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Lower odds of remission among women with rheumatoid arthritis: A cohort study in the Swiss Clinical Quality Management cohort. PLoS One 2022; 17:e0275026. [PMID: 36264948 PMCID: PMC9584448 DOI: 10.1371/journal.pone.0275026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 09/08/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To compare the likelihood of achieving remission between men and women with rheumatoid arthritis (RA) after starting their first biologic or targeted synthetic disease-modifying anti-rheumatic drug (b/tsDMARD). METHODS This cohort study in the Swiss Clinical Quality Management in Rheumatic Diseases (SCQM) registry included RA patients starting their first b/tsDMARD (1997-31/04/2018). The odds of achieving remission at ≤12-months, defined by disease activity score 28-joints (DAS28) <2.6, were compared between men and women. Secondary analyses were adjusted for age and seropositivity, and we investigated potential mediators or factors that could explain the main findings. RESULTS The study included 2839 (76.3%) women and 883 (23.7%) men with RA. Compared to women, men were older at diagnosis and b/tsDMARD start, but had shorter time from diagnosis to b/tsDMARD (3.4 versus 5.0 years, p<0.001), and they had lower DAS28 at b/tsDMARD start. Compared to women, men had 21% increased odds of achieving DAS28-remission, with odds ratio (OR) 1.21, 95% confidence interval (CI) 1.02-1.42. Adjusting for age and seropositivity yielded similar findings (adjusted OR 1.24, 95%CI 1.05-1.46). Analyses of potential mediators suggested that the observed effect may be explained by the shorter disease duration and lower DAS28 at treatment initiation in men versus women. CONCLUSION Men started b/tsDMARD earlier than women, particularly regarding disease duration and disease activity (DAS28), and had higher odds of reaching remission. This highlights the importance of early initiation of second line treatments, and suggests to target an earlier stage of disease in women to match the benefits observed in men.
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Cell-Type Targeted NF-kappaB Inhibition for the Treatment of Inflammatory Diseases. Cells 2020; 9:cells9071627. [PMID: 32640727 PMCID: PMC7407293 DOI: 10.3390/cells9071627] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 06/30/2020] [Accepted: 07/02/2020] [Indexed: 12/29/2022] Open
Abstract
Deregulated NF-k activation is not only involved in cancer but also contributes to the pathogenesis of chronic inflammatory diseases like rheumatoid arthritis (RA) and multiple sclerosis (MS). Ideally, therapeutic NF-KappaB inhibition should only take place in those cell types that are involved in disease pathogenesis to maintain physiological cell functions in all other cells. In contrast, unselective NF-kappaB inhibition in all cells results in multiple adverse effects, a major hindrance in drug development. Hitherto, various substances exist to inhibit different steps of NF-kappaB signaling. However, powerful tools for cell-type specific NF-kappaB inhibition are not yet established. Here, we review the role of NF-kappaB in inflammatory diseases, current strategies for drug delivery and NF-kappaB inhibition and point out the “sneaking ligand” approach. Sneaking ligand fusion proteins (SLFPs) are recombinant proteins with modular architecture consisting of three domains. The prototype SLC1 binds specifically to the activated endothelium and blocks canonical NF-kappaB activation. In vivo, SLC1 attenuated clinical and histological signs of experimental arthritides. The SLFP architecture allows an easy exchange of binding and effector domains and represents an attractive approach to study disease-relevant biological targets in a broad range of diseases. In vivo, SLFP treatment might increase therapeutic efficacy while minimizing adverse effects.
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Heidari P, Cross W, Crawford K. Do out-of-pocket costs affect medication adherence in adults with rheumatoid arthritis? A systematic review. Semin Arthritis Rheum 2018; 48:12-21. [DOI: 10.1016/j.semarthrit.2017.12.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 12/12/2017] [Accepted: 12/21/2017] [Indexed: 12/29/2022]
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Chatzidionysiou K. Optimizing biological treatments for rheumatoid arthritis. Scand J Rheumatol 2016; 45:64-75. [PMID: 27687484 DOI: 10.1080/03009742.2016.1208838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The area of rheumatoid arthritis (RA) treatment has been revolutionized during the last decades with the development of biological therapies and their introduction into daily clinical practice contributing greatly to this dramatic change. However, several aspects of the use of these highly effective but expensive therapies remain far from optimal. To date, there is no clear evidence for the optimal sequence of biological agents, and the choice of a second- or third-line biologic is random. The effect of drug levels and the presence of neutralizing anti-drug antibodies remain unclear. In addition, the identification of prognostic factors of response, both clinical and histopathological, is crucial for a more individualized treatment approach.
