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Larid G, Baudens G, Tiemdjo-Djimaffo G, Coquerelle P, Goeb V, Guyot MH, Marguerie L, Maury F, Veillard E, Houvenagel E, Salmon JH, Flipo RM, Gervais E. Retention rate of subcutaneous TNF inhibitors in axial spondyloarthritis in a multicentre study from the RIC-FRANCE network. Sci Rep 2024; 14:1374. [PMID: 38228719 PMCID: PMC10791989 DOI: 10.1038/s41598-024-52016-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 01/12/2024] [Indexed: 01/18/2024] Open
Abstract
The objectives of our study were to assess retention rate, safety, and predictive factors for retention of subcutaneous (SC) TNF inhibitors (TNFi) (adalimumab (ADA), etanercept (ETN), golimumab (GOL), and certolizumab pegol (CZP)) in axial spondyloarthritis (axSpA) depending on the line of treatment in real-life conditions. A multicentre retrospective observational study was conducted including 552 patients fulfilling the ASAS criteria for axSpA followed in the RIC-France register who began SC-TNFi between 01/01/13 and 08/31/2018 for a total of 824 prescriptions. Taking all lines of treatment into account, GOL had a significantly higher retention rate compared with ADA, ETN, and CZP with a mean retention length of 59 months. As first-line bDMARDs, GOL had a significantly higher retention rate compared with ADA and ETN. ETN had the best retention rate when prescribed as at least 3rd bDMARD. Taking all lines of treatment into account, female sex, peripheral disease, BASDAI at initiation, and line of treatment were predictive factors for treatment cessation. Primary inefficiency was the most frequent reason for treatment cessation. In conclusion, GOL showed the highest retention rate in axSpA. Male sex, absence of peripheral disease, and early line of prescription were associated with better SC-TNFi retention in axSpA.
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Affiliation(s)
- Guillaume Larid
- LITEC, Université de Poitiers, CHU Poitiers, 86000, Poitiers, France.
| | | | | | | | - Vincent Goeb
- University Hospital of Amiens-Picardie, Amiens, France
| | | | | | | | | | | | | | | | - Elisabeth Gervais
- LITEC, Université de Poitiers, CHU Poitiers, 86000, Poitiers, France
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Dalén J, Puenpatom A, Luttropp K, Svedbom A, Black CM. Treatment Persistence in Patients Cycling on Subcutaneous Tumor Necrosis Factor-Alpha Inhibitors in Inflammatory Arthritis: A Retrospective Study. Adv Ther 2022; 39:244-255. [PMID: 34480294 DOI: 10.1007/s12325-021-01879-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 07/30/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Biologic treatments including subcutaneous tumor necrosis factor-alpha inhibitors (SC-TNFis) have greatly improved disease management of rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS) (collectively inflammatory arthritis, IA). Nevertheless, some patients discontinue their first-line treatment; for them, one option may be a subsequent line of the same treatment class (i.e., cycling). The aim of this study was to assess treatment persistence between first- and second-line therapy in Swedish IA patients cycling on SC-TNFis. METHODS Using data from the Swedish Health Data Registers, adult IA patients filling prescriptions between May 1, 2010, and October 31, 2016, for a SC-TNFi (adalimumab, etanercept, certolizumab and golimumab) were included. Treatment persistence was derived based on information from filled prescriptions and a 60-day grace period. Unadjusted and adjusted marginal Cox proportional hazards models were fitted to estimate the relative risk of discontinuation across treatment lines, using robust sandwich covariance matrix estimates to account for intrapatient dependence (i.e., multiple treatment lines per patient). The analysis was restricted to the first two lines of treatment. RESULTS Of the eligible patients, 3181 were identified as cyclers. Among these, most were female (68%), and 46%, 28% and 26% were diagnosed with RA, AS and PsA, respectively. Both the unadjusted and adjusted analyses showed that the relative risk of discontinuing SC-TNFi treatment was significantly lower in second compared to first line (hazard ratio; 0.60 [0.57, 0.63] and HR; 0.59 [0.56, 0.62]). This finding was also consistent across IA indications. CONCLUSIONS In this study of patients cycling on SC-TNFis in IA, persistence was greater in second- compared to first-line treatment. The finding was consistent across all IA indications. Hence, patients who discontinue their first-line treatment may still benefit from treatment with an alternative SC-TNFi as a second-line therapy in IA.
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Rustgi SD, Kayal M, Shah SC. Sex-based differences in inflammatory bowel diseases: a review. Therap Adv Gastroenterol 2020; 13:1756284820915043. [PMID: 32523620 PMCID: PMC7236567 DOI: 10.1177/1756284820915043] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 03/03/2020] [Indexed: 02/04/2023] Open
Abstract
Sex-based differences in inflammatory bowel disease (IBD) pathogenesis, disease course, and response to therapy have been increasingly recognized, however, not fully understood. Experimental and translational models have been leveraged to investigate hypothesized mechanisms for these observed differences, including the potential modifying role of sex hormones and sex-dependent (epi)genetic and gut microbiome changes. The primary objective of this review is to comprehensively describe sex-based differences in IBD including epidemiology, pathogenesis, phenotypic differences, therapeutic response, and outcomes.
