1
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Conaghan PG, Pavelka K, Hsieh SC, Bonnington TL, Kent TC, Marchbank K, Edwards CJ. Evaluating the efficacy of upadacitinib in patients with moderate rheumatoid arthritis: a post-hoc analysis of the SELECT phase 3 trials. Rheumatol Adv Pract 2023; 7:rkad017. [PMID: 36794283 PMCID: PMC9924096 DOI: 10.1093/rap/rkad017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 11/18/2022] [Indexed: 02/11/2023] Open
Abstract
Objectives Moderately active RA is associated with poor patient outcomes. Despite this, some health systems have restricted access to advanced therapies to those with severe RA. There is also limited evidence of the efficacy of advanced therapies in the moderately active RA population. This post-hoc analysis from four phase 3 trials explored the efficacy of upadacitinib (UPA) for moderately active RA. Methods Patients included in this analysis received UPA 15 mg once daily [monotherapy after switching from MTX or in combination with stable background conventional synthetic DMARDs (csDMARDs)] or placebo. Clinical, functional and radiographic outcomes were analysed separately for patients with moderate disease activity {28-joint count DAS using CRP [DAS28(CRP)] of >3.2 and ≤5.1} and severe disease activity [DAS28(CRP) >5.1]. Results Patients with moderate disease activity who received UPA 15 mg (combination or monotherapy) after an inadequate response to biologic DMARDs and/or csDMARDs were significantly more likely to achieve a 20% improvement in the ACR response criteria, low disease activity status [DAS28(CRP) ≤ 3.2] or clinical remission [DAS28(CRP) < 2.6] by week 12/14 vs placebo. Statistically significant improvements in patient-reported functioning and pain from baseline were observed for UPA 15 mg vs placebo at week 12/14. Radiographic progression was also significantly reduced at week 26 compared with placebo. Similar improvements were observed for severe disease. Conclusion This analysis provides support for the use of UPA for the treatment of patients with moderate RA. Trial registration ClinicalTrials.gov: SELECT-NEXT: NCT02675426; SELECT-COMPARE: NCT02629159; SELECT-MONOTHERAPY: NCT02706951; SELECT-BEYOND: NCT02706847.
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Affiliation(s)
- Philip G Conaghan
- Correspondence to: Philip G. Conaghan, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, 2nd Floor, Chapeltown Road, Leeds LS7 4SA, UK. E-mail:
| | - Karel Pavelka
- Institute of Rheumatology, Charles University, Prague, Czech Republic
| | - Song-Chou Hsieh
- International Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | | | | | | | - Christopher J Edwards
- NIHR Southampton Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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2
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Novella-Navarro M, Benavent D, Ruiz-Esquide V, Tornero C, Díaz-Almirón M, Chacur CA, Peiteado D, Villalba A, Sanmartí R, Plasencia-Rodríguez C, Balsa A. Predictive model to identify multiple failure to biological therapy in patients with rheumatoid arthritis. Ther Adv Musculoskelet Dis 2022; 14:1759720X221124028. [PMID: 36226311 PMCID: PMC9549195 DOI: 10.1177/1759720x221124028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 08/16/2022] [Indexed: 11/06/2022] Open
Abstract
Background: Despite advances in the treatment of rheumatoid arthritis (RA) and the wide
range of therapies available, there is a percentage of patients whose
treatment presents a challenge for clinicians due to lack of response to
multiple biologic and target-specific disease-modifying antirheumatic drugs
(b/tsDMARDs). Objective: To develop and validate an algorithm to predict multiple failure to
biological therapy in patients with RA. Design: Observational retrospective study involving subjects from a cohort of
patients with RA receiving b/tsDMARDs. Methods: Based on the number of prior failures to b/tsDMARDs, patients were classified
as either multi-refractory (MR) or non-refractory (NR). Patient
characteristics were considered in the statistical analysis to design the
predictive model, selecting those variables with a predictive capability. A
decision algorithm known as ‘classification and regression tree’ (CART) was
developed to create a prediction model of multi-drug resistance. Performance
of the prediction algorithm was evaluated in an external independent cohort
using area under the curve (AUC). Results: A total of 136 patients were included: 51 MR and 85 NR. The CART model was
able to predict multiple failures to b/tsDMARDs using disease activity
score-28 (DAS-28) values at 6 months after the start time of the initial
b/tsDMARD, as well as DAS-28 improvement in the first 6 months and baseline
DAS-28. The CART model showed a capability to correctly classify 94.1%
NR and 87.5% MR patients with a
sensitivity = 0.88, a specificity = 0.94, and an AUC = 0.89 (95% CI:
0.74–1.00). In the external validation cohort, 35 MR and 47 NR patients were
included. The AUC value for the CART model in this cohort was 0.82 (95% CI:
0.73–0.9). Conclusion: Our model correctly classified NR and MR
patients based on simple measurements available in routine clinical
practice, which provides the possibility to characterize and individualize
patient treatments during early stages.
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Affiliation(s)
| | - Diego Benavent
- Rheumatology, Hospital Universitario La Paz,
Madrid, Spain
| | | | | | | | | | - Diana Peiteado
- Rheumatology, Hospital Universitario La Paz,
Madrid, Spain
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3
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McKenna F. Treatment of Moderate Rheumatoid Arthritis. Rheumatology (Oxford) 2021; 61:478-479. [PMID: 34289023 DOI: 10.1093/rheumatology/keab582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 07/15/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Frank McKenna
- Manchester University NHS Trust, Dept of Rheumatology, Trafford General Hospital, Moorside Rd, Davyhulme, Manchester, M41 5SL
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4
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Nikiphorou E, Jacklin H, Bosworth A, Jacklin C, Kiely P. Disease impact of rheumatoid arthritis in patients not treated with advanced therapies; survey findings from the National Rheumatoid Arthritis Society. Rheumatol Adv Pract 2021; 5:rkaa080. [PMID: 34322656 PMCID: PMC8314206 DOI: 10.1093/rap/rkaa080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/03/2020] [Indexed: 11/21/2022] Open
Abstract
Objective The aim was to reveal the everyday impact of living with RA in people not treated with advanced therapies (i.e. biologic or targeted synthetic DMARDs). Methods People with RA, with disease duration >2 years, not currently treated with advanced therapies, completed an online survey promoted by the National Rheumatoid Arthritis Society. Items covered demographics, current treatment, RA flare frequency, the Rheumatoid Arthritis Impact of Disease (RAID) tool and questions reflecting work status and ability. Descriptive and multivariable regression analyses were performed. Results There were 612 responses from patients having a mean age of 59 years, 88% female, 37.7% with disease duration 2–5 years and 27.9% with disease duration 5–10 years. In the last year, 90% reported an RA flare, with more than six flares in 23%. A RAID patient acceptable state was recorded in 12.4%. Each of the seven domains was scored in the high range by >50% respondents; 74.3% scored sleep problems and 72% fatigue in the high range. A need to change working hours was reported by 70%. Multivariable analyses revealed that increasing difficulties with daily physical activities, reduced emotional and physical well-being in the past week were all significantly associated with pain, number of flares and ability to cope (P < 0.005). The RAID score was significantly predictive of the number of flares. Conclusion Patients not currently treated with advanced therapies experience profound difficulties in everyday living with RA, across a broad range of measures. We advocate that patient-reported measures be used to facilitate holistic care, addressing inflammation and other consequences of RA on everyday life.
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Affiliation(s)
- Elena Nikiphorou
- Department of Inflammation Biology, Centre for Rheumatic Diseases, School of Immunology and Microbial Sciences, Faculty of Life Sciences & Medicine
| | | | | | | | - Patrick Kiely
- Department of Rheumatology, St George's University Hospitals NHS Foundation Trust
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5
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Covarrubias S, Vollmers AC, Capili A, Boettcher M, Shulkin A, Correa MR, Halasz H, Robinson EK, O'Briain L, Vollmers C, Blau J, Katzman S, McManus MT, Carpenter S. High-Throughput CRISPR Screening Identifies Genes Involved in Macrophage Viability and Inflammatory Pathways. Cell Rep 2020; 33:108541. [PMID: 33378675 PMCID: PMC7901356 DOI: 10.1016/j.celrep.2020.108541] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 10/08/2020] [Accepted: 11/30/2020] [Indexed: 12/16/2022] Open
Abstract
Macrophages are critical effector cells of the immune system, and understanding genes involved in their viability and function is essential for gaining insights into immune system dysregulation during disease. We use a high-throughput, pooled-based CRISPR-Cas screening approach to identify essential genes required for macrophage viability. In addition, we target 3' UTRs to gain insights into previously unidentified cis-regulatory regions that control these essential genes. Next, using our recently generated nuclear factor κB (NF-κB) reporter line, we perform a fluorescence-activated cell sorting (FACS)-based high-throughput genetic screen and discover a number of previously unidentified positive and negative regulators of the NF-κB pathway. We unravel complexities of the TNF signaling cascade, showing that it can function in an autocrine manner in macrophages to negatively regulate the pathway. Utilizing a single complex library design, we are capable of interrogating various aspects of macrophage biology, thus generating a resource for future studies.
