1
|
Alotaibi A, Albarrak D, Alammari Y. The Efficacy and Safety of Biologics in Treating Ankylosing Spondylitis and Their Impact on Quality of Life and Comorbidities: A Literature Review. Cureus 2024; 16:e55459. [PMID: 38571822 PMCID: PMC10988185 DOI: 10.7759/cureus.55459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2024] [Indexed: 04/05/2024] Open
Abstract
Ankylosing spondylitis (AS) is a chronic inflammatory arthritis that affects the axial skeleton, causing intense pain, progressive joint destruction, and a gradual reduction in physical function. Additionally, AS can result in extra-musculoskeletal manifestations including inflammatory bowel disease (IBD), psoriasis, and acute anterior uveitis (AAU) affecting patients' quality of life (QoL). Furthermore, AS association with neurological and cardiovascular events has been documented. With the advent of biologics, treating AS has dramatically changed due to their high efficacy and tolerable safety. Nevertheless, there are differences in traits, including rapidity of onset, long-term efficacy, safety profile, and influence on comorbidities. A better understanding of such traits enables clinicians to make the best decision for each patient, increasing persistence, extending medication survival, enhancing patient satisfaction, and reducing the disease effect of AS. A review of the literature published in English in PubMed and Google Scholar databases from 2010 to 2023 was conducted. All relevant results fitting the scope of the topic were included. In this article, we emphasize biologics' efficacy and safety profile in patients with AS. In addition, we discuss the impact of biologics on comorbidities and health-related quality of life (HRQoL).
Collapse
Affiliation(s)
| | - Danah Albarrak
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Yousef Alammari
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| |
Collapse
|
2
|
Farisogullari B, Santos EJF, Dures E, Geenen R, Machado PM. Efficacy of pharmacological interventions: a systematic review informing the 2023 EULAR recommendations for the management of fatigue in people with inflammatory rheumatic and musculoskeletal diseases. RMD Open 2023; 9:e003349. [PMID: 38056919 DOI: 10.1136/rmdopen-2023-003349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/14/2023] [Indexed: 12/08/2023] Open
Abstract
OBJECTIVE To identify the best evidence on the efficacy of pharmacological interventions in reducing fatigue in people with inflammatory rheumatic and musculoskeletal diseases (I-RMDs) and to summarise their safety in the identified studies to inform European Alliance of Associations for Rheumatology recommendations for the management of fatigue in people with I-RMDs. METHODS Systematic review of adults with I-RMDs conducted according to the Cochrane Handbook. Search strategy ran in Medline, Embase, Cochrane Library, CINAHL Complete, PEDro, OTseeker and PsycINFO. Only randomised controlled trials (RCTs) or controlled clinical trials were eligible. Assessment of risk of bias, data extraction and synthesis performed by two reviewers independently and in duplicate. Data pooled in statistical meta-analyses. RESULTS From 4151 records, 455 were selected for full-text review, 99 fulfilled the inclusion criteria and 19 RCTs were included in meta-analyses. Adalimumab was superior to placebo in reducing fatigue at 12 and 52 weeks in rheumatoid arthritis (RA) (n=3 and 2 RCTs; mean difference (MD)= -3.03, p<0.001; MD=-2.25, p=0.03, respectively). Golimumab (n=2 RCTs; 24 weeks: MD=-5.27, p<0.001), baricitinib (n=2 RCTs; 24 weeks: MD=-4.06, p<0.001), sarilumab (n=2 RCTs; 24 weeks: MD=-3.15, p<0.001), tocilizumab (n=3 RCTs; 24 weeks: MD=-3.69, p<0.001) and tofacitinib (n=3 RCTs; 12 weeks: MD=-4.44, p<0.001) were also superior to placebo in reducing fatigue in RA. A dose/effect relationship was observed for sarilumab, tocilizumab and tofacitinib. In spondyloarthritis (excluding psoriatic arthritis), secukinumab was superior to placebo in reducing fatigue at 16 weeks (n=2 RCTs; MD=-4.15, p<0.001), with a dose/effect relationship also observed. The narrative results of the RCTs not included in the meta-analysis indicated that several other pharmacological interventions were efficacious in reducing fatigue, with reassuring safety results. CONCLUSIONS Several pharmacological interventions are efficacious and generally safe for managing fatigue in people with I-RMDs.
Collapse
Affiliation(s)
| | - Eduardo José Ferreira Santos
- School of Health, Polytechnic University, Viseu, Portugal
- Health Sciences Research Unit: Nursing (UICiSA:E), Coimbra, Portugal
| | - Emma Dures
- Academic Rheumatology, Bristol Royal Infirmary, Bristol, UK
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Rinie Geenen
- Department of Psychology, Utrecht University, Utrecht, The Netherlands
| | - Pedro M Machado
- Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London, UK
- National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK
- Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| |
Collapse
|
3
|
Jafari MM, Azimzadeh Tabrizi Z, Dayer MS, Kazemi-Sefat NA, Mohtashamifard M, Mohseni R, Bagheri A, Bahadory S, Karimipour-Saryazdi A, Ghaffarifar F. Immune system roles in pathogenesis, prognosis, control, and treatment of Toxoplasma gondii infection. Int Immunopharmacol 2023; 124:110872. [PMID: 37660595 DOI: 10.1016/j.intimp.2023.110872] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 08/25/2023] [Accepted: 08/27/2023] [Indexed: 09/05/2023]
Abstract
Toxoplasma gondii is the protozoan causative agent of toxoplasmosis in humans and warm-blooded animals. Recent studies have illustrated that the immune system plays a pivotal role in the pathogenesis of toxoplasmosis by triggering immune cytokines like IL-12, TNF-α, and IFN-γ and immune cells like DCs, Th1, and Th17. On the other hand, some immune components can serve as prognosis markers of toxoplasmosis. In healthy people, the disease is often asymptomatic, but immunocompromised people and newborns may suffer severe symptoms and complications. Therefore, the immune prognostic markers may provide tools to measure the disease progress and help patients to avoid further complications. Immunotherapies using monoclonal antibody, cytokines, immune cells, exosomes, novel vaccines, and anti-inflammatory molecules open new horizon for toxoplasmosis treatment. In this review article, we discussed the immunopathogenesis, prognosis, and immunotherapy of Toxoplasma gondii infection.
Collapse
Affiliation(s)
- Mohammad Mahdi Jafari
- Department of Immunology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Zahra Azimzadeh Tabrizi
- Department of Immunology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Mohammad Saaid Dayer
- Department of Parasitology and Medical Entomology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | | | - Mahshid Mohtashamifard
- Department of Immunology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Rahimeh Mohseni
- Department of Immunology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Atefeh Bagheri
- Department of Immunology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Saeed Bahadory
- Department of Parasitology and Medical Entomology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Amir Karimipour-Saryazdi
- Department of Parasitology and Medical Entomology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Fatemeh Ghaffarifar
- Department of Parasitology and Medical Entomology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
| |
Collapse
|
4
|
Ludvigsson J, Routray I, Vigård T, Hanås R, Rathsman B, Carlsson A, Särnblad S, Albin AK, Arvidsson CG, Samuelsson U, Casas R. Combined Etanercept, GAD-alum and vitamin D treatment: an open pilot trial to preserve beta cell function in recent onset type 1 diabetes. Diabetes Metab Res Rev 2021; 37:e3440. [PMID: 33486892 DOI: 10.1002/dmrr.3440] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/31/2020] [Accepted: 01/11/2021] [Indexed: 12/21/2022]
Abstract
AIM We aimed to study the feasibility and tolerability of a combination therapy consisting of glutamic acid decarboxylase (GAD-alum), Etanercept and vitamin D in children and adolescents with newly diagnosed with type 1 diabetes (T1D), and evaluate preservation of beta cell function. MATERIAL AND METHODS Etanercept Diamyd Combination Regimen is an open-labelled multi-centre study pilot trial which enrolled 20 GAD antibodies positive T1D patients (7 girls and 13 boys), aged (mean ±SD): 12.4 ± 2.3 (8.3-16.1) years, with a diabetes duration of 81.4 ± 22.1 days. Baseline fasting C-peptide was 0.24 ± 0.1 (0.10-0.35) nmol/l. The patients received Day 1-450 Vitamin D (Calciferol) 2000 U/d per os, Etanercept sc Day 1-90 0.8 mg/kg once a week and GAD-alum sc injections (20 μg, Diamyd™) Day 30 and 60. They were followed for 30 months. RESULTS No treatment related serious adverse events were observed. After 6 months 90-min stimulated C-peptide had improved in 8/20 patients and C-peptide area under the curve (AUC) after Mixed Meal Tolerance Test in 5 patients, but declined thereafter, while HbA1c and insulin requirement remained close to baseline. Administration of Etanercept did not reduce tumour necrosis factor (TNF) spontaneous secretion from peripheral blood mononuclear cells, but rather GAD65-induced TNF-α increased. Spontaneous interleukin-17a secretion increased after the administration of Etanercept, and GAD65-induced cytokines and chemokines were also enhanced following 1 month of Etanercept administration. CONCLUSIONS Combination therapy with parallel treatment with GAD-alum, Etanercept and vitamin D in children and adolescents with type 1 diabetes was feasible and tolerable but had no beneficial effects on the autoimmune process or beta cell function.
Collapse
Affiliation(s)
- Johnny Ludvigsson
- Department of Biomedical and Clinical Sciences, Crown Princess Victoria Children´s Hospital and Division of Pediatrics, Linköping University, Linköping, Sweden
| | - Indusmita Routray
- Department of Biomedical and Clinical Sciences, Division of Pediatrics, Linköping University, Linköping, Sweden
| | - Tore Vigård
- Department of Clinical Sciences, Pediatric Endocrinology, Lund University, Malmö, Sweden
- Department of Pediatrics, Skåne University Hospital, Malmö, Sweden
| | - Ragnar Hanås
- Department of Pediatrics, NU Hospital Group, Uddevalla, Sweden
- Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Björn Rathsman
- Sachska Pediatric Hospital, Södersjukhuset, Stockholm, Sweden
| | - Annelie Carlsson
- Department of Clinical Sciences, Pediatric Autoimmunity, Lund University, Lund, Sweden
- Skåne University Hospital, Lund, Sweden
| | - Stefan Särnblad
- Department of Pediatrics, University Hospital, Örebro, Sweden
| | - Anna-Karin Albin
- Department of Pediatrics, Helsingborg Central Hospital, Helsingborg, Sweden
| | | | - Ulf Samuelsson
- Department of Biomedical and Clinical Sciences, Crown Princess Victoria Children´s Hospital and Division of Pediatrics, Linköping University, Linköping, Sweden
| | - Rosaura Casas
- Department of Biomedical and Clinical Sciences, Division of Pediatrics, Linköping University, Linköping, Sweden
| |
Collapse
|
5
|
Zhang P, Zhou S, Chen Z, Tian Y, Wang Q, Li H, Zhang T, Guo Q, Wang M, Guo C. TNF Receptor: Fc Fusion Protein Downregulates RANKL/OPG Ratio by Inhibiting CXCL16/CXCR6 in Active Ankylosing Spondylitis. Curr Pharm Biotechnol 2021; 22:305-316. [PMID: 32116188 DOI: 10.2174/1389201021666200302104418] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 12/20/2019] [Accepted: 02/09/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Clinical studies indicate that recombinant tumor necrosis factor receptor:Fc fusion protein (rhTNFR:Fc) quickly alleviates symptoms and physical signs of active Ankylosing Spondylitis (AS), improving the manifestation of spinal inflammation on radiological imaging. However, the regulatory mechanism of rhTNFR:Fc in the chemokine pathway is unclear. Thus we study the mechanism of phlogogenic activity of CXCL16/CXCR6 in AS and the related mechanism of rhTNFR: Fc treatment. METHODS Thirty-two cases of active AS were treated with rhTNFR:Fc for 3 consecutive months. Clinical response was evaluated at baseline and after treatment. CXCL16/CXCR6 expression as well as Receptor Activator Of Nuclear Factor-Κb Ligand (RANKL)/Osteoprotegerin (OPG), essential molecules for osteoclast differentiation, were studied in AS before and after treatment. Further, the proliferation of lymphocytes and the RANKL level stimulated by recombinant human CXCL16 (rhCXCL16) were measured in vitro. RESULTS Thirty cases responded to rhTNFR:Fc treatment. The RANKL level, RANKL/OPG ratio, CXCLl6 level in serum, and CXCLl6 and CXCR6 mRNA levels in active AS were higher than those in controls and treated patients (P<0.001). rhCXCL16 treatment increased lymphocyte proliferation and RANKL level in active AS (P<0.001), but not in controls or treated patients (P>0.05). A positive linear correlation was noted between CXCL16 serum levels and RANKL/OPG ratio and between CXCL16 levels and C-reactive protein results (P<0.001). CONCLUSIONS Our findings suggest that rhTNFR:Fc suppresses inflammation and bone destruction of AS by reducing the RANKL/OPG ratio through inhibition of the CXCL16/CXCR6 pathway.