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Affiliation(s)
- Sheila D. Rustgi
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Maia Kayal
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, USA
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Shimabuco AY, Gonçalves CR, Moraes JCB, Waisberg MG, Ribeiro ACDM, Sampaio-Barros PD, Goldenstein-Schainberg C, Bonfa E, Saad CGS. Factors associated with ASDAS remission in a long-term study of ankylosing spondylitis patients under tumor necrosis factor inhibitors. Adv Rheumatol 2018; 58:40. [PMID: 30657103 DOI: 10.1186/s42358-018-0040-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 11/23/2018] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE To determine the clinical and demographic factors associated with disease remission and drug survival in patients with ankylosing spondylitis (AS) on TNF inhibitors. METHODS Data from a longitudinal electronic database of AS patients under anti-TNF therapy between June/2004 and August/2013. Demographic, clinical parameters, disease activity by ASDAS remission (< 1.3) and inactive/low (< 2.1) were analyzed to characterize reasons for drug survival and switching of anti-TNF. RESULTS Among 117 AS patients, 69 (59%) were prescribed only one anti-TNF, 48 (41%) switched to a second anti-TNF and 13 (11%) to a third anti-TNF. Considering ASDAS-CRP < 1.3, 31 (39%) patients were inactive at the end of the study. Non-switchers (P = 0.04), younger age (P = 0.004), non-smoking (P = 0.016), shorter disease duration (P = 0.047), more frequent use of SSZ (P = 0.037) and lower BASDAI (P = 0.027), BASMI (P = 0.034) and BASFI (P = 0.003) at baseline were associated with remission. In the multivariate analysis younger age (P = 0.016) and lower BASDAI (P = 0.032) remained as remission predictors. CONCLUSION This study supports that ASDAS-CRP remission is an achievable goal not only for non-switchers but also for second anti-TNF, particularly in patients with younger age and lower BASDAI at baseline. Co-medication and non-smoker status seems to have a beneficial effect in anti-TNF response in this population.
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Affiliation(s)
- Andrea Y Shimabuco
- Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455 3° andar - sala 3131 - Cerqueira César, São Paulo, SP, Cep: 01246-903, Brazil
| | - Celio R Gonçalves
- Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455 3° andar - sala 3131 - Cerqueira César, São Paulo, SP, Cep: 01246-903, Brazil
| | - Julio C B Moraes
- Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455 3° andar - sala 3131 - Cerqueira César, São Paulo, SP, Cep: 01246-903, Brazil
| | - Mariana G Waisberg
- Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455 3° andar - sala 3131 - Cerqueira César, São Paulo, SP, Cep: 01246-903, Brazil
| | - Ana Cristina de M Ribeiro
- Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455 3° andar - sala 3131 - Cerqueira César, São Paulo, SP, Cep: 01246-903, Brazil
| | - Percival D Sampaio-Barros
- Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455 3° andar - sala 3131 - Cerqueira César, São Paulo, SP, Cep: 01246-903, Brazil
| | - Claudia Goldenstein-Schainberg
- Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455 3° andar - sala 3131 - Cerqueira César, São Paulo, SP, Cep: 01246-903, Brazil
| | - Eloisa Bonfa
- Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455 3° andar - sala 3131 - Cerqueira César, São Paulo, SP, Cep: 01246-903, Brazil
| | - Carla G S Saad
- Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455 3° andar - sala 3131 - Cerqueira César, São Paulo, SP, Cep: 01246-903, Brazil.
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Tumor Necrosis Factor Inhibitor Discontinuation in Patients with Ankylosing Spondylitis: An Observational Study From the US-Based Corrona Registry. Rheumatol Ther 2018; 5:537-550. [PMID: 30353387 PMCID: PMC6251840 DOI: 10.1007/s40744-018-0129-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Tumor necrosis factor inhibitors (TNFis) have shown efficacy for the treatment of ankylosing spondylitis (AS). However, many patients may discontinue or switch TNFis due to lack of effect or adverse events. As biologics with alternative mechanisms of action become available for the treatment of AS, it is important to better understand the characteristics of patients who discontinue or have an inadequate response to TNFis to help inform treatment choices regarding initiating or switching to a biologic therapy. This study compared demographic and clinical characteristics of patients with AS who discontinued vs. continued a TNFi by their second follow-up visit in the US-based Corrona Psoriatic Arthritis and Spondyloarthritis (PsA/SpA) Registry. METHODS All patients aged ≥ 18 years with AS enrolled in the Corrona PsA/SpA Registry between April 2013 and January 2015 who were receiving or had initiated a TNFi (index therapy) at the time of registry enrollment (baseline) and had ≥ 2 follow-up visits were included. Patient demographics, clinical characteristics, and patient-reported outcome scores at baseline were compared between cohorts of patients who discontinued or continued their TNFi by the second follow-up visit. RESULTS Of the 155 included patients, 37 (23.9%) discontinued their index TNFi therapy by the second follow-up visit (mean follow-up, 17.8 months). Patients who discontinued their TNFi were older (mean age, 52.1 vs. 46.6 years; P = 0.04), were more likely to be obese (59.5% vs. 34.2%; P < 0.01), and had worse mean Bath Ankylosing Spondylitis Disease Activity Index and Bath Ankylosing Spondylitis Functional Index scores (4.8 vs. 3.5 and 4.2 vs. 2.8, respectively; P = 0.01 for both) at baseline than those who continued their TNFi. CONCLUSIONS The results of this real-world study provide insight into the demographic and clinical characteristics of patients with AS who discontinue vs. continue TNFi therapy in US clinical practice. FUNDING Corrona, LLC. Plain language summary available for this article.
