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Akimova AA, Banshchikova NE, Sizikov AE, Mullagaliev AA, Letyagina EA, Ilina NA, Kurochkina YD, Ubshaeva YB, Omelchenko VO, Chumasova OA, Shkaruba NS, Korolev MA. Results of a 12-Week Open-Label, Non-Interventional Study of the Efficacy and Safety of Olokizumab Therapy in Patients with Rheumatoid Arthritis after Switching from Anti-B-Cell Therapy during the SARS-CoV-2 Pandemic. DOKL BIOCHEM BIOPHYS 2024:10.1134/S1607672924701060. [PMID: 38955912 DOI: 10.1134/s1607672924701060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 05/15/2024] [Accepted: 05/15/2024] [Indexed: 07/04/2024]
Abstract
ABSTTACT: -The COVID-19 pandemic has significantly changed the understanding of the safety profile of therapies for immunoinflammatory rheumatic diseases (IRDs). This is primarily due to the negative impact of a number of basic disease-modifying antirheumatic drugs (DMARDs) and genetically engineered biological drugs (biological DMARDs, or biologics) on the course and outcomes of a new coronavirus infection. A number of studies have shown that anti-B-cell therapy (rituximab) gave a statistically significant increase in the risk of severe COVID-19 and an increase in mortality. At the same time, the analysis of real clinical practice data dictated the need to establish a number of restrictions on the use of certain classes of biologics and to search for alternative therapy programs to maintain control over disease activity. PURPOSE OF THE STUDY The purpose of the study was to evaluate the efficacy and safety of the drug Artlegia® (olokizumab), solution for subcutaneous injection, 160 mg/ml-0.4 ml, manufactured by R-Pharm JSC, Russia) for the treatment of patients with rheumatoid arthritis in real clinical practice after switching with rituximab during the COVID-19 pandemic. MATERIALS AND METHODS The study included 14 patients with a confirmed diagnosis of rheumatoid arthritis (RA), who were previously on rituximab therapy at a dose of 1000-500 mg twice with an interval of 2 weeks, who received at least one course of therapy with this drug. As RA worsened, patients were switched to olokizumab against the background of standard DMARDs. On weeks 0, 4, 8, and 12 after the switch, the severity of pain was assessed on the VAS scale, the number of tender and swollen joints (TJC28 and SJC28), the level of acute-phase inflammation markers, the DAS28 (disease activity score), ESR, CRP, CDAI (clinical activity index), and the functional state index HAQ (Health Assessment Questionnaire) were determined, as well as the safety profile of therapy was assessed. RESULTS Data analysis was performed using median values (Me) were used for data analysis. A significant decrease in TJC28 was detected after 8 and 12 weeks of treatment with olokizumab (Artlegia®) (Me baseline = 10, Me 8 weeks = 4, Me 12 weeks = 4, p < 0.05) and a decrease in TSC28 was detected after 4, 8, and 12 weeks of treatment (Me baseline = 9, Me 4 weeks = 3.5, Me 8 weeks = 2.5, Me 12 weeks = 2.0, p < 0.05). Laboratory markers of inflammation showed a decrease in CRP and ESR levels after 4 weeks of treatment (CRP: Me4 weeks = 21, Me4 weeks = 1, p < 0.05, ESR: Mesno = 31, Me4 weeks = 7, p < 0.05). Positive dynamics persisted on 8 and 12 weeks (CRP: Me 8 weeks = 1, Me 12 weeks = 0; ESR: Me 8 weeks = 4, Me 12 weeks = 5). The level of CRP by week 4 became within the normal range, regardless of the initial values. All activity indices improved from week 4 in each evaluation period compared to baseline: DAS28-ESR: Me baseline = 5.52, Me 4 weeks = 3.59, Me 8 weeks = 3.33, Me 12 weeks = 3.22, p < 0.05; DAS28CRP: Me baseline = 5.39, Me 4 weeks = 3.71, Me 8 weeks = 3.35, Me 12 weeks = 3.45, p < 0.05; CDAI: Me baseline = 28.5, Me 4 weeks = 18.0, Me 8 weeks = 16.5, Me 12 weeks = 16.0, p < 0.05. All patients showed a reduction in pain (VAS scale) by week 8. The functional status of patients, according to the HAQ index, showed a significant decrease only by week 12 of the study: Me baseline = 1.62, Me 12 weeks = 1.31, p < 0.05. CONCLUSIONS The study found that switching from rituximab to olokizumab was effective and safe during the COVID-19 pandemic.