Collapse
Affiliation(s)
- Peiyi Zhang
- Department of Rheumatology and Immunology, Jinan Central Hospital Affiliated to Shandong University, Jinan 250013, China
| | - Shufen Zhou
- Department of Rheumatology and Immunology, Southern Medical University Affiliated Shenzhen Baoan Hospital, Shenzhen 518101, China
| | - Zhe Chen
- Department of Rheumatology and Immunology, Southern Medical University Affiliated Shenzhen Baoan Hospital, Shenzhen 518101, China
| | - Ye Tian
- Department of Rheumatology and Immunology, Southern Medical University Affiliated Shenzhen Baoan Hospital, Shenzhen 518101, China
| | - Qianqian Wang
- Department of Rheumatology and Immunology, Southern Medical University Affiliated Shenzhen Baoan Hospital, Shenzhen 518101, China
| | - Hui Li
- Department of Rheumatology and Immunology, Southern Medical University Affiliated Shenzhen Baoan Hospital, Shenzhen 518101, China
| | - Tiantian Zhang
- Department of Rheumatology and Immunology, Southern Medical University Affiliated Shenzhen Baoan Hospital, Shenzhen 518101, China
| | - Qin Guo
- Department of Rheumatology and Immunology, Southern Medical University Affiliated Shenzhen Baoan Hospital, Shenzhen 518101, China
| | - Meiying Wang
- Department of Rheumatology and Immunology, Peking University Shenzhen Hospital, Shenzhen 518000, China
| | - Chengshan Guo
- Department of Rheumatology and Immunology, Southern Medical University Affiliated Shenzhen Baoan Hospital, Shenzhen 518101, China
| |
Collapse
|
6
|
Jørgensen TS, Skougaard M, Hansen RL, Ballegaard C, Mease P, Strand V, Dreyer L, Kristensen LE. Relation Between Fatigue and ACR Response in Patients With Psoriatic Arthritis Treated With Tumor Necrosis Factor Inhibitor Therapy: A Population-based Cohort Study. J Rheumatol 2020; 48:829-835. [PMID: 33191280 DOI: 10.3899/jrheum.191107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The objective of this population-based cohort study was to investigate the association between fatigue with disease activity and drug survival in patients with psoriatic arthritis (PsA) receiving their first tumor necrosis factor inhibitor (TNFi). METHODS Data on patient characteristics, disease activity, and drug survival were obtained from the DANBIO database on all patients with PsA from 2006 through 2015. Information on comorbidities was obtained through linkage with the Danish National Patient Registry. RESULTS A total of 880 patients were eligible for analyses. Patients with upper median fatigue scores had statistically significant higher disease activity measures (Disease Activity Score in 28 joints based on C-reactive protein), pain, and Health Assessment Questionnaire (HAQ) scores; tender joint counts; comorbidities (Charlson Comorbidity Index ≥ 2); and current smoking status at baseline compared to patients with lower median fatigue scores (P < 0.05). In the upper median fatigue group, fewer patients achieved American College of Rheumatology (ACR) responses and improvements in visual analog scale (VAS) fatigue compared to patients in the lower median fatigue group. Kaplan-Meier curves showed shorter drug survival in patients in the upper median fatigue group compared with the lower median fatigue group at 6-month follow-up. CONCLUSION Fatigue remains a dominating symptom after TNFi treatment, and is associated with higher baseline disease activity, pain, and HAQ scores; more comorbidities; and increased risk of TNFi treatment discontinuation in a cohort of Danish patients with PsA. The agreement between ACR and VAS fatigue responses is weak to moderate, suggesting heterogeneity between experienced fatigue and joint inflammation.
Collapse
Affiliation(s)
- Tanja Schjødt Jørgensen
- T.S. Jørgensen, MSc, PhD, Senior Researcher, M. Skougaard, MD, R.L. Hansen, medical student, L.E. Kristensen, MD, PhD, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Frederiksberg, Denmark;
| | - Marie Skougaard
- T.S. Jørgensen, MSc, PhD, Senior Researcher, M. Skougaard, MD, R.L. Hansen, medical student, L.E. Kristensen, MD, PhD, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Frederiksberg, Denmark
| | - Rebekka Lund Hansen
- T.S. Jørgensen, MSc, PhD, Senior Researcher, M. Skougaard, MD, R.L. Hansen, medical student, L.E. Kristensen, MD, PhD, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Frederiksberg, Denmark
| | - Christine Ballegaard
- C. Ballegaard, MD, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Frederiksberg, and DANBIO Registry, Gentofte Hospital, Rigshospitalet, Hellerup, Denmark
| | - Philip Mease
- P. Mease, MD, Clinical Professor, Swedish Medical Center and University of Washington, Seattle, Washington, USA
| | - Vibeke Strand
- V. Strand, MD, Clinical Professor, Division Immunology/Rheumatology, Stanford University, Palo Alto, California, USA
| | - Lene Dreyer
- L. Dreyer, MD, Professor, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, DANBIO Registry, Gentofte Hospital, Rigshospitalet, Hellerup, and Departments of Rheumatology and Clinical Medicine, Aalborg University Hospital and Aalborg University, Aalborg, Denmark
| | - Lars Erik Kristensen
- T.S. Jørgensen, MSc, PhD, Senior Researcher, M. Skougaard, MD, R.L. Hansen, medical student, L.E. Kristensen, MD, PhD, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Frederiksberg, Denmark
| |
Collapse
|
7
|
Seng JJB, Kwan YH, Fong W, Phang JK, Lui NL, Thumboo J, Leung YY. Validity and reliability of EQ-5D-5L among patients with axial spondyloarthritis in Singapore. Eur J Rheumatol 2020; 7:71-78. [PMID: 32644927 DOI: 10.5152/eurjrheum.2020.19043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 01/11/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE This study aims to evaluate the reliability and validity of EuroQOL-5 Dimensions-5 Levels (EQ-5D-5L) among patients with axial spondyloarthritis (SpA) in Singapore. METHODS A cross-sectional study was conducted involving patients with axial SpA in an Asian tertiary hospital from 2017 to 2018. This study followed the COnsensus-based Standards for selection of health Measurement Instruments framework. Construct validity was evaluated by testing 22 a priori hypotheses with other patient-reported outcomes measures. Cronbach's alpha was used to estimate the internal consistency of the EQ-5D-5L, while its test-retest reliability was assessed using weighted kappa and the intraclass correlation coefficient (ICC). The measurement error was assessed by analyzing minimal detectable change (MDC). RESULTS The median age of included patients (n=118) was 35 years (interquartile range: 28, 49). Ninety-six (81.4%) patients were male, while 112 (94.9%) patients were of Chinese ethnicity. The EQ-5D-5L demonstrated good internal consistency with a Cronbach's alpha of 0.79. The test-retest reliability of the EQ-5D-5L was good with a weighted kappa of ≥0.61 for mobility, self-care, usual activities, and anxiety/depression; the ICC was 0.92 and 0.99 for the EQ-5D-5L index and visual analog scale (VAS) scores, respectively. The weighted kappa for the EQ-5D-5L pain/discomfort was moderate [0.53, 95% confidence interval: 0.41-0.60]. The MDC for EQ-5D-5L index and VAS scores was 0.06 and 4.5, respectively. Convergent validity was supported as all hypotheses were confirmed in the results. CONCLUSION This study supports EQ-5D-5L as a valid and reliable instrument for assessing health-related quality of life among patients with axial SpA in Singapore.
Collapse
Affiliation(s)
| | - Yu Heng Kwan
- Program in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, Singapore
| | - Warren Fong
- Department of Medicine, Duke-NUS Medical School, 8 College Road, Singapore.,Department of Rheumatology and Immunology, Singapore General Hospital, Outram Road, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 12 Science Drive 2, Singapore
| | - Jie Kie Phang
- Department of Rheumatology and Immunology, Singapore General Hospital, Outram Road, Singapore
| | - Nai Lee Lui
- Department of Rheumatology and Immunology, Singapore General Hospital, Outram Road, Singapore
| | - Julian Thumboo
- Program in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, Singapore.,Department of Rheumatology and Immunology, Singapore General Hospital, Outram Road, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 12 Science Drive 2, Singapore
| | - Ying Ying Leung
- Department of Medicine, Duke-NUS Medical School, 8 College Road, Singapore.,Department of Rheumatology and Immunology, Singapore General Hospital, Outram Road, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 12 Science Drive 2, Singapore
| |
Collapse
|
8
|
Kiltz U, Kiefer D, Boonen A. (Health-Related) Quality of Life as an Outcome in Studies of Axial Spondyloarthritis. Rheum Dis Clin North Am 2020; 46:379-393. [DOI: 10.1016/j.rdc.2020.01.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
|
9
|
Aydın E, Yıldırım Y, Aydın FY, Bahadır MV, Kaplan İ, Kadiroğlu B, Ketani MA, Yılmaz Z, Kadiroğlu AK, Yılmaz ME. Evaluation of the effect of intraperitoneal etanercept administration on oxidative stress and inflammation indicators in the kidney and blood of experimental sepsis-induced rats. Rev Soc Bras Med Trop 2020; 53:e20200016. [PMID: 32348434 PMCID: PMC7198067 DOI: 10.1590/0037-8682-0016-2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 03/12/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION: Sepsis is an important cause of mortality and morbidity, and inflammatory response and oxidative stress play major roles underlying its pathophysiology. Here, we evaluated the effect of intraperitoneal etanercept administration on oxidative stress and inflammation indicators in the kidney and blood of experimental sepsis-induced rats. METHODS: Twenty-eight adult Sprague Dawley rats were classified into Control (Group 1), Sepsis (Group 2), Sepsis+Cefazolin (Group 3), and Sepsis+Cefazolin+Etanercept (Group 4) groups. Kidney tissue and serum samples were obtained for biochemical and histopathological investigations and examined for the C reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), triggering receptor expressed on myeloid cells (TREM), and malondialdehyde (MDA) levels. RESULTS: The levels of TNF-α, TREM, and MDA in serum and kidney samples were significantly higher in rats from sepsis group than in rats from control group (p < 0.05). Group 3 showed a significant reduction in serum levels of TNF-α, CRP, and TREM as compared with Group 2 (p < 0.05). Serum TNF-α, CRP, TREM, and MDA levels and kidney TNF-α and TREM levels were significantly lower in Group 4 than in Group 2 (p < 0.05). Serum TNF-α and TREM levels in Group 4 were significantly lower than those in Group 3, and histopathological scores were significantly lower in Group 3 and Group 4 than in Group 2 (p < 0.05). Histopathological scores of Group 4 were significantly lower than those of Group 3 (p < 0.05). CONCLUSIONS: Etanercept, a TNF-α inhibitor, may ameliorate sepsis-induced oxidative stress, inflammation, and histopathological damage.
Collapse
Affiliation(s)
- Emre Aydın
- Department of Nephrology, School of Medicine, University of Dicle, Diyarbakır, Turkey
| | - Yaşar Yıldırım
- Department of Nephrology, School of Medicine, University of Dicle, Diyarbakır, Turkey
| | - Fatma Yılmaz Aydın
- Department of Internal Medicine, School of Medicine, University of Dicle, Diyarbakır, Turkey
| | - Mehmet Veysi Bahadır
- Department of General Surgery, School of Medicine, University of Dicle, Diyarbakır, Turkey
| | - İbrahim Kaplan
- Department of Biochemistry, School of Medicine, University of Dicle, Diyarbakır, Turkey
| | - Berfin Kadiroğlu
- Department of Virology, School of Veterinary Medicine, University of Dicle, Diyarbakır, Turkey
| | - Muzaffer Aydın Ketani
- Department of Histology and Embryology, School of Veterinary Medicine, University of Dicle, Diyarbakır, Turkey
| | - Zülfükar Yılmaz
- Department of Nephrology, School of Medicine, University of Dicle, Diyarbakır, Turkey
| | - Ali Kemal Kadiroğlu
- Department of Nephrology, School of Medicine, University of Dicle, Diyarbakır, Turkey
| | - Mehmet Emin Yılmaz
- Department of Nephrology, School of Medicine, University of Dicle, Diyarbakır, Turkey
| |
Collapse
|
10
|
Kiltz U, Braun J, Becker A, Chenot JF, Dreimann M, Hammel L, Heiligenhaus A, Hermann KG, Klett R, Krause D, Kreitner KF, Lange U, Lauterbach A, Mau W, Mössner R, Oberschelp U, Philipp S, Pleyer U, Rudwaleit M, Schneider E, Schulte TL, Sieper J, Stallmach A, Swoboda B, Winking M. [Long version on the S3 guidelines for axial spondyloarthritis including Bechterew's disease and early forms, Update 2019 : Evidence-based guidelines of the German Society for Rheumatology (DGRh) and participating medical scientific specialist societies and other organizations]. Z Rheumatol 2020; 78:3-64. [PMID: 31784900 DOI: 10.1007/s00393-019-0670-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- U Kiltz
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Claudiusstr. 45, 44649, Herne, Deutschland.
