. Main study outcomes included quality-adjusted life years (QALYs) gained and incremental cost-effectiveness ratio in terms of cost per QALY gained. Robustness of results was confirmed by sensitivity analyses and alternative scenario analyses. RESULTS Secukinumab achieved highest QALYs (13.1) at lowest expected lifetime cost (€279,872) vs other comparators in biologic-naïve AS patients in the base case analysis, thus it dominated other biologics. Golimumab had a second highest QALYs (12.9) at the total cost of €309,551. Results were sensitive to variation in BASDAI 50 response for secukinumab, baseline Bath Ankylosing Spondylitis Functional Index (BASFI) score across all drugs, change in BASDAI and BASFI scores, and discount rates as observed in the one-way sensitivity analyses. Secukinumab was either dominant or cost-effective treatment in different alternative scenarios. CONCLUSION Secukinumab presented itself to be the dominant (ie, less costly and more effective) treatment vs other comparators for the biologic-naïve patients with AS in Finland.
Collapse
Affiliation(s)
| | - Kari Puolakka
- South Karelia Central Hospital, Lappeenranta, Finland
| | - Dinesh Mishra
- Novartis Product Lifecycle Services-NBS, Novartis Healthcare Private Limited, Hyderabad, India
| | - Praveen Gunda
- Novartis Product Lifecycle Services-NBS, Novartis Healthcare Private Limited, Hyderabad, India
| | | |
Collapse
|
4
|
Goeree R, Chiva-Razavi S, Gunda P, Jain M, Jugl SM. Cost-effectiveness analysis of secukinumab in ankylosing spondylitis from the Canadian perspective. J Med Econ 2019; 22:45-52. [PMID: 30346844 DOI: 10.1080/13696998.2018.1539400] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AIM To assess the cost-effectiveness of interleukin (IL)-17A inhibitor secukinumab vs the currently licensed biologic therapies in ankylosing spondylitis (AS) patients from a Canadian healthcare system perspective. METHODS A decision analytic model (semi-Markov) evaluated the cost-effectiveness of secukinumab 150 mg compared to certolizumab pegol, adalimumab, golimumab, etanercept and etanercept biosimilar, and infliximab and infliximab biosimilar in a biologic-naïve population, over 60 years of time horizon (lifetime). The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI 50) response rate was used to assess treatment response at week 12. Non-responders or patients discontinuing initial-line of biologic therapy were allowed to switch to subsequent-line biologics. Model input parameters (short-term and long-term changes in BASDAI and Bath Ankylosing Spondylitis Functional Index [BASFI], withdrawal rates, adverse events, costs, resource use, utilities, and disutilities) were obtained from clinical trials, published literature, and other Canadian sources. Benefits were expressed as quality-adjusted life years (QALYs). Cost and benefits were discounted with an annual discount rate of 1.5% for all treatments. RESULTS In the biologic-naïve population, secukinumab 150 mg dominated all comparators, as patients treated with secukinumab 150 mg achieved the highest QALYs (16.46) at the lowest cost (CAD 533,010) over a lifetime horizon vs comparators. In the deterministic sensitivity analysis, results were most sensitive to changes in baseline BASFI non-responders, BASDAI 50 at 3 months and discount rates. Probabilistic sensitivity analysis showed that secukinumab 150 mg demonstrated higher probability of achieving maximum net monetary benefit vs all comparators at various cost thresholds. CONCLUSIONS This analysis demonstrates that secukinumab 150 mg is the most cost-effective treatment option for biologic-naïve AS patients compared to certolizumab pegol, adalimumab, golimumab, etanercept and etanercept biosimilar, and infliximab and infliximab biosimilar for a lifetime horizon in Canada. Treatment with secukinumab translates into substantial benefits for patients and the healthcare system.
Collapse
Affiliation(s)
- Ron Goeree
- a Goeree Consulting Ltd and Professor Emeritus, McMaster University , Hamilton , Ontario , Canada
| | | | - Praveen Gunda
- c Novartis Product Life Cycle Services-NBS, Novartis Healthcare Private Limited , Hyderabad , India
| | - Minal Jain
- c Novartis Product Life Cycle Services-NBS, Novartis Healthcare Private Limited , Hyderabad , India
| | | |
Collapse
|
5
|
Emery P, Van Keep M, Beard S, Graham C, Miles L, Jugl SM, Gunda P, Halliday A, Marzo-Ortega H. Cost Effectiveness of Secukinumab for the Treatment of Active Ankylosing Spondylitis in the UK. PHARMACOECONOMICS 2018; 36:1015-1027. [PMID: 29797186 PMCID: PMC6021464 DOI: 10.1007/s40273-018-0675-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To determine the cost effectiveness of secukinumab, a fully human interleukin-17A inhibitor, for adults in the UK with active ankylosing spondylitis (AS) who have not responded adequately to previous treatment with conventional care (CC; biologic-naïve population) or previous biologic therapy (biologic-experienced population). PERSPECTIVE AND SETTING UK National Health Service (NHS). METHODS The model was structured as a 3-month decision tree leading into a Markov model. Comparators were licensed tumour necrosis factor inhibitors (including available biosimilars) and CC in the biologic-naïve and biologic-experienced populations, respectively. Clinical parameters captured treatment response, short-term disease activity and patient functioning, as well as long-term structural disease progression. Utilities were derived from secukinumab trial data. List prices were used for all drugs. The cost year was 2017 and costs and outcomes were discounted at 3.5%. RESULTS In the biologic-naïve population, secukinumab dominated adalimumab and certolizumab pegol. Incremental cost-effectiveness ratios (ICERs) versus other comparators were either below £10,000 per quality-adjusted life-year (QALY) gained or south-west ICERs that implied cost effectiveness of secukinumab. In biologic-experienced patients, the ICER for secukinumab versus CC was £4927 per QALY gained. Treatment response rates, short-term treatment effects, long-term radiographic progression and biologic acquisition costs were key model drivers. Scenario analysis found results to be robust to changes in model structural assumptions. Probabilistic analysis identified greater uncertainty in results in the biologic-naïve population. CONCLUSIONS Even at list price, secukinumab appears to represent a cost-effective use of NHS resources for biologic-naïve and biologic-experienced patients with active AS. Further research on long-term radiographic progression outcomes would be valuable for future cost-effectiveness analyses in AS.
Collapse
Affiliation(s)
- Paul Emery
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | | | - Chris Graham
- RTI Health Solutions, Research Triangle Park, NC, USA
| | | | | | - Praveen Gunda
- Novartis Healthcare Private Limited, Hyderabad, India
| | - Anna Halliday
- Novartis Pharmaceuticals UK Ltd, Camberley, Surrey, UK.
| | - Helena Marzo-Ortega
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| |
Collapse
|
6
|
The severity of ankylosing spondylitis and responses to anti-tumour necrosis factor biologics are not influenced by the tumour necrosis factor receptor polymorphism incriminated in multiple sclerosis. Genes Immun 2018. [DOI: 10.1038/s41435-018-0017-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
|
7
|
Aquaporin-1 expression as an indicator in evaluating the efficacy of meloxicam in the treatment of ankylosing spondylitis: A comparative study. Biomed Pharmacother 2017; 95:1549-1555. [PMID: 28950654 DOI: 10.1016/j.biopha.2017.08.093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 08/11/2017] [Accepted: 08/23/2017] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE The key objective of the study was to investigate the correlation between the expression of aquaporin-1 (AQP1) and the efficacy of meloxicam and expressions of pro-inflammatory cytokines in ankylosing spondylitis (AS). METHODS 40 AS patients whom had received meloxicam were recruited and subsequently placed into the experiment, while 40 healthy individuals were recruited as control group. Clinical indicators were detected before treatment (0 week), and at 2, 4, 6, 8, 10 and 12 week intervals after treatment, which included various assessments including Ankylosing Spondylitis 20% (ASAS20) response, Bath ankylosing spondylitis disease activity index (BASDAI), visual analog scale (VAS) for back pain, duration of morning stiffness, Bath ankylosing spondylitis functional index (BASFI), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) levels. Healthy volunteers were examined for ESR and CRP levels. The mRNA and protein expressions of AQP1 and pro-inflammatory cytokines, tumor necrosis factor-α (TNF-α) and interleukin-2 (IL-2), in peripheral blood mononuclear cells (PBMCs) were detected 6 and 12 weeks after treatment using reverse transcription quantitative polymerase chain reaction (RT-qPCR) and Western blotting. Correlation of expressions of AQP1, efficacy of meloxicam and expression of pro-inflammatory cytokines were determined via Pearson correlation analysis. RESULTS Following 12 weeks of meloxicam treatment, the ASAS20 response reached 93.7±3.61%. 6 weeks after treatment, BASDAI, VAS for back pain, duration of morning stiffness, BASFI, ESR, and CRP levels all exhibited considerably reduced levels compared to the initial levels observed prior to the commencement of treatment. Compared with before treatment, the expressions of TNF-α, IL-2 and AQP1 mRNA and protein all displayed decreases in the experiment group after both 6 and 12-week periods of treatment. Pre and post treatment levels of TNF-α, IL-2 and AQP1 mRNA and protein expressions were higher than those in the control group. The expressions of AQP1 mRNA and protein in the experiment group were positively correlated with clinical indicators and expressions of pro-inflammatory cytokines. CONCLUSION Our findings indicated that AQP1 was both highly expressed and positively correlated with the efficacy of meloxicam and expressions of pro-inflammatory cytokines in AS patients, thereby highlighting the promise of meloxicam as a potential indicator in predicting the efficacy in the treatment of AS.
