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Bindoli S, De Matteis A, Mitrovic S, Fautrel B, Carmona L, De Benedetti F. Efficacy and safety of therapies for Still's disease and macrophage activation syndrome (MAS): a systematic review informing the EULAR/PReS guidelines for the management of Still's disease. Ann Rheum Dis 2024:ard-2024-225854. [PMID: 39317415 DOI: 10.1136/ard-2024-225854] [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: 03/21/2024] [Accepted: 06/18/2024] [Indexed: 09/26/2024]
Abstract
OBJECTIVES To analyse the efficacy and safety of treatments for Still's disease and macrophage activation syndrome (MAS). METHODS Medline, Embase and Cochrane Library were searched for clinical trials (randomised, randomised controlled trial (RCT), controlled and clinical controlled trial (CCT)), observational studies (retrospective, longitudinal observational retrospective (LOR), prospective and longitudinal observational prospective (LOP)) and systematic reviews (SRs), in which the populations studied were patients with Still's disease and MAS. The intervention was any pharmacological treatment (approved or under evaluation) versus any comparator drug or placebo, and as outcomes, any relevant efficacy and safety event. The risk of bias (RoB) was assessed with the Cochrane RoB and AMSTAR-2 (Assessing the Methodological Quality of Systematic Reviews-2, version 2) for SRs. RESULTS 128 full texts were included: 25 RCTs, 1 CCT, 11 SRs published after 2013 and 91 LOP/LOR studies. In Still's disease, interleukin (IL)-1 inhibitors (IL-1i) and IL-6R inhibitors (IL-6i) were the most studied drugs. Two meta-analyses on RCTs showed an OR, to achieve an ARC50 response rate, of 6.02 (95% CI 2.24 to 21.36) and 8.08 (95% CI 1.89 to 34.57) for IL-1i and IL-6Ri, respectively. Retrospective studies showed that early initiation of IL-1i or IL-6i was associated with high rates of clinically inactive disease. In MAS, GCs were employed in all patients, often associated with ciclosporin and/or anakinra. Rates of complete response were reported, with a range from 53% to 100%. Emapalumab was the only drug tested in a CCT, with a complete response of 93%. CONCLUSION IL-1i and IL-6Ri show the highest level of efficacy in the treatment of Still's disease. For MAS, IL-1 and interferon-γ inhibition appear to be effective on a background of high-dose glucocorticoids.
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Affiliation(s)
- Sara Bindoli
- Rheumatology Unit, Department of Medicine (DIMED), University of Padova, Padova, Italy
| | - Arianna De Matteis
- Division of Rheumatology, IRCCS Ospedale Pediatrico Bambino Gesù, ERN-RITA center, Roma, Italy
| | - Stéphane Mitrovic
- Department of Rheumatology, Pitié-Salpêtriere Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris, France
- CRI-IMIDIATE Clinical Research Network and ERN Rita, CEREMAIA Reference Center, Paris, France
| | - Bruno Fautrel
- Department of Rheumatology, Pitié-Salpêtriere Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris, France
- CRI-IMIDIATE Clinical Research Network and ERN Rita, CEREMAIA Reference Center, Paris, France
- Pierre Louis Institute of Epidemiology and Public Health, INSERM UMR-S 1136, Paris, France
| | - Loreto Carmona
- Instituto de Salud Musculoesquelética (INMUSC), Madrid, Spain
| | - Fabrizio De Benedetti
- Division of Rheumatology, IRCCS Ospedale Pediatrico Bambino Gesù, ERN-RITA center, Roma, Italy