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Affiliation(s)
- A A Akimova
- Research Institute of Clinical and Experimental Lymphology-Branch of the Federal Research Center Institute of Cytology and Genetics of the Siberian Branch of the Russian Academy of Sciences (RICEL-Branch of IC&G SB RAS), Novosibirsk, Russia.
| | - N E Banshchikova
- Federal State Research Institute of Fundamental and Clinical Immunology, Novosibirsk, Russia
| | - A E Sizikov
- Federal State Research Institute of Fundamental and Clinical Immunology, Novosibirsk, Russia
| | - A A Mullagaliev
- Research Institute of Clinical and Experimental Lymphology-Branch of the Federal Research Center Institute of Cytology and Genetics of the Siberian Branch of the Russian Academy of Sciences (RICEL-Branch of IC&G SB RAS), Novosibirsk, Russia
| | - E A Letyagina
- Research Institute of Clinical and Experimental Lymphology-Branch of the Federal Research Center Institute of Cytology and Genetics of the Siberian Branch of the Russian Academy of Sciences (RICEL-Branch of IC&G SB RAS), Novosibirsk, Russia
| | - N A Ilina
- Federal State Research Institute of Fundamental and Clinical Immunology, Novosibirsk, Russia
| | - Y D Kurochkina
- Research Institute of Clinical and Experimental Lymphology-Branch of the Federal Research Center Institute of Cytology and Genetics of the Siberian Branch of the Russian Academy of Sciences (RICEL-Branch of IC&G SB RAS), Novosibirsk, Russia
| | - Y B Ubshaeva
- Research Institute of Clinical and Experimental Lymphology-Branch of the Federal Research Center Institute of Cytology and Genetics of the Siberian Branch of the Russian Academy of Sciences (RICEL-Branch of IC&G SB RAS), Novosibirsk, Russia
| | - V O Omelchenko
- Research Institute of Clinical and Experimental Lymphology-Branch of the Federal Research Center Institute of Cytology and Genetics of the Siberian Branch of the Russian Academy of Sciences (RICEL-Branch of IC&G SB RAS), Novosibirsk, Russia
| | - O A Chumasova
- Federal State Research Institute of Fundamental and Clinical Immunology, Novosibirsk, Russia
| | - N S Shkaruba
- Federal State Research Institute of Fundamental and Clinical Immunology, Novosibirsk, Russia
| | - M A Korolev
- Research Institute of Clinical and Experimental Lymphology-Branch of the Federal Research Center Institute of Cytology and Genetics of the Siberian Branch of the Russian Academy of Sciences (RICEL-Branch of IC&G SB RAS), Novosibirsk, Russia
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Yurdakul F, Bodur H, Cengiz AK, Durmaz Y, Duruöz MT, Kaya T, Ketenci S, Cüzdan N, Güler T, Günendi Z, Sarıkaya S, Çapkın E, Önder ME, Alkan Melikoğlu M, Güzel R, Şen N, Bora Ayna A, Akgül Ö, Eser E, Ataman Ş. Pandemic of the century: COVID-19 in inflammatory rheumatic diseases of a national cohort with 3,532 patients. Arch Rheumatol 2024; 39:203-212. [PMID: 38933732 PMCID: PMC11196221 DOI: 10.46497/archrheumatol.2024.10313] [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: 04/29/2023] [Accepted: 07/24/2023] [Indexed: 06/28/2024] Open
Abstract
Objectives This study aimed to assess the clinical outcomes and risk factors for severe coronavirus disease 2019 (COVID-19) in patients with inflammatory rheumatic disease (IRD) of a national cohort. Patients and methods The multicenter cross-sectional study was carried out between July 15, 2020, and February 28, 2021. Data collection was provided from a national network database system, and 3,532 IRD patients (2,359 males, 1,173 females; mean age: 48.7±13.9 years; range; 18 to 90 years) were analyzed. Demographics, clinics about rheumatic disease, comorbidities, smoking status, being infected with COVID-19, and the course of the infection were questioned by rheumatology specialists. Results One hundred seventeen patients were infected with COVID-19, the hospitalization rate due to COVID-19 was 58.9%, and the mortality rate was 1.7%. There was no difference between the COVID-19 positive and negative groups in terms of rheumatic disease activities and receiving drugs. It was observed that patients with COVID-19 had worse compliance with isolation rules, and bacillus Calmette-Guérin (BCG) vaccination was less common. The mean age and the rate of smoking of hospitalized COVID-19 patients were higher than those without hospitalization. Conclusion In this cohort, in which real-life data were analyzed, COVID-19 rates in IRD patients were similar to the general population for the same period. Compliance with the isolation rules and BCG vaccination attracted attention as components that reduce the risk of COVID-19 infection. The risk factors for hospitalization were older age and smoking.