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Affiliation(s)
- Sergio Covarrubias
- Department of Molecular, Cell and Developmental Biology, University of California, Santa Cruz, Santa Cruz, CA, USA
| | - Apple Cortez Vollmers
- Department of Molecular, Cell and Developmental Biology, University of California, Santa Cruz, Santa Cruz, CA, USA
| | - Allyson Capili
- Department of Molecular, Cell and Developmental Biology, University of California, Santa Cruz, Santa Cruz, CA, USA
| | - Michael Boettcher
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA 94143, USA; Diabetes Center, University of California, San Francisco, San Francisco, CA, USA; W.M. Keck Center for Noncoding RNAs, University of California, San Francisco, San Francisco, CA, USA; Institute for Molecular Medicine, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Aaron Shulkin
- Department of Molecular, Cell and Developmental Biology, University of California, Santa Cruz, Santa Cruz, CA, USA
| | - Michele Ramos Correa
- Department of Molecular, Cell and Developmental Biology, University of California, Santa Cruz, Santa Cruz, CA, USA
| | - Haley Halasz
- Department of Molecular, Cell and Developmental Biology, University of California, Santa Cruz, Santa Cruz, CA, USA
| | - Elektra K Robinson
- Department of Molecular, Cell and Developmental Biology, University of California, Santa Cruz, Santa Cruz, CA, USA
| | - Laura O'Briain
- Department of Molecular, Cell and Developmental Biology, University of California, Santa Cruz, Santa Cruz, CA, USA
| | - Christopher Vollmers
- Department of Biomolecular Engineering, University of California, Santa Cruz, Santa Cruz, CA, USA
| | - James Blau
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA 94143, USA; Diabetes Center, University of California, San Francisco, San Francisco, CA, USA; W.M. Keck Center for Noncoding RNAs, University of California, San Francisco, San Francisco, CA, USA
| | - Sol Katzman
- Center for Biomolecular Science and Engineering, University of California, Santa Cruz, Santa Cruz, CA, USA
| | - Michael T McManus
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA 94143, USA; Diabetes Center, University of California, San Francisco, San Francisco, CA, USA; W.M. Keck Center for Noncoding RNAs, University of California, San Francisco, San Francisco, CA, USA
| | - Susan Carpenter
- Department of Molecular, Cell and Developmental Biology, University of California, Santa Cruz, Santa Cruz, CA, USA.
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6
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Glennon-Alty L, Moots RJ, Edwards SW, Wright HL. Type I interferon regulates cytokine-delayed neutrophil apoptosis, reactive oxygen species production and chemokine expression. Clin Exp Immunol 2020; 203:151-159. [PMID: 32990354 PMCID: PMC7806414 DOI: 10.1111/cei.13525] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/21/2020] [Accepted: 09/14/2020] [Indexed: 02/06/2023] Open
Abstract
Interferons (IFNs) are key regulators of a number of inflammatory conditions in which neutrophils play an important role in pathology, such as rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), where type I IFNs are implicated in disease pathology. However, IFNs are usually generated in vivo together with other cytokines that also have immunoregulatory functions, but such interactions are poorly defined experimentally. We measured the effects of type I (IFN-α) IFN, elevated in both RA and SLE, on the functions of healthy neutrophils incubated in vitro in the absence and presence of proinflammatory cytokines typically elevated in inflammatory diseases [tumour necrosis factor (TNF-α), granulocyte-macrophage colony-stimulating factor (GM-CSF)]. IFN-α alone had no effect on neutrophil apoptosis; however, it abrogated the anti-apoptotic effect of GM-CSF (18 h, P < 0·01). The enhanced stability of the anti-apoptotic protein myeloid cell leukaemia 1 (Mcl-1) and delayed activation of caspase activation normally regulated by GM-CSF were blocked by IFN-α: this effect was mediated, in part, by activation of p38 mitogen-activated protein kinase (MAPK). IFN-α alone also primed reactive oxygen species (ROS) production and maintained the transient priming effect of TNF-α for up to 4 h: it also down-regulated GM-CSF- and TNF-α-activated expression of chemokine (C-X-C motif) ligand (CXCL)1, CXCL2, CXCL3, CXCL8, CCL3 and CCL4 but, in contrast, increased the expression of CXCL10. These novel data identify complex regulatory signalling networks in which type I IFNs profoundly alter the response of neutrophils to inflammatory cytokines. This is likely to have important consequences in vivo and may explain the complexity and heterogeneity of inflammatory diseases such as RA, in which multiple cytokine cascades have been activated.
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Affiliation(s)
- L Glennon-Alty
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, Merseyside, UK.,Liverpool Health Partners, University of Liverpool, Liverpool, Merseyside, UK
| | - R J Moots
- Department of Rheumatology, Aintree University Hospital, Liverpool, UK
| | - S W Edwards
- Institute of Infection, Veterinary and Ecological Science, University of Liverpool, Liverpool, Merseyside, UK
| | - H L Wright
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, Merseyside, UK
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7
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Chadwick L, Kearsley-Fleet L, Brown N, Watson KD, Lunt M, Symmons DPM, Hyrich KL. Cervical screening uptake and rates of cervical dysplasia in the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis. Rheumatology (Oxford) 2020; 59:559-567. [PMID: 31722431 DOI: 10.1093/rheumatology/kez277] [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] [Received: 11/11/2018] [Revised: 04/05/2019] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES To compare cervical screening attendance and cytology (high- and low-grade cervical dysplasia [HGCD and LGCD]) between women with RA and the English general population and between biologic DMARD (bDMARD)-naïve and exposed women. METHODS The British Society for Rheumatology Biologics Register for RA (BSRBR-RA), a national prospective study of RA treatment outcomes, was linked to the National Health Service Cervical Screening Programme, providing data for 12 785 women to compare with national screening data. Rates of HGCD/LGCD were compared with rates of negative smears using risk difference calculations between BSRBR-RA and national statistics. Within the BSRBR-RA, coverage was compared between those with low and high physical disability scores, while coverage and cytology results were compared between bDMARD-naïve and -exposed RA patients. RESULTS The mean 5 year screening coverage was significantly higher in BSRBR-RA (83%) compared with the general population (79%), but lower in women with high disability (78%) compared with lesser disability (85%). Risk differences for HGCD were lower in the BSRBR-RA compared with national statistics, whereas risk differences for LGCD were higher. There was no statistically significant difference in the rates of HGCD or LGCD between bDMARD-exposed and -naïve women. CONCLUSION This first-ever British analysis of cervical screening rates in RA has shown that women with RA have higher screening rates than the general population. Disability negatively impacts attendance, but treatment type does not. Women with RA did not have an increased risk of HGCD compared with national statistics, which was also not influenced by bDMARD exposure.
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Affiliation(s)
- Laura Chadwick
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Lianne Kearsley-Fleet
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Nina Brown
- Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | | | | | - Kath D Watson
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Mark Lunt
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Deborah P M Symmons
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Kimme L Hyrich
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,National Institute of Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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8
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Not all moderate disease is the same - Identification of disability trajectories among patients with rheumatoid arthritis and moderate disease activity. PLoS One 2019; 14:e0215999. [PMID: 31107887 PMCID: PMC6527224 DOI: 10.1371/journal.pone.0215999] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 04/11/2019] [Indexed: 01/08/2023] Open
Abstract
Background United Kingdom guidelines for the use of biologic disease modifying anti-rheumatic drugs (bDMARDS) for rheumatoid arthritis (RA) require patients to have active disease (Disease Activity Score [DAS28] >5.1) and have failed ≥2 previous conventional synthetic DMARDs (csDMARD). Patients with moderate disease activity (MDA) do not meet these criteria, yet often have poor outcomes. This study aimed to identify trajectory groups of disability scores over three years in RA patients with MDA. Methods The study included biologic-naïve patients receiving csDMARDs only with MDA (3.2 <DAS28≤ 5.1) when recruited to the control cohort of the British Society for Rheumatology Biologics Register–RA (BSRBR-RA). Disability scores, measured using the Health Assessment Questionnaire (HAQ), were recorded every six months for three years. Trajectories of HAQ scores over follow-up were assessed using latent class growth models (LCGMs). Baseline age, gender, DAS28, symptom duration, rheumatoid factor status, number of prior csDMARDs and co-morbidities were assessed as potential predictors of group membership. Results In total, 1274 patients were included (mean age: 61 years (standard deviation: 12), 71.4% women). The best fitting model included seven HAQ trajectories. These trajectories were horizontal over follow-up and were related to baseline HAQ: very-low (6.8%, baseline (BL) HAQ: 0.22), low (11.5%, BL HAQ: 0.41), low-moderate (17.0%, BL HAQ: 0.93), moderate (13.4%, BL HAQ: 1.09), high-moderate (19.5%, BL HAQ: 1.61), severe (23.2%, BL HAQ: 1.98) and very-severe (8.6%, BL HAQ: 2.54). Higher DAS28, older age, female gender, longer disease duration and more co-morbidities were independently associated with higher HAQ trajectory group. Conclusion There is substantial heterogeneity in baseline HAQ scores in this population, and the trajectories of HAQ scores after baseline are, on average, relatively flat. As bDMARD therapy has been shown to improve HAQ scores, patients with MDA but high HAQ scores may benefit from a more aggressive approach to therapy.