| | - J Braun
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Claudiusstr. 45, 44649, Herne, Deutschland
| | | | - A Becker
- Allgemeinmedizin, präventive und rehabilitative Medizin, Universität Marburg, Karl-von-Frisch-Str. 4, 35032, Marburg, Deutschland
| | | | - J-F Chenot
- Universitätsmedizin Greifswald, Fleischmann Str. 6, 17485, Greifswald, Deutschland
| | - M Dreimann
- Zentrum für Operative Medizin, Klinik und Poliklinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistraße 52, 20251, Hamburg, Deutschland
| | | | - L Hammel
- Geschäftsstelle des Bundesverbandes der DVMB, Metzgergasse 16, 97421, Schweinfurt, Deutschland
| | | | - A Heiligenhaus
- Augenzentrum und Uveitis-Zentrum, St. Franziskus Hospital, Hohenzollernring 74, 48145, Münster, Deutschland
| | | | - K-G Hermann
- Institut für Radiologie, Charité Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | | | - R Klett
- Praxis Manuelle & Osteopathische Medizin, Fichtenweg 17, 35428, Langgöns, Deutschland
| | | | - D Krause
- , Friedrich-Ebert-Str. 2, 45964, Gladbeck, Deutschland
| | - K-F Kreitner
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - U Lange
- Kerckhoff-Klinik, Rheumazentrum, Osteologie & Physikalische Medizin, Benekestr. 2-8, 61231, Bad Nauheim, Deutschland
| | | | - A Lauterbach
- Schule für Physiotherapie, Orthopädische Universitätsklinik Friedrichsheim, Marienburgstraße 2, 60528, Frankfurt, Deutschland
| | | | - W Mau
- Institut für Rehabilitationsmedizin, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, 06097, Halle (Saale), Deutschland
| | - R Mössner
- Klinik für Dermatologie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland
| | | | - U Oberschelp
- , Barlachstr. 6, 59368, Werne a.d. L., Deutschland
| | | | - S Philipp
- Praxis für Dermatologie, Bernauer Str. 66, 16515, Oranienburg, Deutschland
| | - U Pleyer
- Campus Virchow-Klinikum, Charité Centrum 16, Klinik f. Augenheilkunde, Charité, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - M Rudwaleit
- Klinikum Bielefeld, An der Rosenhöhe 27, 33647, Bielefeld, Deutschland
| | - E Schneider
- Abt. Fachübergreifende Frührehabilitation und Sportmedizin, St. Antonius Hospital, Dechant-Deckersstr. 8, 52249, Eschweiler, Deutschland
| | - T L Schulte
- Klinik für Orthopädie und Unfallchirurgie, Orthopädische Universitätsklinik, Ruhr-Universität Bochum, Gudrunstr. 65, 44791, Bochum, Deutschland
| | - J Sieper
- Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Deutschland
| | - A Stallmach
- Klinik für Innere Medizin IV, Universitätsklinikum Jena, Am Klinikum 1, 07743, Jena, Deutschland
| | | | - B Swoboda
- Abteilung für Orthopädie und Rheumatologie, Orthopädische Universitätsklinik, Malteser Waldkrankenhaus St. Marien, 91054, Erlangen, Deutschland
| | | | - M Winking
- Zentrum für Wirbelsäulenchirurgie, Klinikum Osnabrück, Am Finkenhügel 3, 49076, Osnabrück, Deutschland
| | | |
Collapse
|
11
|
Patra MC, Shah M, Choi S. Toll-like receptor-induced cytokines as immunotherapeutic targets in cancers and autoimmune diseases. Semin Cancer Biol 2019; 64:61-82. [PMID: 31054927 DOI: 10.1016/j.semcancer.2019.05.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 04/27/2019] [Accepted: 05/01/2019] [Indexed: 12/14/2022]
Abstract
Immune cells of the myeloid and lymphoid lineages express Toll-like receptors (TLRs) to recognize pathogenic components or cellular debris and activate the immune system through the secretion of cytokines. Cytokines are signaling molecules that are structurally and functionally distinct from one another, although their secretion profiles and signaling cascades often overlap. This situation gives rise to pleiotropic cell-to-cell communication pathways essential for protection from infections as well as cancers. Nonetheless, deregulated signaling can have detrimental effects on the host, in the form of inflammatory or autoimmune diseases. Because cytokines are associated with numerous autoimmune and cancerous conditions, therapeutic strategies to modulate these molecules or their biological responses have been immensely beneficial over the years. There are still challenges in the regulation of cytokine function in patients, even in those who take approved biological therapeutics. In this review, our purpose is to discuss the differential expression patterns of TLR-regulated cytokines and their cell type specificity that is associated with cancers and immune-system-related diseases. In addition, we highlight key structural features and molecular recognition of cytokines by receptors; these data have facilitated the development and approval of several biologics for the treatment of autoimmune diseases and cancers.
Collapse
Affiliation(s)
- Mahesh Chandra Patra
- Department of Molecular Science and Technology, Ajou University, Suwon, 16499, Republic of Korea
| | - Masaud Shah
- Department of Molecular Science and Technology, Ajou University, Suwon, 16499, Republic of Korea
| | - Sangdun Choi
- Department of Molecular Science and Technology, Ajou University, Suwon, 16499, Republic of Korea.
| |
Collapse
|
12
|
Yang R, Liu H, Fan M. A quick decrease of bone marrow edema in sacroiliac joint could be served as a novel marker for dose tapering of etanercept in ankylosing spondylitis patients. Medicine (Baltimore) 2019; 98:e14620. [PMID: 30882628 PMCID: PMC6426528 DOI: 10.1097/md.0000000000014620] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
The purpose of this study was to investigate the correlation of bone marrow edema (BME) in sacroiliac joint (SIJ) with clinical characteristics and clinical response, and whether the quick decrease of BME could be served as a novel marker for dose tapering of etanercept in ankylosing spondylitis (AS) patients.Ninety active AS patients underwent etanercept treatment for 6 months were enrolled consecutively and classified into standard dose group (n = 37) and dose tapering group (n = 53). BME in SIJ and clinical response were assessed by SPARCC criteria and ASAS 40 response criteria, respectively. "Quick decrease of BME in SIJ" was defined as the decrease of SPARCC score≥50% from M0 to M1.BME in SIJ was positively correlated with pain VAS score, BASDAI score, CRP, IL-1β, IL-17, and TNF-α levels. ASAS 40 response rate at M6 was lower in dose tapering group than standard dose group, while higher in patients with a quick decrease of BME in SIJ than other patients. Besides, the ASAS 40 response rate in dose tapering group was similar to standard dose group in patients with a quick decrease of BME in SIJ but was lower than standard dose group in patients without a quick decrease of BME in SIJ at M6.A quick decrease of BME in SIJ predicts better treatment response to etanercept, and it might be served as a novel marker for dose tapering initiation of etanercept in AS patients.
Collapse
Affiliation(s)
- Ruishan Yang
- Department of CT/MRI, The Second People's Hospital of Liaocheng, Linqing, Shandong
| | - Hongda Liu
- Foot and Ankle Surgery, The Second Hospital of Tangshan, Tangshan, Hebei
| | - Mengpo Fan
- Department of Orthopaedic Surgery, The Second People's Hospital of Liaocheng, Linqing, Shandong, China
| |
Collapse
|
13
|
Abstract
Axial spondyloarthritis (AxSpA) is an inflammatory spondyloarthritis (SpA) that has significant impact on a patient's life. Symptoms, including fatigue, sleep problems, depression, and sexual dysfunction, can profoundly impact health-related quality of life (HRQoL) and limit work, leisure, and daily activities. Available therapies effectively manage pain and inflammation in early-stage disease, but patients often continue to experience impaired HRQoL. Thus, there remains a need for new therapies with novel mechanisms that can stop disease progression, potentially reverse damage caused by AxSpA and improve HRQoL in patients with AxSpA. Newer biologic agents, such as those targeting the interleukin 17-interleukin 23 axis, have promising efficacy and may improve HRQoL for patients with AxSpA. The AxSpA has many negative effects on HRQoL. By targeting disease pathways responsible for the development of AxSpA, approved and emerging therapies potentially reduce disease activity and improve the functional status of patients with AxSpA. This narrative review reflects on the findings of studies evaluating HRQoL of individuals with AxSpA and the role of newer therapies.
Collapse
|
14
|
Chen MH, Lee MH, Liao HT, Chen WS, Lai CC, Tsai CY. Health-related quality of life outcomes in patients with rheumatoid arthritis and ankylosing spondylitis after tapering biologic treatment. Clin Rheumatol 2018; 37:429-438. [DOI: 10.1007/s10067-017-3965-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 12/01/2017] [Accepted: 12/18/2017] [Indexed: 12/19/2022]
|
15
|
Dau JD, Lee M, Ward MM, Gensler LS, Brown MA, Learch TJ, Diekman LA, Tahanan A, Rahbar MH, Weisman MH, Reveille JD. Opioid Analgesic Use in Patients with Ankylosing Spondylitis: An Analysis of the Prospective Study of Outcomes in an Ankylosing Spondylitis Cohort. J Rheumatol 2017; 45:188-194. [PMID: 29196383 DOI: 10.3899/jrheum.170630] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Opioid analgesics may be prescribed to ankylosing spondylitis (AS) patients with pain that is unresponsive to antirheumatic treatment. Our study assessed factors associated with opioid usage in AS. METHODS A prospective cohort of 706 patients with AS meeting modified New York criteria followed at least 2 years underwent comprehensive clinical evaluation of disease activity and functional impairment. These were assessed by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI). Radiographic severity was assessed by the Bath Ankylosing Spondylitis Radiology Index and modified Stokes Ankylosing Spondylitis Scoring System. Medications taken concurrently with opioids, as well as C-reactive protein (CRP) levels and erythrocyte sedimentation rate (ESR), were determined at each study visit, performed every 6 months. Analyses were carried out at baseline, and longitudinal multivariable models were developed to identify factors independently associated with chronic and intermittent opioid usage over time. RESULTS Factors significantly associated with opioid usage, especially chronic opioid use, included longer disease duration, smoking, lack of exercise, higher disease activity (BASDAI) and functional impairment (BASFI), depression, radiographic severity, and cardiovascular disease. Patients taking opioids were more likely to be using anxiolytic, hypnotic, antidepressant, and muscle relaxant medications. Multivariable analysis underscored the association with smoking, older age, antitumor necrosis factor agent use, and psychoactive drugs, as well as with subjective but not objective determinants of disease activity. CONCLUSION Opioid usage was more likely to be associated with subjective measures (depression, BASDAI, BASFI) than objective measures (CRP, ESR), suggesting that pain in AS may derive from sources other than spinal inflammation alone.