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Ulu K, Aliyev E, Kılıç Könte E, Tanatar A, Türkmen Ş, Doğantan Ş, Kızıldağ Z, Kasap Demir B, Gezgin Yıldırım D, Otar Yener G, Öztürk K, Baba Ö, Açarı C, Kılbaş G, Taşkın SN, Haşlak F, Çağlayan Ş, Bağlan E, Dundar HA, Başaran Ö, Barut K, Karadağ ŞG, Coşkuner T, Sönmez HE, Yüksel S, Kalyoncu M, Bakkaloğlu SA, Ünsal E, Paç Kısaarslan A, Bilginer Y, Aktay Ayaz N, Kasapçopur Ö, Özen S, Sözeri B. Macrophage activation syndrome in patients with systemic juvenile idiopathic arthritis on anti-interleukin-1 or -6 therapy. Rheumatology (Oxford) 2024; 63:SI167-SI172. [PMID: 38441301 DOI: 10.1093/rheumatology/keae124] [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: 06/21/2023] [Accepted: 02/01/2024] [Indexed: 09/10/2024] Open
Abstract
OBJECTIVES The aim of this study is to investigate the effect of anti-interleukin (IL)-1/-6 biologics on systemic juvenile idiopathic arthritis (sJIA)-associated macrophage activation syndrome (MAS). METHODS Demographic, clinical and laboratory data of patients followed up with a diagnosis of sJIA-associated MAS assessed from sixteen paediatric rheumatology centres across the country. The clinical and laboratory features of MAS developing while on biological drugs were compared with those without this treatment. RESULTS One hundred and sixty-two patients were included in the study. Forty-five of the MAS events were detected under the effect of anti-IL-1/-6 biologics, while the patients experiencing the remaining 155 events have not received biological treatment in the last three months. Platelet count [128 (72-232) vs 199 (130-371) 109/l], ferritin level on admission [1107 (676-2050) vs 2863 (1193-9562) ng/ml], C-reactive protein level [15.4 (2.9-56) vs 90 (32-160) mg/l], erythrocyte sedimentation rate [13 (3-36) vs 43.5 (13-77) mm/h] and fever duration [5 (4-7.5) vs 10 (7-14.3) days] were found lower in the group under the impact of anti-IL-1/-6 biologics. Among patients treated with biologics, 26.6% did not meet the published 2016 MAS classification criteria at presentation. The rates of hepatomegaly and splenomegaly were relatively lower in the canakinumab-treated group when compared with those receiving other biologicals or to patients, not on biologicals. CONCLUSION Anti-IL-1/-6 therapies can mask the clinical and laboratory features of MAS, and proposed guidelines for MAS classification criteria may not be met.
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Affiliation(s)
- Kadir Ulu
- Department of Pediatric Rheumatology, Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - Emil Aliyev
- Department of Pediatric Rheumatology, Hacettepe University, Ankara, Turkey
| | - Elif Kılıç Könte
- Department of Pediatric Rheumatology, İstanbul University-Cerrahpasa, İstanbul, Turkey
| | - Ayşe Tanatar
- Department of Pediatric Rheumatology, İstanbul University, İstanbul, Turkey
| | - Şeyma Türkmen
- Department of Pediatric Rheumatology, Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - Şeyda Doğantan
- Department of Pediatric Rheumatology, Erciyes University, Kayseri, Turkey
| | - Zehra Kızıldağ
- Department of Pediatric Rheumatology, Dokuz Eylül University, İzmir, Turkey
| | - Belde Kasap Demir
- Department of Pediatric Rheumatology, Tepecik Training and Research Hospital, İzmir, Turkey
| | | | - Gülçin Otar Yener
- Department of Pediatric Rheumatology, Gaziantep Medical Point Hospital, Gaziantep, Turkey
| | - Kübra Öztürk
- Department of Pediatric Rheumatology, İstanbul Medeniyet University, İstanbul, Turkey
| | - Özge Baba
- Department of Pediatric Rheumatology, Karadeniz Technical University, Trabzon, Turkey
| | - Ceyhun Açarı
- Department of Pediatric Rheumatology, İnönü University, Malatya, Turkey
| | - Gülşah Kılbaş
- Department of Pediatric Rheumatology, Pamukkale University, Denizli, Turkey
| | - Sema Nur Taşkın
- Department of Pediatric Rheumatology, Erciyes University, Kayseri, Turkey
| | - Fatih Haşlak
- Department of Pediatric Rheumatology, İstanbul University-Cerrahpasa, İstanbul, Turkey
| | - Şengül Çağlayan
- Department of Pediatric Rheumatology, Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - Esra Bağlan