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9
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Prothero L, Sturt J, de Souza S, Lempp H. Intensive management for moderate rheumatoid arthritis: a qualitative study of patients' and practitioners' views. BMC Rheumatol 2019; 3:12. [PMID: 30976751 PMCID: PMC6437952 DOI: 10.1186/s41927-019-0057-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 02/26/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The TITRATE trial seeks to test whether intensive management is valuable in achieving disease remission in moderately active rheumatoid arthritis. Intensive management is a complex intervention consisting of: 1) 12 x monthly appointments, 2) tailored 'treatment support' based on motivational interviewing techniques, 3) optimised medication (including the opportunity for biologics), 4) provision of a Patient Handbook, and 5) shared treatment planning. This study aims to understand: a) patients' and practitioners' views on the feasibility and acceptability of intensive management, and b) patients' and practitioners' experience of receiving/providing intensive management. METHODS A qualitative study, nested within a randomised controlled trial. Participants were patients (n = 15) in the intensive management arm of the trial and rheumatology practitioners (n = 16) providing the intensive management intervention, from 18/42 clinics across England. Data were collected via semi-structured interviews and analysed using thematic analysis and iterative categorization. RESULTS Monthly appointments were largely acceptable to both groups who cited several treatment benefits (e.g. regular review of medication, practitioners built close relationships with patients). Practitioners were 'fairly confident' using the motivational interviewing techniques. Learning to pace was the most commonly reported self-management technique that patients and healthcare professionals worked on together, followed by gaining control over pain and fatigue. Practitioners liked having the option to offer biologics to patients with moderate RA. Most patients found the optimised medication (following monthly joint assessment) helpful and side-effects experienced were resolved. Variation existed in the extent to which patients engaged with the Patient Handbook and shared treatment planning, with those who did engage doing so in the early stages. CONCLUSIONS Feedback from patient participants about the intensive management intervention was positive. They found increased medication helpful. Continuity of care with the same healthcare professional at regular intensive management sessions, and the treatment support provided, were highly rated. Feedback from practitioners indicated that intensive management training is feasible. Evidence from the interviews showed that some practitioners applied motivational interviewing techniques during standard care appointments and they would like the opportunity to address lifestyle issues with patients.
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Affiliation(s)
- Louise Prothero
- Department of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King’s College London, 10 Cutcombe Road, Denmark Hill, London, SE5 9RJ UK
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, 57 Waterloo Road, London, SE1 8WA UK
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, 57 Waterloo Road, London, SE1 8WA UK
| | - Savia de Souza
- Department of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King’s College London, 10 Cutcombe Road, Denmark Hill, London, SE5 9RJ UK
| | - Heidi Lempp
- Department of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King’s College London, 10 Cutcombe Road, Denmark Hill, London, SE5 9RJ UK
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10
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Pauly MP, Tucker LY, Szpakowski JL, Ready JB, Baer D, Hwang J, Lok ASF. Incidence of Hepatitis B Virus Reactivation and Hepatotoxicity in Patients Receiving Long-term Treatment With Tumor Necrosis Factor Antagonists. Clin Gastroenterol Hepatol 2018; 16:1964-1973.e1. [PMID: 29702293 DOI: 10.1016/j.cgh.2018.04.033] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 03/13/2018] [Accepted: 04/13/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Tumor necrosis factor (TNF) antagonists are the first-line treatment for many autoimmune diseases. However, they have been associated with reactivation of hepatitis B virus (HBV). We determined the rate of HBV reactivation and hepatotoxicity grade 3 or 4 (HT ≥3) in patients treated with an anti-TNF agent for an autoimmune disease. METHODS We collected data from 8887 adult patients in the Kaiser Permanente Northern California database who began treatment with TNF antagonists for autoimmune diseases (dermatologic, rheumatologic, or gastrointestinal) from 2001 through 2010, followed through December 2012. We obtained data on HBV infection (52% of patients were screened for HBV before treatment), demographic features, comorbidities, and use of immunosuppressive agents. HBV reactivation was defined as 1 of the following: >1 log increase in HBV DNA, HBV DNA-positive when previously negative, HBV DNA >2000 IU/mL if no baseline level was available, or reverse seroconversion. HT ≥3 was defined according to the National Cancer Institute Common Toxicity Criteria. We performed multivariable logistic regression to identify factors associated with HT ≥3. RESULTS Twenty-three patients tested positive for HB surface antigen (HBsAg) at baseline and 9 of these had HBV reactivation; of the 4267 patients with unknown HBV status at baseline, 2 had HBV reactivation. None of the 178 patients who were HBsAg negative and positive for the hepatitis B core antibody (anti-HBc+) had HBV reactivation. HBV reactivation occurred in 1/5 HBsAg+ patients who received prophylactic antiviral therapy and 8/18 who did not (P = .61). No one with HBV reactivation had liver failure. HT ≥3 occurred in 273 patients (2.7%), but only 3 cases were attributed to HBV. Cirrhosis was significantly associated with HT ≥3 (P < .001). CONCLUSION In a retrospective analysis of patients treated with TNF antagonists for autoimmune diseases, we found HBV reactivation in 39% of patients who were HBsAg+ before therapy, but not in any patients who were HBsAg-negative and anti-HBc+ before therapy. Patients should be screened for HBV infection before anti-TNF therapy; HBsAg+ patients should receive prophylactic antiviral therapy, but not HBsAg-negative, anti-HBc+ patients.
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Affiliation(s)
- Mary Patricia Pauly
- Department of Gastroenterology, Kaiser Permanente Northern California, Sacramento, California.
| | - Lue-Yen Tucker
- Division of Research, Kaiser Permanente Northern California, Sacramento, California
| | - Jean-Luc Szpakowski
- Department of Gastroenterology, Kaiser Permanente Northern California, Sacramento, California
| | - Joanna B Ready
- Department of Gastroenterology, Kaiser Permanente Northern California, Sacramento, California
| | - David Baer
- Department of Hematology and Oncology, Kaiser Permanente Northern California, Sacramento, California
| | - Jessica Hwang
- Department of General Internal Medicine, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Anna S-F Lok
- Department of Internal Medicine and Gastroenterology, University of Michigan, Ann Arbor, Michigan
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11
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Caporali R, Crepaldi G, Codullo V, Benaglio F, Monti S, Todoerti M, Montecucco C. 20 years of experience with tumour necrosis factor inhibitors: what have we learned? Rheumatology (Oxford) 2018; 57:vii5-vii10. [DOI: 10.1093/rheumatology/key059] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Indexed: 12/17/2022] Open
Affiliation(s)
- Roberto Caporali
- Division of Rheumatology, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia
| | | | - Veronica Codullo
- Division of Rheumatology, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia
| | - Francesca Benaglio
- Division of Rheumatology, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia
| | - Sara Monti
- Division of Rheumatology, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia
| | - Monica Todoerti
- Division of Rheumatology, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia
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12
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Lyman M, Lieuw V, Richardson R, Timmer A, Stewart C, Granger S, Woods R, Silacci M, Grabulovski D, Newman R. A bispecific antibody that targets IL-6 receptor and IL-17A for the potential therapy of patients with autoimmune and inflammatory diseases. J Biol Chem 2018; 293:9326-9334. [PMID: 29678878 DOI: 10.1074/jbc.m117.818559] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 04/03/2018] [Indexed: 01/10/2023] Open
Abstract
Despite the success of current biological therapeutics for rheumatoid arthritis, these therapies, targeting individual cytokines or pathways, produce beneficial responses in only about half of patients. Therefore, better therapeutics are needed. IL-6 and IL-17A are proinflammatory cytokines in many autoimmune and inflammatory diseases, and several therapeutics have been developed to specifically inhibit them. However, targeting both of these cytokines with a bispecific therapeutic agent could account for their nonoverlapping proinflammatory functions and for the fact that IL-6 and IL-17A act in a positive feedback loop. Here, we present the development of MT-6194, a bispecific antibody targeting both IL-6R and IL-17A that was developed with the FynomAb technology. We also present data from mouse inflammatory disease experiments, indicating that simultaneous inhibition of both IL-6 and IL-17A yields enhanced efficacy compared with inhibition of each cytokine alone.
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Affiliation(s)
- Michael Lyman
- From Tanabe Research Labs U.S.A. Inc., San Diego, California 92121 and
| | - Vincent Lieuw
- From Tanabe Research Labs U.S.A. Inc., San Diego, California 92121 and
| | - Robyn Richardson
- From Tanabe Research Labs U.S.A. Inc., San Diego, California 92121 and
| | - Anjuli Timmer
- From Tanabe Research Labs U.S.A. Inc., San Diego, California 92121 and
| | - Christine Stewart
- From Tanabe Research Labs U.S.A. Inc., San Diego, California 92121 and
| | - Steve Granger
- From Tanabe Research Labs U.S.A. Inc., San Diego, California 92121 and
| | - Richard Woods
- Covagen AG, Wagistrasse 25, 8952 Schlieren, Switzerland
| | | | | | - Roland Newman
- From Tanabe Research Labs U.S.A. Inc., San Diego, California 92121 and
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13
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Biologics registers in RA: methodological aspects, current role and future applications. Nat Rev Rheumatol 2017; 13:503-510. [PMID: 28569267 DOI: 10.1038/nrrheum.2017.81] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The beginning of the 21st century saw a biopharmaceutical revolution in the treatment of inflammatory rheumatic diseases, particularly rheumatoid arthritis. The fast-evolving use of biologic therapies highlighted the need to develop registers at national and international levels with the aim of collecting long-term data on patient outcomes. Over the past 15 years, many biologics registers have contributed a wealth of data and provided robust and reliable evidence on the use, effectiveness and safety of these therapies. The unavoidable challenges posed by the continuous introduction of new therapies, particularly with regard to understanding their long-term safety, highlights the importance of learning from experience with established biologic therapies. In this Perspectives article, the role of biologics registers in bridging the evidence gap between efficacy in clinical trials and real-world effectiveness is discussed, with a focus on methodological aspects of registers, their unique features and challenges and their role going forward.