Collapse
Affiliation(s)
- Jonathan D Dau
- From the Department of Internal Medicine, Division of Rheumatology, and the Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston, Houston, Texas; National Institute of Arthritis and Musculoskeletal and Skin Diseases, US National Institutes of Health, Bethesda, Maryland; Department of Medicine, Division of Rheumatology, University of California San Francisco (UCSF), San Francisco, California, USA; University of Queensland Diamantina Institute, Translational Research Institute, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Princess Alexandra Hospital, Queensland, Australia; Division of Rheumatology, Cedars Sinai Medical Center, Los Angeles, California, USA.,J.D. Dau, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; M.J. Lee, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.M. Ward, MD, MPH, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health; L.S. Gensler, MD, Department of Medicine, Division of Rheumatology, UCSF; M.A. Brown, FRACP, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital; T.J. Learch, MD, Division of Rheumatology, Cedars Sinai Medical Center; L.A. Diekman, MS, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; A. Tahanan, BS, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Rahbar, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Weisman, MD, Division of Rheumatology, Cedars Sinai Medical Center; J.D. Reveille, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston
| | - MinJae Lee
- From the Department of Internal Medicine, Division of Rheumatology, and the Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston, Houston, Texas; National Institute of Arthritis and Musculoskeletal and Skin Diseases, US National Institutes of Health, Bethesda, Maryland; Department of Medicine, Division of Rheumatology, University of California San Francisco (UCSF), San Francisco, California, USA; University of Queensland Diamantina Institute, Translational Research Institute, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Princess Alexandra Hospital, Queensland, Australia; Division of Rheumatology, Cedars Sinai Medical Center, Los Angeles, California, USA.,J.D. Dau, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; M.J. Lee, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.M. Ward, MD, MPH, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health; L.S. Gensler, MD, Department of Medicine, Division of Rheumatology, UCSF; M.A. Brown, FRACP, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital; T.J. Learch, MD, Division of Rheumatology, Cedars Sinai Medical Center; L.A. Diekman, MS, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; A. Tahanan, BS, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Rahbar, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Weisman, MD, Division of Rheumatology, Cedars Sinai Medical Center; J.D. Reveille, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston
| | - Michael M Ward
- From the Department of Internal Medicine, Division of Rheumatology, and the Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston, Houston, Texas; National Institute of Arthritis and Musculoskeletal and Skin Diseases, US National Institutes of Health, Bethesda, Maryland; Department of Medicine, Division of Rheumatology, University of California San Francisco (UCSF), San Francisco, California, USA; University of Queensland Diamantina Institute, Translational Research Institute, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Princess Alexandra Hospital, Queensland, Australia; Division of Rheumatology, Cedars Sinai Medical Center, Los Angeles, California, USA.,J.D. Dau, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; M.J. Lee, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.M. Ward, MD, MPH, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health; L.S. Gensler, MD, Department of Medicine, Division of Rheumatology, UCSF; M.A. Brown, FRACP, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital; T.J. Learch, MD, Division of Rheumatology, Cedars Sinai Medical Center; L.A. Diekman, MS, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; A. Tahanan, BS, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Rahbar, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Weisman, MD, Division of Rheumatology, Cedars Sinai Medical Center; J.D. Reveille, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston
| | - Lianne S Gensler
- From the Department of Internal Medicine, Division of Rheumatology, and the Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston, Houston, Texas; National Institute of Arthritis and Musculoskeletal and Skin Diseases, US National Institutes of Health, Bethesda, Maryland; Department of Medicine, Division of Rheumatology, University of California San Francisco (UCSF), San Francisco, California, USA; University of Queensland Diamantina Institute, Translational Research Institute, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Princess Alexandra Hospital, Queensland, Australia; Division of Rheumatology, Cedars Sinai Medical Center, Los Angeles, California, USA.,J.D. Dau, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; M.J. Lee, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.M. Ward, MD, MPH, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health; L.S. Gensler, MD, Department of Medicine, Division of Rheumatology, UCSF; M.A. Brown, FRACP, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital; T.J. Learch, MD, Division of Rheumatology, Cedars Sinai Medical Center; L.A. Diekman, MS, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; A. Tahanan, BS, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Rahbar, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Weisman, MD, Division of Rheumatology, Cedars Sinai Medical Center; J.D. Reveille, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston
| | - Matthew A Brown
- From the Department of Internal Medicine, Division of Rheumatology, and the Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston, Houston, Texas; National Institute of Arthritis and Musculoskeletal and Skin Diseases, US National Institutes of Health, Bethesda, Maryland; Department of Medicine, Division of Rheumatology, University of California San Francisco (UCSF), San Francisco, California, USA; University of Queensland Diamantina Institute, Translational Research Institute, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Princess Alexandra Hospital, Queensland, Australia; Division of Rheumatology, Cedars Sinai Medical Center, Los Angeles, California, USA.,J.D. Dau, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; M.J. Lee, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.M. Ward, MD, MPH, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health; L.S. Gensler, MD, Department of Medicine, Division of Rheumatology, UCSF; M.A. Brown, FRACP, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital; T.J. Learch, MD, Division of Rheumatology, Cedars Sinai Medical Center; L.A. Diekman, MS, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; A. Tahanan, BS, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Rahbar, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Weisman, MD, Division of Rheumatology, Cedars Sinai Medical Center; J.D. Reveille, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston
| | - Thomas J Learch
- From the Department of Internal Medicine, Division of Rheumatology, and the Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston, Houston, Texas; National Institute of Arthritis and Musculoskeletal and Skin Diseases, US National Institutes of Health, Bethesda, Maryland; Department of Medicine, Division of Rheumatology, University of California San Francisco (UCSF), San Francisco, California, USA; University of Queensland Diamantina Institute, Translational Research Institute, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Princess Alexandra Hospital, Queensland, Australia; Division of Rheumatology, Cedars Sinai Medical Center, Los Angeles, California, USA.,J.D. Dau, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; M.J. Lee, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.M. Ward, MD, MPH, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health; L.S. Gensler, MD, Department of Medicine, Division of Rheumatology, UCSF; M.A. Brown, FRACP, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital; T.J. Learch, MD, Division of Rheumatology, Cedars Sinai Medical Center; L.A. Diekman, MS, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; A. Tahanan, BS, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Rahbar, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Weisman, MD, Division of Rheumatology, Cedars Sinai Medical Center; J.D. Reveille, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston
| | - Laura A Diekman
- From the Department of Internal Medicine, Division of Rheumatology, and the Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston, Houston, Texas; National Institute of Arthritis and Musculoskeletal and Skin Diseases, US National Institutes of Health, Bethesda, Maryland; Department of Medicine, Division of Rheumatology, University of California San Francisco (UCSF), San Francisco, California, USA; University of Queensland Diamantina Institute, Translational Research Institute, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Princess Alexandra Hospital, Queensland, Australia; Division of Rheumatology, Cedars Sinai Medical Center, Los Angeles, California, USA.,J.D. Dau, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; M.J. Lee, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.M. Ward, MD, MPH, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health; L.S. Gensler, MD, Department of Medicine, Division of Rheumatology, UCSF; M.A. Brown, FRACP, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital; T.J. Learch, MD, Division of Rheumatology, Cedars Sinai Medical Center; L.A. Diekman, MS, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; A. Tahanan, BS, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Rahbar, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Weisman, MD, Division of Rheumatology, Cedars Sinai Medical Center; J.D. Reveille, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston
| | - Amirali Tahanan
- From the Department of Internal Medicine, Division of Rheumatology, and the Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston, Houston, Texas; National Institute of Arthritis and Musculoskeletal and Skin Diseases, US National Institutes of Health, Bethesda, Maryland; Department of Medicine, Division of Rheumatology, University of California San Francisco (UCSF), San Francisco, California, USA; University of Queensland Diamantina Institute, Translational Research Institute, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Princess Alexandra Hospital, Queensland, Australia; Division of Rheumatology, Cedars Sinai Medical Center, Los Angeles, California, USA.,J.D. Dau, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; M.J. Lee, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.M. Ward, MD, MPH, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health; L.S. Gensler, MD, Department of Medicine, Division of Rheumatology, UCSF; M.A. Brown, FRACP, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital; T.J. Learch, MD, Division of Rheumatology, Cedars Sinai Medical Center; L.A. Diekman, MS, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; A. Tahanan, BS, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Rahbar, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Weisman, MD, Division of Rheumatology, Cedars Sinai Medical Center; J.D. Reveille, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston
| | - Mohammad H Rahbar
- From the Department of Internal Medicine, Division of Rheumatology, and the Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston, Houston, Texas; National Institute of Arthritis and Musculoskeletal and Skin Diseases, US National Institutes of Health, Bethesda, Maryland; Department of Medicine, Division of Rheumatology, University of California San Francisco (UCSF), San Francisco, California, USA; University of Queensland Diamantina Institute, Translational Research Institute, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Princess Alexandra Hospital, Queensland, Australia; Division of Rheumatology, Cedars Sinai Medical Center, Los Angeles, California, USA.,J.D. Dau, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; M.J. Lee, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.M. Ward, MD, MPH, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health; L.S. Gensler, MD, Department of Medicine, Division of Rheumatology, UCSF; M.A. Brown, FRACP, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital; T.J. Learch, MD, Division of Rheumatology, Cedars Sinai Medical Center; L.A. Diekman, MS, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; A. Tahanan, BS, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Rahbar, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Weisman, MD, Division of Rheumatology, Cedars Sinai Medical Center; J.D. Reveille, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston
| | - Michael H Weisman
- From the Department of Internal Medicine, Division of Rheumatology, and the Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston, Houston, Texas; National Institute of Arthritis and Musculoskeletal and Skin Diseases, US National Institutes of Health, Bethesda, Maryland; Department of Medicine, Division of Rheumatology, University of California San Francisco (UCSF), San Francisco, California, USA; University of Queensland Diamantina Institute, Translational Research Institute, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Princess Alexandra Hospital, Queensland, Australia; Division of Rheumatology, Cedars Sinai Medical Center, Los Angeles, California, USA.,J.D. Dau, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; M.J. Lee, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.M. Ward, MD, MPH, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health; L.S. Gensler, MD, Department of Medicine, Division of Rheumatology, UCSF; M.A. Brown, FRACP, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital; T.J. Learch, MD, Division of Rheumatology, Cedars Sinai Medical Center; L.A. Diekman, MS, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; A. Tahanan, BS, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Rahbar, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Weisman, MD, Division of Rheumatology, Cedars Sinai Medical Center; J.D. Reveille, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston
| | - John D Reveille
- From the Department of Internal Medicine, Division of Rheumatology, and the Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston, Houston, Texas; National Institute of Arthritis and Musculoskeletal and Skin Diseases, US National Institutes of Health, Bethesda, Maryland; Department of Medicine, Division of Rheumatology, University of California San Francisco (UCSF), San Francisco, California, USA; University of Queensland Diamantina Institute, Translational Research Institute, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Princess Alexandra Hospital, Queensland, Australia; Division of Rheumatology, Cedars Sinai Medical Center, Los Angeles, California, USA. .,J.D. Dau, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; M.J. Lee, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.M. Ward, MD, MPH, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health; L.S. Gensler, MD, Department of Medicine, Division of Rheumatology, UCSF; M.A. Brown, FRACP, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital; T.J. Learch, MD, Division of Rheumatology, Cedars Sinai Medical Center; L.A. Diekman, MS, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; A. Tahanan, BS, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Rahbar, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Weisman, MD, Division of Rheumatology, Cedars Sinai Medical Center; J.D. Reveille, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston.
| |
Collapse
|
16
|
Subramaniam SR, Federoff HJ. Targeting Microglial Activation States as a Therapeutic Avenue in Parkinson's Disease. Front Aging Neurosci 2017. [PMID: 28642697 PMCID: PMC5463358 DOI: 10.3389/fnagi.2017.00176] [Citation(s) in RCA: 216] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Parkinson’s disease (PD) is a chronic and progressive disorder characterized neuropathologically by loss of dopamine neurons in the substantia nigra, intracellular proteinaceous inclusions, reduction of dopaminergic terminals in the striatum, and increased neuroinflammatory cells. The consequent reduction of dopamine in the basal ganglia results in the classical parkinsonian motor phenotype. A growing body of evidence suggest that neuroinflammation mediated by microglia, the resident macrophage-like immune cells in the brain, play a contributory role in PD pathogenesis. Microglia participate in both physiological and pathological conditions. In the former, microglia restore the integrity of the central nervous system and, in the latter, they promote disease progression. Microglia acquire different activation states to modulate these cellular functions. Upon activation to the M1 phenotype, microglia elaborate pro-inflammatory cytokines and neurotoxic molecules promoting inflammation and cytotoxic responses. In contrast, when adopting the M2 phenotype microglia secrete anti-inflammatory gene products and trophic factors that promote repair, regeneration, and restore homeostasis. Relatively little is known about the different microglial activation states in PD and a better understanding is essential for developing putative neuroprotective agents. Targeting microglial activation states by suppressing their deleterious pro-inflammatory neurotoxicity and/or simultaneously enhancing their beneficial anti-inflammatory protective functions appear as a valid therapeutic approach for PD treatment. In this review, we summarize microglial functions and, their dual neurotoxic and neuroprotective role in PD. We also review molecules that modulate microglial activation states as a therapeutic option for PD treatment.
Collapse
Affiliation(s)
| | - Howard J Federoff
- Department of Neurology, University of California, Irvine, Irvine, CAUnited States
| |
Collapse
|
17
|
Structural Evaluation and Binding Mode Analysis of CCL19 and CCR7 Proteins—Identification of Novel Leads for Rheumatic and Autoimmune Diseases: An Insilico study. Interdiscip Sci 2017; 10:346-366. [DOI: 10.1007/s12539-017-0212-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 12/30/2016] [Accepted: 01/06/2017] [Indexed: 12/20/2022]
|
18
|
Common Adverse Effects of Anti-TNF Agents on Gestation. Obstet Gynecol Int 2016; 2016:8648651. [PMID: 28044081 PMCID: PMC5156819 DOI: 10.1155/2016/8648651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 10/27/2016] [Indexed: 12/16/2022] Open
Abstract
Autoimmune disease has affected up to 50 million Americans, according to the American Autoimmune Related Diseases Association (AARDA) and 75 percent of those affected are women. These inflammatory diseases have variable activity and a lot of women will have to undergo major therapies during and after pregnancy. Many of the women suffering from these disease will improve during gestation. However a lot of women will require continuation of disease-modifying therapies (i.e., biological therapies) throughout pregnancy and post-partum involving many risks. In the past decade all gaze turned to biological therapies, as an attempt, to obtain even more effective medications in order to suppress the exacerbation of autoimmune disease, even at the most unfit circumstances such as pregnancy. The results are both satisfying and promising since increasingly proven thoughts prevail on making anti-TNF agents first-line medications, clearing up the limited knowledge over human influence. The purpose of this review is to summarize the results of the reports with the highest and representative range of patients of the last decade involving the use of anti-TNF agents during pregnancy.