- Department of Pediatric Rheumatology, Dr Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | | | - Özge Başaran
- Department of Pediatric Rheumatology, Hacettepe University, Ankara, Turkey
| | - Kenan Barut
- Department of Pediatric Rheumatology, İstanbul University-Cerrahpasa, İstanbul, Turkey
| | - Şerife Gül Karadağ
- Department of Pediatric Rheumatology, İstanbul University, İstanbul, Turkey
| | - Taner Coşkuner
- Department of Pediatric Rheumatology, Ümraniye Training and Research Hospital, İstanbul, Turkey
| | | | - Selçuk Yüksel
- Department of Pediatric Rheumatology, Pamukkale University, Denizli, Turkey
| | - Mukaddes Kalyoncu
- Department of Pediatric Rheumatology, Karadeniz Technical University, Trabzon, Turkey
| | | | - Erbil Ünsal
- Department of Pediatric Rheumatology, Dokuz Eylül University, İzmir, Turkey
| | | | - Yelda Bilginer
- Department of Pediatric Rheumatology, Hacettepe University, Ankara, Turkey
| | - Nuray Aktay Ayaz
- Department of Pediatric Rheumatology, İstanbul University, İstanbul, Turkey
| | - Özgür Kasapçopur
- Department of Pediatric Rheumatology, İstanbul University-Cerrahpasa, İstanbul, Turkey
| | - Seza Özen
- Department of Pediatric Rheumatology, Hacettepe University, Ankara, Turkey
| | - Betül Sözeri
- Department of Pediatric Rheumatology, Ümraniye Training and Research Hospital, İstanbul, Turkey
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3
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Brunner HI, Ruperto N, Ramanan AV, Horneff G, Minden K, Calvo Penades I, Alexeeva E, Cleary G, Stern SM, Kone-Paut I, Maldonado Velázquez MDR, Rabinovich CE, Remesal A, Silva CA, Nikishina I, Zucchetto M, Brockwell L, Gordon O, Nagel S, De Benedetti F. Long-term efficacy and safety of subcutaneous tocilizumab in clinical trials of polyarticular or systemic juvenile idiopathic arthritis. Rheumatology (Oxford) 2024; 63:2535-2546. [PMID: 38552315 PMCID: PMC11371380 DOI: 10.1093/rheumatology/keae180] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/17/2024] [Indexed: 09/05/2024] Open
Abstract
OBJECTIVE To investigate the safety and efficacy of subcutaneous tocilizumab (SC-TCZ) treatment in a long-term extension (LTE) of clinical trials in polyarticular or systemic juvenile idiopathic arthritis (pJIA or sJIA). METHODS Patients with pJIA or sJIA from two open-label, 52-week phase 1b core trials of SC-TCZ who had adequate response per investigator assessment entered the LTE and continued SC-TCZ treatment according to body weight-based dosing regimens until commercial availability or up to 5 years. Pharmacokinetics, pharmacodynamics, and efficacy were assessed for up to 3 years, and safety for up to 5 years in the LTE. RESULTS Forty-four patients with pJIA and 38 patients with sJIA entered the LTE. Tocilizumab trough concentrations were maintained within the range expected to provide clinical benefit (mean values: pJIA, ∼10 μg/ml; sJIA, ∼75 μg/ml over 3 years). Pharmacodynamic parameters (interleukin-6, soluble interleukin-6 receptor, erythrocyte sedimentation rate, C-reactive protein) were maintained throughout the LTE at levels achieved in the core trials. Inactive disease per American College of Rheumatology provisional criteria was reported for 90% (17/19) and 53% (8/15) of patients with pJIA and 91% (10/11) and 92% (12/13) of patients with sJIA in the <30 and ≥30 kg body weight groups, respectively. Serious adverse events in the LTE were reported in six patients with pJIA (13.6%; five serious infections) and five patients with sJIA (13.2%; one serious infection). CONCLUSION Patients with pJIA or sJIA experienced long-term disease control with SC-TCZ treatment. Long-term safety was consistent with the known tocilizumab safety profile. CLINICAL TRIAL REGISTRATION clinicaltrials.gov, NCT02165345.