Collapse
|
8
|
Harvard S, Guh D, Bansback N, Richette P, Saraux A, Fautrel B, Anis A. Access criteria for anti-TNF agents in spondyloarthritis: influence on comparative 1-year cost-effectiveness estimates. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2017; 15:20. [PMID: 28904528 PMCID: PMC5590198 DOI: 10.1186/s12962-017-0081-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 08/23/2017] [Indexed: 12/17/2022] Open
Abstract
Background Anti-tumor necrosis factor (anti-TNF) agents are an effective, but costly, treatment for spondyloarthritis (SpA). Worldwide, multiple sets of access criteria aim to restrict anti-TNF therapy to patients with specific clinical characteristics, yet the influence of access criteria on anti-TNF cost-effectiveness is unknown. Our objective was to use data from the DESIR cohort, a prospective study of early SpA patients in France, to determine whether the French anti-TNF access criteria are the most cost-effective in that setting relative to other potential restrictions. Methods We used data from the DESIR cohort to create five study populations of patients meeting anti-TNF access criteria from Canada, France, Germany, United Kingdom, and Hong Kong, respectively. For each study population, we calculated the costs and quality-adjusted life years (QALYs) over 1 year of patients treated and not treated with anti-TNF therapy. To control for differences between anti-TNF users and non-users, we used linear regression models to derive adjusted mean costs and QALYs. We calculated incremental cost-effectiveness ratios (ICERs) representing the incremental cost per additional QALY gained by treating with an anti-TNF within each of the five study populations, using bootstrapping to explore the range of uncertainty in costs and QALYs. A series of sensitivity analyses was conducted, including one to simulate the effect of a 24-week stopping rule for anti-TNF non-responders. Results Anti-TNF access criteria from France were satisfied by the largest proportion of DESIR patients (27.8%), followed by Germany (25.1%), Canada (23.8%), the UK (12.1%) and Hong Kong (8.6%). Confidence intervals around incremental costs and QALYs in the basecase analysis were overlapping, indicating that anti-TNF cost-effectiveness estimates derived from each subset were similar. In the sensitivity analysis that examined the effect of excluding costs accumulated past 24 weeks by anti-TNF non-responders, the incremental cost per QALY was reduced by approximately 25% relative to the basecase analysis (France: €857,992 vs. €1,105,859; Canada: € 626,459 vs. €818,186; Germany: € 422,568 vs. €545,808); UK €578,899 vs. €766,217; Hong Kong €335,418 vs. €456,850). Conclusions Anti-TNF cost-effectiveness is strongly affected by treatment continuation among non-responders. Access criteria could improve anti-TNF cost-effectiveness by defining patients likely to respond. Electronic supplementary material The online version of this article (doi:10.1186/s12962-017-0081-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Stephanie Harvard
- University of British Columbia, Vancouver, Canada.,Centre for Health Evaluation and Outcome Sciences, 588-1081, Burrard Street, Vancouver, BC V6Z 1Y6 Canada.,Sorbonne Universités, UPMC-GRC08, Pierre Louis Institute for Epidemiology and Public Health, Paris, France
| | - Daphne Guh
- Centre for Health Evaluation and Outcome Sciences, 588-1081, Burrard Street, Vancouver, BC V6Z 1Y6 Canada
| | - Nick Bansback
- University of British Columbia, Vancouver, Canada.,Centre for Health Evaluation and Outcome Sciences, 588-1081, Burrard Street, Vancouver, BC V6Z 1Y6 Canada
| | - Pascal Richette
- University Paris Diderot, Faculty of Medicine, Paris 07, Paris, France.,AP-HP, Rheumatology Department, Lariboisiere University Hospital, Paris, France
| | - Alain Saraux
- Rheumatology Unit, Hôpital de la Cavale Blanche, 29609 Brest, France.,EA2216, INSERM ESPRI ERI29 Université de Brest LabEx IGO, Brest, France
| | - Bruno Fautrel
- Sorbonne Universités, UPMC-GRC08, Pierre Louis Institute for Epidemiology and Public Health, Paris, France.,AP-HP, Rheumatology Department, Pitié Salpétrière University Hospital, Paris, France
| | - Aslam Anis
- University of British Columbia, Vancouver, Canada.,Centre for Health Evaluation and Outcome Sciences, 588-1081, Burrard Street, Vancouver, BC V6Z 1Y6 Canada
| |
Collapse
|
9
|
Handa R, Upadhyaya S, Kapoor S, Jois R, Pandey BD, Bhatnagar AK, Khanna A, Goyal V, Kumar K. Tuberculosis and biologics in rheumatology: A special situation. Int J Rheum Dis 2017; 20:1313-1325. [PMID: 28730751 DOI: 10.1111/1756-185x.13129] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
India has a huge patient burden of rheumatic diseases (RDs) including rheumatoid arthritis. The use of biologics has transformed the treatment paradigm for RD; however, biologic treatment-related infections (especially tuberculosis [TB]) are an area of potential concern for TB-endemic nations like India. Anti-tumor necrosis factor (TNF) therapy impairs the physiological TNF-mediated signaling and may cause reactivation and dissemination of latent TB infection (LTBI). Careful screening is, thus, crucial in RD patients who are about to commence anti-TNF treatment. To date, there is no consensus available for the screening, evaluation and treatment of LTBI as well as on the drug dosage and duration regimen (monotherapy or combination therapy) in the Indian population. An evidence-based algorithm for LTBI screening and management in RD patients undergoing biologic disease-modifying anti-rheumatic drug therapy is suggested in this review for Indian rheumatologists. The proposed algorithm guides physicians through a step-wise screening approach, including medical history, tuberculin skin test, interferon gamma release assay, chest radiograph and management of LTBI with isoniazid therapy or its combination with rifampicin. Further, the provided algorithm can aid the national bodies (such as National TB Control Program) in formulating recommendations for LTBI in this high-risk population.
Collapse
Affiliation(s)
- Rohini Handa
- Department of Rheumatology, Indraprastha Apollo Hospital, New Delhi, India
| | - Sundeep Upadhyaya
- Department of Rheumatology, Indraprastha Apollo Hospital, New Delhi, India
| | - Sanjiv Kapoor
- Department of Rheumatology, Indian Spinal Injuries Center, New Delhi, India
| | - Ramesh Jois
- Department of Rheumatology, Fortis Hospital, Bangalore, India
| | | | - Anuj K Bhatnagar
- Rajan Babu Institute of Pulmonary Medicine and Tuberculosis, New Delhi, India
| | | | - Vishal Goyal
- Medical Affairs Department, Janssen India, Johnson & Johnson Pvt. Ltd., Mumbai, India
| | - Kamal Kumar
- Medical Affairs Department, Janssen India, Johnson & Johnson Pvt. Ltd., Mumbai, India
| |
Collapse
|
10
|
Corbett M, Soares M, Jhuti G, Rice S, Spackman E, Sideris E, Moe-Byrne T, Fox D, Marzo-Ortega H, Kay L, Woolacott N, Palmer S. Tumour necrosis factor-α inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis: a systematic review and economic evaluation. Health Technol Assess 2016; 20:1-334, v-vi. [PMID: 26847392 DOI: 10.3310/hta20090] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Tumour necrosis factor (TNF)-α inhibitors (anti-TNFs) are typically used when the inflammatory rheumatologic diseases ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nr-AxSpA) have not responded adequately to conventional therapy. Current National Institute for Health and Care Excellence (NICE) guidance recommends treatment with adalimumab, etanercept and golimumab in adults with active (severe) AS only if certain criteria are fulfilled but it does not recommend infliximab for AS. Anti-TNFs for patients with nr-AxSpA have not previously been appraised by NICE. OBJECTIVE To determine the clinical effectiveness, safety and cost-effectiveness within the NHS of adalimumab, certolizumab pegol, etanercept, golimumab and infliximab, within their licensed indications, for the treatment of severe active AS or severe nr-AxSpA (but with objective signs of inflammation). DESIGN Systematic review and economic model. DATA SOURCES Fifteen databases were searched for relevant studies in July 2014. REVIEW METHODS Clinical effectiveness data from randomised controlled trials (RCTs) were synthesised using Bayesian network meta-analysis methods. Results from other studies were summarised narratively. Only full economic evaluations that compared two or more options and considered both costs and consequences were included in the systematic review of cost-effectiveness studies. The differences in the approaches and assumptions used across the studies, and also those in the manufacturer's submissions, were examined in order to explain any discrepancies in the findings and to identify key areas of uncertainty. A de novo decision model was developed with a generalised framework for evidence synthesis that pooled change in disease activity (BASDAI and BASDAI 50) and simultaneously synthesised information on function (BASFI) to determine the long-term quality-adjusted life-year and cost burden of the disease in the economic model. The decision model was developed in accordance with the NICE reference case. The model has a lifetime horizon (60 years) and considers costs from the perspective of the NHS and personal social services. Health effects were expressed in terms of quality-adjusted life-years. RESULTS In total, 28 eligible RCTs were identified and 26 were placebo controlled (mostly up to 12 weeks); 17 extended into open-label active treatment-only phases. Most RCTs were judged to have a low risk of bias overall. In both AS and nr-AxSpA populations, anti-TNFs produced clinically important benefits to patients in terms of improving function and reducing disease activity; for AS, the relative risks for ASAS 40 ranged from 2.53 to 3.42. The efficacy estimates were consistently slightly smaller for nr-AxSpA than for AS. Statistical (and clinical) heterogeneity was more apparent in the nr-AxSpA analyses than in the AS analyses; both the reliability of the nr-AxSpA meta-analysis results and their true relevance to patients seen in clinical practice are questionable. In AS, anti-TNFs are approximately equally effective. Effectiveness appears to be maintained over time, with around 50% of patients still responding at 2 years. Evidence for an effect of anti-TNFs delaying disease progression was limited; results from ongoing long-term studies should help to clarify this issue. Sequential treatment with anti-TNFs can be worthwhile but the drug survival response rates and benefits are reduced with second and third anti-TNFs. The de novo model, which addressed many of the issues of earlier evaluations, generated incremental cost-effectiveness ratios ranging from £19,240 to £66,529 depending on anti-TNF and modelling assumptions. CONCLUSIONS In both AS and nr-AxSpA populations anti-TNFs are clinically effective, although more so in AS than in nr-AxSpA. Anti-TNFs may be an effective use of NHS resources depending on which assumptions are considered appropriate. FUTURE WORK RECOMMENDATIONS Randomised trials are needed to identify the nr-AxSpA population who will benefit the most from anti-TNFs. STUDY REGISTRATION This study is registered as PROSPERO CRD42014010182. FUNDING The National Institute for Health Research Health Technology Assessment programme.