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Affiliation(s)
- K Chatzidionysiou
- a Department of Rheumatology , Karolinska University Hospital, Karolinska Institute , Stockholm , Sweden
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Emamikia S, Arkema EV, Györi N, Detert J, Chatzidionysiou K, Dougados M, Burmester GR, van Vollenhoven R. Induction maintenance with tumour necrosis factor-inhibitor combination therapy with discontinuation versus methotrexate monotherapy in early rheumatoid arthritis: a systematic review and meta-analysis of efficacy in randomised controlled trials. RMD Open 2016; 2:e000323. [PMID: 27651929 PMCID: PMC5013458 DOI: 10.1136/rmdopen-2016-000323] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 08/08/2016] [Accepted: 08/11/2016] [Indexed: 12/17/2022] Open
Abstract
Objective To determine whether an induction-maintenance strategy of combined therapy (methotrexate (MTX)+tumour necrosis factor (TNF) inhibitor (TNFi)) followed by withdrawal of TNFi could yield better long-term results than a strategy with MTX monotherapy, since it is unclear if the benefits from an induction phase with combined therapy are sustained if TNFi is withdrawn. Methods We performed a meta-analysis of trials using the initial combination of MTX+TNFi in conventional synthetic disease-modifying antirheumatic drug-naïve patients with early rheumatoid arthritis (RA). A systematic literature search was performed for induction-maintenance randomised controlled trials (RCTs) where initial combination therapy was compared with MTX monotherapy in patients with clinically active early RA. Our primary outcome was the proportion of patients who achieved low disease activity (LDA; Disease Activity Score (DAS)28<3.2) and/or remission (DAS28<2.6) at 12–76 weeks of follow-up. A random-effects model was used to pool the risk ratio (RR) for LDA and remission and heterogeneity was explored by subgroup analyses. Results We identified 6 published RCTs, 4 of them where MTX+adalimumab was given as initial therapy and where adalimumab was withdrawn in a subset of patients after LDA/remission had been achieved. 2 additional trials used MTX+infliximab as combination therapy. The pooled RRs for achieving LDA and clinical remission at follow-up after withdrawal of TNFi were 1.41 (95% CI 1.05 to 1.89) and 1.34 (95% CI 0.95 to 1.89), respectively. There was significant heterogeneity between trials due to different treatment strategies, which was a limitation to this study. Conclusions Initial therapy with MTX+TNFi is associated with a higher chance of retaining LDA and/or remission even after discontinuation of TNFi.
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Affiliation(s)
- Sharzad Emamikia
- Department of Medicine , ClinTRID, Solna, Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden
| | | | - Noémi Györi
- Department of Medicine , ClinTRID, Solna, Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden
| | - Jacqueline Detert
- Charité-Universitätsmedizin, Berlin, Institute of Clinical Immunology and Rheumatology , Berlin , Germany
| | - Katerina Chatzidionysiou
- Department of Medicine , ClinTRID, Solna, Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden
| | - Maxime Dougados
- Department of Rheumatology , Paris Descartes University, Hôpital Cochin. Assistance Publique-Hôpitaux de Paris INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité , Paris , France
| | - Gerd Rüdiger Burmester
- Charité-Universitätsmedizin, Berlin, Institute of Clinical Immunology and Rheumatology , Berlin , Germany
| | - Ronald van Vollenhoven
- Department of Medicine, ClinTRID, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Immunology & Rheumatology, Academic Medical Center, Amsterdam, The Netherlands
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Figueiredo CP, Bang H, Cobra JF, Englbrecht M, Hueber AJ, Haschka J, Manger B, Kleyer A, Reiser M, Finzel S, Tony HP, Kleinert S, Wendler J, Schuch F, Ronneberger M, Feuchtenberger M, Fleck M, Manger K, Ochs W, Schmitt-Haendle M, Lorenz HM, Nuesslein H, Alten R, Henes J, Krueger K, Rech J, Schett G. Antimodified protein antibody response pattern influences the risk for disease relapse in patients with rheumatoid arthritis tapering disease modifying antirheumatic drugs. Ann Rheum Dis 2016; 76:399-407. [PMID: 27323772 DOI: 10.1136/annrheumdis-2016-209297] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 04/26/2016] [Accepted: 05/27/2016] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To perform a detailed analysis of the autoantibody response against post-translationally modified proteins in patients with rheumatoid arthritis (RA) in sustained remission and to explore whether its composition influences the risk for disease relapse when tapering disease modifying antirheumatic drug (DMARD) therapy. METHODS Immune responses against 10 citrullinated, homocitrullinated/carbamylated and acetylated peptides, as well as unmodified vimentin (control) and cyclic citrullinated peptide 2 (CCP2) were tested in baseline serum samples from 94 patients of the RETRO study. Patients were classified according to the number of autoantibody reactivities (0-1/10, 2-5/10 and >5/10) or specificity groups (citrullination, carbamylation and acetylation; 0-3) and tested for their risk to develop relapses after DMARD tapering. Demographic and