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Affiliation(s)
- Fatma Yurdakul
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Ankara City Hospital, Ankara, Türkiye
| | - Hatice Bodur
- Department of Physical Medicine and Rehabilitation, Medicine Faculty of Yıldırım Beyazıt University, Ministry of Health Ankara City Hospital, Ankara, Türkiye
| | - Ahmet Kıvanç Cengiz
- Department of Physical Medicine and Rehabilitation, Medicine Faculty of Ondokuz Mayıs University, Samsun, Türkiye
| | - Yunus Durmaz
- Rheumatology Clinic, Karabük Training and Research Hospital, Karabük, Türkiye
| | - Mehmet Tuncay Duruöz
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Medicine Faculty of Marmara University, Istanbul, Türkiye
| | - Taciser Kaya
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Izmir Faculty of Medicine, Izmir, Türkiye
| | - Sertaç Ketenci
- Department of Physical Medicine and Rehabilitation, Medicine Faculty of Ondokuz Mayıs University, Samsun, Türkiye
| | - Nihan Cüzdan
- Department of Physical Medicine and Rehabilitation, Medicine Faculty of Hatay Mustafa Kemal University, Hatay, Türkiye
| | - Tuba Güler
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Ankara City Hospital, Ankara, Türkiye
| | - Zafer Günendi
- Department of Physical Medicine and Rehabilitation, Medicine Faculty of Gazi University, Ankara, Türkiye
| | - Selda Sarıkaya
- Department of Physical Medicine and Rehabilitation, Medicine Faculty of Bülent Ecevit Üniversitesi, Zonguldak, Türkiye
| | - Erhan Çapkın
- Department of Physical Medicine and Rehabilitation, Medicine Faculty of Karadeniz Technical University, Trabzon, Türkiye
| | - Mustafa Erkut Önder
- Department of Rheumatology, Aksaray University Training and Research Hospital, Aksaray, Türkiye
| | - Meltem Alkan Melikoğlu
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Medicine Faculty of Atatürk University, Erzurum, Türkiye
| | - Rengin Güzel
- Department of Physical Medicine and Rehabilitation, Medicine Faculty of Çukurova University, Adana, Türkiye
| | - Nesrin Şen
- Rheumatology Clinic, Kartal Dr. Lütfi Kırdar Training and Research Hospital, Istanbul, Türkiye
| | - Ata Bora Ayna
- Rheumatology Clinic, Çekirge State Hospital, Bursa, Türkiye
| | - Özgür Akgül
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Medicine Faculty of Manisa Celal Bayar University, Manisa, Türkiye
| | - Erhan Eser
- Department of Public Health, Medicine Faculty of Manisa Celal Bayar University, Manisa, Türkiye
| | - Şebnem Ataman
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Medicine Faculty of Ankara University, Ankara, Türkiye
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Misra R, Bhattacharya D, Ahmed S, Amin S, Shobha V, Ghosh A, Pandya SC, Parai D, Padhan P, Priyadarshini S, Mohapatra I, Patro ARK, Mohanty AP, Pati S. SARS-CoV-2 seroprevalence in patients with autoimmune rheumatic diseases versus family controls: a multi-city cross-sectional survey. Rheumatol Int 2024; 44:81-87. [PMID: 37906254 DOI: 10.1007/s00296-023-05489-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/04/2023] [Indexed: 11/02/2023]
Abstract
There is uncertainty regarding the effect of the SARS-CoV-2 infection on patients with autoimmune rheumatic diseases (AIRD) who are on immunosuppressive drugs. We did a multicity cross-sectional seroprevalence study conducted in five different cities in India before COVID-19 immunization. Patients with a diagnosis of AIRD and DMARDs were included. Relatives of the patients, preferably staying in the same household with no known rheumatic diseases served as controls. Serum IgG antibodies to SARS-CoV-2 Receptor Binding Domain (RBD) of the spike protein and nucleoprotein (NP) were assayed in eight hundred and eighty nine sera (subjects with disease = 379 and in subjects without disease = 510). IgG antibodies to either RBD and/or NP were positive in 135 (36%) subjects with AIRD as compared to 196 (38%) controls. The seroprevalence of anti-RBD and anti-NP varied between different cities but was not significantly different between subjects with and without disease in Mumbai, Ahmedabad, Bengaluru and Bhubaneswar. However, the occurrence of IgG antibodies to RBD was significantly (p < 0.05) lower in subjects with disease (28/65;43%) as compared to subjects without disease (42/65;65%) in Kolkata, where the positivity rate was lower in connective tissue disease group than in inflammatory arthritis group. Overall, patients with rheumatic diseases on DMARDs have IgG antibodies to RBD and NP of SARSCoV-2 at a comparable level with that of subjects without disease, but the level of antibodies to RBD is lower in patients with connective tissue disease on immunosuppressive drugs in one centre.