Collapse
Affiliation(s)
- Mark Corbett
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Marta Soares
- Centre for Health Economics, University of York, York, UK
| | - Gurleen Jhuti
- Centre for Health Economics, University of York, York, UK
| | - Stephen Rice
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Eldon Spackman
- Centre for Health Economics, University of York, York, UK
| | | | | | - Dave Fox
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Helena Marzo-Ortega
- Division of Rheumatic and Musculoskeletal Disease, Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust and University of Leeds, Leeds, UK
| | - Lesley Kay
- Division of Rheumatic and Musculoskeletal Disease, Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust and University of Leeds, Leeds, UK
| | - Nerys Woolacott
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Stephen Palmer
- Centre for Health Economics, University of York, York, UK
| |
Collapse
|
11
|
Hamilton L, Barkham N, Bhalla A, Brittain R, Cook D, Jones G, Mackay K, Marshall D, Marzo-Ortega H, Murphy D, Riddell C, Sengupta R, Siebert S, Van Rossen L, Gaffney K. BSR and BHPR guideline for the treatment of axial spondyloarthritis (including ankylosing spondylitis) with biologics. Rheumatology (Oxford) 2016; 56:313-316. [DOI: 10.1093/rheumatology/kew223] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 04/12/2016] [Indexed: 11/13/2022] Open
|
12
|
Abstract
Axial spondyloarthritis (axSpA), a subtype of spondyloarthritis, is a debilitating inflammatory condition involving the spinal and sacroiliac joints, contributing to a significant diminution in quality of life. Historically, characterization of patient outcomes in axSpA has been a challenge due to the lack of data from longitudinal epidemiologic studies and the nonspecific nature of inflammatory laboratory markers to monitor disease activity. In this review, measures developed to address these clinical domains are discussed and compared, of which 3 are commonly used in diagnosis and therapeutic planning. Provider data regarding utilization of these measures are also included to clarify current clinical practice trends.
Collapse
Affiliation(s)
- Derek T Nhan
- Veterans Affairs Medical Center (VAMC), Denver, CO, USA; University of Colorado School of Medicine, Aurora, CO, USA
| | - Liron Caplan
- Veterans Affairs Medical Center (VAMC), Denver, CO, USA; University of Colorado School of Medicine, Aurora, CO, USA.
| |
Collapse
|
13
|
Tran-Duy A, Boonen A, van de Laar MAFJ, Severens JL. Impact on total population health and societal cost, and the implication on the actual cost-effectiveness of including tumour necrosis factor-α antagonists in management of ankylosing spondylitis: a dynamic population modelling study. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2015; 13:18. [PMID: 26451133 PMCID: PMC4597433 DOI: 10.1186/s12962-015-0044-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 09/29/2015] [Indexed: 12/30/2022] Open
Abstract
Background Sequential treatment of ankylosing spondylitis (AS) that includes tumour necrosis factor-α antagonists (anti-TNF agents) has been applied in most of the Western countries. Existing cost-effectiveness (CE) models almost exclusively presented the incremental CE of anti-TNF agents using a closed cohort while budget impact studies are mainly lacking. Notwithstanding, information on impact on total population health and societal budget as well as on actual incremental CE for a given decision time span are important for decision makers. This study aimed at quantifying, for different decision time spans starting from January 1, 2014 in the Dutch society, (1) impact of sequential drug treatment strategies without and with inclusion of anti-TNF agents (Strategies 1 and 2, respectively) on total population health and societal cost, and (2) the actual incremental CE of Strategy 2 compared to Strategy 1. Methods Dynamic population modelling was used to capture total population health and cost, and the actual incremental CE. Distinguishing the prevalent AS population on January 1, 2014 and the incident AS cohorts in the subsequent 20 years, the model tracked individually an actual number of AS patients until death or end of the simulation time. During the simulation, data on patient characteristics, history of drug use, costs and health at discrete time points were generated. In Strategy 1, five nonsteroidal anti-inflammatory drugs (NSAIDs) were available but anti-TNF agents withdrawn. In Strategy 2, five NSAIDs and two anti-TNF agents continued to be available. Results The predicted size of the prevalent AS population in the Dutch society varied within the range of 67,145–69,957 with 44–46 % of the patients receiving anti-TNF agents over the period 2014–2034. The use of anti-TNF agents resulted in an increase in the annual drug costs (168.54–205.28 million Euros), but at the same time caused a decrease in the annual productivity costs (12.58–31.21 million Euros) and in annual costs of healthcare categories other than drugs (7.23–11.90 million Euros). Incremental cost (Euros) per QALY gained in Strategy 2 compared to Strategy 1 corresponding to decision time spans of 5, 10, 15 and 20 years improved slightly from 75,379 to 67,268, 63,938 and 61,129, respectively. At willingness-to-pay thresholds of 118,656, 112,067, 110,188 and 110,512 Euros, it was 99 % certain that Strategy 2 was cost-effective for decision time spans of 5, 10, 15 and 20, respectively. Conclusions Using the dynamic population approach, the present model can project real-time data to inform a healthcare system decision that affects all actual number of AS patients eligible for anti-TNF agents within different decision time spans. The predicted total population costs of different categories in the present study can help plan the organization of the healthcare resources based on the national budget for the disease.
Collapse
Affiliation(s)
- An Tran-Duy
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands ; Division of Rheumatology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands ; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Annelies Boonen
- Division of Rheumatology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands ; Caphri School for Public Health and Primary Care, Maastricht UMC+, Maastricht, The Netherlands
| | - Mart A F J van de Laar
- Department of Rheumatology and Clinical Immunology, Twente University and Medisch Spectrum Twente, Enschede, The Netherlands
| | - Johan L Severens
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
14
|
Vetkova ES, Dydykina IS, Nasonov EL. [Biological agents and fracture risk]. TERAPEVT ARKH 2015; 87:113-117. [PMID: 26155629 DOI: 10.17116/terarkh2015875113-117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In patients with chronic inflammatory diseases, including rheumatic ones, the risk of fractures exceeds that in the population. Chronic inflammation is one of the most discussed and most important pathogenic factors of reduced bone mineral density (BMD), its worse quality and increased fracture risk. The chronic inflammatory process contributes to the imbalance of bone remodeling toward bone resorption. The use of biological agents in patients with rheumatic and other autoimmune diseases effectively suppresses systemic inflammation and increases BMD. However, the effect of the biological agents in lessening the risk of fractures remains unproven.
Collapse
Affiliation(s)
- E S Vetkova
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia
| | - I S Dydykina
- V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia
| | - E L Nasonov
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia
| |
Collapse
|
15
|
Cheung PP, Lahiri M, Teng GG, Lui NL, Chia FL, Koh DR, Koh WH, Ng SC, Suresh E, Leong KP, Lim AYN, Thumboo J, Lau TC, Leong KH. Consensus development on eligibility of government subsidisation of biologic disease modifying anti-rheumatic agents for treatment of ankylosing spondylitis: The Singapore experience. Int J Rheum Dis 2015; 20:1517-1526. [PMID: 26177789 DOI: 10.1111/1756-185x.12707] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION The beneficial effects of biologic disease-modifying anti-rheumatic drugs (bDMARDs), such as tumour necrosis factor inhibitors (anti-TNF) in active ankylosing spondylitis (AS) are well established. The significant costs on patients in the absence of financial subsidization can limit their use. The objective was to describe a consensus development process on recommendations for government-assisted funding of biologic therapy for AS patients in Singapore. METHODS Evidence synthesis followed by a modified RAND/UCLA Appropriateness Method (RAM) was used. Eleven rheumatologists rated indications for therapies for different proposed clinical scenarios. Points reflecting the output from the formal group consensus were used to formulate 10 practice recommendations. RESULTS It was agreed that a bDMARD (anti-TNF) is indicated if a patient has active AS with a Bath Ankylosing Spondylitis Activity Index (BASDAI) ≥ 4 and spinal pain of ≥ 4 cm on visual analogue scale (VAS) on two occasions at least 12 weeks apart, despite being on a minimum of two sequential non-steroidal anti-inflammatory drugs at maximal tolerated dose for at least 4 weeks, in addition to adherence to an appropriate physiotherapy program for at least 3 months. To qualify for continued biologic therapy, a patient must have documentation of response every 3 months and at least 50% improvement in BASDAI and reduction of spinal pain VAS ≥ 2 cm. CONCLUSION A validated and feasible consensus process can enable pragmatic standardized recommendations to be developed for bDMARD subsidization for AS patients in a local Asian context.