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14
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Silva-Fernández L, Lunt M, Kearsley-Fleet L, Watson KD, Dixon WG, Symmons DPM, Hyrich KL. The incidence of cancer in patients with rheumatoid arthritis and a prior malignancy who receive TNF inhibitors or rituximab: results from the British Society for Rheumatology Biologics Register-Rheumatoid Arthritis. Rheumatology (Oxford) 2016; 55:2033-2039. [PMID: 27550304 PMCID: PMC5088627 DOI: 10.1093/rheumatology/kew314] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 07/22/2016] [Indexed: 11/18/2022] Open
Abstract
Objective. To explore the influence of TNF inhibitor (TNFi) therapy and rituximab (RTX) upon the incidence of cancer in patients with RA and prior malignancy. Methods. The study population comprised RA subjects with a prior malignancy reported to the UK national cancer registers, recruited to the British Society for Rheumatology Biologics Register from 2001 to 2013. We compared rates of first incident malignancy in a TNFi cohort, RTX cohort and synthetic DMARDs (sDMARD) cohort. Results. We identified 425 patients with a prior malignancy from 18 000 RA patients in the study. Of these, 101 patients developed a new malignancy. The rates of incident malignancy were 33.3 events/1000 person-years (py) in the TNFi cohort, 24.7 events/1000 py in the RTX cohort and 53.8 events/1000 py in the sDMARD cohort. The age- and gender-adjusted hazard ratio was 0.55 (95% CI: 0.35, 0.86) for the TNFi cohort and 0.43 (95% CI: 0.10, 1.80) for the RTX cohort in comparison with the sDMARDs cohort. The 17.0% of patients in the sDMARDs cohort had a recurrence of the same cancer in comparison with the 12.8% and the 4.3% in the TNFi and RTX cohorts, respectively. Conclusions. Although numbers are still low, it seems that patients with RA and prior malignancy selected to receive either a TNFi or RTX in the UK do not have an increased risk of future incident malignancy.
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Affiliation(s)
- Lucía Silva-Fernández
- Arthritis Research UK Centre for Epidemiology, The University of Manchester, Manchester, UK.,Rheumatology Department, Complexo Hospitalario Universitario de Ferrol, Ferrol, Spain
| | - Mark Lunt
- Arthritis Research UK Centre for Epidemiology, The University of Manchester, Manchester, UK
| | - Lianne Kearsley-Fleet
- Arthritis Research UK Centre for Epidemiology, The University of Manchester, Manchester, UK
| | - Kath D Watson
- Arthritis Research UK Centre for Epidemiology, The University of Manchester, Manchester, UK
| | - William G Dixon
- Arthritis Research UK Centre for Epidemiology, The University of Manchester, Manchester, UK.,NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust and University of Manchester Partnership, Manchester, UK
| | - Deborah P M Symmons
- Arthritis Research UK Centre for Epidemiology, The University of Manchester, Manchester, UK
| | - Kimme L Hyrich
- Arthritis Research UK Centre for Epidemiology, The University of Manchester, Manchester, UK .,NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust and University of Manchester Partnership, Manchester, UK
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15
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Dennison EM, Packham J, Hyrich K. The BSRBR-RA at 15 years. Rheumatology (Oxford) 2016; 55:2093-2095. [PMID: 27012687 DOI: 10.1093/rheumatology/kew053] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
- Elaine M Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK, .,School of Biological Sciences, Victoria University of Wellington, Wellington, New Zealand
| | - Jon Packham
- Institute of Science and Technology in Medicine, Keele University, Keele
| | - Kimme Hyrich
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, Manchester University and.,NIHR Manchester Musculoskeletal BRU, Central Manchester Foundation Trust, Manchester, UK
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16
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Nikiphorou E, Norton S, Young A, Carpenter L, Dixey J, Walsh DA, Kiely P. Association between rheumatoid arthritis disease activity, progression of functional limitation and long-term risk of orthopaedic surgery: combined analysis of two prospective cohorts supports EULAR treat to target DAS thresholds. Ann Rheum Dis 2016; 75:2080-2086. [PMID: 26979104 PMCID: PMC5136699 DOI: 10.1136/annrheumdis-2015-208669] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 02/18/2016] [Accepted: 02/21/2016] [Indexed: 11/17/2022]
Abstract
Objectives To examine the association between disease activity in early rheumatoid arthritis (RA), functional limitation and long-term orthopaedic episodes. Methods Health Assessment Questionnaire (HAQ) disability scores were collected from two longitudinal early RA inception cohorts in routine care; Early Rheumatoid Arthritis Study and Early Rheumatoid Arthritis Network from 1986 to 2012. The incidence of major and intermediate orthopaedic surgical episodes over 25 years was collected from national data sets. Disease activity was categorised by mean disease activity score (DAS28) annually between years 1 and 5; remission (RDAS≤2.6), low (LDAS>2.6–3.2), low-moderate (LMDAS≥3.2–4.19), high-moderate (HMDAS 4.2–5.1) and high (HDAS>5.1). Results Data from 2045 patients were analysed. Patients in RDAS showed no HAQ progression over 5 years, whereas there was a significant relationship between rising DAS28 category and HAQ at 1 year, and the rate of HAQ progression between years 1 and 5. During 27 986 person-years follow-up, 392 intermediate and 591 major surgeries were observed. Compared with the RDAS category, there was a significantly increased cumulative incidence of intermediate surgery in HDAS (OR 2.59 CI 1.49 to 4.52) and HMDAS (OR 1.8 CI 1.05 to 3.11) categories, and for major surgery in HDAS (OR 2.48 CI 1.5 to 4.11), HMDAS (OR 2.16 CI 1.32 to 3.52) and LMDAS (OR 2.07 CI 1.28 to 3.33) categories. There was no significant difference in HAQ progression or orthopaedic episodes between RDAS and LDAS categories. Conclusions There is an association between disease activity and both poor function and long-term orthopaedic episodes. This illustrates the far from benign consequences of persistent moderate disease activity, and supports European League Against Rheumatism treat to target recommendations to secure low disease activity or remission in all patients.
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Affiliation(s)
- Elena Nikiphorou
- Department of Rheumatology, Whittington Hospital NHS Trust, London, UK.,Early Rheumatoid Arthritis Study, Department of Rheumatology, St Albans City Hospital, St Albans, UK
| | - Sam Norton
- Psychology Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Division of Health & Social Care Research, Faculty of Life and Medical Science, King's College London, London, UK
| | - Adam Young
- Early Rheumatoid Arthritis Study, Department of Rheumatology, St Albans City Hospital, St Albans, UK
| | - Lewis Carpenter
- Centre for Lifespan & Chronic Illness Research, University of Hertfordshire, Hatfield, UK
| | - Josh Dixey
- Department of Rheumatology, New Cross Hospital, Wolverhampton, UK
| | | | - Patrick Kiely
- Department of Rheumatology, St Georges University Hospitals NHS Foundation Trust, London, UK
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17
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Olofsson T, Johansson K, Eriksson JK, van Vollenhoven R, Miller H, Petersson IF, Askling J, Neovius M. Does disease activity at start of biologic therapy influence work-loss in RA patients? Rheumatology (Oxford) 2015; 55:729-34. [PMID: 26683196 DOI: 10.1093/rheumatology/kev407] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To compare work-loss in RA patients starting their first biologic with high vs moderate disease activity. METHODS We identified all RA patients aged 20-63 years in the Swedish Biologics Register who started their first biologic 2007-09 with high disease activity (DAS28 >5.1; n = 868) or moderate disease activity (DAS28 3.2-5.1; n = 854). Work days lost, defined as sick leave and disability pension days from the Swedish Social Insurance Agency, were assessed over 5 years after first bio-start. We estimated between-group mean differences adjusted for age, sex, calendar year, education level, disease duration, comorbidities and work-loss the month before bio-start. RESULTS During 5 years after anti-TNF start, mean monthly work days lost declined from 16.0 to 9.2 (42%; P < 0.001) in patients with high disease activity at baseline and from 12.0 to 7.2 (40%; P < 0.001) in patients with moderate disease activity, with no between-group difference (adjusted mean difference 0.81; 95% CI - 0.44, 2.05). Accumulated 5-year work-loss was, however, higher in the high activity group (724 vs 548 days; adjusted mean difference 70; 95% CI 20, 120), but after stratification on baseline disability pension status, no differences in accumulated work-loss were detected. CONCLUSION Substantial work-loss was seen in both patients with high and patients with moderate disease activity at anti-TNF start, with a 5-year decline in mean monthly work days lost by ∼40% in both groups and no between-group difference. Accumulated work-loss over 5 years was higher in the high-activity group, which may be explained by differences in baseline disability pension status.
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Affiliation(s)
- Tor Olofsson
- Section of Rheumatology, Department of Clinical Sciences, Lund University, Lund,
| | | | | | - Ronald van Vollenhoven
- CLINTRID, Rheumatology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm and
| | | | - Ingemar F Petersson
- Section of Rheumatology, Department of Clinical Sciences, Lund University, Lund, Orthopedics, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Johan Askling
- Clinical Epidemiology Unit, Rheumatology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm and
| | - Martin Neovius
- Section of Rheumatology, Department of Clinical Sciences, Lund University, Lund
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18
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Fautrel B, Nab HW, Brault Y, Gallo G. Identifying patients with rheumatoid arthritis with moderate disease activity at risk of significant radiographic progression despite methotrexate treatment. RMD Open 2015; 1:e000018. [PMID: 26509051 PMCID: PMC4613151 DOI: 10.1136/rmdopen-2014-000018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 06/05/2015] [Accepted: 06/08/2015] [Indexed: 01/18/2023] Open
Abstract
Objectives To determine the baseline factors predictive of significant radiographic progression (SRP) in patients with moderately active rheumatoid arthritis (RA) despite receiving methotrexate (MTX). Methods Patients from the MTX arm of the Trial of Etanercept and Methotrexate with Radiographic Patient Outcomes (TEMPO) trial with sustained moderate RA (defined as ≥3.2 mean disease activity score in 28 joints ≤5.1 during the last 6 months of the first year) were analysed for SRP (mTSS >3.0 overall) after 2 and 3 years. Baseline predictors for SRP were identified by univariate and multivariate analyses. All variables shown to be significantly associated with SRP were categorised based on clinically relevant cut-offs and tertiles and were included in a matrix risk model. Results 228 patients were assigned MTX treatment, 210 patients were in the radiographic intention-to-treat population, and 96 of these had sustained moderate RA. SRP occurred in 25 (26%) and 33 (34%) patients after 2 and 3 years of MTX treatment, respectively. Univariate and multivariate analyses found that C reactive protein (CRP) and rheumatoid factor (RF) positivity at baseline were predictive of SRP after 2 and 3 years (p<0.05 for all). The matrix risk model showed that RF positivity and CRP levels >40 mg/L at baseline were significantly associated with SRP after 2 (p<0.05 for both; R2=0.24) and 3 years (p<0.05 for both; R2=0.22). The baseline erosion score was not found to be predictive of SRP. Conclusions Patients with sustained moderate RA despite receiving MTX treatment are at risk of SRP, with both RF positivity and high CRP levels shown to be predictive of this.