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MESH Headings
- Humans
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/adverse effects
- Antibodies, Monoclonal, Humanized/pharmacokinetics
- Arthritis, Juvenile/drug therapy
- Child
- Female
- Male
- Treatment Outcome
- Injections, Subcutaneous
- Adolescent
- Child, Preschool
- Antirheumatic Agents/therapeutic use
- Antirheumatic Agents/administration & dosage
- Antirheumatic Agents/adverse effects
- C-Reactive Protein/metabolism
- Receptors, Interleukin-6/antagonists & inhibitors
- Interleukin-6/antagonists & inhibitors
- Interleukin-6/blood
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Affiliation(s)
- Hermine I Brunner
- Pediatric Rheumatology Collaborative Study Group (PRCSG), University of Cincinnati, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Nicolino Ruperto
- IRCCS Istituto Giannina Gaslini, UOC Servizio Sperimentazioni Cliniche Pediatriche/Gaslini Trial Centre, PRINTO, Genoa, Italy
| | - Athimalaipet V Ramanan
- Bristol Royal Hospital for Children and Translational Health Sciences, University of Bristol, Bristol, UK
| | - Gerd Horneff
- Department of General Paediatrics, Asklepios Clinic Sankt Augustin, Sankt Augustin, Germany
- Department of Pediatric and Adolescent Medicine, University Hospital of Cologne, Cologne, Germany
| | - Kirsten Minden
- German Rheumatism Research Centre Berlin, Berlin, Germany
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin, Berlin, Germany
| | | | - Ekaterina Alexeeva
- National Medical Research Center of Children’s Health, Moscow, Russia
- First Moscow State Medical University, Moscow, Russia
| | - Gavin Cleary
- Paediatric Rheumatology, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - Sara M Stern
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Isabelle Kone-Paut
- European Reference Network for Immunodeficiency, Autoinflammatory, Autoimmune, and Paediatric Rheumatic Diseases (ERN-RITA) Member, Pediatric Rheumatology and, Bicêtre Hospital AP-HP, Centre de Référence des Maladies Autoinflammatoires et des Amyloses (CéRéMAIA), Paris, France
| | | | - C Egla Rabinovich
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Agustin Remesal
- Pediatric Rheumatology Unit, University Hospital La Paz, Madrid, Spain
| | - Clovis Artur Silva
- Pediatric Rheumatology Unit, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Irina Nikishina
- Pediatric Department, V.A. Nasonova Research Institute of Rheumatology, Moscow, Russian Federation
| | | | | | | | - Sandra Nagel
- Roche Pharmaceutical Research and Early Development, Roche Innovation Center, Basel, Switzerland
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Kilic Konte E, Akay N, Gul U, Ucak K, Derelioglu EI, Gurleyik D, Aslan E, Gunalp A, Haslak F, Yildiz M, Adrovic A, Sahin S, Barut K, Kasapcopur O. Long-term safety profile and secondary effectiveness of canakinumab in pediatric rheumatic diseases: a single-center experience. Expert Opin Drug Saf 2024:1-9. [PMID: 39069814 DOI: 10.1080/14740338.2024.2386370] [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: 01/23/2024] [Revised: 06/06/2024] [Accepted: 06/27/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND To demonstrate the long-term safety profile of canakinumab over a nine-year period by documenting adverse events in patients with various pediatric rheumatic diseases. RESEARCH DESIGN AND METHODS This retrospective observational study was conducted at the Pediatric Rheumatology Department of Istanbul University Cerrahpasa between 2015 and 2023. The analysis concerned individuals who had been administered canakinumab treatment for at least six months. The exposure-adjusted event rates were calculated as adverse events per 100 patient days and were compared among three groups based on the cumulative canakinumab dose of <35 mg/kg, 35-70 mg/kg, and >70 mg/kg. RESULTS Among 189 patients, the median exposure time to canakinumab was 2.9 (1.5-4.1) years, corresponding to 573.4 patient years. The median cumulative dose of canakinumab was 2205 (1312-3600) mg. The most common adverse event was upper respiratory tract infection (0.76), followed by urinary tract infection (0.02), pneumonia (0.009), latent tuberculosis (0.009) and lymphadenitis (0.004). A total of 55 serious adverse events (0.025) were reported, 12 (0.006) of which led to drug discontinuation. The event rate of macrophage activation syndrome and disease exacerbation was statistically higher in patients receiving <35 mg/kg cumulative canakinumab dose (p < 0.05). CONCLUSIONS An increase in side effect was not observed with the increasing cumulative doses of canakinumab. Canakinumab demonstrated long-term safety with appropriate indication and monitoring.