Collapse
Affiliation(s)
- Peter P Cheung
- Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Manjari Lahiri
- Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Gim-Gee Teng
- Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Nai-Lee Lui
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
| | - Faith L Chia
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore
| | - Dow-Rhoon Koh
- Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wei-Howe Koh
- Koh Wei Howe Arthritis & Rheumatism Medical Clinic, Mount Elizabeth Medical Centre, Singapore
| | - Swee-Cheng Ng
- Department of Medicine, Khoo Teck Puat Hospital, Singapore
| | - Ernest Suresh
- Department of Medicine, Alexandra Hospital (Jurong Health), Singapore
| | - Khai-Pang Leong
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore
| | - Anita Y N Lim
- Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Julian Thumboo
- Koh Wei Howe Arthritis & Rheumatism Medical Clinic, Mount Elizabeth Medical Centre, Singapore
| | - Tang-Ching Lau
- Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Keng-Hong Leong
- Leong Keng Hong Arthritis and Medical Clinic, Gleneagles Medical Centre, Singapore
| |
Collapse
|
16
|
Suh YS, Kwok SK, Ju JH, Park KS, Park SH, Yoon CH. Safe re-administration of tumor necrosis factor-alpha (TNFα) inhibitors in patients with rheumatoid arthritis or ankylosing spondylitis who developed active tuberculosis on previous anti-TNFα therapy. J Korean Med Sci 2014; 29:38-42. [PMID: 24431903 PMCID: PMC3890474 DOI: 10.3346/jkms.2014.29.1.38] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 10/31/2013] [Indexed: 12/17/2022] Open
Abstract
There is no consensus on whether it is safe to re-administer tumor necrosis factor-alpha (TNFα) inhibitors in patients with rheumatoid arthritis (RA) or ankylosing spondylitis (AS) flared after withdrawal of TNFα inhibitors due to active tuberculosis (TB). We evaluated the safety of restarting anti-TNFα therapy in patients with TNFα-associated TB. We used data of 1,012 patients with RA or AS treated with TNFα inhibitors at Seoul St. Mary's Hospital between January 2003 and July 2013 to identify patients who developed active TB. Demographic and clinical data including the results of tuberculin skin tests (TST) and interferon-γ releasing assays (IGRA) were collected. Fifteen patients developed active TB. Five cases were occurred in RA and 10 cases in AS. Nine of 15 patients had a negative TST or IGRA and 6 TST-positive patients had received prophylaxis prior to initiating anti-TNFα therapy. All patients discontinued TNFα inhibitors with starting the treatment of TB. Eight patients were re-administered TNFα inhibitors due to disease flares and promptly improved without recurrence of TB. TNFα inhibitors could be safely resumed after starting anti-TB regimen in patients with RA or AS.
Collapse
MESH Headings
- Adalimumab
- Adult
- Aged
- Anti-Inflammatory Agents, Non-Steroidal/adverse effects
- Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
- Antibodies, Monoclonal/adverse effects
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized/adverse effects
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antirheumatic Agents/adverse effects
- Antirheumatic Agents/therapeutic use
- Arthritis, Rheumatoid/drug therapy
- Enzyme Inhibitors/adverse effects
- Enzyme Inhibitors/therapeutic use
- Etanercept
- Female
- Humans
- Hydroxychloroquine/adverse effects
- Hydroxychloroquine/therapeutic use
- Immunoglobulin G/adverse effects
- Immunoglobulin G/therapeutic use
- Immunosuppressive Agents/adverse effects
- Immunosuppressive Agents/therapeutic use
- Infliximab
- Interferon-gamma Release Tests
- Male
- Methotrexate/adverse effects
- Methotrexate/therapeutic use
- Middle Aged
- Mycobacterium tuberculosis/isolation & purification
- Receptors, Tumor Necrosis Factor/therapeutic use
- Retrospective Studies
- Spondylitis, Ankylosing/drug therapy
- Tuberculin Test
- Tuberculosis/chemically induced
- Tuberculosis/microbiology
- Tumor Necrosis Factor-alpha/antagonists & inhibitors
Collapse
Affiliation(s)
- Young Sun Suh
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung-ki Kwok
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Hyeon Ju
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyung-Su Park
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung-Hwan Park
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chong-Hyeon Yoon
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| |
Collapse
|
17
|
Abstract
Clinical practice guidelines aid clinicians in providing optimal care for their patients. Over the past decade, treatment guidelines have been published for ankylosing spondylitis (AS), but there are no evidence-based recommendations for the management of axial spondyloarthritis. In 2003, Canadian rheumatologists published treatment recommendations for AS, which have been subsequently updated. More recently, in 2011, the Assessment of SpondyloArthritis international Society and the European League Against Rheumatism published recommendations for the management of AS. SPondyloArthritis Research and Treatment Network proposes an American College of Rheumatology-led effort to develop treatment recommendations for axial spondyloarthritis.
Collapse
|
18
|
Mycobacterial infections in patients treated with tumor necrosis factor antagonists in South Korea. Lung 2013; 191:565-71. [PMID: 23728990 DOI: 10.1007/s00408-013-9481-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 05/15/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND The aims of this study were to determine the incidence of tuberculosis (TB) and nontuberculous mycobacteria (NTM) lung disease in patients who were treated with tumor necrosis factor (TNF) antagonists in South Korea and to evaluate their clinical characteristics. METHODS We surveyed all patients (N = 509) who were treated with TNF antagonists at Severance Hospital, South Korea, between January 2002 and December 2011. We reviewed the patients' medical records and collected microbiological, radiographic, and clinical data, including the type of TNF blocker(s) used and the results of tuberculin skin tests and interferon-gamma release assays. RESULTS Rheumatoid arthritis (43.6 %) and ankylosing spondylitis (27.9 %) were the most common diseases in the patients treated with TNF antagonists. Patients received etanercept (33.4 %), infliximab (23.4 %), or adalimumab (13.2 %). The remaining patients received two or more TNF antagonists (30 %). Nine patients developed TB, and four patients developed NTM lung disease. After adjustment for age and sex, the standardized TB incidence ratio was 6.4 [95 % CI 3.1-11.7] compared with the general population. The estimated NTM incidence rate was 230.7 per 100,000 patients per year. CONCLUSIONS Our results show that mycobacterial infections increase in patients treated with TNF antagonists. The identification of additional predictors of TB for the treatment of latent tuberculosis infection and the careful monitoring and timely diagnosis of NTM-related lung disease are needed for patients who receive long-term therapy with TNF antagonists.
Collapse
|
19
|
Petříková A, Doležal T, Klimeš J, Vocelka M, Sedová L, Kolář J. The economic burden of the ankylosing spondylitis in the Czech Republic: comparison between 2005 and 2008. Rheumatol Int 2013; 33:1813-9. [PMID: 23314983 DOI: 10.1007/s00296-012-2542-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Accepted: 10/21/2012] [Indexed: 11/29/2022]
Abstract
To investigate the burden of ankylosing spondylitis in the Czech Republic as a baseline for future health economic evaluations. Data were obtained from two cross-sectional studies Beda I (2005) and Beda II (2008), performed in 1,008 and 509 patients, respectively. Methodology used was Cost-of-Illness prevalence-based analysis bottom-up approach. Analysis was performed from payer (health insurance companies) and societal perspective (including productivity costs using friction cost approach). Mean age of sample in Beda I and Beda II was 50.2 and 52.5 years, male were present by 61.0 and 62.7 %; average disease duration was 23.0 and 26.4 years, respectively. Mean total annual costs per patient in the sample were €4,782 in Beda I and €5806 in Beda II. Average direct costs per patient in the sample per year are estimated at €1,812 (Beda I) and €2,588 (Beda II) with the average productivity costs €2,970 (Beda I) and €3,218 (Beda II). We observed a small decrement in percentage (6.7 %) of productivity costs for Beda II as an influence of higher consumption of biologic drugs, hence higher direct costs and possible productivity preservation. The largest direct cost burdens were spa procedures (45.3 %, Beda I) and biological drugs (52.8 %, Beda II). Unique analysis of the burden of the AS in the Central-Eastern Europe presents health care resource and cost consumption by comparing two cross-sectional prevalence-based studies. Further analysis should be carried to obtain data connecting health status with costs consumption in order to analyse the AS from this perspective.
Collapse
Affiliation(s)
- Alena Petříková
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy, Charles University, Prague, Czech Republic.
| | | | | | | | | | | |
Collapse
|
20
|
Rees F, Peffers G, Bell C, Obrenovic K, Sandhu R, Packham J, Erb N. Compliance with NICE guidance on the use of anti-TNFalpha agents in ankylosing spondylitis: an east and west Midlands regional audit. Clin Med (Lond) 2012; 12:324-7. [PMID: 22930875 PMCID: PMC4952119 DOI: 10.7861/clinmedicine.12-4-324] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Here we report on an audit performed to examine compliance with National Institute for Health and Clinical Excellence (NICE) guidelines for the use of anti-tumour necrosis factor alpha (anti-TNFalpha) in treating patients with ankylosing spondylitis (AS). Data from 17 rheumatology centres across the Midlands were collected prospectively from patients with AS attending outpatient clinics and retrospectively in patients receiving anti-TNFalpha but not attending outpatient clinics during the audit. In total, 80% of the 416 patients for whom data were collected were male. Of the 238 patients recruited prospectively, 41% were receiving anti-TNFalpha. Reviewing all patients on anti-TNFalpha (N=275), pre-treatment assessments 12 weeks apart were documented in 55% of patients. After anti-TNFalpha treatment had started, regular 12-weekly assessments occurred in 46% of patients. Therefore, compliance with NICE guidance was found to vary among centres. Based on our audit, clinical capacity, and clinical or patient choice might be influencing the suboptimal adherence seen in assessment timing suggested by NICE guidelines relating to the use of anti-TNFalpha in treating patients with AS.