disease-specific parameters were included in multivariate logistic regression analysis for defining the role of autoantibodies in predicting relapse. RESULTS Patients varied in their antimodified protein antibody response with the extremes from recognition of no (0/10) to all antigens (10/10). Antibodies against citrullinated vimentin (51%), acetylated ornithine (46%) and acetylated lysine (37%) were the most frequently observed subspecificities. Relapse risk significantly (p=0.011) increased from 18% (0-1/10 reactivities) to 34% (2-5/10) and 55% (>5/10). With respect to specificity groups (0-3), relapse risk significantly (p=0.021) increased from 18% (no reactivity) to 28%, 36% and finally to 52% with one, two or three antibody specificity groups, respectively. CONCLUSIONS The data suggest that the pattern of antimodified protein antibody response determines the risk of disease relapse in patients with RA tapering DMARD therapy. TRIAL REGISTRATION NUMBER 2009-015740-42; Results.
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Affiliation(s)
- Camille P Figueiredo
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany.,Division of Rheumatology, Universidade des Sao Paulo, Sao Paulo, Brazil
| | | | | | - Matthias Englbrecht
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Axel J Hueber
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Judith Haschka
- Department of Internal Medicine 2, The Vinforce Study Group, Saint Vincent Hospital, Vienna, Austria
| | - Bernhard Manger
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Arnd Kleyer
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Michaela Reiser
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Stephanie Finzel
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Hans-Peter Tony
- Department of Internal Medicine 2, University of Wurzburg, Wurzburg, Germany
| | | | | | | | | | - Martin Feuchtenberger
- Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen, Germany
| | - Martin Fleck
- Department of Rheumatology and Clinical Immunology, Asklepios Medical Center Bad Abbach, Germany
| | | | | | | | - Hanns-Martin Lorenz
- Division of Rheumatology, Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany.,ACURA Center for Rheumatic Diseases Baden-Baden, Baden-Baden, Germany
| | | | | | - Joerg Henes
- Department of Internal Medicine 2, University of Tubingen, Tubingen, Germany
| | | | - Jürgen Rech
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Georg Schett
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany
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Schett G, Emery P, Tanaka Y, Burmester G, Pisetsky DS, Naredo E, Fautrel B, van Vollenhoven R. Tapering biologic and conventional DMARD therapy in rheumatoid arthritis: current evidence and future directions. Ann Rheum Dis 2016; 75:1428-37. [DOI: 10.1136/annrheumdis-2016-209201] [Citation(s) in RCA: 181] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 05/16/2016] [Indexed: 01/01/2023]
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Rech J, Hueber AJ, Finzel S, Englbrecht M, Haschka J, Manger B, Kleyer A, Reiser M, Cobra JF, Figueiredo C, Tony HP, Kleinert S, Wendler J, Schuch F, Ronneberger M, Feuchtenberger M, Fleck M, Manger K, Ochs W, Schmitt-Haendle M, Lorenz HM, Nuesslein H, Alten R, Henes J, Krueger K, Schett G. Prediction of disease relapses by multibiomarker disease activity and autoantibody status in patients with rheumatoid arthritis on tapering DMARD treatment. Ann Rheum Dis 2015; 75:1637-44. [PMID: 26483255 PMCID: PMC5013080 DOI: 10.1136/annrheumdis-2015-207900] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 09/26/2015] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To analyse the role of multibiomarker disease activity (MBDA) score in predicting disease relapses in patients with rheumatoid arthritis (RA) in sustained remission who tapered disease modifying antirheumatic drug (DMARD) therapy in RETRO, a prospective randomised controlled trial. METHODS MBDA scores (scale 1-100) were determined based on 12 inflammation markers in baseline serum samples from 94 patients of the RETRO study. MBDA scores were compared between patients relapsing or remaining in remission when tapering DMARDs. Demographic and disease-specific parameters were included in multivariate logistic regression analysis for defining predictors of relapse. RESULTS Moderate-to-high MBDA scores were found in 33% of patients with RA overall. Twice as many patients who relapsed (58%) had moderate/high MBDA compared with patients who remained in remission (21%). Baseline MBDA scores were significantly higher in patients with RA who were relapsing than those remaining in stable remission (N=94; p=0.0001) and those tapering/stopping (N=59; p=0.0001). Multivariate regression analysis identified MBDA scores as independent predictor for relapses in addition to anticitrullinated protein antibody (ACPA) status. Relapse rates were low (13%) in patients who were MBDA-/ACPA-, moderate in patients who were MBDA+/ACPA- (33.3%) and MBDA-ACPA+ (31.8%) and high in patients who were MBDA+/ACPA+ (76.4%). CONCLUSIONS MBDA improved the prediction of relapses in patients with RA in stable remission undergoing DMARD tapering. If combined with ACPA testing, MBDA allowed prediction of relapse in more than 80% of the patients. TRIAL REGISTRATION NUMBER EudraCT 2009-015740-42.