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Affiliation(s)
- Elif Kilic Konte
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Nergis Akay
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Umit Gul
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Kubra Ucak
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ecenur Izzete Derelioglu
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Damla Gurleyik
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Esma Aslan
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Aybuke Gunalp
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Fatih Haslak
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Mehmet Yildiz
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Amra Adrovic
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Sezgin Sahin
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Kenan Barut
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ozgur Kasapcopur
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Fatma A, Raida BS, Mourad C, Ikram D, Zouheir B, Henda E. Performances of the H-score and the HLH-2004 score in the positive diagnosis of secondary hemophagocytic lymphohistiocytosis. Curr Res Transl Med 2024; 72:103430. [PMID: 38266400 DOI: 10.1016/j.retram.2023.103430] [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: 05/24/2023] [Revised: 09/11/2023] [Accepted: 11/06/2023] [Indexed: 01/26/2024]
Abstract
Hemophagocytic lymphocytosis (HLH) is a rare clinical and biological entity that can be life-threatening. Early diagnosis can improve the overall prognosis of HLH. OBJECTIVES The aims of this study are to evaluate the performances of HLH-2004-score and H-score in identifying patients with secondary HLH and to determine an optimal H-score cut-off for our population. METHODS A retrospective study that involved all patients, with images of hemophagocytosis in myelograms analyzed at the laboratory of hematology, followed at these departments: clinical-hematology, internal-medicine, infectious-diseases and gastroenterology, University-Hospital "Hédi-Chaker", Sfax-Tunisia, (June2017-May2021). We identified two groups of patients: "HLH" and "Not-HLH". Then, for each patient, we calculated the HLH-2004-score and the H-score. RESULTS Forty-two patients were included in this study. Twenty-five (60 %) belonging to group "HLH" and seventeen (40 %) to group "Not-HLH" with a mean age (38.72 vs. 39.82 years, p = 0.846) respectively. The study of the performances demonstrated that H-score had better performances. The best cut-off value of H-score for our population was 158.5, allowing a gain in sensitivity (from 92 % to 96 %) compared to the original study cut-off of 169. CONCLUSION Both H-score and HLH-2004-score showed excellent discriminative powers with better performances for H-score. The new H-score cut-off at 158.5 can be applied to our population.
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Affiliation(s)
- Abida Fatma
- Laboratory of Hematology, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Ben Salah Raida
- Department of Internal Medicine, Hedi Chaker University Hospital, Sfax, Tunisia.
| | - Chaari Mourad
- Laboratory of Hematology, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Dammak Ikram
- Laboratory of Hematology, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Bahloul Zouheir
- Department of Internal Medicine, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Elleuch Henda
- Laboratory of Hematology, Hedi Chaker University Hospital, Sfax, Tunisia
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Qiu L, Ma L, Xie Y, Jin J, Pan Y, Li S, Fan Z, Yu H. Efficacy and safety of canakinumab in systemic juvenile idiopathic arthritis, the first Chinese experience. Pediatr Rheumatol Online J 2024; 22:38. [PMID: 38504360 PMCID: PMC10949691 DOI: 10.1186/s12969-024-00974-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 03/10/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Systemic juvenile idiopathic arthritis (sJIA) is a severe form of juvenile arthritis that is characterized by chronic joint inflammation and systemic symptoms such as fever, rash, and organ involvement. Anti-IL-6 receptor monoclonal antibody tocilizumab is an effective treatment. However, some patients still experience persisting or recurrent symptoms and the real-world effectiveness of canakinumab in Chinese patients with sJIA has never been reported. Therefore, this study aimed to assess the efficacy and safety of canakinumab in Chinese patients with sJIA using real-world data. METHODS We conducted a retrospective study on children with active sJIA. Clinical features, laboratory data, corticosteroid dosage, and adverse events (AEs) were collected at baseline and at 4, 8, 12, and 24 weeks after initiating canakinumab treatment. RESULTS Seven female and four male patients were included in the study. All patients had previously been treated with tocilizumab and were administered canakinumab for 12.4 ± 3.4 months. Notably, significant improvements were observed in both clinical signs and symptoms as well as laboratory indicators. Four children under corticosteroid treatment were able to successfully discontinue their corticosteroid therapy: one at week 4, two at week 12, and one at week 24. Notably, there was a significant reduction in the number of tender and swollen joints (P = 0.0059) as well as the systemic juvenile arthritis disease activity score (P < 0.0001). The most common AE was infection, but no patients experienced serious AEs. No cases of macrophage activation syndrome or death were reported during the follow-up period. CONCLUSIONS Canakinumab was found to be potentially efficacious and safe in Chinese patients with sJIA. No new AEs were observed with canakinumab treatment.