Collapse
Affiliation(s)
- Frances Rees
- Nottingham University Hospitals NHS Trust, Nottingham.
| | | | | | | | | | | | | |
Collapse
|
21
|
Devauchelle-Pensec V, D'Agostino MA, Marion J, Lapierre M, Jousse-Joulin S, Colin D, Chary-Valckenaere I, Marcelli C, Loeuille D, Aegerter P, Guis S, Gaudin P, Breban M, Saraux A. Computed tomography scanning facilitates the diagnosis of sacroiliitis in patients with suspected spondylarthritis: Results of a prospective multicenter French cohort study. ACTA ACUST UNITED AC 2012; 64:1412-9. [DOI: 10.1002/art.33466] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
22
|
Cost-Effectiveness Evaluation of Etoricoxib versus Celecoxib and Nonselective NSAIDs in the Treatment of Ankylosing Spondylitis in Norway. Int J Rheumatol 2011; 2011:160326. [PMID: 21772851 PMCID: PMC3134091 DOI: 10.1155/2011/160326] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Accepted: 03/20/2011] [Indexed: 12/13/2022] Open
Abstract
Objectives. To evaluate the cost-effectiveness of etoricoxib (90 mg) relative to celecoxib (200/400 mg), and the nonselective NSAIDs naproxen (1000 mg) and diclofenac (150 mg) in the initial treatment of ankylosing spondylitis in Norway. Methods. A previously developed Markov state-transition model was used to estimate costs and benefits associated with initiating treatment with the different competing NSAIDs. Efficacy, gastrointestinal and cardiovascular safety, and resource use data were obtained from the literature. Data from different studies were synthesized and translated into direct costs and quality adjusted life years by means of a Bayesian comprehensive decision modeling approach. Results. Over a 30-year time horizon, etoricoxib is associated with about 0.4 more quality adjusted life years than the other interventions. At 1 year, naproxen is the most cost-saving strategy. However, etoricoxib is cost and quality adjusted life year saving relative to celecoxib, as well as diclofenac and naproxen after 5 years of follow-up. For a willingness-to-pay ceiling ratio of 200,000 Norwegian krones per quality adjusted life year, there is a >95% probability that etoricoxib is the most-cost-effective treatment when a time horizon of 5 or more years is considered. Conclusions. Etoricoxib is the most cost-effective NSAID for initiating treatment of ankylosing spondylitis in Norway.
Collapse
|
23
|
Interferon-γ release assay in the diagnosis of latent tuberculosis infection in arthritis patients treated with tumor necrosis factor antagonists in Korea. Clin Rheumatol 2011; 30:1535-41. [PMID: 21556777 DOI: 10.1007/s10067-011-1771-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2010] [Revised: 04/23/2011] [Accepted: 04/26/2011] [Indexed: 10/18/2022]
Abstract
The aim of this study was to evaluate the usefulness of the interferon-γ release assay (IGRA) for the diagnosis of latent tuberculosis infection (LTBI) in arthritis patients who received tumor necrosis factor (TNF) antagonist in Korea. The study involved 107 consecutive patients: 61 (57%) with ankylosing spondylitis and 46 (43%) with rheumatoid arthritis. Screening tests were performed including the tuberculin skin test (TST), the QuantiFERON-TB Gold In-Tube (QFT-IT) test, and chest radiography. A positive QFT-IT test result, regardless of TST results, was considered an indication for LTBI treatment. If the QFT-IT results were indeterminate, a positive TST was regarded as an indication for LTBI treatment. A Bacillus Calmette-Guérin (BCG) scar was found in 63 patients (59%). LTBI treatment was performed in 37 patients (35%), including 36 with positive QFT-IT results and one with indeterminate QFT-IT and positive TST results. No patients developed tuberculosis during a median of 18 months (range, 13-26 months) of TNF antagonist therapy. In 16 patients who had positive TST and negative QFT-IT results, TNF antagonists were given without LTBI treatment. Tuberculosis did not occur, even in these patients, during a median of 24.5 months (range, 15-33.5 months) of TNF antagonist therapy. IGRA may be used instead of TST for the diagnosis of LTBI in patients before starting TNF antagonists in countries where tuberculosis prevalence is intermediate and the BCG vaccination is mandatory at birth, such as in Korea.
Collapse
|
24
|
Lian F, Yang X, Liang L, Xu H, Zhan Z, Qiu Q, Ye Y. Treatment efficacy of etanercept and MTX combination therapy for ankylosing spondylitis hip joint lesion in Chinese population. Rheumatol Int 2011; 32:1663-7. [PMID: 21387110 DOI: 10.1007/s00296-011-1844-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2010] [Accepted: 12/26/2010] [Indexed: 11/29/2022]
Abstract
To investigate the efficacy of etanercept and MTX (methotrexate) combination therapy in Chinese patients with ankylosing spondylitis hip joint lesion, the possible courses and maintenance protocol, altogether 97 ankylosing spondylitis patients fulfilling the modified New York criteria with hip joint lesion were enrolled in a 12-month trial treated with combined etanercept and MTX. All these patients were required to be poor responders to SSZ (Sulfasalazine) or MTX therapy for 6 consecutive months or the longer. Etanercept was administered subcutaneously twice a week at a fixed dosage of 25 mg for the first six months, followed by 25 mg once a week in patients with good control of both symptoms and radiological progression, or twice a week for another six months in patients with BASDAI > or = 4. Combined MTX was administered intravenously once a week at the dosage of 15 mg. Demographics, clinical and laboratory features, physical function and quality of life using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Functional Index (BASFI), Harris hip score, and radiological assessment using the BASRI-hip index were recorded. Most patients achieved pain release at the end point of assessment. Significant improvement in Bath AS Disease Activity Index (BASDAI) (P < 0.05), Bath AS Functional Activity Index (BASFI) (P < 0.05), and Harris hip score (P < 0.05) was demonstrated. Radiographic progression was recorded as no exacerbation or alleviated. Larger interval between two etanercept administrations would provide similar advantages to standard method and possibly less adverse events if MTX was combined. Etanercept and MTX combination therapy was beneficial to ankylosing spondylitis patients with hip joint lesion, and staged dosage deduction in the long term proved to be effective as well as adverse event preventing.
Collapse
Affiliation(s)
- Fan Lian
- Department of Rheumatology & Clinical Immunology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | | | | | | | | | | | | |
Collapse
|
25
|
de Vries HS, van Oijen MGH, Driessen RJB, de Jong EMGJ, Creemers MCW, Kievit W, de Jong DJ. Appropriate infliximab infusion dosage and monitoring: results of a panel meeting of rheumatologists, dermatologists and gastroenterologists. Br J Clin Pharmacol 2011; 71:7-19. [PMID: 21143496 DOI: 10.1111/j.1365-2125.2010.03760.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT Infliximab is an effective treatment for rheumatoid arthritis, ankylosing spondylitis, Crohn's disease (both adult and paediatric), ulcerative colitis, psoriatic arthritis and plaque psoriasis and national and international guidelines have been developed for each indication. WHAT THIS STUDY ADDS This study is the first study which compared current international, national and local guidelines from the medical specialties involved in the treatment with infliximab on the following topics: indication, dosage, synergy and monitoring of vital signs. AIMS Infliximab, an anti-TNF biologic agent, is currently indicated and reimbursed for rheumatoid arthritis, ankylosing spondylitis, Crohn's disease (both adult and paediatric), ulcerative colitis, psoriatic arthritis and plaque psoriasis. Development of national and international guidelines for rheumatology, gastroenterology and dermatology, was mostly based on clinical studies and expert opinion. The aim of this study was to compare available guidelines and local protocols for rheumatology, dermatology and gastroenterology, regarding dosage of infliximab, synergy of infliximab with concomitant medication and monitoring of vital signs during infliximab administration, for achieving optimal care. METHODS Current international, national and local guidelines on the use of infliximab were reviewed and compared, differences and shortcomings were identified, and optimal treatment schedules discussed during a meeting (July 2008) of clinical experts and researchers from three departments of a Dutch university hospital. RESULTS Recommended dosages of infliximab are not equal for different indications. Loss of response to infliximab is a common problem encountered within the three medical specialties, but indications for adjustments in treatment schedules are lacking in all of the guidelines. Monitoring of vital signs (blood pressure, pulse, temperature) during infusion with infliximab is common practice and recommended by some guidelines. Routine measurement of vital signs is not of any value in predicting or recognizing acute infusion reactions, in our experience, and this is confirmed by literature on inflammatory bowel disease. CONCLUSION Different indications encompass different dosing schedules. National and internal guidelines do not provide advice regarding loss of response. Routine measurement of vital signs during infusion is not valuable in detecting acute infusion reactions and should only be performed in case of an acute infusion reaction. These topics need to be studied in future studies and covered in future guidelines.
Collapse
Affiliation(s)
- Hilbert S de Vries
- Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | | | | | | | | | | | | |
Collapse
|
26
|
Ankylosing spondylitis in Ireland: patient access and response to TNF-α blockers. Rheumatol Int 2011; 32:1305-9. [DOI: 10.1007/s00296-011-1797-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Accepted: 01/16/2011] [Indexed: 01/17/2023]
|
27
|
Sieper J. Management of ankylosing spondylitis. Rheumatology (Oxford) 2011. [DOI: 10.1016/b978-0-323-06551-1.00116-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
|
28
|
Abstract
TNF blockade therapy has substantially advanced the treatment of peripheral spondyloarthritides but revolutionised the treatment of severe ankylosing spondylitis. The capacity of biologic treatment to improve dramatically symptoms and quality of life in patients with spinal disease is undoubted, although important questions remain. Notable amongst these are concerns about skeletal disease modification and the true balance between costs and effectiveness. Guidelines for the biologic treatment of ankylosing spondylitis and psoriatic arthritis have been introduced in North America and Europe with considerable consensus. However, the absence of clear criteria for the diagnosis of early disease leaves the issue of biologic treatment of ankylosing spondylitis at the pre-radiographic stage unresolved. Newer biologic agents are entering the field, although superiority over TNF blockers will be difficult to demonstrate.