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The effect of extra-articular manifestations on tumor necrosis factor-α inhibitor treatment duration in patients with ankylosing spondylitis: nationwide data from the Korean College of Rheumatology BIOlogics (KOBIO) registry. Clin Rheumatol 2018; 37:3275-3284. [PMID: 30251059 DOI: 10.1007/s10067-018-4290-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 08/12/2018] [Accepted: 09/09/2018] [Indexed: 01/17/2023]
Abstract
Tumor necrosis factor-α inhibitor (TNFi) therapy has shown to be remarkably effective for treating ankylosing spondylitis (AS); however, nearly 30% of AS patients every year either stop TNFi therapy or switch to a different TNFi due to inefficacy or adverse effects. The goal of this study was to identify predictors of TNFi treatment duration, including extra-articular manifestations, using a nationwide registry in Korea. Data obtained from the Korean College of Rheumatology Biologics (KOBIO) registry, a nationwide, multi-center database representing 58 tertiary care hospitals in Korea. Demographics, clinical features, laboratory findings, disease activity indices (BASDAI, ASDAS-ESR, ASDAS-CRP), peripheral arthritis, and extra-articular manifestations (uveitis, enthesitis, dactylitis, psoriasis, and inflammatory bowel disease) were studied in patients with AS during TNFi therapy. We also analyzed treatment duration outcomes for five TNFi agents (etanercept, infliximab, infliximab biosimilar, adalimumab, and golimumab), as well as factors associated with treatment duration, particularly in terms of extra-articular manifestations. Univariable and multivariable Cox regression analyses were performed to verify preliminary results. A total 1482 AS patients starting TNFi drug therapy between Dec. 2012 and Jan. 2017 were included. No differences in demographics, disease activity, or extra-articular manifestations were evident between continued and discontinued TNFi groups at baseline, though baseline differences were detected for gender distribution, CRP, platelet counts, and HLA-B27 positivity. During treatment period, the effects of extra-articular manifestations, including uveitis (unadjusted hazard ratio [HR] 0.92, 95% confidence interval [CI] 0.57 to 1.48, p = 0.74), enthesitis, dactylitis, psoriasis, and inflammatory bowel disease, on TNFi treatment duration were not statistically significant. By contrast, the occurrence of peripheral arthritis was significantly associated with shorter TNFi treatment duration (unadjusted HR 2.21, 95% CI 1.66 to 2.95; adjusted HR 1.38, 95% CI 1.01 to 1.88). Among disease activity indices, higher ASDAS-ESR levels were significantly associated with shortening of the TNFi treatment duration (unadjusted HR 1.87, 95% CI 1.73 to 2.03; adjusted HR 2.23, 95% CI 2.00 to 2.63). Among TNFi drugs, golimumab had a lower discontinuation rate than that of etanercept over a 3-year follow-up period (unadjusted HR 0.46, 95% CI 0.31 to 0.68; adjusted HR 0.65, 95% CI 0.43 to 0.99). In a nationwide KOBIO registry, extra-articular manifestations, including uveitis, were not associated with TNFi treatment duration. Among clinical cofactors, the development of peripheral arthritis during TNFi therapy was associated with a higher risk of TNFi treatment discontinuance in AS patients.
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Soubrier M, Pereira B, Fan A, Frayssac T, Couderc M, Malochet-Guinamand S, Mathieu S, Tatar Z, Tournadre A, Dubost JJ. Retention rates of adalimumab, etanercept, and infliximab as first- or second-line biotherapies for spondyloarthritis patients in daily practice in Auvergne (France). Int J Rheum Dis 2018; 21:1986-1992. [PMID: 30168265 PMCID: PMC6585683 DOI: 10.1111/1756-185x.13375] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 05/24/2018] [Accepted: 07/24/2018] [Indexed: 11/26/2022]
Abstract
Objective To compare, in real‐life settings, the retention rates of initial anti‐tumor‐necrosis factor (TNF) treatments (etanercept [ETN], adalimumab [ADA] and infliximab [IFX]) used as first‐line biotherapy for axial spondyloarthritis (axSpA), and evaluate treatment switches to another anti‐TNF inhibitor in the event of treatment failure. Methods We analyzed the medical records of all SpA patients (Assessment in Ankylosing Spondylitis International Working Group axial criteria) treated with ETN, IFX or ADA between 2001 and February 2015. Drug retention rates were calculated using the Kaplan‐Meier method and compared by means of the Cox extended model. Sub‐analyses were performed according to discontinuation reasons. Results Of the 249 SpA patients analyzed (135 radiographic cases, 114 non‐radiographic), 102 received ETN, 62 ADA, and 85 IFX. In total, 103 discontinued treatment. The retention rates of IFX, ADA and ETN were 67%, 59% and 56% after 3 years; 62%, 42% and 47% after 5 years; 55%, 42% and 24% after 8 years; 53%, 42% and 12% after 10 years, respectively. In multivariate analyses, the predictive factors for retention were: low BASDAI score (hazard ratio [HR]: 1.02 [1.01‐1.04]), high C‐reactive protein levels (HR: 0.98 [0.97‐0.99]), concomitant disease‐modifying therapy (HR: 0.4 [0.21‐0.75]), and radiographic SpA (HR: 1.5 [1.0‐2.52]). In total, 61 patients switched to another anti‐TNF therapy. No difference was observed among the three anti‐TNF therapies regarding median retention duration, although the retention rate proved higher for treatment switches from one monoclonal antibody to another. Conclusion The retention rate in SpA patients proved high, with retention for IFX superior to that of ETN.