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Affiliation(s)
- Lingzhi Qiu
- Department of Rheumatology and Immunology, Children's Hospital of Nanjing Medical University, No. 72 Guangzhou Road, Nanjing, Jiangsu Province, 210008, China
| | - Le Ma
- Department of Rheumatology and Immunology, Children's Hospital of Nanjing Medical University, No. 72 Guangzhou Road, Nanjing, Jiangsu Province, 210008, China
| | - Yifan Xie
- Department of Rheumatology and Immunology, Children's Hospital of Nanjing Medical University, No. 72 Guangzhou Road, Nanjing, Jiangsu Province, 210008, China
| | - Jing Jin
- Department of Rheumatology and Immunology, Children's Hospital of Nanjing Medical University, No. 72 Guangzhou Road, Nanjing, Jiangsu Province, 210008, China
| | - Yuting Pan
- Department of Rheumatology and Immunology, Children's Hospital of Nanjing Medical University, No. 72 Guangzhou Road, Nanjing, Jiangsu Province, 210008, China
| | - Shumin Li
- Department of Rheumatology and Immunology, Children's Hospital of Nanjing Medical University, No. 72 Guangzhou Road, Nanjing, Jiangsu Province, 210008, China
| | - Zhidan Fan
- Department of Rheumatology and Immunology, Children's Hospital of Nanjing Medical University, No. 72 Guangzhou Road, Nanjing, Jiangsu Province, 210008, China.
| | - Haiguo Yu
- Department of Rheumatology and Immunology, Children's Hospital of Nanjing Medical University, No. 72 Guangzhou Road, Nanjing, Jiangsu Province, 210008, China.
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7
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Kontzias A, Petryna O, Nakasato P, Efthimiou P. Diagnosing and Treating Systemic Juvenile Idiopathic Arthritis and Adult-Onset Still's Disease as Part of the Still's Disease Continuum. Mediterr J Rheumatol 2024; 35:45-57. [PMID: 38756937 PMCID: PMC11094444 DOI: 10.31138/mjr.290323.dat] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 11/02/2023] [Accepted: 12/11/2023] [Indexed: 05/18/2024] Open
Abstract
Aim We have summarised the existing evidence supporting the concept that systemic juvenile idiopathic arthritis (sJIA) and adult-onset Still's disease (AOSD) are part of the same Still's disease spectrum. Methods A PubMed/Embase database search was conducted using specific search strings and free text words to screen for relevant articles. The search was limited to studies in humans, published up to June 2023, in English-language. Summary sJIA and AOSD are rare autoinflammatory disorders that have similar pathophysiological and clinical features. The clinical presentations of sJIA and AOSD are highly variable, with differential diagnoses that include a broad range of malignancies, infectious diseases, and autoimmune disorders, which contribute to delays in diagnosis. Several sets of classification exist to help diagnose patients in clinical practice; the International League of Associations for Rheumatology criteria for sJIA and the Yamaguchi and Fautrel criteria for AOSD are the most-used criteria. The therapeutic strategy for Still's disease aims to relieve signs and symptoms, prevent irreversible joint damage and potentially life-threatening complications, and avoid deleterious side effects of treatment. Recently, targeted therapies such as interleukin (IL)-1 and IL-6 inhibitors have become available for the treatment of sJIA and AOSD. While these biologics were originally largely reserved for patients in whom non-steroidal anti-inflammatory drugs, corticosteroids and conventional synthetic disease-modifying anti-rheumatic drugs had failed, they are increasingly used earlier in the treatment paradigm. Among IL-1 inhibitors, canakinumab is the only biologic approved in the US for the treatment of both sJIA and AOSD.