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Affiliation(s)
- Ramnath Misra
- Professor and Head Clinical Immunology and Rheumatology, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, 751024, Odisha, India.
| | - Debdutta Bhattacharya
- Department of Health Research, ICMR- Regional Medical Research Centre, Ministry of Health & Family Welfare, Government of India, Bhubaneswar, Odisha, India
| | - Sakir Ahmed
- Professor and Head Clinical Immunology and Rheumatology, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, 751024, Odisha, India
| | - Sanjiv Amin
- Rheumatic Disease Clinic, Mumbai, Maharashtra, India
| | - Vineeta Shobha
- St Johns Medical College and Hospital, Bengaluru, Karnataka, India
| | - Alakendu Ghosh
- Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Sapan C Pandya
- Rheumatology Clinic, Navrangpura, Ahmedabad, Gujarat, India
| | - Debaprasad Parai
- Department of Health Research, ICMR- Regional Medical Research Centre, Ministry of Health & Family Welfare, Government of India, Bhubaneswar, Odisha, India
| | - Prasanta Padhan
- Professor and Head Clinical Immunology and Rheumatology, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, 751024, Odisha, India
| | - Subhadra Priyadarshini
- Professor and Head Clinical Immunology and Rheumatology, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, 751024, Odisha, India
| | - Ipsa Mohapatra
- Professor and Head Clinical Immunology and Rheumatology, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, 751024, Odisha, India
| | - A Raj Kumar Patro
- Professor and Head Clinical Immunology and Rheumatology, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, 751024, Odisha, India
| | - Ambika Prasad Mohanty
- Professor and Head Clinical Immunology and Rheumatology, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, 751024, Odisha, India
| | - Sanghamitra Pati
- Department of Health Research, ICMR- Regional Medical Research Centre, Ministry of Health & Family Welfare, Government of India, Bhubaneswar, Odisha, India
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4
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Yan D, Yan B. Viral target and metabolism-based rationale for combined use of recently authorized small molecule COVID-19 medicines: Molnupiravir, nirmatrelvir, and remdesivir. Fundam Clin Pharmacol 2023; 37:726-738. [PMID: 36931725 PMCID: PMC10505250 DOI: 10.1111/fcp.12889] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 02/12/2023] [Accepted: 02/27/2023] [Indexed: 03/19/2023]
Abstract
The COVID-19 pandemic remains a major health concern worldwide, and SARS-CoV-2 is continuously evolving. There is an urgent need to identify new antiviral drugs and develop novel therapeutic strategies. Combined use of newly authorized COVID-19 medicines including molnupiravir, nirmatrelvir, and remdesivir has been actively pursued. Mechanistically, nirmatrelvir inhibits SARS-CoV-2 replication by targeting the viral main protease (Mpro ), a critical enzyme in the processing of the immediately translated coronavirus polyproteins for viral replication. Molnupiravir and remdesivir, on the other hand, inhibit SARS-CoV-2 replication by targeting RNA-dependent RNA-polymerase (RdRp), which is directly responsible for genome replication and production of subgenomic RNAs. Molnupiravir targets RdRp and induces severe viral RNA mutations (genome), commonly referred to as error catastrophe. Remdesivir, in contrast, targets RdRp and causes chain termination and arrests RNA synthesis of the viral genome. In addition, all three medicines undergo extensive metabolism with strong therapeutic significance. Molnupiravir is hydrolytically activated by carboxylesterase-2 (CES2), nirmatrelvir is inactivated by cytochrome P450-based oxidation (e.g., CYP3A4), and remdesivir is hydrolytically activated by CES1 but covalently inhibits CES2. Additionally, remdesivir and nirmatrelvir are oxidized by the same CYP enzymes. The distinct mechanisms of action provide strong rationale for their combined use. On the other hand, these drugs undergo extensive metabolism that determines their therapeutic potential. This review discusses how metabolism pathways and enzymes involved should be carefully considered during their combined use for therapeutic synergy.
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Affiliation(s)
- Daisy Yan
- Department of Dermatology, Boston University School of Medicine 609 Albany Street Boston, MA 02118
| | - Bingfang Yan
- Division of Pharmaceutical Sciences, James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, OH 45229
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