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Affiliation(s)
- Martin Soubrier
- Rhumatologie, Clermont-Ferrand University Hospital, Hôpital Gabriel Montpied, Clermont-Ferrand, France
| | - Bruno Pereira
- DRCI, Clermont-Ferrand University Hospital, Hôpital Gabriel Montpied, Clermont-Ferrand, France
| | - Angelique Fan
- Rhumatologie, Clermont-Ferrand University Hospital, Hôpital Gabriel Montpied, Clermont-Ferrand, France
| | - Thomas Frayssac
- Rhumatologie, Clermont-Ferrand University Hospital, Hôpital Gabriel Montpied, Clermont-Ferrand, France
| | - Marion Couderc
- Rhumatologie, Clermont-Ferrand University Hospital, Hôpital Gabriel Montpied, Clermont-Ferrand, France
| | | | - Sylvain Mathieu
- Rhumatologie, Clermont-Ferrand University Hospital, Hôpital Gabriel Montpied, Clermont-Ferrand, France
| | - Zuzana Tatar
- Rhumatologie, Clermont-Ferrand University Hospital, Hôpital Gabriel Montpied, Clermont-Ferrand, France
| | - Anne Tournadre
- Rhumatologie, Clermont-Ferrand University Hospital, Hôpital Gabriel Montpied, Clermont-Ferrand, France
| | - Jean-Jacques Dubost
- Rhumatologie, Clermont-Ferrand University Hospital, Hôpital Gabriel Montpied, Clermont-Ferrand, France
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Alazmi M, Sari I, Krishnan B, Inman RD, Haroon N. Profiling Response to Tumor Necrosis Factor Inhibitor Treatment in Axial Spondyloarthritis. Arthritis Care Res (Hoboken) 2018; 70:1393-1399. [DOI: 10.1002/acr.23465] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 11/07/2017] [Indexed: 12/31/2022]
Affiliation(s)
- Mansour Alazmi
- Toronto Western Hospital; University of Toronto; Toronto Ontario Canada
| | - Ismail Sari
- Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada; and Dokuz Eylul University, School of Medicine; Izmir Turkey
| | - Bharath Krishnan
- Toronto Western Hospital; University of Toronto; Toronto Ontario Canada
| | - Robert D. Inman
- Toronto Western Hospital; University of Toronto; Toronto Ontario Canada
| | - Nigil Haroon
- Toronto Western Hospital and Krembil Research Institute; University Health Network; University of Toronto; Toronto Ontario Canada
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Rubbert-Roth A, Atzeni F, Masala IF, Caporali R, Montecucco C, Sarzi-Puttini P. TNF inhibitors in rheumatoid arthritis and spondyloarthritis: Are they the same? Autoimmun Rev 2018; 17:24-28. [DOI: 10.1016/j.autrev.2017.11.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 09/13/2017] [Indexed: 12/18/2022]
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Ibáñez Vodnizza S, Visman IM, van Denderen C, Lems WF, Jaime F, Nurmohamed MT, van der Horst-Bruinsma IE. Muscle wasting in male TNF-α blocker naïve ankylosing spondylitis patients: a comparison of gender differences in body composition. Rheumatology (Oxford) 2017; 56:1566-1572. [PMID: 28605535 DOI: 10.1093/rheumatology/kex187] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Indexed: 12/14/2022] Open
Abstract
Objective To assess gender differences in body composition (BC) in a cohort of AS patients naïve to TNF-α blockers. Methods Patients included fulfilled the Modified New York criteria for AS. Demographic information and disease activity measures (ASDAS and BASDAI) were reported. BC was measured by whole body DXA. Body fat percentage (BF%), fat mass index (FMI), fat free mass index (FFMI) and android/gynoid fat ratio were reported and compared between men and women and with the reference population (percentiles). Results Seventy consecutive patients were included; 60% were men. Demographic variables were similar, except for dyslipidaemia (57.1% of men; 14.3% of women). Women had significantly more fat (BF%, FMI), and less muscle (FFMI) than men, but below the median of the reference population. Male AS patients had a markedly low FFMI (31.7th percentile) compared with the reference population. In the whole group, after multivariate analysis, an ASDAS CRP >3.5 was related to lower fat free mass content. In men, a significant relationship between having a high disease activity (ASDAS, BASDAI) and lower BF% or FMI percentile was found, but in women it was the opposite. Conclusion Muscle wasting, measured as low FFMI compared with the reference population, was found in male TNF-α blocker naïve AS patients, especially in those with active disease. Women had higher volumes of body fat than men, but near the median of the reference population. The relationships between fat content and disease activity support the complex association between adipose tissue and inflammation.