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Affiliation(s)
- Apostolos Kontzias
- Department of Internal Medicine, Division of Rheumatology, Allergy and Immunology, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Olga Petryna
- Department of Medicine, White Plains Hospital, White Plains, NY, USA
| | | | - Petros Efthimiou
- Department of Medicine, White Plains Hospital, White Plains, NY, USA
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8
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Ruscitti P, Cantarini L, Nigrovic PA, McGonagle D, Giacomelli R. Recent advances and evolving concepts in Still's disease. Nat Rev Rheumatol 2024; 20:116-132. [PMID: 38212542 DOI: 10.1038/s41584-023-01065-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2023] [Indexed: 01/13/2024]
Abstract
Still's disease is a rare inflammatory syndrome that encompasses systemic juvenile idiopathic arthritis and adult-onset Still's disease, both of which can exhibit life-threatening complications, including macrophage activation syndrome (MAS), a secondary form of haemophagocytic lymphohistiocytosis. Genetic insights into Still's disease involve both HLA and non-HLA susceptibility genes, suggesting the involvement of adaptive immune cell-mediated immunity. At the same time, phenotypic evidence indicates the involvement of autoinflammatory processes. Evidence also implicates the type I interferon signature, mechanistic target of rapamycin complex 1 signalling and ferritin in the pathogenesis of Still's disease and MAS. Pathological entities associated with Still's disease include lung disease that could be associated with biologic DMARDs and with the occurrence of MAS. Historically, monophasic, recurrent and persistent Still's disease courses were recognized. Newer proposals of alternative Still's disease clusters could enable better dissection of clinical heterogeneity on the basis of immune cell profiles that could represent diverse endotypes or phases of disease activity. Therapeutically, data on IL-1 and IL-6 antagonism and Janus kinase inhibition suggest the importance of early administration in Still's disease. Furthermore, there is evidence that patients who develop MAS can be treated with IFNγ antagonism. Despite these developments, unmet needs remain that can form the basis for the design of future studies leading to improvement of disease management.
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Affiliation(s)
- Piero Ruscitti
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
| | - Luca Cantarini
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy
| | - Peter A Nigrovic
- Division of Immunology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Dennis McGonagle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK
- National Institute for Health Research (NIHR) Leeds Biomedical Research Centre (BRC), Leeds Teaching Hospitals, Leeds, UK
| | - Roberto Giacomelli
- Clinical and research section of Rheumatology and Clinical Immunology, Fondazione Policlinico Campus Bio-Medico, Rome, Italy
- Rheumatology and Clinical Immunology, Department of Medicine, University of Rome "Campus Biomedico", School of Medicine, Rome, Italy
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Gagro A, Tomičić M, Škarić I, Dawidowsky B. Case report: Suspected transfusion-related acute lung injury type II in a child with refractory systemic juvenile idiopathic arthritis complicated by macrophage activation syndrome. Front Pediatr 2024; 11:1237111. [PMID: 38259599 PMCID: PMC10801163 DOI: 10.3389/fped.2023.1237111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 12/15/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction Transfusion-related acute lung injury is a rare but potentially fatal complication, which may appear during or post-transfusion of blood products. Patients with macrophage activation syndrome, a serious life-threatening complication associated with systemic juvenile idiopathic arthritis, often require transfusion or administration of blood products for correction of cytopenia, coagulopathy and hypofibrinogenemia. Case report A 6-year-old girl with a past medical history of systemic juvenile idiopathic arthritis had the first relapse of the disease during which she developed macrophage activation syndrome. During this life-threatening complication, she received a second dose of whole blood derived filtered and irradiated platelets from a single male donor due to profound thrombocytopenia. Approximately one hour post-infusion, the patient developed progressive dyspnea, hypoxemia and bilateral pulmonary edema. She was promptly intubated and placed on mechanical ventilation for 40 h. Clinical, laboratory and radiological findings, as well as the success of supportive ventilation therapy were highly suggestive of transfusion-related acute lung injury, a life-threatening complication that occurs within six hours of blood component transfusion. Blood immunology showed no presence of anti-human neutrophil antigen and anti-leukocyte antigen class I and class II antibodies in the donor's or patient's plasma. Conclusion To the best of our knowledge, we report the first case of a child with systemic juvenile idiopathic arthritis complicated with macrophage activation syndrome who developed type II transfusion-related acute lung injury following platelet transfusion. It is important to consider transfusion-related acute lung injury in transfusion settings in these children and apply critical and restrictive approach for platelet transfusion.