Collapse
Affiliation(s)
- Andrew Barr
- Rheumatology Department, Northwick Park Hospital, Harrow, Middlesex HA1 3UJ, UK.
| | | |
Collapse
|
29
|
Oliver SM. The role of the clinical nurse specialist in the assessment and management of biologic therapies. Musculoskeletal Care 2010; 9:54-62. [PMID: 20939102 DOI: 10.1002/msc.190] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Susan M Oliver
- Nurse Consultant Rheumatology, 7 Trafalgar Lawn, Barnstaple, Devon, UK.
| |
Collapse
|
30
|
Neilson AR, Sieper J, Deeg M. Cost-effectiveness of etanercept in patients with severe ankylosing spondylitis in Germany. Rheumatology (Oxford) 2010; 49:2122-34. [DOI: 10.1093/rheumatology/keq222] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
|
31
|
Martindale J, Smith J, Grennan D, Goodacre L, Goodacre JA. Outcome of active disease in ankylosing spondylitis: a prospective study. Musculoskeletal Care 2010; 8:10-17. [PMID: 19821259 DOI: 10.1002/msc.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND People with ankylosing spondylitis (AS) typically experience episodic exacerbations, but the extent to which they subsequently experience a sustained reduction in disease markers below recognized thresholds for active disease is unclear. OBJECTIVE To investigate changes in, and associations between, disease markers over 18 months in people with active AS. METHODS Within a cohort of 89 participants with AS, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores of 4 or higher were used to identify those with active disease. Standard assessment tools were used to monitor participants prospectively at four consecutive six-monthly intervals. Participants received standard treatments but none received anti-tumor necrosis factor-alpha (TNFalpha) medication during the study. RESULTS The median age of the cohort was 50 years (inter-quartile range [IQR] 38.5-55.5), the median age of disease onset was 25 years (IQR 18-33) and the median disease duration was 18 years (IQR 13-27). Forty-seven (53%) participants had a BASDAI score of 4 or higher on the first assessment, of whom 45 (51%) scored 4 or higher on all subsequent assessments. Furthermore, 38 (43%) and 16 (18%) participants scored BASDAI 5 or 6, respectively, or higher, throughout. BASDAI scores correlated strongly with Bath Ankylosing Spondylitis Functional Index (BASFI) scores. Compared with 19 (21%) participants whose BASDAI scores were consistently below 4 throughout, participants with persistently high BASDAI scores showed higher scores for anxiety and depression, and some evidence of functional deterioration during the study period. CONCLUSIONS In this cohort, disease markers in most people with active AS were sustained above the standard threshold for active disease. This has important implications for planning care pathways and for optimal utilization of anti-TNFalpha treatment.
Collapse
Affiliation(s)
- J Martindale
- Wrightington, Wigan and Leigh NHS Foundation Trust, Lancashire, UK
| | | | | | | | | |
Collapse
|
32
|
Carmona Ortells L, Loza Santamaría E. [Management of spondyloarthritis (ESPOGUIA): methodology and general data from the document]. ACTA ACUST UNITED AC 2010; 6 Suppl 1:1-5. [PMID: 21794745 DOI: 10.1016/j.reuma.2009.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Revised: 12/02/2009] [Accepted: 12/02/2009] [Indexed: 10/19/2022]
Abstract
BACKGROUND The need for clinical practice guidelines for spondyloarthritis (SpA) comes from the complexity of its management and the great advances that both its treatment and its diagnosis have experiences, which come accompanied by a great variability in its management that exceeds what is considered acceptable. The objective of the ESPOGUIA is to reduce the variability in the management of SA, improving the quality of care through clinical recommendations adapted to their particular environment and based on the best available evidence. METHODS For the development of ESPOGUÍA the following methods have been employed: nominal group, systematic review and Delphi surveys. The expert panel is voluntary, with multiple disciplines participating and based on selection criteria. For the first time in a SER recommendation document, the opinion of the patient was included. In a meeting of the nominal group, the reach, objective, users, organization and needs of the systematic review were established. The elaboration of the guideline, along with its recommendations, was performed in parallel to the systematic reviews, with a meeting for agreement held afterward. The scoring of the degree of evidence and the level of the recommendation was established from the evidence levels proposed by the Oxford Center of Evidence-Based Medicine and the degree of agreement was obtained through a two-round Delphi exercise. RESULTS We have produced a clinical guideline that encompasses all of the SpA, although it has two sub-guidelines, one for ankylosing spondylitis and the other one for psoriatic arthritis. The target users are mainly rheumatologists, although other specialists and paramedical staff, such as nurses or patient associations, might benefit. Its content envelops all of the management aspects of SpA, from clinical suspicion to treatment, follow-up and day-to-day activities of the patient. CONCLUSIONS ESPOGUIA can become a very useful instrument for the management of SA and an interactive reference.
Collapse
|
33
|
Jansen JP, Gaugris S, Choy EH, Ostor A, Nash JT, Stam W. Cost effectiveness of etoricoxib versus celecoxib and non-selective NSAIDS in the treatment of ankylosing spondylitis. PHARMACOECONOMICS 2010; 28:323-344. [PMID: 20222755 DOI: 10.2165/11314690-000000000-00000] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
To evaluate the cost effectiveness of etoricoxib (90 mg/day) relative to celecoxib (200 or 400 mg/day), and the non-selective NSAIDs naproxen (1000 mg/day) and diclofenac (150 mg/day) in the initial treatment of ankylosing spondylitis (AS) from the UK NHS perspective. A Bayesian cost-effectiveness model was developed to estimate the costs and benefits associated with initiating AS treatment with etoricoxib, celecoxib, diclofenac or naproxen. Efficacy, safety and medical resource and cost data were obtained from the literature. The obtained efficacy estimates were synthesized with a mixed treatment comparison meta-analysis. Treatment benefit and degree of disease activity, as reflected with Bath Ankylosing Spondylitis Functional Index (BASFI) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores, were related to QALYs and AS-specific costs (related to BASDAI). Other cost outcomes related to drug acquisition, and gastrointestinal and cardiovascular safety. Uncertainty in the source data was translated into uncertainty in cost-effectiveness estimates and therefore decision uncertainty. Costs and outcomes were discounted at 3.5% per annum. There was a >98% probability that treatment with etoricoxib results in greater QALYs than the other interventions. Over a 30-year time horizon, starting AS treatment with etoricoxib was associated with about 0.4 more QALYs than the other interventions. At 2 years there was a 77% probability that etoricoxib had the lowest cost. This increased to >99% at 30 years. Etoricoxib is expected to save 13 620 UK pounds (year 2007 values) relative to celecoxib (200/400 mg), 9957 UK pounds relative to diclofenac and 9863 UK pounds relative to naproxen. For a willingness-to-pay ceiling ratio of 20 000 UK pounds per QALY, there was a >97% probability that etoricoxib was the most cost-effective treatment. Additional analysis with different assumptions, including celecoxib 200 mg, and ignoring cost-offsets associated with improvements in disease activity, supported these findings. This economic evaluation suggests that, from the UK NHS perspective, etoricoxib is the most cost-effective initial NSAID treatment for AS patients.
Collapse
|
34
|
Lord PAC, Farragher TM, Lunt M, Watson KD, Symmons DPM, Hyrich KL. Predictors of response to anti-TNF therapy in ankylosing spondylitis: results from the British Society for Rheumatology Biologics Register. Rheumatology (Oxford) 2009; 49:563-70. [PMID: 20032223 PMCID: PMC2820265 DOI: 10.1093/rheumatology/kep422] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objective. Few data exist on the use of anti-TNF drugs for AS during routine clinical use in the UK. This report describes an improvement in Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI) after 6 months of therapy in 261 patients enrolled in a national prospective observational register. Methods. The British Society for Rheumatology Biologics Register (BSRBR) recruited patients starting anti-TNF therapy for AS between 2002 and 2006. Multivariable linear regression models were used to estimate the predictors of absolute improvement in BASDAI and BASFI at 6 months. Covariates included age, gender, disease duration, baseline BASDAI and BASFI, presence of raised inflammatory markers (defined as twice the upper limit of normal) and DMARD therapy. Results. The cohort was young (median age 43 years) and 82% were males. Median baseline BASDAI was 7.6 and BASFI 7.9. At 6 months, the mean improvements in BASDAI and BASFI were 3.6 and 2.6 U, respectively; 52% reached a BASDAI50. Patients with raised inflammatory markers at the start of therapy had a 0.9-U (95% CI 0.2, 1.5) better improvement in BASDAI compared with those without. Lesser responses were seen in those with higher baseline BASFI scores. Women had a 1.1-U (95% CI 0.3, 2.0) greater improvement in BASFI at 6 months, as did those who were receiving concurrent DMARD therapy [0.9 U (95% CI 0.2, 1.7)]. Conclusions. The majority of patients receiving anti-TNF therapy for AS during routine care demonstrated an improvement in disease activity. Raised inflammatory markers at the start of therapy predicted a greater improvement in BASDAI, identifying a group of patients who may be more responsive to anti-TNF therapies, although the results were not confined to this group.
Collapse
Affiliation(s)
- Paul A C Lord
- University of Manchester, Manchester Academic Health Sciences Centre, Manchester M13 9PT, UK
| | | | | | | | | | | | | |
Collapse
|
35
|
Ankylosing spondylitis patients commencing biologic therapy have high baseline levels of comorbidity: a report from the Australian rheumatology association database. Int J Rheumatol 2009; 2009:268569. [PMID: 20107564 PMCID: PMC2809318 DOI: 10.1155/2009/268569] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2009] [Accepted: 05/28/2009] [Indexed: 01/21/2023] Open
Abstract
Aims. To compare the baseline characteristics of a population-based cohort of patients with ankylosing spondylitis (AS) commencing biological therapy to the reported characteristics of bDMARD randomised controlled trials (RCTs) participants.
Methods. Descriptive analysis of AS participants in the Australian Rheumatology Association Database (ARAD) who were commencing bDMARD therapy. Results. Up to December 2008, 389 patients with AS were enrolled in ARAD. 354 (91.0%) had taken bDMARDs at some time, and 198 (55.9%) completed their entry questionnaire prior to or within 6 months of commencing bDMARDs. 131 (66.1%) had at least one comorbid condition, and 24 (6.8%) had a previous malignancy (15 nonmelanoma skin, 4 melanoma, 2 prostate, 1 breast, cervix, and bowel). Compared with RCT participants, ARAD participants were older, had longer disease duration and higher baseline disease activity.