Collapse
|
19
|
Wei JCC, Tsai WC, Citera G, Kotak S, Llamado L. Efficacy and safety of etanercept in patients from Latin America, Central Europe and Asia with early non-radiographic axial spondyloarthritis. Int J Rheum Dis 2016; 21:1443-1451. [DOI: 10.1111/1756-185x.12973] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- James Cheng-Chung Wei
- Division of Allergy, Immunology and Rheumatology; Chung Shan Medical University Hospital; Taichung Taiwan
- Institute of Medicine; Chung Shan Medical University; Taichung Taiwan
- Institute of Integrated Medicine; China Medical University; Taichung Taiwan
| | - Wen-Chan Tsai
- Division of Rheumatology; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
| | - Gustavo Citera
- Instituto de Rehabilitación Psicofísica; Buenos Aires Argentina
| | | | | |
Collapse
|
20
|
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
|
21
|
Tumor necrosis factor inhibitor therapy in ankylosing spondylitis: differential effects on pain and fatigue and brain correlates. Pain 2015; 156:297-304. [PMID: 25599451 DOI: 10.1097/01.j.pain.0000460310.71572.16] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Ankylosing spondylitis is associated with back pain and fatigue and impacts mobility but can be treated with tumor necrosis factor inhibitors (TNFi). The differential effects of TNFi treatment on multiple symptoms and the brain is not well delineated. Thus, we conducted a 2-part study. In study 1, we conducted a retrospective chart review in 129 ankylosing spondylitis patients to assess TNFi effects on pain, fatigue, motor function, mobility, and quality of life (QoL). After at least 10 weeks of TNFi treatment, patients had clinically significant improvements (>30%) in pain (including neuropathic pain), most disease and QoL factors, and normalized sensory detection thresholds. However, residual fatigue (mean = 5.3) was prominent. Although 60% of patients had significant relief of pain, only 22% of patients had significant relief of both pain and fatigue. Therefore, the preferential TNFi treatment effect on pain compared with fatigue could contribute to suboptimal effects on QoL. Part 2 was a prospective study in 14 patients to identify TNFi treatment effects on pain, fatigue, sensory and psychological factors, and brain cortical thickness based on 3T magnetic resonance imaging. Centrally, TNFi was associated with statistically significant cortical thinning of motor, premotor, and posterior parietal regions. Pain intensity reduction was associated with cortical thinning of the secondary somatosensory cortex, and pain unpleasantness reduction was associated with the cortical thinning of motor areas. In contrast, fatigue reduction correlated with cortical thinning of the insula, primary sensory cortex/inferior parietal sulcus, and superior temporal polysensory areas. This indicates that TNFi treatment produces changes in brain areas implicated in sensory, motor, affective, and cognitive functions.
Collapse
|
22
|
El-Sayed NM, Ismail KA, Badawy AF, Elhasanein KF. In vivo effect of anti-TNF agent (etanercept) in reactivation of latent toxoplasmosis. J Parasit Dis 2015; 40:1459-1465. [PMID: 27876967 DOI: 10.1007/s12639-015-0712-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 08/20/2015] [Indexed: 01/08/2023] Open
Abstract
Toxoplasma gondii (T. gondii), an intracellular parasite, establishes a chronic infection by forming cysts preferentially in the brain. TNF-α plays an important role in controlling the infection caused by this protozoan. Thus, the blockade of TNF-α could cause reactivation of latent toxoplasmosis infection as well as increase the risk of acute toxoplasmosis. This study evaluated the effect of etanercept, a TNF-α antagonist in reactivation of latent toxoplasmosis compared to the therapeutic effect of sulfadiazine and pyrimethamine in combination on the progress of the disease. A total of 40 laboratory-bred Swiss albino mice were infected with Me49 strain of T. gondii and divided into four groups: infected control group; treated group with sulfadiazine and pyrimethamine; treated group with etanercept and treated group with both etanercept and sulfadiazine and pyrimethamine. The mean number and size of tissue cysts in brain smears of mice of each group were determined and also, serum levels of TNF-α were assessed in different study groups by an enzyme linked immunosorbent assay. The results showed that the mean TNF-α level was significantly different in the treated groups compared to that in infected control group. The highest level of TNF-α was found in the infected controls. After treatment with etanercept alone or combined with sulfadiazine and pyrimethamine, it was significantly decreased. In this study, reactivation of latent toxoplasmosis was observed by a significant increase in the mean number and sizes of Toxoplasma tissue cysts in brains of mice with established chronic toxoplasmosis after treatment with etanercept alone or combined with conventional treatment compared to both untreated chronically infected controls and infected mice treated with sulfadiazine and pyrimethamine. It was concluded that etanercept, a TNF-α antagonist may play a role in reactivation of latent toxoplasmosis. So, serological screening for toxoplasmosis might offer a valuable aid for patients treated with this drug.
Collapse
Affiliation(s)
- Nagwa Mostafa El-Sayed
- Medical Parasitology Department, Research Institute of Ophthalmology, Ministry of Scientific Research and Technology, Giza, Egypt
| | - Khadiga Ahmed Ismail
- Parasitology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Abeer Fathy Badawy
- Parasitology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Khaled Fathy Elhasanein
- Rheumatology Division, Internal Medicine Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| |
Collapse
|
23
|
Dougados M, Tsai WC, Saaibi DL, Bonin R, Bukowski J, Pedersen R, Vlahos B, Kotak S. Evaluation of Health Outcomes with Etanercept Treatment in Patients with Early Nonradiographic Axial Spondyloarthritis. J Rheumatol 2015; 42:1835-41. [DOI: 10.3899/jrheum.141313] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2015] [Indexed: 01/31/2023]
Abstract
Objective.Analyses were conducted to examine the baseline burden of illness and compare the effect of etanercept (ETN) versus placebo (PBO) on quality of life (QOL) in patients with nonradiographic axial spondyloarthritis (nr-axSpA) who failed nonsteroidal antiinflammatory drugs (NSAID).Methods.Patients fulfilling the Assessment of Spondyloarthritis International Society axSpA criteria, not meeting the modified New York criteria for ankylosing spondylitis (AS), who were symptomatic 3 months to 5 years, with a Bath AS Disease Activity Index score ≥ 4, and failed ≥ 2 NSAID were randomized to ETN 50 mg weekly or PBO (double-blind) for 12 weeks, followed by open-label ETN 50 mg for 92 weeks. Stable NSAID were allowed throughout our study. QOL outcomes over 24 weeks were analyzed using ANCOVA models.Results.At baseline, Multidimensional Fatigue Inventory (MFI; ETN mean 14.7, PBO mean 15.0), EQ-5D utility (0.52, 0.57), EQ-5D visual analog scale (56.5, 56.4), and Medical Outcomes Study (MOS) Sleep Index II (45.5, 48.1) were worse than population norms (6.6–8.0, 0.86, 82.5, and 25.8, respectively). At Week 12, Bath AS Patient Global Score, nocturnal and average back pain, MOS Short Form-36 (SF-36) physical component, and Work Productivity and Activity Index (WPAI) presenteeism and activity impairment favored ETN (p < 0.05). Nonsignificant improvements for ETN were seen in other WPAI domains, MFI, MOS-Sleep Index I and II, Hospital Anxiety and Depression Scale, EQ-5D utility score, and SF-36 mental component (p > 0.05). At Week 24, patients in the PBO group who had switched to ETN at Week 12 showed improvement in most QOL assessments, similar to that seen in patients receiving ETN for 24 weeks.Conclusion.Improvements favored ETN in QOL and productivity measures, with limited improvement on general QOL measures. Short disease duration, a short PBO-controlled period, and a wide range of QOL scores at baseline may have influenced improvements.
Collapse
|
24
|
Abstract
With its approval more than 15 years ago, subcutaneous etanercept (Enbrel(®)) was the first biological disease-modifying antirheumatic drug (bDMARD) and the first tumour necrosis factor inhibitor to be approved for use in rheumatic diseases. Etanercept remains an important cost-effective treatment option in adult patients with rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis or plaque psoriasis, and in paediatric patients with juvenile idiopathic arthritis or plaque psoriasis. In all of these populations, etanercept (with or without methotrexate) effectively reduced signs and symptoms, disease activity and disability, and improved health-related quality of life, with these benefits sustained during long-term treatment. The safety profile of etanercept during short- and long-term treatment was consistent with the approved product labelling, with adverse events being of a predictable and manageable nature. The introduction of etanercept and other bDMARDs as therapeutic options for patients with autoimmune rheumatic diseases and spondyloarthropathies revolutionized disease management and these agents continue to have a central role in treatment strategies. This article reviews the extensive clinical experience with etanercept in these patient populations.
Collapse
Affiliation(s)
- Lesley J Scott
- Springer, Private Bag 65901, Mairangi Bay, 0754, Auckland, New Zealand,
| |
Collapse
|
25
|
Maxwell LJ, Zochling J, Boonen A, Singh JA, Veras MMS, Tanjong Ghogomu E, Benkhalti Jandu M, Tugwell P, Wells GA. TNF-alpha inhibitors for ankylosing spondylitis. Cochrane Database Syst Rev 2015:CD005468. [PMID: 25887212 DOI: 10.1002/14651858.cd005468.pub2] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND TNF (tumor necrosis factor)-alpha inhibitors block a key protein in the inflammatory chain reaction responsible for joint inflammation, pain, and damage in ankylosing spondylitis. OBJECTIVES To assess the benefit and harms of adalimumab, etanercept, golimumab, and infliximab (TNF-alpha inhibitors) in people with ankylosing spondylitis. SEARCH METHODS We searched the following databases to January 26, 2009: MEDLINE (from 1966); EMBASE (from 1980); the Cochrane Central Register of Controlled Trials (CENTRAL; 2008, Issue 4); ACP Journal Club; CINAHL (from 1982); and ISI Web of Knowledge (from 1900). We ran updated searches in May 2012, October 2013, and in June 2014 for McMaster PLUS. We searched major regulatory agencies for safety warnings and clinicaltrials.gov for registered trials. SELECTION CRITERIA Randomized controlled trials (RCTs) comparing adalimumab, etanercept, golimumab and infliximab to placebo, other drugs or usual care in patients with ankylosing spondylitis, reported in abstract or full-text. DATA COLLECTION AND ANALYSIS Two authors independently assessed search results, risk of bias, and extracted data. We conducted Bayesian mixed treatment comparison (MTC) meta-analyses using WinBUGS software. To investigate a class-effect of harms across biologics, we pooled harms data using Review Manager 5. MAIN RESULTS We included twenty-one, short-term (24 weeks or less) RCTs with a total of 3308 participants; 18 contributed data to the MTC analysis: adalimumab (4 studies), etanercept (8 studies), golimumab (2 studies), infliximab (3 studies), and one head-to-head study (etanercept versus infliximab) which was unblinded and considered at a higher risk of bias. The risk of selection and detection bias was low or unclear for most of the studies. The risk of selective outcome reporting was low for most studies as they reported on outcomes recommended by the Assessment of SpondyloArthritis international Society. We found little heterogeneity and no significant inconsistency in the MTC analyses. The majority of the studies were funded by pharmaceutical companies. Most studies permitted concomitant therapy of stable doses of disease-modifying anti-rheumatic drugs, non-steroidal anti-inflammatory drugs, or corticosteroids, but allowances varied across studies.Compared with placebo, there was high quality evidence that patients on an anti-TNF agent were three to four times more likely to achieve an ASAS40 response (assessing spinal pain, function, and inflammation, as measured by the mean of intensity and duration of morning stiffness, and patient global assessment) by six months (adalimumab: risk ratio (RR) 3.53, 95% credible interval (Crl) 2.49 to 4.91; etanercept: RR 3.31, 95% Crl 2.38 to 4.53; golimumab: RR 2.90, 95% Crl 1.90 to 4.23; infliximab: RR 4.07, 95% Crl 2.80 to 5.74, with a 25% to 40% absolute difference between treatment and placebo groups. The number needed to treat (NNT) to achieve an ASAS 40 response ranged from 3 to 5.There was high quality evidence of improvement in physical function on a 0 to 10 scale (adalimumab: mean difference (MD) -1.6, 95% Crl -2.2 to -0.9; etanercept: MD -1.1, 95% CrI -1.6 to -0.6; golimumab: MD -1.5, 95% Crl -2.3 to -0.7; infliximab: MD -2.1, 95% Crl -2.7 to -1.4, with an 11% to 21% absolute difference between treatment and placebo groups. The NNT to achieve the minimally clinically important difference of 0.7 points ranged from 2 to 4.Compared with placebo, there was moderate quality evidence (downgraded for imprecision) that patients on an anti-TNF agent were more likely to achieve an ASAS partial remission by six months (adalimumab: RR 6.28, 95% Crl 3.13 to 12.78; etanercept: RR 4.24, 95% Crl 2.31 to 8.09; golimumab: RR 5.18, 95% Crl 1.90 to 14.79; infliximab: RR 15.41, 95% Crl 5.09 to 47.98 with a 10% to 44% absolute difference between treatment and placebo groups. The NNT to achieve an ASAS partial remission response ranged from 3 to 11.There was low to moderate level evidence of a greater reduction in spinal inflammation as measured by magnetic resonance imaging though the absolute differences were small and the clinical relevance of the difference was unclear: adalimumab (1 trial; -6% (95% confidence interval (CI) -12% to 0.05%); 1 trial: 53.6% mean decrease from baseline versus 9.4% mean increase in the placebo group), golimumab (1 trial; -2.5%, (95% CI -5.6% to -0.7%)), and infliximab (1 trial; -3% (95% CI -4% to -2.4%)).Radiographic progression was measured in one trial (N = 60) of etanercept versus placebo and it found that radiologic changes were similar in both groups (detailed data not provided).There were few events of withdrawals due to adverse events leading to imprecision around the estimates. When all the anti-TNF agents were combined against placebo, there was moderate quality evidence from 16 studies of an increased risk of withdrawals due to adverse events in the anti-TNF group (Peto odds ratio (OR) 2.44, 95% CI 1.26 to 4.72; total events: 38/1637 in biologic group; 7/986 in placebo) though the absolute increase in harm was small (1%; 95% CI 0% to 2%).Due to low event rates, evidence of the effect of individual TNF-inhibitors against placebo or for all four biologics pooled together versus placebo on serious adverse events is inconclusive (moderate quality; downgraded for imprecision). For all anti-TNF pooled versus placebo based on 16 studies: Peto OR 1.45, 95% CI 0.85 to 2.48; 51/1530 in biologic group; 18/878 in placebo; absolute difference: 1% (95% CI 0% to 2%).Using indirect comparison methodology, and one head-to-head study of etanercept versus infliximab, wide confidence intervals meant that results were inconclusive for evidence of differences in the major outcomes between different anti-TNF agents. Regulatory agencies have published warnings about rare adverse events of serious infections, including tuberculosis, malignancies and lymphoma. AUTHORS' CONCLUSIONS There is moderate to high quality evidence that anti-TNF agents improve clinical symptoms in the treatment of ankylosing spondylitis. More participants withdrew due to adverse events when on an anti-TNF agent but we did not find evidence of an increase in serious adverse events, though event rates were low and trials had a short duration. The short-term toxicity profile appears acceptable. Based on indirect comparison methodology, we are uncertain whether there are differences between anti-TNF agents in terms of the key benefit or harm outcomes.