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Affiliation(s)
- B Fautrel
- UPMC-GRC 08 (EEMOIS) , Paris , France ; AP-HP, Pitie Salpetriere Hospital, Dept of Rheumatology , Paris , France
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19
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Kotak S, Mardekian J, Horowicz-Mehler N, Shah A, Burgess A, Kim J, Gemmen E, Boyd H, Koenig A. Impact of Etanercept Therapy on Disease Activity and Health-Related Quality of Life in Moderate Rheumatoid Arthritis Patients Population from a National British Observational Cohort. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2015; 18:817-823. [PMID: 26409609 DOI: 10.1016/j.jval.2015.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 03/20/2015] [Accepted: 05/05/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To describe a population with moderate rheumatoid arthritis (RA) before biologic initiation and assess change in disease status, health-related quality of life (HRQOL), and adverse events in etanercept (ETN)-treated patients. METHODS Data on adult patients with moderate RA (3.2 < Disease Activity Score in 28 Joints [DAS28] ≤ 5.1) were retrospectively analyzed from the British Society for Rheumatology Biologics Register comparing a nonbiologic-treated group (nBG) using at least one traditional disease-modifying antirheumatic drug to a biologic group (BG) treated with ETN. The HRQOL was assessed by using the Health Assessment Questionnaire disability index score. To mitigate confounding, we controlled for drivers of progression. Appropriate univariate, multivariate, and regression analyses were used. RESULTS A total of 1754 patients with RA were assessed (211 BG and 1543 nBG). Compared with the nBG, the BG tended toward higher disease activity, such as significantly higher tender joints and DAS28. The BG compared with the nBG had 1) a greater reduction in DAS28 and Health Assessment Questionnaire scores; 2) disease remission occurring more often (odds ratio = 2.7; P = 0.006); and 3) progression occurring in fewer patients (odds ratio = 0.3; P = 0.002). BG patients had a higher incidence of "other serious infection" and "other central nervous system-related events," with no significant differences in associated hospitalization rates or deaths. CONCLUSIONS Among patients with moderate RA from a clinical practice registry, ETN-treated patients had significantly higher disease activity at the time of biologic initiation but significantly reduced disease activity and better HRQOL after 6 months compared with nBG patients, although the possibility of unmeasured confounding remains. The ETN group reported significantly higher incidences of "other serious infections" and "other central nervous system-related events" without higher hospitalization rates.
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20
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Hirota T, Suzuki T, Ogishima H, Hagiwara S, Ebe H, Takahashi H, Yokosawa M, Umeda N, Kondo Y, Tsuboi H, Matsumoto I, Sumida T. Evaluation of changes in magnetic resonance images following 24 and 52 weeks of treatment of rheumatoid arthritis with infliximab, tocilizumab, or abatacept. Mod Rheumatol 2015; 26:29-35. [DOI: 10.3109/14397595.2015.1069471] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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21
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Gogna R, Cheung G, Arundell M, Deighton C, Lindau TR. Rheumatoid hand surgery: is there a decline? A 22-year population-based study. Hand (N Y) 2015; 10:272-8. [PMID: 26034443 PMCID: PMC4447684 DOI: 10.1007/s11552-014-9708-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Rheumatoid arthritis (RA) is the most common idiopathic inflammatory arthritis affecting 0.8 % of the population. It can cause significant hand and wrist damage and dysfunction. Recent advances in anti-rheumatic treatments have the potential to decrease the prevalence of hand deformities in patients with RA. Our aim was to investigate whether there has been a decline over 22-years in the number of hand surgical procedures being undertaken for patients with RA and whether this correlates with the introduction of new anti-rheumatic therapies. METHODS We performed a retrospective, population-based (Derbyshire) study of all patients with RA who underwent hand surgery at the Pulvertaft Hand Centre from 1990 to 2012. Index procedures included (1) teno-synovectomy and soft tissue procedures, (2) wrist arthrodesis/arthroplasty and (3) finger arthrodesis. RESULTS A total of 297 procedures were performed in 153 Derbyshire patients with RA over the 22-year period, with mean age at surgery 59 years (range 24-88 years). The female to male ratio was 2.5:1. The overall trend showed a peak in 2004 and a subsequent decline thereafter. This coincides with an increasing tendency by local rheumatologists to introduce earlier and more intensive conventional disease-modifying drugs and biological therapies for more resistant disease. CONCLUSIONS There has been a decline in the number of hand surgery procedures being performed on patients with RA during our 22-year population-based study. It indicates that medical treatments and strategies have been successful at preventing disease progression.
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Affiliation(s)
- Rajiv Gogna
- />Department of Trauma and Orthopaedics, University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX UK
| | - Graham Cheung
- />Department of Trauma and Orthopaedics, Royal Liverpool Hospitals, Prescot St, Liverpool, Merseyside L7 8XP UK
| | - Melanie Arundell
- />The Pulvertaft Hand Centre, Royal Derby Hospital, Kings Treatment Centre (KTC), Uttoxeter Road, Derby, DE22 3NE UK
| | - Chris Deighton
- />Department of Rheumatology, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE UK
| | - Tommy R. Lindau
- />The Pulvertaft Hand Centre, Royal Derby Hospital, Kings Treatment Centre (KTC), Uttoxeter Road, Derby, DE22 3NE UK
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Johansson K, Eriksson JK, van Vollenhoven R, Miller H, Askling J, Neovius M. Does disease activity at the start of biologic therapy influence health care costs in patients with RA? Rheumatology (Oxford) 2015; 54:1472-7. [PMID: 25796560 DOI: 10.1093/rheumatology/kev021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To investigate whether disease activity at baseline influences health care costs in patients with RA initiating biologic treatment. METHODS In the Swedish Biologics Register, we identified patients with RA with baseline 28-joint DAS (DAS28) recorded and starting their first biologic in 2007-11 [n = 1638 with moderate disease activity (DAS28 3.2-5.1) and n = 1870 with high disease activity (DAS28 > 5.1)]. Data on inpatient and outpatient care and prescription drugs were retrieved from nationwide registers. Mean cost differences were estimated adjusted for age, sex and costs the year before treatment start. RESULTS Patients with high (vs moderate) disease activity were older (60 vs 56 years; P < 0.001), but did not differ in sex distribution (75 vs 74% women; P = 0.99) or disease duration (10 vs 10 years; P = 0.13). The year after initiation of biologics, patients with high (vs moderate) baseline disease activity accumulated 9% higher health care costs, but the difference was not statistically significant after adjustment [€19,333 vs €17,810; adjusted difference €870 (95% CI -2, 1742)]. In the subgroup of patients with up to 4 years of follow-up data, decreasing costs were observed over the follow-up time, but no difference was found between patients with high compared with moderate baseline disease activity [€13,704 vs €12,349; adjusted difference 878 (95% CI -364, 2120)]. Irrespective of baseline disease activity, health care costs were approximately three times higher the year after initiation of biologics than the year before due to increased drug costs. CONCLUSION Over up to 4 years of follow-up, no difference in health care costs was found after adjustment in patients starting their first biologic treatment with high vs moderate baseline disease activity.
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Affiliation(s)
| | | | - Ronald van Vollenhoven
- CLINTRID and Rheumatology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Johan Askling
- Clinical Epidemiology Unit, Rheumatology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
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23
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Kang JH, Park DJ, Lee JW, Lee KE, Wen L, Kim TJ, Park YW, Lee SS. Drug survival rates of tumor necrosis factor inhibitors in patients with rheumatoid arthritis and ankylosing spondylitis. J Korean Med Sci 2014; 29:1205-11. [PMID: 25246737 PMCID: PMC4168172 DOI: 10.3346/jkms.2014.29.9.1205] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Accepted: 06/03/2014] [Indexed: 11/20/2022] Open
Abstract
We investigated the compliance of Korean patients using tumor necrosis factor (TNF) inhibitors to treat rheumatoid arthritis (RA) and ankylosing spondylitis (AS), and identified potential predictors associated with treatment discontinuation. The study population comprised 114 RA and 310 AS patients treated with TNF inhibitors at a single tertiary center for at least 1 yr from December 2002 to November 2011. Of the 114 RA patients, 64 (56.1%) discontinued their first TNF inhibitors with a mean duration of 18.1 months. By contrast, 65 of 310 patients (21.0%) with AS discontinued their first TNF inhibitors, with a mean duration of 84 months. Although the survival rate did not differ among the three TNF inhibitors in the AS patients, the etanercept group had a lower discontinuation rate than the infliximab group in the RA patients. In addition, RA patients who received corticosteroids in combination with TNF inhibitors were more likely to discontinue their TNF inhibitors. The independent predictors of drug discontinuation in AS patients were male gender and complete ankylosis on radiographs of the sacroiliac joint. Our results provide further evidence that real-life treatment outcomes of RA and AS patients may be different from those observed in randomized clinical trials.