Conclusions. AS patients commencing bDMARDs in routine care are significantly different to RCT participants and have significant baseline comorbidities.
Collapse
|
36
|
Goh L, Samanta A. A systematic MEDLINE analysis of therapeutic approaches in ankylosing spondylitis. Rheumatol Int 2009; 29:1123-35. [PMID: 19562344 DOI: 10.1007/s00296-009-0973-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2008] [Accepted: 05/20/2009] [Indexed: 12/17/2022]
Abstract
Ankylosing spondylitis (AS) is a chronic inflammatory disorder involving the sacroiliac joints (SIJs), spine and less frequently the peripheral joints. Traditionally, it is well recognised that AS is a challenging disease to manage due to the lack of effective therapeutic options. Current evidence would suggest this has changed and there are now a number of therapies available that provide persistent control of inflammatory symptoms with improvement in daily function. NSAIDs remain the first step in patient treatment. Sulphasalazine may be effective in peripheral arthritis and there are emerging data to support its use in early inflammatory back pain. Studies have shown that pamidronate and steroid injection into SIJ have a symptom-modifying effect in AS. Current data suggest that anti-TNF treatment promises early benefit which is likely to continue in the longer term. Treatment with biologics should be considered sooner rather than later in the management of AS.
Collapse
Affiliation(s)
- L Goh
- Department of Rheumatology, Musgrove Park Hospital, Taunton and Somerset NHS Trust, Taunton, TA1 5DA, UK.
| | | |
Collapse
|
37
|
Kobelt G, Sobocki P, Mulero J, Gratacos J, Collantes-Estevez E, Braun J. The cost-effectiveness of infliximab in the treatment of ankylosing spondylitis in Spain. Comparison of clinical trial and clinical practice data. Scand J Rheumatol 2008; 37:62-71. [PMID: 18189197 DOI: 10.1080/03009740701607224] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To estimate the cost-effectiveness of treating ankylosing spondylitis (AS) with infliximab (Remicade) in Spain for up to 40 years. METHODS A previously published disease model was adapted to the Spanish setting using resource consumption from a cross-sectional burden of an illness study in 601 patients in Spain. Cost-effectiveness estimates were based on a placebo-controlled clinical trial as well as an open clinical study in Spain. In the model, patients with insufficient response to treatment at 12 weeks [Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) <4 or > or =50% reduction] discontinue treatment. The results are presented in 2005 euros, from societal and health-care payer perspectives. RESULTS In the societal perspective, infliximab treatment dominates standard treatment in both analyses. In the perspective of the health-care system, with the assumption that, over the long term, functional ability of patients on treatment would decline at half the natural rate, the cost per quality-adjusted life year (QALY) gained was estimated at EUR 22 519 (double-blind trial) and EUR 8866 (open study). Assuming that patients' function on treatment remains stable, the cost-effectiveness ratios are EUR 15 157 and EUR 5307, respectively. Under the most conservative assumption (no effect of treatment on progression), the ratios are EUR 31 721 and EUR 13 659, respectively. In addition, the results are sensitive to the time horizon and discontinuation rates. CONCLUSIONS Our results indicate that infliximab therapy for patients with active AS should be cost-effective both in the societal perspective (dominating) and in the perspective of the health-care system (ranges from EUR 5300 to EUR 32 000 per QALY) in Spain.
Collapse
|
38
|
Hoy SM, Scott LJ. Etanercept: a review of its use in the management of ankylosing spondylitis and psoriatic arthritis. Drugs 2008; 67:2609-33. [PMID: 18034593 DOI: 10.2165/00003495-200767170-00009] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Etanercept (Enbrel), a recombinant, dimeric, soluble tumour necrosis factor (TNF) receptor protein, is approved in various countries for the treatment of adult patients with ankylosing spondylitis or psoriatic arthritis. Monotherapy with subcutaneous etanercept 25mg twice weekly or 50mg once weekly was effective and generally well tolerated in patients with ankylosing spondylitis or psoriatic arthritis participating in several large, well designed clinical studies. Treatment with etanercept was more effective than placebo in reducing disease activity and improving health-related quality of life (HR-QOL) in both patient populations, and in delaying structural disease progression in patients with psoriatic arthritis. The beneficial response to etanercept achieved with shorter-term treatment was sustained in studies of up to 4 years' total duration. Randomised, well designed, head-to-head comparisons, including pharmacoeconomic analyses, with other anti-TNF biological modulators are required to accurately position etanercept and fully establish its cost effectiveness. In the meantime, etanercept is a valuable treatment option for patients with ankylosing spondylitis or psoriatic arthritis who are suitable candidates for therapy.
Collapse
Affiliation(s)
- Sheridan M Hoy
- Wolters Kluwer Health
- Adis, Auckland, New Zealand, an editorial office of Wolters Kluwer Health, Conshohocken, Pennsylvania, USA.
| | | |
Collapse
|
39
|
Pham T, Fautrel B, Dernis E, Goupille P, Guillemin F, Le Loët X, Ravaud P, Claudepierre P, Miceli-Richard C, de Bandt M, Breban M, Maillefert JF, Masson C, Saraux A, Schaeverbeke T, Wendling D, Mariette X, Combe B. Recommendations of the French Society for Rheumatology regarding TNFα antagonist therapy in patients with ankylosing spondylitis or psoriatic arthritis: 2007 update. Joint Bone Spine 2007; 74:638-46. [DOI: 10.1016/j.jbspin.2007.10.003] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2007] [Accepted: 10/11/2007] [Indexed: 12/25/2022]
|
40
|
Sengupta R, Stone MA. The assessment of ankylosing spondylitis in clinical practice. ACTA ACUST UNITED AC 2007; 3:496-503. [PMID: 17762848 DOI: 10.1038/ncprheum0591] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2007] [Accepted: 07/16/2007] [Indexed: 02/07/2023]
Abstract
Ankylosing Spondylitis (AS) is a chronic inflammatory arthritis that predominantly affects the axial skeleton in adolescent patients causing spinal pain and stiffness. There is a marked delay, on average 8 years, between onset of disease symptoms and clinical diagnosis. The distinction between the symptoms of mechanical and inflammatory back pain remains one of the main contributing factors for the delay in diagnosis. Several classification criteria exist to aid the diagnosis of AS, but their accuracy is poor. The Ankylosing Spondylitis Assessment Study group (ASAS) has defined a core set of domains for clinical outcome measurement in AS in order to assess the disease process in individual patients and to identify those with rapidly progressive disease. New therapies, such as the tumor necrosis factor (TNF) inhibitors, have transformed the treatment paradigm in AS, especially for those patients with aggressive disease. Thus, the definition of both patient selection criteria for these agents and the development of clinical methods to assess response to therapy have become a priority. This Review focuses on measuring the degree of disease activity, function and damage in patients with AS in an ambulatory care setting, and the assessment of suitability of various outcome measures for monitoring response to treatment with TNF inhibitors.
Collapse
Affiliation(s)
- Raj Sengupta
- Royal National Hospital for Rheumatic Diseases in Bath, UK
| | | |
Collapse
|
41
|
Yun JW, Lim SY, Suh GY, Chung MP, Kim H, Kwon OJ, Cha HS, Koh EM, Koh WJ. Diagnosis and treatment of latent tuberculosis infection in arthritis patients treated with tumor necrosis factor antagonists in Korea. J Korean Med Sci 2007; 22:779-83. [PMID: 17982222 PMCID: PMC2693840 DOI: 10.3346/jkms.2007.22.5.779] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Tumor necrosis factor (TNF) is essential for host defense against Mycobacterium tuberculosis, and the risk of reactivation of latent tuberculosis infection (LTBI) increases with anti-TNF therapy. This study estimated the prevalence of LTBI and evaluated the safety and completion rate of short-course therapy with isoniazid plus rifampin for 3 months to treat LTBI in a cohort of Korean arthritis patients before initiating anti-TNF therapy. We retrospectively studied the files of 112 consecutive patients to evaluate LTBI before starting anti-TNF drugs. Screening tests were performed, including a tuberculin skin test and chest radiography. LTBI treatment was indicated in 41 patients (37%). Of these, three patients refused the LTBI treatment. Of the 38 patients who underwent LTBI treatment, 36 (95%) took isoniazid plus rifampin for 3 months. Six patients (16%) showed transient elevations of liver enzymes during the LTBI treatment. Overall, 35 patients (92%) completed the LTBI treatment as planned. In conclusion, LTBI was diagnosed in one-third of Korean arthritis patients before initiating anti-TNF therapy. A high percentage of these patients completed 3 months of LTBI treatment with isoniazid plus rifampin without serious complications.