Collapse
Affiliation(s)
- Lara J Maxwell
- Centre for Practice-Changing Research (CPCR), Ottawa Hospital Research Institute (OHRI), The Ottawa Hospital - General Campus, 501 Smyth Road, Box 711, Ottawa, ON, Canada, K1H 8L6
| | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Moehle MS, West AB. M1 and M2 immune activation in Parkinson's Disease: Foe and ally? Neuroscience 2014; 302:59-73. [PMID: 25463515 DOI: 10.1016/j.neuroscience.2014.11.018] [Citation(s) in RCA: 141] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 10/03/2014] [Accepted: 11/06/2014] [Indexed: 12/20/2022]
Abstract
Parkinson's Disease (PD) is a chronic and progressive neurodegenerative disorder of unknown etiology. Autopsy findings, genetics, retrospective studies, and molecular imaging all suggest a role for inflammation in the neurodegenerative process. However, relatively little is understood about the causes and implications of neuroinflammation in PD. Understanding how inflammation arises in PD, in particular the activation state of cells of the innate immune system, may provide an exciting opportunity for novel neuroprotective therapeutics. We analyze the evidence of immune system involvement in PD susceptibility, specifically in the context of M1 and M2 activation states. Tracking and modulating these activation states may provide new insights into both PD etiology and therapeutic strategies.
Collapse
Affiliation(s)
- M S Moehle
- Center for Neurodegeneration and Experimental Therapeutics, Department of Neurology, The University of Alabama at Birmingham, Birmingham, AL, United States.
| | - A B West
- Center for Neurodegeneration and Experimental Therapeutics, Department of Neurology, The University of Alabama at Birmingham, Birmingham, AL, United States
| |
Collapse
|
27
|
Kiltz U, Sieper J, Kellner H, Krause D, Rudwaleit M, Chenot JF, Stallmach A, Jaresch S, Braun J. [German Society for Rheumatology S3 guidelines on axial spondyloarthritis including Bechterew's disease and early forms: 8.4 Pharmaceutical therapy, 8.5 Evaluation of therapy success of pharmaceutical measures]. Z Rheumatol 2014; 73 Suppl 2:78-96. [PMID: 25181978 DOI: 10.1007/s00393-014-1443-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- U Kiltz
- Deutsche Gesellschaft für Rheumatologie (DGRh), Berlin, Deutschland,
| | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Rival G, Lacasse Y, Martin S, Bonnet S, Provencher S. Effect of Pulmonary Arterial Hypertension-Specific Therapies on Health-Related Quality of Life. Chest 2014; 146:686-708. [DOI: 10.1378/chest.13-2634] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
|
29
|
Garip Y. Functional assessment measures in rheumatologic disorders. World J Rheumatol 2014; 4:6-13. [DOI: 10.5499/wjr.v4.i2.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 06/12/2014] [Accepted: 07/17/2014] [Indexed: 02/06/2023] Open
Abstract
Rheumatologic disorders cause functional impairment and significantly affect health-related quality of life. Functional assessment and health-related quality of life scales are increasingly being used as outcome measures to assess the influence of the diseases and health outcome in clinical studies of patients with rheumatologic diseases. In this article, we review the functional assessment and health-related quality of life measures which have been commonly used as outcome measures in rheumatologic disorders. These measures are Short form-36 (SF-36), SF-12, Nottingham Health Profile, Sickness Impact Profile, EuroQol, SF-6D, Health Utilities Index mark 2 and 3, Stanford Health Assessment Questionnaire, Rheumatoid Arthritis Quality of Life Questionnaire, Arthritis Impact Measurement Scales, McMaster Toronto Arthritis Patient Preference Disability Questionnaire, Western Ontario and McMaster Universities Osteoarthritis Index, Lequesne Index, Knee Disability and Osteoarthritis Outcome Score, Knee Disability and Osteoarthritis Outcome Score-Physical Function Short-form, Hip Disability and Osteoarthritis Outcome Score, Hip Disability and Osteoarthritis Outcome Score-Physical Function SF, Fibromyalgia Impact Questionnaire, Psoriatic Arthritis Quality of Life Scale, Gout Assessment Questionnaires, Dougados Functional Index, Bath Ankylosing Spondylitis Functional Index, and Ankylosing Spondylitis Quality of Life Scale.
Collapse
|
30
|
Haroon NN, Sriganthan J, Al Ghanim N, Inman RD, Cheung AM. Effect of TNF-alpha inhibitor treatment on bone mineral density in patients with ankylosing spondylitis: a systematic review and meta-analysis. Semin Arthritis Rheum 2014; 44:155-61. [PMID: 24909809 DOI: 10.1016/j.semarthrit.2014.05.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Revised: 04/10/2014] [Accepted: 05/05/2014] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Ankylosing spondylitis (AS) is a chronic inflammatory disease associated with an increased risk of osteoporosis and fractures. TNF inhibitors have been used to treat AS, but their effect on bone is unclear. Thus, we conducted a meta-analysis to study the effect of TNF inhibitors on spine and hip BMD in patients with AS. METHODS Two authors independently searched MEDLINE and PubMed for longitudinal studies that had assessed the effect of TNF inhibitors on BMD in patients with AS. Studies with a minimum follow-up period of 1 year were included. RESULTS Seven longitudinal studies and one randomized control trial were included, with a total of 568 AS patients (mean age range of 36-48 years and disease duration of 9-17 years). Lumbar spine BMD increased by 5.1% (95% CI: 4.0-6.1%, p = 0.00000) after 1 year of treatment with TNF inhibitors and by 8.6% (95% CI: 6.8-10.3%, p < 0.00001) after 2 years. Significant improvements in total hip BMD were also noted after 1 [1.8% (1.0-2.5%)] and 2 years [2.5% (1.9-3.0%)]. Compared to baseline, femoral neck BMD remained stable after 1 year [0.7% (-0.8% to 2.2%), p = 0.34]. No significant heterogeneity was noted amongst the included studies. CONCLUSIONS TNF inhibitors can increase lumbar spine and total hip BMD and maintain femoral neck BMD for up to 2 years in patients with AS. More research is needed to assess the effect of TNF inhibitors on bone quality and fracture risk.
Collapse
Affiliation(s)
| | | | - Nayef Al Ghanim
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Robert D Inman
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Angela M Cheung
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
31
|
van der Heijde D, Deodhar A, Braun J, Mack M, Hsu B, Gathany TA, Inman RD, Han C. The effect of golimumab therapy on disease activity and health-related quality of life in patients with ankylosing spondylitis: 2-year results of the GO-RAISE trial. J Rheumatol 2014; 41:1095-103. [PMID: 24737912 DOI: 10.3899/jrheum.131003] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To evaluate the effects of golimumab therapy on achieving inactive disease or major improvement, as assessed by the Ankylosing Spondylitis Disease Activity Score (ASDAS), and improvements in health-related quality of life (HRQOL) and productivity through 2 years in patients with AS. METHODS In the phase III GO-RAISE trial, 356 patients were randomized to placebo with crossover to golimumab 50 mg at Week 24 (n = 78), golimumab 50 mg (n = 138), or golimumab 100 mg (n = 140) at baseline and every 4 weeks. The proportions of patients with ASDAS major improvement (improvement ≥ 2.0) or inactive disease (score < 1.3) were determined. HRQOL was assessed using the 36-item Medical Outcomes Study Short Form-36 physical/mental component summary (SF-36 PCS/MCS) scores (normal score ≥ 50). The effect of disease on productivity was assessed by visual analog scale (0-10). Regression analyses on the association of disease activity and HRQOL were performed. The final assessment was at Week 104. RESULTS Significantly greater proportions of golimumab-treated patients achieved ASDAS major improvement or inactive disease at weeks 14 and 24 versus placebo. Through Week 104, patients who achieved ASDAS inactive disease or major improvement had significantly greater improvements in SF-36 PCS and MCS scores and productivity than did patients not meeting these targets. Among all patients, achieving ASDAS inactive disease at weeks 52 and 104 was associated with normalized SF-36 PCS/MCS scores and significant improvements in work productivity. CONCLUSION Greater proportions of golimumab-treated patients achieved ASDAS major improvement or inactive disease and improved HRQOL versus placebo. Achieving an inactive disease state by ASDAS criteria (< 1.3) was associated with normalized HRQOL through 2 years.
Collapse
Affiliation(s)
- Désirée van der Heijde
- From the Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; Oregon Health and Science University, Portland, Oregon, USA; Rheumazentrum Ruhrgebiet, Herne, Germany; Biostatistics and Immunology, Janssen Research & Development LLC, Spring House; Janssen Global Services, Malvern, Pennsylvania, USA; Department of Medicine and Immunology, University of Toronto, Toronto, Ontario, Canada.D. van der Heijde, MD, Rheumatology Department, Leiden University Medical Center; A. Deodhar, MD, Oregon Health & Science University; J. Braun, MD, Rheumazentrum Ruhrgebiet; M. Mack, PhD, Biostatistics, Janssen Research & Development LLC; B. Hsu, MD, PhD, Immunology, Janssen Research & Development LLC; T.A. Gathany, MSEd, Janssen Global Services; R.D. Inman, MD, FRCPC, FACP, FRCP Edin, Department of Medicine and Immunology, University of Toronto; C. Han, PhD, Janssen Global Services.