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Affiliation(s)
- Ji-Hyoun Kang
- Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School & Hospital, Gwangju, Korea
| | - Dong-Jin Park
- Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School & Hospital, Gwangju, Korea
| | - Jeong-Won Lee
- Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School & Hospital, Gwangju, Korea
| | - Kyung-Eun Lee
- Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School & Hospital, Gwangju, Korea
| | - Lihui Wen
- Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School & Hospital, Gwangju, Korea
| | - Tae-Jong Kim
- Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School & Hospital, Gwangju, Korea
| | - Yong-Wook Park
- Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School & Hospital, Gwangju, Korea
| | - Shin-Seok Lee
- Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School & Hospital, Gwangju, Korea
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24
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Diamantopoulos A, Finckh A, Huizinga T, Sungher DK, Sawyer L, Neto D, Dejonckheere F. Tocilizumab in the treatment of rheumatoid arthritis: a cost-effectiveness analysis in the UK. PHARMACOECONOMICS 2014; 32:775-87. [PMID: 24854959 PMCID: PMC4113684 DOI: 10.1007/s40273-014-0165-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND Since receiving a positive recommendation in England, Wales and Scotland, tocilizumab (TCZ) is one of the options available to clinicians for the treatment of rheumatoid arthritis (RA) patients in the UK. OBJECTIVE The objective of this study was to evaluate the cost effectiveness of adding TCZ to the current treatment sequence of RA patients from a UK payer's perspective over a patient lifetime horizon. METHODS An individual sampling model was developed to synthesise all clinical and economic inputs. Two scenarios were explored separately: patients contraindicated to methotrexate (MTX) and those MTX tolerant. For each scenario, the analysis compared three strategies. The standard of care (SoC) strategy included a sequence of the most commonly prescribed biologics; the other two comparator strategies considered the addition of TCZ to SoC at first line and second line. Patient characteristics were representative of UK patients. Treatment efficacy and quality-of-life evidence were synthesised from clinical trials and secondary sources. An analysis of a patient registry informed the model parameters regarding treatment discontinuation. The safety profile of all treatments in a given strategy was based on a network meta-analysis and literature review. Resource utilisation, treatment acquisition, administration, monitoring and adverse event treatment costs were considered. All costs reflect 2012 prices. Uncertainty in model parameters was explored by one-way and probabilistic sensitivity analysis. RESULTS In the MTX-contraindicated population, if TCZ was added to the SoC in first line, the estimated incremental cost-effectiveness ratio (ICER) was £7,300 per quality-adjusted life-year (QALY) gained; if added in second line, the estimated ICER was £11,400 per QALY. In the MTX-tolerant population, the estimated costs and QALYs of the TCZ strategy were similar to those of the SoC strategy. Sensitivity analysis showed that parameters that affect the treatment cost (such as patient weight) can have a noticeable impact on the overall cost-effectiveness results. The majority of the other sensitivity analyses resulted in modest changes to the ICER. CONCLUSION For the treatment of RA in MTX-tolerant and contraindicated patients, the addition of TCZ to the SoC was estimated to be a cost-effective strategy.
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MESH Headings
- Anti-Inflammatory Agents/administration & dosage
- Anti-Inflammatory Agents/adverse effects
- Anti-Inflammatory Agents/economics
- Anti-Inflammatory Agents/therapeutic use
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/adverse effects
- Antibodies, Monoclonal, Humanized/economics
- Antibodies, Monoclonal, Humanized/therapeutic use
- Arthritis, Rheumatoid/drug therapy
- Arthritis, Rheumatoid/economics
- Arthritis, Rheumatoid/immunology
- Contraindications
- Cost-Benefit Analysis
- Drug Costs
- Drug Therapy, Combination
- Humans
- Interleukin-6/antagonists & inhibitors
- Methotrexate
- Models, Economic
- Quality of Life
- Surveys and Questionnaires
- Treatment Outcome
- United Kingdom
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Affiliation(s)
- Alex Diamantopoulos
- Symmetron Limited, Kinetic Centre, Theobald Street, Elstree, London, WD6 4PJ, UK,
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Shen S, Guo J, Luo Y, Zhang W, Cui Y, Wang Q, Zhang Z, Wang T. Functional proteomics revealed IL-1β amplifies TNF downstream protein signals in human synoviocytes in a TNF-independent manner. Biochem Biophys Res Commun 2014; 450:538-44. [DOI: 10.1016/j.bbrc.2014.06.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 06/02/2014] [Indexed: 10/25/2022]
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Leukocyte production of inflammatory mediators is inhibited by the antioxidants phloretin, silymarin, hesperetin, and resveratrol. Mediators Inflamm 2014; 2014:938712. [PMID: 24707119 PMCID: PMC3953573 DOI: 10.1155/2014/938712] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 01/09/2014] [Accepted: 01/11/2014] [Indexed: 12/18/2022] Open
Abstract
Antioxidants possess significant therapeutic potential for the treatment of inflammatory disorders. One such disorder is periodontitis characterised by an antimicrobial immune response, inflammation, and irreversible changes to the supporting structures of the teeth. Recognition of conserved pathogen-associated molecular patterns is a crucial component of innate immunity to Gram-negative bacteria such as Escherichia coli, as well as the periodontal pathogen Aggregatibacter actinomycetemcomitans. In this study, we investigated the antioxidants Phloretin, Silymarin, Hesperetin, and Resveratrol to ascertain whether they altered the production of inflammatory mediators by innately-activated leukocytes. Peripheral blood mononuclear cells were stimulated with lipopolysaccharide purified from Aggregatibacter actinomycetemcomitans, and the production of cytokines, chemokines, and differentiation factors was assayed by enzyme-linked immunosorbent assay, cytometric bead array, and RT-PCR. Significant inhibition of these factors was achieved upon treatment with Phloretin, Silymarin, Hesperetin, and Resveratrol. These data further characterise the potent anti-inflammatory properties of antioxidants. Their ability to inhibit the production of inflammatory cytokines, chemokines, and differentiation factors by a heterogeneous population of leukocytes has clear implications for their therapeutic potential in vivo.
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Smolen JS, Emery P, Ferraccioli GF, Samborski W, Berenbaum F, Davies OR, Koetse W, Purcaru O, Bennett B, Burkhardt H. Certolizumab pegol in rheumatoid arthritis patients with low to moderate activity: the CERTAIN double-blind, randomised, placebo-controlled trial. Ann Rheum Dis 2014; 74:843-50. [PMID: 24431394 PMCID: PMC4392224 DOI: 10.1136/annrheumdis-2013-204632] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 12/14/2013] [Indexed: 12/29/2022]
Abstract
Objectives This 52-week, randomised, double-blind phase IIIb study assessed efficacy and safety of certolizumab pegol (CZP) as add-on therapy to non-biologic disease-modifying antirheumatic drugs (DMARDs) in rheumatoid arthritis (RA) patients with low to moderate disease activity, and stopping therapy in patients in sustained remission. Methods Patients were randomised 1:1 to CZP (400 mg at weeks 0, 2 and 4, then 200 mg every 2 weeks) or placebo (every 2 weeks) plus current non-biologic DMARDs. At week 24, patients who achieved the primary endpoint of Clinical Disease Activity Index (CDAI) remission at both weeks 20 and 24 stopped study treatment and continued in the study until week 52. Results Of 194 patients (CZP=96; placebo=98), >90% had moderate disease activity at baseline. Significantly more CZP patients met the primary endpoint than placebo patients (week 20 and 24 CDAI remission rates: 18.8% vs 6.1%; p≤0.05). At week 24, 63.0% vs 29.7% of CZP versus placebo patients (p<0.001) achieved LDA. Disease activity score (ESR) based on 28-joint count and Simplified Disease Activity Index remission rates were also significantly higher with CZP versus placebo (19.8% vs 3.1%; p≤0.01 and 14.6% vs 4.1%; p≤0.05). CZP patients reported improvements in physical function versus placebo (mean Health Assessment Questionnaire-Disability-Index change from baseline: CZP, −0.25 vs placebo, −0.03; p≤0.01). During the period following withdrawal of CZP or placebo, only 3/17 prior CZP patients and 2/6 prior placebo patients maintained CDAI remission until week 52, but CZP reinstitution allowed renewed improvement. Adverse and serious adverse event rates were comparable between CZP and placebo groups. Conclusions Addition of CZP to non-biologic DMARDs is an effective treatment in RA patients with predominantly moderate disease activity, allowing low-disease activity or remission to be reached in a majority of the patients. However, the data suggest that CZP cannot be withdrawn in patients achieving remission. Trial registration number NCT00674362.