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Affiliation(s)
- Sebastián Ibáñez Vodnizza
- Rheumatology Department, Clínica Alemana de Santiago.,Rheumatology Department, Hospital Padre Hurtado, Santiago, Chile
| | - Ingrid M Visman
- Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam
| | | | - Willem F Lems
- Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam.,Amsterdam Rheumatology and Immunology Center, VU University Medical Center, The Netherlands
| | - Francisca Jaime
- Medicine Faculty, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Michael T Nurmohamed
- Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam.,Amsterdam Rheumatology and Immunology Center, VU University Medical Center, The Netherlands
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Ibáñez Vodnizza SE, Nurmohamed MT, Visman IM, van Denderen JC, Lems WF, Jaime F, van der Horst-Bruinsma IE. Fat Mass Lowers the Response to Tumor Necrosis Factor-α Blockers in Patients with Ankylosing Spondylitis. J Rheumatol 2017; 44:1355-1361. [PMID: 28711878 DOI: 10.3899/jrheum.170094] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Our main objective was to assess the relationship between body composition (BC) and response to tumor necrosis factor-α (TNF-α) blocker treatment in patients with ankylosing spondylitis (AS). Our secondary objective was to evaluate the change of BC after treatment, accounting for sex and age. METHODS All included patients fulfilled the modified New York criteria for AS and were naive to TNF-α blocker. They were followed for at least 6 months after the start of etanercept or adalimumab. The Ankylosing Spondylitis Disease Activity Score containing C-reactive protein (ASDAS-CRP) and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) were reported. BC was assessed by whole body dual-energy X-ray absorptiometry. Body fat percentage (BF%), fat mass index (FMI), and fat free mass index (FFMI) were reported as absolute values and as percentiles. RESULTS Forty-one patients were included (61% men). The median followup was 14.3 months (interquartile range 8.4-19.4). After multivariate regression analysis, more fat at baseline (BF%, FMI, or FMI percentile) was significantly related with a lower chance of achieving a clinically important improvement of the ASDAS-CRP or BASDAI after treatment. The body composition did not change significantly after treatment, but there was a trend toward muscle recovery in men (FFMI change from 34.0th to 37.4th percentile). CONCLUSION Higher body fat content at baseline was independently associated with a worse response to treatment with TNF-α blockers, measured by ASDAS-CRP and BASDAI change, and might contribute to the lower response rates in female patients. Also, there is a trend toward muscle mass recovery in male patients after treatment.
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Affiliation(s)
- Sebastián E Ibáñez Vodnizza
- From the Amsterdam Rheumatology and Immunology Center, Reade and VU University Medical Center, Amsterdam, the Netherlands; Rheumatology Department, Clínica Alemana de Santiago and Hospital Padre Hurtado, Santiago, Chile.,S.E. Ibáñez Vodnizza, MD, Rheumatology Department, Clínica Alemana de Santiago and Hospital Padre Hurtado; M.T. Nurmohamed, MD, Professor, Amsterdam Rheumatology and Immunology Center, Reade and VU University Medical Center; I.M. Visman, Amsterdam Rheumatology and Immunology Center, Reade; J.C. van Denderen, MD, PhD, Amsterdam Rheumatology and Immunology Center; W.F. Lems, MD, Professor, Amsterdam Rheumatology and Immunology Center, Reade and VU University Medical Center; F. Jaime, MD, Faculty of Medicine, Pontificia Universidad Católica de Chile; I.E. van der Horst-Bruinsma, MD, PhD, Amsterdam Rheumatology and Immunology Center, VU University Medical Center
| | - Michael T Nurmohamed
- From the Amsterdam Rheumatology and Immunology Center, Reade and VU University Medical Center, Amsterdam, the Netherlands; Rheumatology Department, Clínica Alemana de Santiago and Hospital Padre Hurtado, Santiago, Chile.,S.E. Ibáñez Vodnizza, MD, Rheumatology Department, Clínica Alemana de Santiago and Hospital Padre Hurtado; M.T. Nurmohamed, MD, Professor, Amsterdam Rheumatology and Immunology Center, Reade and VU University Medical Center; I.M. Visman, Amsterdam Rheumatology and Immunology Center, Reade; J.C. van Denderen, MD, PhD, Amsterdam Rheumatology and Immunology Center; W.F. Lems, MD, Professor, Amsterdam Rheumatology and Immunology Center, Reade and VU University Medical Center; F. Jaime, MD, Faculty of Medicine, Pontificia Universidad Católica de Chile; I.E. van der Horst-Bruinsma, MD, PhD, Amsterdam Rheumatology and Immunology Center, VU University Medical Center
