Long-term efficacy and safety of add-on tacrolimus for persistent, active rheumatoid arthritis despite treatment with methotrexate and tumor necrosis factor inhibitors

The type of infections and the use of antibiotics among patients with rheumatoid arthritis: A review

Patients diagnosed with rheumatoid arthritis have a heightened susceptibility to infections, which may lead to higher rates of illness and death. The heightened susceptibility may arise from the illness itself, which causes changes in the body's innate cellular defense mechanisms, or from the medications used to manage the condition. The precise level of risk for infections associated with traditional disease-modifying anti-rheumatic drugs has not been fully elucidated. This review aimed To investigate the type of infections and the use of antibiotics among patients with rheumatoid arthritis. An electronic literature search was conducted using the MEDLINE database, with the indicated search keywords: infections, antibiotics, use, patients, rheumatoid, and arthritis. To identify relevant information, the search was limited to articles published between 2017 and 2024. The researchers used suitable search terms on Google Scholar to discover and examine relevant scholarly articles. The selection of articles was determined by several inclusion criteria. The research included publications that were published from 2017 to 2024. The study was organized into many sections, each including particular categories within the analysis section.we reportrd that : Within the developing age of focused synthetic treatments for RA, severe infections persist as the primary consequence of long-term treatment. In all patients with rheumatoid arthritis, it is necessary to conduct initial screenings for hepatitis B virus and tuberculosis. Additionally, it is important to administer vaccinations for specific pathogens (such as pneumococcal, herpes zoster, and influenza) before and during treatment. Aggressive therapy should be pursued to effectively manage disease activity in RA patients, while also maintaining constant vigilance for early signs of infections. Extra care should be given to senior rheumatoid arthritis (RA) patients who are over 65 years old and have other medical conditions. These people are often more susceptible to developing infections, regardless of the medication they get. The trials conducted with different antibiotics have confirmed the effectiveness of these medications in treating rheumatoid arthritis. Thus, it is plausible that the culprit responsible for rheumatoid arthritis is a microbe, namely periodontopathic bacteria.

Effectiveness of tacrolimus concomitant with biological disease-modifying antirheumatic drugs in patients with rheumatoid arthritis

OBJECTIVES

The study aimed to investigate the effectiveness and tolerance of biological disease-modifying antirheumatic drugs (bDMARDs) therapy administered concomitantly with tacrolimus (TAC) treatment in patients with rheumatoid arthritis.

METHODS

2792 patients who underwent therapy with five bDMARDs (etanercept: ETN, adalimumab, golimumab, tocilizumab, and abatacept: ABT) were enrolled. Among the study subjects, 1582 were concomitant methotrexate (MTX group), 147 were concomitant TAC (TAC group), and 1063 were non-concomitant MTX and TAC (non-MTX/TAC group). The primary outcome was the incident rate of discontinuation of bDMARDs by adverse events (AEs) or loss of efficacy.

RESULTS

Concerning the analysis for each reasons of discontinuation, including AEs and loss of efficacy, the hazards ratio (HR) was significantly lower in the TAC group than in non-MTX/TAC groups (AEs: HR = 0.39, 95% confidence interval, 0.23-0.68, loss of efficacy: HR = 0.49, 95% confidence interval, 0.30-0.78). The loss of efficacy with the use of ETN and ABT was lower in the TAC group than in non-MTX/TAC groups. Concomitant TAC did not induce elevated risk for discontinuation of AEs in all bDMARD analyses.

CONCLUSIONS

Concomitant TAC with ABT or ETN showed higher retention rates than bDMARDs therapy without TAC or MTX. AEs did not increase over long-term observation.

Tacrolimus as an alternative treatment for patients with juvenile idiopathic arthritis

OBJECTIVE

To evaluate the efficacy and safety of tacrolimus in patients with juvenile idiopathic arthritis (JIA).

METHODS

We retrospectively analysed 27 patients with JIA who received tacrolimus therapy at the Department of Pediatric Rheumatology of the Tokyo Medical and Dental University between April 2019 and August 2020. We collected background and clinical characteristics at the time of add-on tacrolimus therapy initiation (baseline; Month 0) and after 3, 6, and 12 months. The primary outcome was successful medication reduction after 12 months. Patients requiring reduced and additional treatments were assigned as 'did not require additional treatment patients' and 'required additional treatment patients', respectively. The Wilcoxon signed-rank test was used to evaluate the continuous distribution of laboratory data and Juvenile Arthritis Disease Activity Score-27 at 3, 6, and 12 months relative to baseline values. Statistical significance was set as p < .05.

RESULTS

Among the 27 included cases, 17 patients were classified as did not require additional treatment patients, and there was a significant improvement in Juvenile Arthritis Disease Activity Score-27 scores in this group (p < .05). No patients presented tacrolimus-related adverse events throughout the study period.

CONCLUSION

Tacrolimus is an effective and safe therapeutic alternative for approximately 60% of patients with JIA.

Combined treatment of Taraxaci Herba and R7050 alleviates the symptoms of herpes simplex virus-induced Behçet's disease in rats

Background

Behçet's disease (BD) is a chronic inflammatory systemic disease that affects multiple organs. The causes of BD are still unknown, but it is primarily characterized by autoimmune reaction in the blood vessels. Current research focuses on treatments that can reduce the non-typical inflammatory responses of BD. Nevertheless, studies on improving the inflammatory effect of BD using inflammation mechanisms are still insufficient. Therefore, we conducted the integrated treatments related to inflammation modulation and achieved alleviation of symptoms in BD mice.

Methods

To understand the complex etiology of BD and compare its management, the herpes simplex virus (HSV)-induced BD mouse model was used. In order to alleviate the inflammatory response in BD mice, Taraxaci Herba (TH, herbal medicine), R7050-a TNFα inhibitor, and a mixture of TH and R7050 were injected for 2 weeks repetitively. The SCORAD index was examined to evaluate the cutaneous inflammations. In addition, histological changes and inflammatory factors were analyzed.

Results

Repetitive injection of TH and/or R7050 reduced the symptoms of BD and significantly decreased IL-6, IL-1β, and TNFα in blood sera. Moreover, this treatment reduced the ulcers and the deterioration of skin.

Conclusions

The results of our study showed that the down-regulation of inflammatory factors is related to the control of immune responses in BD models, suggesting that a mixed drug treatment may be more effective in improving the condition of BD.