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Affiliation(s)
- J S Smolen
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, and 2nd Department of Medicine, Hietzing Hospital, Vienna, Austria
| | - P Emery
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - G F Ferraccioli
- Institute of Rheumatology and Affine Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - W Samborski
- University of Medical Sciences, Poznan, Poland
| | - F Berenbaum
- Department of Rheumatology, DHU i2B, INSERM UMR-S938, Pierre & Marie Curie University Paris 06, Saint-Antoine hospital, AP-HP, Paris, France
| | | | - W Koetse
- UCB Pharma, Raleigh, North Carolina, USA
| | | | | | - H Burkhardt
- CIRI/Division of Rheumatology and Fraunhofer TMP, Goethe-University, Frankfurt am Main, Germany
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Predictors of response to anti-TNF therapy in RA patients with moderate or high DAS28 scores. Joint Bone Spine 2014; 81:37-40. [DOI: 10.1016/j.jbspin.2013.04.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 04/06/2013] [Indexed: 11/23/2022]
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Iannone F, Gremese E, Gallo G, Sarzi-Puttini P, Botsios C, Trotta F, Gasperini S, Galeazzi M, Adami S, Cantini F, Sebastiani M, Gorla R, Marchesoni A, Giardina A, Foti R, Mele A, Bruschi E, Bagnato G, Erre GL, Lapadula G. High rate of disease remission in moderate rheumatoid arthritis on etanercept therapy: data from GISEA, the Italian biologics register. Clin Rheumatol 2013; 33:31-7. [PMID: 23954923 DOI: 10.1007/s10067-013-2348-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 07/15/2013] [Accepted: 07/21/2013] [Indexed: 12/16/2022]
Abstract
The aim of this study was to evaluate the clinical outcomes of etanercept in rheumatoid arthritis (RA) patients with moderate or severe disease activity. We analyzed data from the Italian biologics register Gruppo Italiano Studio Early Arthritides (GISEA) to investigate the rate of disease remission and functional improvement, based on the 28-Joint Disease Activity Score (DAS28) and the (Health Assessment Questionnaire (HAQ) score in RA patients with moderate or severe disease activity beginning etanercept therapy. Disease was defined as severe (H-RA) with DAS28 ≥5.1 and moderate (M-RA) with DAS28 ≥3.2 to 5.1 at baseline. Patients were considered in remission if DAS28 was ≤2.6, and HAQ ≤0.5 defined normal function. We enrolled 953 RA patients, 320 with M-RA and 633 H-RA. Age and disease duration were similar in the two cohorts, but H-RA patients had significantly more comorbidities (p < 0.01) and took significantly more disease-modifying antirheumatic drugs (p < 0.001) than M-RA patients. After 1 year, the percentage of patients achieving disease remission and normal function (DAS28 ≤2.6 plus HAQ ≤0.5) was higher in M-RA (21.4 %) than in H-RA patients (14.8 %, p = 0.007), regardless of the disease duration. Additionally, female gender (p = 0.006) and H-RA class (p = 0.002) negatively predicted disease remission at 1 year. However, the drug survival rate did not differ between the two subsets. This study confirms that etanercept was effective in the treatment of active RA, but best response, in terms of disease remission and normal function ability, was greater and easier to attain in M-RA patients. These findings may aid clinicians to choose the best strategy to treat RA.
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Affiliation(s)
- Florenzo Iannone
- Interdisciplinary Department of Medicine, Rheumatology Unit, Policlinico, Piazza G. Cesare 11, 70124, Bari, Italy,
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Ibrahim I, Owen SA, Barton A. Genetics and the impact on treatment protocols in patients with rheumatoid arthritis. Expert Rev Clin Immunol 2013; 8:509-11. [PMID: 22992143 DOI: 10.1586/eci.12.51] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Ibrahim Ibrahim
- Arthritis Research UK Epidemiology Unit, Manchester Academy of Health Sciences, University of Manchester, Stopford Building, Oxford Road, Manchester, UK
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31
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Suzuki T, Horikoshi M, Sugihara M, Hirota T, Ogishima H, Umeda N, Kondo Y, Tsuboi H, Hayashi T, Chino Y, Matsumoto I, Sumida T. Therapeutic efficacy of tocilizumab in patients with rheumatoid arthritis refractory to anti-tumor-necrosis-factor inhibitors: 1 year follow-up with low-field extremity MRI. Mod Rheumatol 2012; 23:782-7. [PMID: 22975733 DOI: 10.1007/s10165-012-0746-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 08/06/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Tocilizumab (TCZ) is effective in patients with rheumatoid arthritis (RA) who are refractory to anti-tumor-necrosis-factor (anti-TNF) biologics. The Rheumatoid Arthritis Society Disease Activity Score in 28 Joints (DAS28) is used to evaluate the response to TCZ. However, DAS28 is inappropriate marker because TCZ normalizes C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) in the early stage of treatment. The aim of our study was to test the usefulness of magnetic resonance imaging (MRI)-based markers of response to TCZ treatment. METHODS Nine patients with RA who were refractory to anti-TNF inhibitors (six to infliximab, one to etanercept, one to adalimumab, and one to both) were assessed. MRI images of both hands were obtained by low-field extremity MRI at baseline, 20, and 44 weeks of treatment, in addition to assessment with DAS28-ESR. The effect of TCZ on RA was examined by compact MRI score (cMRIS). RESULTS All patients showed good or moderate response to TCZ treatment, as evaluated by significant reduction in DAS28-ESR at both 20 and 44 weeks (p < 0.001, each, relative to baseline). In contrast, MRI-based indexes (e.g., cMRIS, synovitis, edema, erosion scores) improved significantly at 44 weeks but not at 20 weeks. CONCLUSION Differences in response to TCZ therapy were determined based on the method of evaluation, suggesting that MRI-based markers are potentially useful for evaluating RA response to TCZ therapy.
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Affiliation(s)
- Takeshi Suzuki
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
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High Survivin Levels Predict Poor Clinical Response to Infliximab Treatment in Patients with Rheumatoid Arthritis. Semin Arthritis Rheum 2012; 41:652-7. [DOI: 10.1016/j.semarthrit.2011.08.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Revised: 04/15/2011] [Accepted: 08/22/2011] [Indexed: 01/24/2023]
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Kingsley G, Scott IC, Scott DL. Quality of life and the outcome of established rheumatoid arthritis. Best Pract Res Clin Rheumatol 2012; 25:585-606. [PMID: 22137926 DOI: 10.1016/j.berh.2011.10.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Accepted: 10/11/2011] [Indexed: 02/01/2023]
Abstract
Rheumatoid arthritis (RA) is a long-term condition causing joint pain and swelling and sometimes systemic involvement. The aims of treatment are, first, to reduce the impact the disease has on a patient and, second, to halt progression of disease. The advent of intensive therapy, including biologics, has led to a major improvement in outcome. To assess treatment impact, formal outcome measures have been developed. Traditionally, these focussed on the clinical aspects such as disease activity and joint damage. More recently, there has been an increased focus on patient-related outcome measures including quality-of-life measures. These enable illness evaluation from patients' perspectives, examination of care quality and comparison of the effectiveness and cost-effectiveness of treatment. This article examines advantages and disadvantages of the various outcome measures which are generally used in RA, with a focus on quality of life and patient-related measures.
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Affiliation(s)
- Gabrielle Kingsley
- Department of Rheumatology, King's College London School of Medicine, Weston Education Centre, UK.
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Wade AG, Crawford GM, Pumford N, Koscielny V, Maycock S, McConnachie A. Baseline characteristics and patient reported outcome data of patients prescribed etanercept: web-based and telephone evaluation. BMC Med Res Methodol 2011; 11:91. [PMID: 21672203 PMCID: PMC3141801 DOI: 10.1186/1471-2288-11-91] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Accepted: 06/14/2011] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The anti-TNF inhibitor, etanercept is administered as a once or twice weekly subcutaneous injection for the treatment of rheumatoid arthritis, psoriasis, ankylosing spondylitis, psoriatic arthritis and juvenile idiopathic arthritis (JIA). Limited data from the patients' perspective are available on the use of biologics in the treatment of these chronic conditions and this evaluation was designed to collect data from patients who had been prescribed etanercept for the first time. This manuscript describes the self-reported baseline characteristics and health-related quality of life of patients prior to treatment. Follow-up data will be reported separately. METHODS Patients throughout the United Kingdom prescribed etanercept were invited to participate in an evaluation of their condition and treatment using a data collection tool consisting of a web-based system supplemented by telephone reporting (PROBE). Outcome measures reported at baseline included demographic data, the condition being treated, previous treatment with biologic agents and current and previous medications. Questions modified from standard, validated quality of life questionnaires such as EQ-5D were incorporated and patients made a global assessment of the severity of their own illness using the CGI-S scale. RESULTS A total of 344 patients/carers/parents participated in the evaluation at baseline, 290 (84%) by online questionnaire and 54 (16%) by telephone. Overall, the study population had a mean age of 53 years, was predominantly female (62%) and 20% had been previously treated with a biologic agent. A total of 191 (56%) patients were receiving treatment with etanercept for rheumatoid arthritis, 44 (13%) for psoriatic arthritis, 43 (13%) for ankylosing spondylitis, 35 (10%) for psoriasis, 9 (3%) for known juvenile idiopathic arthritis (JIA) and 22 (6%) for another condition/patient unsure/missing response. All patients were prescribed the 50 mg weekly dose of etanercept except for 1 patient with JIA (40 mg) dose and 2 patients with psoriasis (100 mg). Thirty-eight percent of patients with rheumatoid arthritis were not receiving treatment with methotrexate. CONCLUSIONS The baseline characteristics and health-related quality of life of first time users of etanercept can be adequately described using self-reported patient data collected using an online questionnaire with a telephone option (PROBE).
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Affiliation(s)
| | | | | | | | | | - Alex McConnachie
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
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Kapetanovic MC, Lindqvist E, Geborek P, Saxne T, Eberhard K. Long-term mortality rate in rheumatoid arthritis patients with disease onset in the 1980s. Scand J Rheumatol 2011; 40:433-8. [DOI: 10.3109/03009742.2011.573503] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Anti-TNF-α therapy has become the most effective biological treatment for rheumatoid arthritis. Despite having changed the prognosis of the disease establishing new targets for treatment strategy, there are several aspects that still remain unmatched. About 30% of the patients with rheumatoid arthritis have a less than satisfactory response to anti-TNF therapy, which has led the way for the pursuit of new targets and approaches to treatment. IL-6 is one of these alternative targets and data from the more recent clinical trials involving tocilizumab (an anti-IL-6 soluble receptor antibody) suggest advantages in relation to some clinical aspects which are not addressed by anti-TNF-α treatment.