| | - Ingrid M Visman
- From the Amsterdam Rheumatology and Immunology Center, Reade and VU University Medical Center, Amsterdam, the Netherlands; Rheumatology Department, Clínica Alemana de Santiago and Hospital Padre Hurtado, Santiago, Chile.,S.E. Ibáñez Vodnizza, MD, Rheumatology Department, Clínica Alemana de Santiago and Hospital Padre Hurtado; M.T. Nurmohamed, MD, Professor, Amsterdam Rheumatology and Immunology Center, Reade and VU University Medical Center; I.M. Visman, Amsterdam Rheumatology and Immunology Center, Reade; J.C. van Denderen, MD, PhD, Amsterdam Rheumatology and Immunology Center; W.F. Lems, MD, Professor, Amsterdam Rheumatology and Immunology Center, Reade and VU University Medical Center; F. Jaime, MD, Faculty of Medicine, Pontificia Universidad Católica de Chile; I.E. van der Horst-Bruinsma, MD, PhD, Amsterdam Rheumatology and Immunology Center, VU University Medical Center
| | - J Christiaan van Denderen
- From the Amsterdam Rheumatology and Immunology Center, Reade and VU University Medical Center, Amsterdam, the Netherlands; Rheumatology Department, Clínica Alemana de Santiago and Hospital Padre Hurtado, Santiago, Chile.,S.E. Ibáñez Vodnizza, MD, Rheumatology Department, Clínica Alemana de Santiago and Hospital Padre Hurtado; M.T. Nurmohamed, MD, Professor, Amsterdam Rheumatology and Immunology Center, Reade and VU University Medical Center; I.M. Visman, Amsterdam Rheumatology and Immunology Center, Reade; J.C. van Denderen, MD, PhD, Amsterdam Rheumatology and Immunology Center; W.F. Lems, MD, Professor, Amsterdam Rheumatology and Immunology Center, Reade and VU University Medical Center; F. Jaime, MD, Faculty of Medicine, Pontificia Universidad Católica de Chile; I.E. van der Horst-Bruinsma, MD, PhD, Amsterdam Rheumatology and Immunology Center, VU University Medical Center
| | - Willem F Lems
- From the Amsterdam Rheumatology and Immunology Center, Reade and VU University Medical Center, Amsterdam, the Netherlands; Rheumatology Department, Clínica Alemana de Santiago and Hospital Padre Hurtado, Santiago, Chile.,S.E. Ibáñez Vodnizza, MD, Rheumatology Department, Clínica Alemana de Santiago and Hospital Padre Hurtado; M.T. Nurmohamed, MD, Professor, Amsterdam Rheumatology and Immunology Center, Reade and VU University Medical Center; I.M. Visman, Amsterdam Rheumatology and Immunology Center, Reade; J.C. van Denderen, MD, PhD, Amsterdam Rheumatology and Immunology Center; W.F. Lems, MD, Professor, Amsterdam Rheumatology and Immunology Center, Reade and VU University Medical Center; F. Jaime, MD, Faculty of Medicine, Pontificia Universidad Católica de Chile; I.E. van der Horst-Bruinsma, MD, PhD, Amsterdam Rheumatology and Immunology Center, VU University Medical Center
| | - Francisca Jaime
- From the Amsterdam Rheumatology and Immunology Center, Reade and VU University Medical Center, Amsterdam, the Netherlands; Rheumatology Department, Clínica Alemana de Santiago and Hospital Padre Hurtado, Santiago, Chile.,S.E. Ibáñez Vodnizza, MD, Rheumatology Department, Clínica Alemana de Santiago and Hospital Padre Hurtado; M.T. Nurmohamed, MD, Professor, Amsterdam Rheumatology and Immunology Center, Reade and VU University Medical Center; I.M. Visman, Amsterdam Rheumatology and Immunology Center, Reade; J.C. van Denderen, MD, PhD, Amsterdam Rheumatology and Immunology Center; W.F. Lems, MD, Professor, Amsterdam Rheumatology and Immunology Center, Reade and VU University Medical Center; F. Jaime, MD, Faculty of Medicine, Pontificia Universidad Católica de Chile; I.E. van der Horst-Bruinsma, MD, PhD, Amsterdam Rheumatology and Immunology Center, VU University Medical Center
| | - Irene E van der Horst-Bruinsma
- From the Amsterdam Rheumatology and Immunology Center, Reade and VU University Medical Center, Amsterdam, the Netherlands; Rheumatology Department, Clínica Alemana de Santiago and Hospital Padre Hurtado, Santiago, Chile. .,S.E. Ibáñez Vodnizza, MD, Rheumatology Department, Clínica Alemana de Santiago and Hospital Padre Hurtado; M.T. Nurmohamed, MD, Professor, Amsterdam Rheumatology and Immunology Center, Reade and VU University Medical Center; I.M. Visman, Amsterdam Rheumatology and Immunology Center, Reade; J.C. van Denderen, MD, PhD, Amsterdam Rheumatology and Immunology Center; W.F. Lems, MD, Professor, Amsterdam Rheumatology and Immunology Center, Reade and VU University Medical Center; F. Jaime, MD, Faculty of Medicine, Pontificia Universidad Católica de Chile; I.E. van der Horst-Bruinsma, MD, PhD, Amsterdam Rheumatology and Immunology Center, VU University Medical Center.