| | - Atul Deodhar
- From the Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; Oregon Health and Science University, Portland, Oregon, USA; Rheumazentrum Ruhrgebiet, Herne, Germany; Biostatistics and Immunology, Janssen Research & Development LLC, Spring House; Janssen Global Services, Malvern, Pennsylvania, USA; Department of Medicine and Immunology, University of Toronto, Toronto, Ontario, Canada.D. van der Heijde, MD, Rheumatology Department, Leiden University Medical Center; A. Deodhar, MD, Oregon Health & Science University; J. Braun, MD, Rheumazentrum Ruhrgebiet; M. Mack, PhD, Biostatistics, Janssen Research & Development LLC; B. Hsu, MD, PhD, Immunology, Janssen Research & Development LLC; T.A. Gathany, MSEd, Janssen Global Services; R.D. Inman, MD, FRCPC, FACP, FRCP Edin, Department of Medicine and Immunology, University of Toronto; C. Han, PhD, Janssen Global Services
| | - Jürgen Braun
- From the Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; Oregon Health and Science University, Portland, Oregon, USA; Rheumazentrum Ruhrgebiet, Herne, Germany; Biostatistics and Immunology, Janssen Research & Development LLC, Spring House; Janssen Global Services, Malvern, Pennsylvania, USA; Department of Medicine and Immunology, University of Toronto, Toronto, Ontario, Canada.D. van der Heijde, MD, Rheumatology Department, Leiden University Medical Center; A. Deodhar, MD, Oregon Health & Science University; J. Braun, MD, Rheumazentrum Ruhrgebiet; M. Mack, PhD, Biostatistics, Janssen Research & Development LLC; B. Hsu, MD, PhD, Immunology, Janssen Research & Development LLC; T.A. Gathany, MSEd, Janssen Global Services; R.D. Inman, MD, FRCPC, FACP, FRCP Edin, Department of Medicine and Immunology, University of Toronto; C. Han, PhD, Janssen Global Services
| | - Michael Mack
- From the Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; Oregon Health and Science University, Portland, Oregon, USA; Rheumazentrum Ruhrgebiet, Herne, Germany; Biostatistics and Immunology, Janssen Research & Development LLC, Spring House; Janssen Global Services, Malvern, Pennsylvania, USA; Department of Medicine and Immunology, University of Toronto, Toronto, Ontario, Canada.D. van der Heijde, MD, Rheumatology Department, Leiden University Medical Center; A. Deodhar, MD, Oregon Health & Science University; J. Braun, MD, Rheumazentrum Ruhrgebiet; M. Mack, PhD, Biostatistics, Janssen Research & Development LLC; B. Hsu, MD, PhD, Immunology, Janssen Research & Development LLC; T.A. Gathany, MSEd, Janssen Global Services; R.D. Inman, MD, FRCPC, FACP, FRCP Edin, Department of Medicine and Immunology, University of Toronto; C. Han, PhD, Janssen Global Services
| | - Benjamin Hsu
- From the Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; Oregon Health and Science University, Portland, Oregon, USA; Rheumazentrum Ruhrgebiet, Herne, Germany; Biostatistics and Immunology, Janssen Research & Development LLC, Spring House; Janssen Global Services, Malvern, Pennsylvania, USA; Department of Medicine and Immunology, University of Toronto, Toronto, Ontario, Canada.D. van der Heijde, MD, Rheumatology Department, Leiden University Medical Center; A. Deodhar, MD, Oregon Health & Science University; J. Braun, MD, Rheumazentrum Ruhrgebiet; M. Mack, PhD, Biostatistics, Janssen Research & Development LLC; B. Hsu, MD, PhD, Immunology, Janssen Research & Development LLC; T.A. Gathany, MSEd, Janssen Global Services; R.D. Inman, MD, FRCPC, FACP, FRCP Edin, Department of Medicine and Immunology, University of Toronto; C. Han, PhD, Janssen Global Services
| | - Timothy A Gathany
- From the Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; Oregon Health and Science University, Portland, Oregon, USA; Rheumazentrum Ruhrgebiet, Herne, Germany; Biostatistics and Immunology, Janssen Research & Development LLC, Spring House; Janssen Global Services, Malvern, Pennsylvania, USA; Department of Medicine and Immunology, University of Toronto, Toronto, Ontario, Canada.D. van der Heijde, MD, Rheumatology Department, Leiden University Medical Center; A. Deodhar, MD, Oregon Health & Science University; J. Braun, MD, Rheumazentrum Ruhrgebiet; M. Mack, PhD, Biostatistics, Janssen Research & Development LLC; B. Hsu, MD, PhD, Immunology, Janssen Research & Development LLC; T.A. Gathany, MSEd, Janssen Global Services; R.D. Inman, MD, FRCPC, FACP, FRCP Edin, Department of Medicine and Immunology, University of Toronto; C. Han, PhD, Janssen Global Services
| | - Robert D Inman
- From the Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; Oregon Health and Science University, Portland, Oregon, USA; Rheumazentrum Ruhrgebiet, Herne, Germany; Biostatistics and Immunology, Janssen Research & Development LLC, Spring House; Janssen Global Services, Malvern, Pennsylvania, USA; Department of Medicine and Immunology, University of Toronto, Toronto, Ontario, Canada.D. van der Heijde, MD, Rheumatology Department, Leiden University Medical Center; A. Deodhar, MD, Oregon Health & Science University; J. Braun, MD, Rheumazentrum Ruhrgebiet; M. Mack, PhD, Biostatistics, Janssen Research & Development LLC; B. Hsu, MD, PhD, Immunology, Janssen Research & Development LLC; T.A. Gathany, MSEd, Janssen Global Services; R.D. Inman, MD, FRCPC, FACP, FRCP Edin, Department of Medicine and Immunology, University of Toronto; C. Han, PhD, Janssen Global Services
| | - Chenglong Han
- From the Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; Oregon Health and Science University, Portland, Oregon, USA; Rheumazentrum Ruhrgebiet, Herne, Germany; Biostatistics and Immunology, Janssen Research & Development LLC, Spring House; Janssen Global Services, Malvern, Pennsylvania, USA; Department of Medicine and Immunology, University of Toronto, Toronto, Ontario, Canada.D. van der Heijde, MD, Rheumatology Department, Leiden University Medical Center; A. Deodhar, MD, Oregon Health & Science University; J. Braun, MD, Rheumazentrum Ruhrgebiet; M. Mack, PhD, Biostatistics, Janssen Research & Development LLC; B. Hsu, MD, PhD, Immunology, Janssen Research & Development LLC; T.A. Gathany, MSEd, Janssen Global Services; R.D. Inman, MD, FRCPC, FACP, FRCP Edin, Department of Medicine and Immunology, University of Toronto; C. Han, PhD, Janssen Global Services
| | | |
Collapse
|
32
|
Borghi SM, Zarpelon AC, Pinho-Ribeiro FA, Cardoso RD, Martins-Pinge MC, Tatakihara RI, Cunha TM, Ferreira SH, Cunha FQ, Casagrande R, Verri WA. Role of TNF-α/TNFR1 in intense acute swimming-induced delayed onset muscle soreness in mice. Physiol Behav 2014; 128:277-87. [DOI: 10.1016/j.physbeh.2014.01.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 11/27/2013] [Accepted: 01/26/2014] [Indexed: 12/18/2022]
|
33
|
Braun J, Baraliakos X, Heldmann F, Kiltz U. Tumor necrosis factor alpha antagonists in the treatment of axial spondyloarthritis. Expert Opin Investig Drugs 2014; 23:647-59. [DOI: 10.1517/13543784.2014.899351] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
|
34
|
Harrison AA, Badenhorst C, Kirby S, White D, Athens J, Stebbings S. Comparison of rates of referral and diagnosis of axial spondyloarthritis before and after an ankylosing spondylitis public awareness campaign. Clin Rheumatol 2014; 33:963-8. [DOI: 10.1007/s10067-014-2551-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Revised: 01/24/2014] [Accepted: 02/20/2014] [Indexed: 01/09/2023]
|
35
|
Fond G, Hamdani N, Kapczinski F, Boukouaci W, Drancourt N, Dargel A, Oliveira J, Le Guen E, Marlinge E, Tamouza R, Leboyer M. Effectiveness and tolerance of anti-inflammatory drugs' add-on therapy in major mental disorders: a systematic qualitative review. Acta Psychiatr Scand 2014; 129:163-79. [PMID: 24215721 DOI: 10.1111/acps.12211] [Citation(s) in RCA: 126] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/20/2013] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To provide a systematic review of the literature regarding the efficacy of anti-inflammatory drugs in three major mental disorders [major depressive disorder (MDD), schizophrenia and bipolar disorders]. METHOD Four databases were explored, without any year or language restrictions. The baseline search paradigm was limited to open-labelled clinical and randomized controlled trials (RCTs). RESULTS Four major classes of anti-inflammatory drugs were identified, namely polyunsaturated fatty acids (PUFAs), cyclooxygenase (COX) inhibitors, anti-TNFalpha and minocycline. Effectiveness and benefit/risk ratio of each class in MDD, bipolar disorders and schizophrenia was detailed when data were available. Several meta-analyses indicated effectiveness of PUFAs in MDD with a good tolerance profile. One meta-analysis indicated that COX-2 specific inhibitors showed effectiveness in schizophrenia. Anti-TNFalpha showed important effectiveness in resistant MDD with blood inflammatory abnormalities. Minocycline showed effectiveness in schizophrenia. CONCLUSION Polyunsaturated fatty acids seem to have the best benefit/risk ratio profile but proved their effectiveness only in MDD. A number of anti-inflammatory drugs are available as adjunct treatment for treatment-resistant patients with MDD, schizophrenia and bipolar disorder. If used with caution regarding their possible side-effects, they may be reasonable therapeutic alternatives for resistant symptomatology.
Collapse
Affiliation(s)
- G Fond
- Pôle de psychiatrie des hôpitaux universitaires H Mondor, University Paris Est-Créteil, INSERM U955, Eq Psychiatrie Génétique, Fondation FondaMental Fondation de coopération scientifique en santé mentale, Créteil, France
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Inotai A, Petrova G, Vitezic D, Kaló Z. Benefits of investment into modern medicines in Central–Eastern European countries. Expert Rev Pharmacoecon Outcomes Res 2013; 14:71-9. [DOI: 10.1586/14737167.2014.868314] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
37
|
Senabre-Gallego JM, Santos-Ramírez C, Santos-Soler G, Salas-Heredia E, Sánchez-Barrioluengo M, Barber X, Rosas J. Long-term safety and efficacy of etanercept in the treatment of ankylosing spondylitis. Patient Prefer Adherence 2013; 7:961-72. [PMID: 24101863 PMCID: PMC3790868 DOI: 10.2147/ppa.s33109] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
To date, anti-tumor necrosis factor alfa (anti-TNF-α) therapy is the only alternative to nonsteroidal anti-inflammatory drugs for the treatment of ankylosing spondylitis. Etanercept is a soluble TNF receptor, with a mode of action and pharmacokinetics different to those of antibodies and distinctive efficacy and safety. Etanercept has demonstrated efficacy in the treatment of ankylosing spondylitis, with or without radiographic sacroiliitis, and other manifestations of the disease, including peripheral arthritis, enthesitis, and psoriasis. Etanercept is not efficacious in inflammatory bowel disease, and its efficacy in the treatment of uveitis appears to be lower than that of other anti-TNF drugs. Studies of etanercept confirmed regression of bone edema on magnetic resonance imaging of the spine and sacroiliac joint, but failed to reduce radiographic progression, as do the other anti-TNF drugs. It seems that a proportion of patients remain in disease remission when the etanercept dose is reduced or administration intervals are extended. Etanercept is generally well tolerated with an acceptable safety profile in the treatment of ankylosing spondylitis. The most common adverse effect of etanercept treatment is injection site reactions, which are generally self-limiting. Reactivation of tuberculosis, reactivation of hepatitis B virus infection, congestive heart failure, demyelinating neurologic disorders, hematologic disorders like aplastic anemia and pancytopenia, vasculitis, immunogenicity, and exacerbation or induction of psoriasis are class effects of all the anti-TNF drugs, and have been seen in patients with ankylosing spondylitis. However, etanercept is less likely to induce reactivation of tuberculosis than the other anti-TNF drugs and it has been suggested that etanercept might be less immunogenic, especially in ankylosing spondylitis. Acute uveitis, Crohn's disease, and sarcoidosis are other adverse events that have been rarely associated with etanercept therapy in patients with ankylosing spondylitis.
Collapse
Affiliation(s)
| | | | | | | | - Mabel Sánchez-Barrioluengo
- INGENIO (Instituto de Gestión de la Inovación y del Conocimiento) (CSIC [Consejo Superior de Investigaciones Científicas]-UPV [Universidad Politécnica de Valencia]), Universitat Politècnica de València, Valencia, Spain
| | - Xavier Barber
- CIO (Centro de Investigación Operativa)-UMH (Universidad Miguel Hernández), Universidad Miguel Henández, Elche, Spain
| | - José Rosas
- Rheumatology, Hospital Marina Baixa, Villajoyosa, Spain
| | | |
Collapse
|
38
|
Treatment of ankylosing spondylitis with TNF blockers: a meta-analysis. Rheumatol Int 2013; 33:2199-213. [PMID: 23686218 DOI: 10.1007/s00296-013-2772-6] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 04/30/2013] [Indexed: 01/17/2023]
Abstract
Biological agents directed against tumor necrosis factor (TNF) represent therapeutic options for patients with ankylosing spondylitis with high disease activity despite use of non-steroidal anti-inflammatory drugs. To evaluate the efficacy and safety of the anti-TNF agents infliximab, etanercept, adalimumab, golimumab, and certolizumab for the treatment of ankylosing spondylitis, we performed a systematic review of randomized clinical trials on adult patients with ankylosing spondylitis using articles culled from the EMBASE, MEDLINE, Cochrane Controlled Trials Register and LILACS databases (September/2012), manual literature search, and the gray literature. Study selections and data collection were performed by two independent reviewers, with disagreements solved by a third reviewer. The following outcomes were evaluated: ASAS 20 response, disease activity, physical function, vertebral mobility, adverse events, and withdraws. The meta-analysis was performed using the Review Manager(®) 5.1 software by applying the random effects model. Eighteen studies were included in this review. No study of certolizumab was included. Patients treated with anti-TNF agents were more likely to display an ASAS 20 response after 12/14 weeks (RR 2.21; 95 % CI 1.91; 2.56) and 24 weeks (RR 2.68; 95 % CI 2.06; 3.48) compared with controls, which was also true for several other efficacy outcomes. Meta-analysis of safety outcomes and withdraws did not indicate statistically significant differences between treatment and control groups after 12 or 30 weeks. Adalimumab, infliximab, etanercept, and golimumab can effectively reduce the signs and symptoms of the axial component of ankylosing spondylitis. Safety outcomes deserve further study, especially with respect to long-term follow-ups.