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Affiliation(s)
- J D Alves
- Department of Medicine IV, Fernando da Fonseca Hospital, Lisbon, Portugal.
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Tamori A, Koike T, Goto H, Wakitani S, Tada M, Morikawa H, Enomoto M, Inaba M, Nakatani T, Hino M, Kawada N. Prospective study of reactivation of hepatitis B virus in patients with rheumatoid arthritis who received immunosuppressive therapy: evaluation of both HBsAg-positive and HBsAg-negative cohorts. J Gastroenterol 2011; 46:556-64. [PMID: 21246383 DOI: 10.1007/s00535-010-0367-5] [Citation(s) in RCA: 120] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Accepted: 12/21/2010] [Indexed: 02/04/2023]
Abstract
BACKGROUND Screening and prophylactic treatment for hepatitis B virus (HBV) reactivation is recommended for patients who receive immunosuppressive or cytotoxic therapy. The aim of this study was to clarify the prevalence of HBV reactivation in rheumatoid arthritis (RA) patients who had received more than 1 year of immunosuppressive therapy. This study also evaluated guidelines for determining HBV reactivation in patients with RA. METHODS This was a prospective non-randomized, non-controlled study. We enrolled 50 patients with RA who had antibodies against hepatitis B core antigen (anti-HBc) and who had started treatment with disease-modifying anti-rheumatic drugs, including those who had additionally received anti-tumor necrosis factor-α (anti-TNF-α). HBV DNA levels were measured every 2-3 months by a real-time, polymerase chain reaction-based method. Entecavir was administered to patients with HBV DNA levels >2.1 log/ml. RESULTS The mean observation period was 23 months (range 12-32 months). HBV reactivation occurred in 2 of 5 patients with HBV surface antigen (HBsAg) and in 1 of 45 patients without HBsAg. In patients who received anti-TNF-α therapy, antibodies against HBsAg decreased significantly. Entecavir therapy inhibited HBV amplification and prevented HBV-associated flares of hepatitis. CONCLUSIONS The incidence of HBV reactivation was low in RA patients in whom HBV infection had been resolved. Screening for HBV reactivation and prophylactic therapy with entecavir were effective means of preventing HBV-associated hepatic failure in patients with HBsAg, as well as in those with only anti-HBc who received immunosuppressive therapy for RA.
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Affiliation(s)
- Akihiro Tamori
- Department of Hepatology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka 545-8585, Japan.
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Kiely P, Walsh D, Williams R, Young A. Outcome in rheumatoid arthritis patients with continued conventional therapy for moderate disease activity--the early RA network (ERAN). Rheumatology (Oxford) 2010; 50:926-31. [DOI: 10.1093/rheumatology/keq406] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Staples MP, March L, Lassere M, Reid C, Buchbinder R. Health-related quality of life and continuation rate on first-line anti-tumour necrosis factor therapy among rheumatoid arthritis patients from the Australian Rheumatology Association Database. Rheumatology (Oxford) 2010; 50:166-75. [PMID: 20929971 DOI: 10.1093/rheumatology/keq322] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To describe changes in health-related quality of life (HRQoL) up to 60 months after commencing anti-TNF therapy for RA patients enrolled in the Australian Rheumatology Association Database (ARAD), and to determine the continuation rate and predictors of discontinuation of first-line anti-TNF therapy. METHODS Responses to the HAQ, Assessment of Quality of Life, Medical Outcomes Study Short Form-36 (SF-36) and European Quality of Life-5 Dimensions (EQ-5D) were extracted from ARAD for patients commencing anti-TNF therapy and analysed in 6-monthly intervals from the start date. Predictors of discontinuation of therapy were assessed using Cox regression. RESULTS Since September 2001, 2601 RA patients have enrolled in ARAD; 1801 have used anti-TNF therapy. Before starting the therapy, all HRQoL scores were below the population norms, but showed improvements in the first 6 months. From 12 to 60 months, HRQoL remained stable but below population means. Data to 60 months were available for 106 patients; 47% were still on first-line therapy at 5 years, all were using concurrent DMARDs and 55% were using concurrent prednisolone. Predictors of discontinuation of therapy were poorer HRQoL scores, a more recent therapy start date, concurrent prednisolone use and self-reported severe infection. Older patients and those with longer symptom duration were more likely to remain on therapy. CONCLUSIONS In routine practice, HRQoL scores improve rapidly within 6 months of starting anti-TNFs and then remain stable for up to 60 months. Almost half remain on first-line therapy.
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Affiliation(s)
- Margaret P Staples
- Monash Department of Clinical Epidemiology, Cabrini Hospital, and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Cabrini Institute, 183 Wattletree Rd, Malvern, Victoria, Australia 3144.
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Conaghan PG, Hensor EMA, Keenan AM, Morgan AW, Emery P. Persistently moderate DAS-28 is not benign: loss of function occurs in early RA despite step-up DMARD therapy. Rheumatology (Oxford) 2010; 49:1894-9. [PMID: 20542894 DOI: 10.1093/rheumatology/keq178] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Current UK management of RA initially employs conventional DMARDs, with biological therapy reserved for DMARD-resistant RA patients with persistently high 28-joint disease activity score (DAS-28). The aim of this study was to examine the effect on patient-reported function of persistently moderate DAS-28 despite modern step-up DMARD therapy in an early arthritis cohort. METHODS Data were obtained from the Yorkshire Early Arthritis Register, a cohort of early (<12 months) RA patients treated with dose-escalated DMARDs. Change in HAQ exceeding the minimum clinically important difference (MCID) was determined for three values of MCID (0.22, 0.31 and 0.49). Changes in HAQ over Months 6-12 were compared between patients whose DAS-28(ESR) was persistently high (> 5.1 at 6- and/or 9-month visits and at the 12-month visit), persistently moderate (>3.2 and ≤ 5.1) or persistently low (≤ 3.2). RESULTS We selected 194 patients for this analysis. Deteriorating HAQ scores were observed in 10.9% of patients with persistently low DAS-28 compared with 21.4% (persistently moderate DAS-28) and 46.7% (persistently high DAS-28), respectively, for MCID = 0.22; 7.3, 14.3 and 20.0% for MCID = 0.31; 5.5, 10.7 and 11.1% for MCID = 0.49. CONCLUSIONS A high DAS-28 was generally associated with a greater degree of functional decline, but persistent moderate elevation of DAS-28 was associated with important functional deterioration in 10-21% of early RA patients (depending on choice of MCID) following a modern DMARD protocol. A proportion of patients with persistently moderate DAS-28 may therefore benefit from more aggressive therapy than that allowed by current UK recommendations.
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Affiliation(s)
- Philip G Conaghan
- Section of Musculoskeletal Disease, Chapel Allerton Hospital, Leeds, UK.
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Deighton C, Hyrich K, Ding T, Ledingham J, Lunt M, Luqmani R, Kiely P, Bukhari M, Abernethy R, Ostor A, Bosworth A, Gadsby K, McKenna F, Finney D, Dixey J. BSR and BHPR rheumatoid arthritis guidelines on eligibility criteria for the first biological therapy. Rheumatology (Oxford) 2010; 49:1197-9. [DOI: 10.1093/rheumatology/keq006a] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Deighton C, Hyrich K, Ding T, Ledingham J, Lunt M, Luqmani R, Kiely P, Bukhari M, Abernethy R, Ostor A, Bosworth A, Gadsby K, McKenna F, Finney D, Dixey J. BSR and BHPR rheumatoid arthritis guidelines on eligibility criteria for the first biological therapy. Rheumatology (Oxford) 2010:keq006b. [PMID: 20308120 DOI: 10.1093/rheumatology/keq006b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024] Open
Affiliation(s)
- Chris Deighton
- Rheumatology Department, Royal Derby Hospital, Derby, ARC Epidemiology Unit, University of Manchester, Manchester, Rheumatology Unit, Queen Alexandra Hospital, Portsmouth, Rheumatology Department, Nuffield Orthopaedic Centre, Oxford, Rheumatology Department, St George's Healthcare, London, Rheumatology Department, Royal Lancaster Infirmary, Lancaster, Rheumatology Department, St Helens Hospital, St Helens, Rheumatology Department, Addenbrooke's Hospital, Cambridge, National Rheumatoid Arthritis Society, Maidenhead, Department of Rheumatology, Trafford General Hospital, Manchester, Rheumatology Unit, Worthing and Southlands NHS Trust, Worthing and Department of Rheumatology, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK
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Zetzmann CP, Swamy OR, Loss GE, Bohorquez H, Cohen AJ. Improving Donor Livers by Inhibiting TNF-α Production. Ochsner J 2010; 10:250-255. [PMID: 21603393 PMCID: PMC3096233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
Hepatic ischemia/reperfusion (I/R) injury has a significant influence on the outcome of liver transplants. Inhibiting certain enzymatic reactions that occur during I/R injury may have a protective effect on the liver during transplantation. After reviewing the biochemical pathways involved in hepatic I/R injury, we describe a pharmacologic line of defense against this injury by means of the enzyme tissue inhibitor of metalloproteinase 3 (TIMP-3). Current results suggest that TIMP-3 will play a clinically relevant role in improving outcomes of liver transplants by reducing I/R injury to the donor liver.
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Affiliation(s)
| | | | | | | | - Ari J. Cohen
- Address correspondence to: Ari J Cohen, MD, Transplantation Research Laboratory, Ochsner Clinic Foundation, 1514 Jefferson Highway, New Orleans, LA 70121, (504) 842-3925, (504) 842-5746, e-mail:
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Affiliation(s)
- Sang-Heon Lee
- Division of Rheumatology, School of Medicine, Konkuk University, Seoul, Korea
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