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Deodhar A, Yu D. Switching tumor necrosis factor inhibitors in the treatment of axial spondyloarthritis. Semin Arthritis Rheum 2017; 47:343-350. [PMID: 28551170 DOI: 10.1016/j.semarthrit.2017.04.005] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 04/11/2017] [Accepted: 04/24/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To assess the impact of switching tumor necrosis factor (TNF)-alpha inhibitors on patients with axial spondyloarthritis (axSpA). METHODS PubMed literature searches were conducted using combinations of search terms including ankylosing spondylitis, spondyloarthropathy, spondyloarthritis, switch/switching, drug survival, and TNF/tumor necrosis factor to identify published articles with data on outcomes related to switching biologic therapies in patients with axSpA. RESULTS Of the 134 studies screened, 21 were identified as reporting data on switching TNF inhibitors in patients carrying a diagnosis of axSpA or ankylosing spondylitis. The most common reasons for switching from the first TNF inhibitor were lack of efficacy (14-68%), loss of efficacy (13-61%), and adverse events/poor tolerability (13-57%). Switching TNF inhibitors was beneficial for a substantial proportion of patients with axSpA who failed to respond to initial or even second TNF inhibitor therapy and adverse effects were not enhanced. Drug survival rates were generally lower for the second (47-72% at 2 years) or third TNF inhibitor (49% at 2 years) than for the first TNF inhibitor (58-75% at 2 years). Predictors of responses in TNF-naïve patients included HLA-B27 positivity, absence of enthesitis, age ≤40 years, elevated C-reactive protein level, good functional status, and shorter disease duration. Predictors of drug survival included male sex and peripheral arthritis. Common characteristics of patients who switched TNF inhibitors included female sex, older age, more severe disease, greater symptom burden, higher erythrocyte sedimentation rate, complete ankyloses, and enthesitis. CONCLUSION When the first or even the second TNF inhibitor fails, switching to an alternate one is not an unreasonable clinical therapeutic decision.
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Affiliation(s)
- Atul Deodhar
- Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97299.
| | - David Yu
- Ronald Reagan UCLA Medical Center, Los Angeles, CA
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Cantini F, Niccoli L, Nannini C, Cassarà E, Kaloudi O, Giulio Favalli E, Becciolini A, Benucci M, Gobbi FL, Guiducci S, Foti R, Mosca M, Goletti D. Second-line biologic therapy optimization in rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. Semin Arthritis Rheum 2017; 47:183-192. [PMID: 28413099 DOI: 10.1016/j.semarthrit.2017.03.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 03/05/2017] [Accepted: 03/15/2017] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The Italian board for the TAilored BIOlogic therapy (ITABIO) reviewed the most consistent literature to indicate the best strategy for the second-line biologic choice in patients with rheumatoid arthritis (RA), spondyloarthritis (SpA), and psoriatic arthritis (PsA). METHODS Systematic review of the literature to identify English-language articles on efficacy of second-line biologic choice in RA, PsA, and ankylosing spondylitis (AS). Data were extracted from available randomized, controlled trials, national biologic registries, national healthcare databases, post-marketing surveys, and open-label observational studies. RESULTS Some previously stated variables, including the patients׳ preference, the indication for anti-tumor necrosis factor (TNF) monotherapy in potential childbearing women, and the intravenous route with dose titration in obese subjects resulted valid for all the three rheumatic conditions. In RA, golimumab as second-line biologic has the highest level of evidence in anti-TNF failure. The switching strategy is preferable for responder patients who experience an adverse event, whereas serious or class-specific side effects should be managed by the choice of a differently targeted drug. Secondary inadequate response to etanercept (ETN) should be treated with a biologic agent other than anti-TNF. After two or more anti-TNF failures, the swapping to a different mode of action is recommended. Among non-anti-TNF targeted biologics, to date rituximab (RTX) and tocilizumab (TCZ) have the strongest evidence of efficacy in the treatment of anti-TNF failures. In PsA and AS patients failing the first anti-TNF, the switch strategy to a second is advisable, taking in account the evidence of adalimumab efficacy in patients with uveitis. The severity of psoriasis, of articular involvement, and the predominance of enthesitis and/or dactylitis may drive the choice toward ustekinumab or secukinumab in PsA, and the latter in AS. CONCLUSION Taking in account the paucity of controlled trials, second-line biologic therapy may be reasonably optimized in patients with RA, SpA, and PsA.