Collapse
Affiliation(s)
- Jong Wook Yun
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Yong Lim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gee Young Suh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Man Pyo Chung
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hojoong Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - O Jung Kwon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hoon-Suk Cha
- Division of Rheumatology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun-Mi Koh
- Division of Rheumatology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won-Jung Koh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
42
|
Goycochea-Robles MV, Arce-Salinas CA, Guzmán-Vázquez S, Cardiel-Ríos MH. Prescription rheumatology practices among Mexican specialists. Arch Med Res 2007; 38:354-9. [PMID: 17350489 DOI: 10.1016/j.arcmed.2006.11.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2006] [Accepted: 11/06/2006] [Indexed: 11/25/2022]
Abstract
BACKGROUND We undertook this study to describe prescription practices and the degree of disease control in a large sample of patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS) treated by rheumatologists in Mexico. METHODS Board-certified Mexican rheumatologists across the country were asked to assess consecutive RA and AS patients; 1208 patients completed a self-administered questionnaire with information on demographics, disease duration, co-morbidity, treatment, pain, disability and a validated Spanish version of instruments to measure physical function and quality of life. RESULTS Of the 1096 RA patients, 88.1% were treated with nonsteroidal anti-inflammatory drugs (NSAIDs), 1020 (93.3%) with disease-modifying anti-rheumatic drugs (DMARDs), 365 (33.4%) with steroids, and 70 (6.4%) with biological agents. Their mean Health Assessment Questionnaire Disability Index (HAQ-Di) score was 1.21+/-0.80, Disease Activity Index, 28 joint count (DAS 28) 3.9+/-1.29, and Rheumatoid Arthritis Disease Activity Index (RADAI), 3.94+/-2.01. Regarding the 112 AS patients, 110 (98.2%) received NSAIDs, 90 (80.4%) were on DMARDs, 11 (9.8%) took steroids, and 11 (9.8%) received biological agents, their functional status shown as Bath Ankylosing Spondylitis Functional Index (BASFI) score of 4.4+/-2.5. Among the 1110 DMARD users, only 64 received one drug, and a great proportion used two or more DMARDs; 81 subjects (16.2%) were on biological agents, in any combination. RA patients more commonly used methotrexate, 791 (72%) cases, and hydroxychloroquine. Taking into account their diagnosis, the combination most prescribed was NSAIDs plus DMARDs in 660 subjects (54.7%). CONCLUSIONS DMARDs in combination with other drug are the most frequently prescribed therapeutic scheme for RA and AS patients. These schemes used for both conditions by Mexican rheumatologists are in line with current international recommendations.
Collapse
Affiliation(s)
- María Victoria Goycochea-Robles
- Unit of Clinical Epidemiology, Hospital General Regional No. 1 Gabriel Mancera, Instituto Mexicano del Seguro Social, D. F., and Unidad de Posgrado, Universidad Autónoma del Estado de México, México.
| | | | | | | |
Collapse
|
43
|
Dernis E, Lavie F, Pavy S, Wendling D, Flipo RM, Saraux A, Cantagrel A, Claudepierrre P, Goupille P, Le Loët X, Maillefert JF, Mariette X, Schaeverbeke T, Tebib J, Combe B. Clinical and laboratory follow-up for treating and monitoring patients with ankylosing spondylitis: development of recommendations for clinical practice based on published evidence and expert opinion. Joint Bone Spine 2007; 74:330-7. [PMID: 17590366 DOI: 10.1016/j.jbspin.2007.04.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2006] [Accepted: 04/26/2007] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To develop French recommendations about the clinical and laboratory follow-up of patients with axial ankylosing spondylitis (AS) seen in everyday practice. METHODS The recommendations were developed based on evidence from the literature and on expert opinion. A Delphi consensus procedure was used by a scientific committee to select five focal points, about which evidence was obtained by searching Medline and the databases maintained by the French Society for Rheumatology, European League against Rheumatism, and American College of Rheumatology. The results of the literature review were used by a panel of experienced rheumatologists to draft and to validate the recommendations, using expert opinion if needed to supplement gaps in published knowledge. For each recommendation, the level of evidence and the level of agreement among the experts were specified. RESULTS The three focal points selected using the Delphi procedure dealt with choosing the best clinical and laboratory parameters for monitoring patients with AS; whether follow-up benefits from the use of composite indices (e.g., the Bath Ankylosing Spondylitis Disease Activity Index [BASDAI], the BAS Functional Index [BASFI] and the BAS Metrology Index [BASMI]); and the clinical and laboratory parameters that predict functional or structural outcomes in patients with AS. The literature search retrieved 1510 relevant articles based on titles and abstracts, of which 322 were selected for in-depth review. Five recommendations about the clinical and laboratory follow-up of patients with AS were developed then validated by having all panel participants vote during a final meeting. CONCLUSION Recommendations about the clinical and laboratory follow-up of patients with AS were developed. They can be expected to improve clinical practice uniformity and, in the longer term, to optimize the management of patients with AS.
Collapse
|
44
|
Schachna L, Brown MA. Australian data do not support current Pharmaceutical Benefits Scheme criteria for use of tumour necrosis factor-α inhibitors in ankylosing spondylitis. Intern Med J 2006; 36:755-6. [PMID: 17040370 DOI: 10.1111/j.1445-5994.2006.01185.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
45
|
Kay LJ, Griffiths ID. UK consultant rheumatologists' access to biological agents and views on the BSR Biologics Register. Rheumatology (Oxford) 2006; 45:1376-9. [PMID: 17040892 DOI: 10.1093/rheumatology/kel333] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES The British Society for Rheumatology Biologics Register (BSRBR) is a prospective cohort study to determine the efficacy and toxicity of biological agents in rheumatoid arthritis (RA) patients compared with RA controls. Entry of patients to the register is a condition of use of anti-tumour necrosis factor (anti-TNF) therapy in the UK, but little is known of clinicians' views of its usefulness. Data from the register suggest uneven provision of anti-TNF-alpha therapy. METHODS A questionnaire was sent on behalf of the BSRBR to all UK consultant rheumatologists concerning provision and use of anti-TNF-alpha therapy and their experience of working with the BSRBR. RESULTS Response rate was 49.5% representing 252 consultants. Fourty-six per cent had some limitation of access to anti-TNF-alpha drugs, usually a financial cap (70%), even for RA patients meeting National Institute for Health and Clinical Excellence (NICE) criteria. Sixty-seven per cent could prescribe for ankylosing spondylitis (AS) or psoriatic arthritis (PsA) in some circumstances but only 25 and 35%, respectively, could prescribe according to BSR guidance. More than 50% found the workload involved in submitting data to the registry at least difficult, but most had favourable impressions of the BSRBR and thought similar registries desirable or essential for PsA, AS and rituximab. CONCLUSIONS Access to anti-TNF therapy for patients with inflammatory arthritis is variable in the UK, even for RA where it is NICE-approved. Access is more limited for conditions where NICE has not yet issued guidance. The BSRBR generates a significant workload for rheumatology staff but is generally well-regarded.
Collapse
Affiliation(s)
- L J Kay
- Musculoskeletal Unit, Freeman Hospital, Newcastle-upon-Tyne NE7 7DN, UK.
| | | |
Collapse
|
46
|
Pham T, Guillemin F, Claudepierre P, Luc M, Miceli-Richard C, Fautrel B, de Bandt M, Breban M, Goupille P, Maillefert JF, Masson C, Saraux A, Schaeverbeke T, Wendling D, Mariette X, Combe B. TNFα antagonist therapy in ankylosing spondylitis and psoriatic arthritis: recommendations of the French Society for Rheumatology. Joint Bone Spine 2006; 73:547-53. [PMID: 16843030 DOI: 10.1016/j.jbspin.2006.02.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2005] [Accepted: 02/14/2006] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To develop recommendations for TNFalpha antagonist therapy in patients with spondyloarthropathies. METHODS The Delphi consensus procedure was used to select questions, to which evidence-based answers were sought in the literature. Expert opinion was used when needed to estimate the risks and benefits of TNFalpha antagonists. TNFalpha antagonists exert potent antiinflammatory effects but fail to provide a definitive cure. RESULTS Recommendations were developed for patients with ankylosing spondylitis (AS) or psoriatic arthritis (PsA). The following criteria for TNFalpha antagonist therapy were selected: definitive diagnosis of AS or PsA, active disease for at least 4 consecutive weeks documented during two physician visits, overall physician's assessment of disease activity>/=4/10 and BASDAI>/=4/10 in axial disease or at least three tender and swollen joints in peripheral disease, failure to respond adequately to at least three nonsteroidal antiinflammatory drugs given in optimal dosages for at least 3 months in axial disease or at least one disease-modifying antirheumatic drug (methotrexate, leflunomide, sulfasalazine) for at least 4 months, with local glucocorticoid injections if appropriate, in peripheral disease. Effectiveness and safety should be evaluated by a rheumatologist. The frequency of monitoring depends on the drug. Lack of effectiveness should be defined as inadequate improvement after 6-12 weeks, with a less than two-point decrease in the BASDAI in axial disease or a less than 30% decrease in the tender and swollen joint counts in peripheral disease. CONCLUSION These clinical practice recommendations should help rheumatologists in their everyday decisions regarding the use of TNFalpha antagonist therapy in patients with AS or PsA.
Collapse
Affiliation(s)
- Thao Pham
- Service de Rhumatologie, CHU de la Conception, 147, bd Baille, 13005 Marseille, France.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Affiliation(s)
- Claire M McVeigh
- Department of Rheumatology, Musgrave Park Hospital, Belfast BT9 7JB
| | | |
Collapse
|
48
|
Keat A, Sturrock R, Somerville M, Paul S. BSR guidelines for TNF blockers in ankylosing spondylitis: reply. Rheumatology (Oxford) 2006. [DOI: 10.1093/rheumatology/kel183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
49
|
Sheehy C, Murphy E, Barry M. BSR guidelines for TNF blockers in ankylosing spondylitis—how useful are they? Rheumatology (Oxford) 2006; 45:1176-7; author reply 1177-8. [PMID: 16820380 DOI: 10.1093/rheumatology/kel181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
50
|
Zochling J, Braun J. Developments and current pharmacotherapeutic recommendations for ankylosing spondylitis. Expert Opin Pharmacother 2006; 7:869-83. [PMID: 16634710 DOI: 10.1517/14656566.7.7.869] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The introduction of anti-TNFalpha therapy into the field of rheumatology has led to dramatic improvements in patient care, perhaps the most remarkable being in the management of ankylosing spondylitis. As experience with these compounds grows, their place in therapeutic strategy is becoming clearer, and it has been possible to develop evidence- and expertise-based recommendations for the management of ankylosing spondylitis to aid the clinician in patient care. This review outlines treatment advances in ankylosing spondylitis, including the use of anti-TNFalpha agents, and how these have been incorporated into clinical recommendations for daily use.
Collapse
Affiliation(s)
- Jane Zochling
- Rheumazentrum-Ruhrgebiet, Landgrafenstr. 15, 44652 Herne, Germany.
| | | |
Collapse
|