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Affiliation(s)
- Juergen Rech
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Axel J Hueber
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Stephanie Finzel
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Matthias Englbrecht
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Judith Haschka
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany The Vinforce Study Group, Department of Internal Medicine 2, Saint Vincent Hospital, Vienna, Austria
| | - Bernhard Manger
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Arnd Kleyer
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Michaela Reiser
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany
| | | | - Camille Figueiredo
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany Division of Rheumatology, Universidade des Sao Paulo, Sao Paulo, Brazil
| | - Hans-Peter Tony
- Department of Internal Medicine 2, University of Wurzburg, Wurzburg, Germany
| | - Stefan Kleinert
- Department of Internal Medicine 2, University of Wurzburg, Wurzburg, Germany Rheumatology Practice, Erlangen, Germany
| | | | | | | | - Martin Feuchtenberger
- Department of Internal Medicine 2, University of Wurzburg, Wurzburg, Germany Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen, Germany
| | - Martin Fleck
- Department of Rheumatology and Clinical Immunology, Asklepios Medical Center, Bad Abbach, Germany
| | | | | | | | - Hanns-Martin Lorenz
- Division of Rheumatology, Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany ACURA Center for Rheumatic Diseases, Baden-Baden, Germany
| | | | | | - Joerg Henes
- Department of Internal Medicine 2, University of Tubingen, Tubingen, Germany
| | | | - Georg Schett
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany
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Strand V, Burmester GR, Zerbini CAF, Mebus CA, Zwillich SH, Gruben D, Wallenstein GV. Tofacitinib with methotrexate in third-line treatment of patients with active rheumatoid arthritis: patient-reported outcomes from a phase III trial. Arthritis Care Res (Hoboken) 2015; 67:475-83. [PMID: 25186034 DOI: 10.1002/acr.22453] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 08/26/2014] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To assess patient-reported outcomes (PROs) for tofacitinib, an oral JAK inhibitor for the treatment of rheumatoid arthritis (RA), in a 6-month, phase III, randomized controlled trial. METHODS Patients ages ≥18 years with active RA with an inadequate response to ≥1 tumor necrosis factor inhibitor (TNFi) and receiving stable background methotrexate were randomized 2:2:1:1 to tofacitinib 5 mg or 10 mg twice daily, or placebo advanced to tofacitinib 5 mg or 10 mg twice daily at month 3. PROs measured at month 3 included patient global assessment of disease activity (PtGA), pain, Health Assessment Questionnaire (HAQ) disability index (DI), Medical Outcomes Study (MOS) Short Form 36 Health Survey version 2 (SF-36v2; acute), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), and MOS Sleep Scale. RESULTS Patients received tofacitinib 5 mg (n = 133) or 10 mg (n = 134) or placebo advanced to tofacitinib 5 mg (n = 66) or 10 mg (n = 66). HAQ DI (reported previously), PtGA (P < 0.0001), and SF-36v2 physical and mental component summary (P < 0.05) scores were improved for both tofacitinib doses versus placebo. Furthermore, improvements greater than or equal to the minimum clinically important difference were more frequently reported by tofacitinib-treated patients versus placebo for PtGA (P < 0.05), pain (P < 0.0001), HAQ DI (P < 0.05), SF-36v2 physical and mental component summary scores (P < 0.05), and FACIT-F (P < 0.001 for 5 mg twice daily). No statistical differences were observed in the MOS Sleep Scale. CONCLUSION Tofacitinib treatment resulted in significant, clinically meaningful improvements in multiple PROs versus placebo over 3 months of treatment in patients with active RA and a previous inadequate response to TNFi.