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Affiliation(s)
- Fabrizio Cantini
- Division of Rheumatology, Hospital of Prato, Piazza Ospedale, 1, 59100 Prato, Italy.
| | - Laura Niccoli
- Division of Rheumatology, Hospital of Prato, Piazza Ospedale, 1, 59100 Prato, Italy
| | - Carlotta Nannini
- Division of Rheumatology, Hospital of Prato, Piazza Ospedale, 1, 59100 Prato, Italy
| | - Emanuele Cassarà
- Division of Rheumatology, Hospital of Prato, Piazza Ospedale, 1, 59100 Prato, Italy
| | - Olga Kaloudi
- Division of Rheumatology, Hospital of Prato, Piazza Ospedale, 1, 59100 Prato, Italy
| | | | | | | | | | - Serena Guiducci
- Department of Biomedicine, Section of Rheumatology, University of Florence, Florence, Italy
| | - Rosario Foti
- Rheumatology Unit, Vittorio-Emanuele University Hospital of Catania, Catania, Italy
| | - Marta Mosca
- UO di Reumatologia, Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa, Pisa, Italy
| | - Delia Goletti
- Translational Research Unit, Department of Epidemiology and Preclinical Research, "L. Spallanzani" National Institute for Infectious Diseases (INMI), IRCCS, Rome, Italy
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14
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Svedbom A, Dalén J, Black CM, Kachroo S. Persistence and costs with subcutaneous TNF-alpha inhibitors in immune-mediated rheumatic disease stratified by treatment line. Patient Prefer Adherence 2017; 11:95-106. [PMID: 28144130 PMCID: PMC5248937 DOI: 10.2147/ppa.s119808] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The objectives of this study were to 1) describe and compare treatment persistence with first- and second-line subcutaneous tumor necrosis factor-alpha inhibitors (SC-TNFis) in patients with ankylosing spondylitis (AS), psoriatic arthritis (PsA), or rheumatoid arthritis (RA) (collectively immune-mediated rheumatic disease) in Sweden and 2) estimate and contrast health care costs in the two groups. METHODS Patients who initiated their first or second SC-TNFi between May 6 2010 and December 12 2012 were identified from the Prescribed Drug Register. Persistence was estimated using survival analysis. Costs comprised specialized outpatient care, inpatient care, and medication. The persistence analysis was stratified by immune-mediated rheumatic disease diagnosis. RESULTS A total of 4,903 patients treated with their first and 845 patients treated with their second SC-TNFi were identified. Baseline characteristics differed between the two groups. Therefore, propensity score matching analysis was implemented. Second-line patients were matched to first-line patients, and four cohort pairs (AS, PsA, RA, and all diagnoses combined) were generated. Patients treated with their first SC-TNFi had statistically significant higher persistence than patients treated with their second SC-TNFi in PsA (P=0.036), RA (P=0.048), and all diagnoses combined (P<0.001) but not in AS (P=0.741). Patients who were treated with their second SC-TNFi incurred higher costs than patients treated with their first SC-TNFi. CONCLUSION Overall, persistence to the first SC-TNFi was higher than persistence to the second SC-TNFi. Furthermore, the second SC-TNFi was associated with higher costs than the first SC-TNFi. Therefore, prescribing the SC-TNFi with the best long-term persistence first may be beneficial.
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Affiliation(s)
| | | | | | - Sumesh Kachroo
- Merck & Co., Inc., Kenilworth, NJ, USA
- Correspondence: Sumesh Kachroo, Merck & Co., Inc., 126 E. Lincoln Avenue, Rahway, NJ 07065, USA, Tel +1 732 594 3847, Fax +1 732 594 4910, Email
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Lopez-Gonzalez R, Seoane-Mato D, Perez-Vicente S, Martin-Martinez MA, Sanchez-Alonso F, Silva-Fernandez L. Variability in the frequency of rheumatology consultations in patients with rheumatoid arthritis in Spain. Rheumatol Int 2016; 36:1525-1534. [PMID: 27538838 DOI: 10.1007/s00296-016-3547-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 08/02/2016] [Indexed: 11/30/2022]
Abstract
The aim of this work was to assess the variability in the use of health-care resources, based on the number of visits to rheumatology departments by rheumatoid arthritis patients, in Spain, and its association with patient, physician and center characteristics. The sample consisted of patient records of men and women (aged 16 or older), with a clinical diagnosis of RA, who met the American Rheumatism Association 1987 revised criteria and who had been treated in a rheumatology department at a Spanish hospital with at least one visit to a rheumatologist during the two years preceding the date of the study. To analyze which variables were independently associated with the number of consultations, those with a statistically significant result in the bivariate analysis, or which were clinically relevant or deemed confounders, were used in the construction of a linear regression model. The records of 1188 RA patients were studied. The linear regression model explained the 26.67 % of the variability in the number of visits. The number of csDMARDs prescribed, the administration of biological therapy, corticoid prescription, the presence of nursing consultation, mean time to first visit in the department and attended population showed a positive significant association, while the presence of telephone consultation, distance from the hospital to the patient´s residence (≥20 km) and drug monitoring by rheumatology department + primary care physician or by other specialists were negatively associated with the number of consultations. We observed a high variability in the number of visits, which remains partially unexplained even after taking into account individual, physician and center characteristics.
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Affiliation(s)
- R Lopez-Gonzalez
- Rheumatology Unit, Rheumatology Department, Complejo Hospitalario de Zamora, Avenida Requejo 35, 49022, Zamora, Spain.
| | - D Seoane-Mato
- Research Unit, Spanish Society of Rheumatology, Madrid, Spain
| | - S Perez-Vicente
- Research Unit, Spanish Society of Rheumatology, Madrid, Spain
| | | | | | - L Silva-Fernandez
- Rheumatology Department, Complexo Hospitalario Universitario de Ferrol, Ferrol, A Coruña, Spain
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