Collapse
|
39
|
Cantini F, Niccoli L, Cassarà E, Kaloudi O, Nannini C. Duration of remission after halving of the etanercept dose in patients with ankylosing spondylitis: a randomized, prospective, long-term, follow-up study. Biologics 2013; 7:1-6. [PMID: 23319853 PMCID: PMC3540908 DOI: 10.2147/btt.s31474] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background The aim of this study was to evaluate the proportion of patients with ankylosing spondylitis maintaining clinical remission after reduction of their subcutaneous etanercept dose to 50 mg every other week compared with that in patients receiving etanercept 50 mg weekly. Methods In the first phase of this randomized, prospective, follow-up study, all biologic-naïve patients identified between January 2005 and December 2009 as satisfying the modified New York clinical criteria for ankylosing spondylitis treated with etanercept 50 mg weekly were evaluated for disease remission in January 2010. In the second phase, patients meeting the criteria for remission were randomized to receive subcutaneous etanercept as either 50 mg weekly or 50 mg every other week. The randomization allocation was 1:1. Remission was defined as Bath Ankylosing Spondylitis Disease Activity Index < 4, no extra-axial manifestations of peripheral arthritis, dactylitis, tenosynovitis, or iridocyclitis, and normal acute-phase reactants. The patients were assessed at baseline, at weeks 4 and 12, and every 12 weeks thereafter. The last visit constituted the end of the follow-up. Results During the first phase, 78 patients with ankylosing spondylitis (57 males and 21 females, median age 38 years, median disease duration 12 years) were recruited. In January 2010, after a mean follow-up of 25 ± 11 months, 43 (55.1%) patients achieving clinical remission were randomized to one of the two treatment arms. Twenty-two patients received etanercept 50 mg every other week (group 1) and 21 received etanercept 50 mg weekly (group 2). At the end of follow-up, 19 of 22 (86.3%) subjects in group 1 and 19 of 21 (90.4%) in group 2 were still in remission, with no significant difference between the two groups. The mean follow-up duration in group 1 and group 2 was 22 ± 1 months and 21 ± 1.6 months, respectively. Conclusion Remission of ankylosing spondylitis is possible in at least 50% of patients treated with etanercept 50 mg weekly. After halving of the etanercept dose, remission is maintained in a high percentage of patients during long-term follow-up, with important economic implications.
Collapse
Affiliation(s)
- Fabrizio Cantini
- Division of Rheumatology, Misericordia e Dolce Hospital, Prato, Italy
| | | | | | | | | |
Collapse
|
40
|
Gast H, Müller A, Lopez M, Meier D, Huber R, Dechent F, Prinz M, Emmenegger Y, Franken P, Birchler T, Fontana A. CD40 activation induces NREM sleep and modulates genes associated with sleep homeostasis. Brain Behav Immun 2013; 27:133-44. [PMID: 23072727 DOI: 10.1016/j.bbi.2012.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2012] [Revised: 10/02/2012] [Accepted: 10/02/2012] [Indexed: 01/26/2023] Open
Abstract
The T-cell derived cytokine CD40 ligand is overexpressed in patients with autoimmune diseases. Through activation of its receptor, CD40 ligand leads to a tumor necrosis factor (TNF) receptor 1 (TNFR1) dependent impairment of locomotor activity in mice. Here we report that this effect is explained through a promotion of sleep, which was specific to non-rapid eye movement (NREM) sleep while REM sleep was suppressed. The increase in NREM sleep was accompanied by a decrease in EEG delta power during NREM sleep and by a decrease in the expression of transcripts in the cerebral cortex known to be associated with homeostatic sleep drive, such as Homer1a, Early growth response 2, Neuronal pentraxin 2, and Fos-like antigen 2. The effect of CD40 activation was mimicked by peripheral TNF injection and prevented by the TNF blocker etanercept. Our study indicates that sleep-wake dysregulation in autoimmune diseases may result from CD40 induced TNF:TNFR1 mediated alterations of molecular pathways, which regulate sleep-wake behavior.
Collapse
Affiliation(s)
- Heidemarie Gast
- Department of Neurology, Inselspital, University Hospital Berne, University of Bern, Bern, Switzerland
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Pharmaceutical perspectives for the delivery of TNF-α in cancer therapy. JOURNAL OF PHARMACEUTICAL INVESTIGATION 2012. [DOI: 10.1007/s40005-012-0044-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
42
|
Acute and long-term effect of infliximab on humoral and echocardiographic parameters in patients with chronic inflammatory diseases. Clin Rheumatol 2012; 32:61-6. [DOI: 10.1007/s10067-012-2091-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2012] [Revised: 08/31/2012] [Accepted: 09/11/2012] [Indexed: 10/27/2022]
|
43
|
Gignac MAM, Cao X, Mcalpine J, Badley EM. Measures of disability: Arthritis Impact Measurement Scales 2 (AIMS2), Arthritis Impact Measurement Scales 2-Short Form (AIMS2-SF), The Organization for Economic Cooperation and Development (OECD) Long-Term Disability (LTD) Questionnaire, EQ-5D, World Health Organization Disability Assessment Schedule II (WHODASII), Late-Life Function and Disability Instrument (LLFDI), and Late-Life Function and Disability Instrument-Abbreviated Version (LLFDI-Abbreviated). Arthritis Care Res (Hoboken) 2012; 63 Suppl 11:S308-24. [PMID: 22588753 DOI: 10.1002/acr.20640] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Monique A M Gignac
- Toronto Western Research Institute, and University of Toronto, Toronto, Ontario, Canada.
| | | | | | | |
Collapse
|
44
|
Kerensky TA, Gottlieb AB, Yaniv S, Au SC. Etanercept: efficacy and safety for approved indications. Expert Opin Drug Saf 2011; 11:121-39. [DOI: 10.1517/14740338.2012.633509] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
45
|
Braun J, van den Berg R, Baraliakos X, Boehm H, Burgos-Vargas R, Collantes-Estevez E, Dagfinrud H, Dijkmans B, Dougados M, Emery P, Geher P, Hammoudeh M, Inman RD, Jongkees M, Khan MA, Kiltz U, Kvien T, Leirisalo-Repo M, Maksymowych WP, Olivieri I, Pavelka K, Sieper J, Stanislawska-Biernat E, Wendling D, Ozgocmen S, van Drogen C, van Royen B, van der Heijde D. 2010 update of the ASAS/EULAR recommendations for the management of ankylosing spondylitis. Ann Rheum Dis 2011; 70:896-904. [PMID: 21540199 PMCID: PMC3086052 DOI: 10.1136/ard.2011.151027] [Citation(s) in RCA: 607] [Impact Index Per Article: 46.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
This first update of the ASAS/EULAR recommendations on the management of ankylosing spondylitis (AS) is based on the original paper, a systematic review of existing recommendations and the literature since 2005 and the discussion and agreement among 21 international experts, 2 patients and 2 physiotherapists in a meeting in February 2010. Each original bullet point was discussed in detail and reworded if necessary. Decisions on new recommendations were made — if necessary after voting. The strength of the recommendations (SOR) was scored on an 11-point numerical rating scale after the meeting by email. These recommendations apply to patients of all ages that fulfill the modified NY criteria for AS, independent of extra-articular manifestations, and they take into account all drug and non-drug interventions related to AS. Four overarching principles were introduced, implying that one bullet has been moved to this section. There are now 11 bullet points including 2 new ones, one related to extra-articular manifestations and one to changes in the disease course. With a mean score of 9.1 (range 8-10) the SOR was generally very good.
Collapse
Affiliation(s)
- J Braun
- Rheumazentrum Ruhrgebiet, Landgrafenstrasse 15, 44652 Herne, Germany.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Abstract
Spondyloarthritides are a group of inflammatory rheumatic disorders related by clinical symptoms and genetic predisposition; the most important subtype is ankylosing spondylitis. The other subtypes include psoriatic spondyloarthritis, after preceding infections, in association with chronic inflammatory bowel diseases, and undifferentiated spondyloarthritis. The most significant clinical symptoms are inflammatory back pain and peripheral, usually asymmetric oligoarthritis and enthesitis. The possibility of other organs being involved is typical to some extent and the frequency varies among the subtypes: particularly affected are the eyes, the skin, and the intestines. Less commonly aortic valve defects and arrhythmias occur. The strongest genetic factor is the MHC class I molecule HLA-B27, which is exhibited by 90% of the patients with ankylosing spondylitis. The diagnostic possibilities for early identification have improved in the last few years. Early determination of HLA-B27 and magnetic resonance imaging have contributed to this development. Conventional radiography still represents the gold standard in the diagnostic workup. New criteria for classification of axial and peripheral spondyloarthritis have recently become available and international recommendations for the management of ankylosing spondylitis were recently published.
Collapse
|
47
|
Revicki DA, Rentz AM, Luo MP, Wong RL. Psychometric characteristics of the short form 36 health survey and functional assessment of chronic illness Therapy-Fatigue subscale for patients with ankylosing spondylitis. Health Qual Life Outcomes 2011; 9:36. [PMID: 21600054 PMCID: PMC3124410 DOI: 10.1186/1477-7525-9-36] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Accepted: 05/22/2011] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND We evaluated the psychometric characteristics of the Short Form 36 (SF-36) Health Survey and the Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue subscale in patients with ankylosing spondylitis (AS). METHODS We analyzed clinical and patient-reported outcome (PRO) data collected during 12-week, double-blind, placebo-controlled periods of two randomized controlled trials comparing adalimumab and placebo for the treatment of active AS. The Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Functional Index, and other clinical measures were collected during the clinical trial. We evaluated internal consistency/reliability, construct validity, and responsiveness to change for the SF-36 and FACIT-Fatigue. RESULTS The SF-36 (Cronbach alpha, 0.74-0.92) and FACIT-Fatigue (Cronbach alpha, 0.82-0.86) both had good internal consistency/reliability. At baseline, SF-36 and FACIT-Fatigue scores correlated significantly with Ankylosing Spondylitis Quality of Life scores (r = -0.36 to -0.66 and r = -0.70, respectively; all p < 0.0001). SF-36 scores varied by indicators of clinical severity, with greater impairment observed for more severe degrees of clinical activity (all p < 0.0001). FACIT-Fatigue scores correlated significantly with SF-36 scores (r = 0.42 to 0.74; all p < 0.0001) and varied by clinical severity (p < 0.05 to p < 0.0001). CONCLUSIONS The SF-36 is a reliable, valid, and responsive measure of health-related quality of life and the FACIT-Fatigue is a brief and psychometrically sound measure of the effects of fatigue on patients with AS. These PROs may be useful in evaluating effectiveness of new treatments for AS.
Collapse
Affiliation(s)
- Dennis A Revicki
- Outcomes Research, United BioSource Corporation, Bethesda, MD, USA
| | - Anne M Rentz
- Outcomes Research, United BioSource Corporation, Bethesda, MD, USA
| | - Michelle P Luo
- Formerly Abbott Laboratories, Global Health Economics & Outcomes Research, Abbott Park, IL, USA
| | - Robert L Wong
- Abbott Laboratories, Abbott Immunology, Parsippany, NJ, USA
| |
Collapse
|
48
|
Towards a multidimensional patient reported outcome measures assessment: Development and validation of a questionnaire for patients with ankylosing spondylitis/spondyloarthritis. Joint Bone Spine 2010; 77:575-81. [DOI: 10.1016/j.jbspin.2010.02.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Accepted: 02/24/2010] [Indexed: 11/18/2022]
|
49
|
van Luijn JCF, Danz M, Bijlsma JWJ, Gribnau FWJ, Leufkens HGM. Post-approval trials of new medicines: widening use or deepening knowledge? Analysis of 10 years of etanercept. Scand J Rheumatol 2010; 40:183-91. [DOI: 10.3109/03009742.2010.509102] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
50
|
Extended dosing of etanercept 25 mg can be effective in patients with ankylosing spondylitis: a retrospective analysis. Clin Rheumatol 2010; 29:1149-54. [DOI: 10.1007/s10067-010-1542-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Revised: 07/20/2010] [Accepted: 07/21/2010] [Indexed: 12/19/2022]
|