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Affiliation(s)
- Vibeke Strand
- Biopharmaceutical consultant, Portola Valley, California
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Haschka J, Englbrecht M, Hueber AJ, Manger B, Kleyer A, Reiser M, Finzel S, Tony HP, Kleinert S, Feuchtenberger M, Fleck M, Manger K, Ochs W, Schmitt-Haendle M, Wendler J, Schuch F, Ronneberger M, Lorenz HM, Nuesslein H, Alten R, Demary W, Henes J, Schett G, Rech J. Relapse rates in patients with rheumatoid arthritis in stable remission tapering or stopping antirheumatic therapy: interim results from the prospective randomised controlled RETRO study. Ann Rheum Dis 2015; 75:45-51. [DOI: 10.1136/annrheumdis-2014-206439] [Citation(s) in RCA: 128] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 01/13/2015] [Indexed: 01/19/2023]
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Aguilar-Lozano L, Castillo-Ortiz JD, Vargas-Serafin C, Morales-Torres J, Sanchez-Ortiz A, Sandoval-Castro C, Padilla-Ibarra J, Hernandez-Cuevas C, Ramos-Remus C. Sustained clinical remission and rate of relapse after tocilizumab withdrawal in patients with rheumatoid arthritis. J Rheumatol 2013; 40:1069-73. [PMID: 23729804 DOI: 10.3899/jrheum.121427] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Data on when to stop use of biological agents in rheumatoid arthritis (RA) are scant. We assessed the length of remission and the rate of clinical relapse in patients with RA who had to discontinue treatment with tocilizumab (TCZ) because of the ending of longterm (5 yrs) open-label clinical trials. METHODS All patients at 2 participating centers in Mexico were in remission, defined as Disease Activity Score 28 ≤ 2.6, with no swollen joints at the time of the last TCZ infusion. Patients were followed thereafter every 8 weeks for 12 months or until relapse. Relapse was defined as the presence of ≥ 1 swollen joint. Doses of methotrexate and antiinflammatory drugs were not changed during the followup period. RESULTS Forty-five patients were analyzed, 87% were women (mean age 52 yrs, mean disease duration 14 yrs). During the 12 months of followup, 44% of patients maintained remission. Relapses occurred in 56% of patients: 14 during the first 3 months after the last TCZ administration. Retreatment using other agents achieved low disease activity or remission. CONCLUSION Longterm clinical remission is possible in a number of patients with RA after suspension of TCZ. This effect has also been reported with other biologic agents. Additional data are required to support recommendations for discontinuing a biological agent after achieving remission.
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Affiliation(s)
- Luis Aguilar-Lozano
- Unidad de Investigación en Enfermedades Crónico-Degenerativas, Guadalajara, Mexico
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Epis OM, Giacomelli L, Deidda S, Bruschi E. Tight control applied to the biological therapy of rheumatoid arthritis. Autoimmun Rev 2012; 12:839-41. [PMID: 23219770 DOI: 10.1016/j.autrev.2012.11.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In the last decade, treatment strategies for rheumatoid arthritis (RA) have included the early use of disease-modifying anti-rheumatic drugs, since prompt suppression of disease activity is associated with a reduction in radiological damage. This strategy has now been incorporated into the broader concept of "tight control", defined as a treatment strategy tailored to each patient with RA, which aims to achieve a predefined level of low disease activity or remission within a certain period of time. To pursue this goal, tight control should include careful and continuous monitoring of disease activity, and early therapeutic adjustments or switches should be considered as necessary. It is noteworthy that the key role of tight control of RA has been stressed by the recent EULAR Guidelines. This review discusses the most recent evidence concerning the role of a tight control strategy in the treatment of RA, and on how this strategy should be pursued.
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Abstract
Rheumatoid arthritis (RA) remains a major clinical problem, but treatments involving biologics have revolutionized its management. They target pathogenically relevant cytokines such as tumor necrosis factor and immune cells such as B cells. In RA, biologics reduce joint inflammation, limit erosive damage, decrease disability, and improve quality of life. Infections are the main risk associated with their use. Because of the high prices of biologics, their cost-effectiveness is a matter of debate. They are mainly coadministered with disease-modifying drugs such as methotrexate when the latter are found to achieve insufficient disease control on their own.
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Affiliation(s)
- D L Scott
- Department of Rheumatology, King's College London School of Medicine, Weston Education Centre, London, UK.
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Jolobe OMP. Pharmacogenetic profiling might meet the challenge. J Intern Med 2011; 270:494-5. [PMID: 21819465 DOI: 10.1111/j.1365-2796.2011.02436.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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