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Affiliation(s)
- Alenka Gagro
- Department of Pediatrics, Zagreb Children’s Hospital, School of Medicine, University of Zagreb, Zagreb, Croatia
- School of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Maja Tomičić
- Department of Platelet and Leukocyte Diagnosis and Hemostasis, Croatian Institute of Transfusion Medicine, Zagreb, Croatia
| | - Ivančica Škarić
- Department of Anesthesiology, Resuscitation and Intensive Care Medicine, Zagreb Children’s Hospital, Zagreb, Croatia
| | - Barbara Dawidowsky
- Department of Pediatric Surgery, Zagreb Children’s Hospital, Zagreb, Croatia
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Di Cola I, Ruscitti P. The latest advances in the use of biological DMARDs to treat Still's disease. Expert Opin Biol Ther 2024; 24:63-75. [PMID: 38284774 DOI: 10.1080/14712598.2024.2307340] [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: 09/28/2023] [Accepted: 01/16/2024] [Indexed: 01/30/2024]
Abstract
INTRODUCTION Currently, the therapeutic management of Still's disease, a multisystemic inflammatory rare disorder, is directed to target the inflammatory symptoms and signs of patients. The treatment varies from glucocorticoids to disease-modifying antirheumatic drugs (DMARDs), both conventional synthetic and biological (bDMARDs). Usually, in refractory patients, bDMARDs are administered. AREAS COVERED Among bDMARDs, IL-1 and IL-6 inhibitors are frequently used, as data reported from both clinical trials and 'real-life' experiences. Recently, innovative therapeutic strategies have suggested an early administration of bDMARDs to increase the rate of clinical response and drug-free remission. Some new targets have been also proposed targeting IL-18, IFN-γ, and JAK/STAT pathway, which could be applied to Still's disease and its life-threatening evolution. EXPERT OPINION Many lines of evidence improved the knowledge about the therapeutic management of Still's disease with bDMARDs. However, many unmet needs may be still highlighted which could provide the basis to arrange further specific research in increasing the rate of clinical response. In fact, Still's disease remains a highly heterogeneous disease suggesting possible diverse underlying pathogenic mechanisms, at least partially, and consequent different therapeutic strategies. A better patient stratification may help in arranging specific studies to improve the long-term outcome of Still's disease.
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Affiliation(s)
- Ilenia Di Cola
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Piero Ruscitti
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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11
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Caricchio R, Gallucci S. Systemic Lupus Erythematosus and Cytokine Storm. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1448:355-364. [PMID: 39117826 DOI: 10.1007/978-3-031-59815-9_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
Systemic lupus erythematosus (SLE) is the prototype of autoimmune diseases and can manifest with a plethora of clinical signs and symptoms associated with a myriad of laboratory abnormalities. An infrequent but potentially lethal complication of SLE is macrophage activation syndrome (MAS). The diagnosis of MAS in SLE can be very challenging due to similarities in presentation of both flares and infections, such as fever, lymphadenopathy, splenomegaly, and cytopenias. These aggravating factors contribute to the increased risk of poor outcomes in SLE-associated MAS. Indeed, at the moment MAS remains invariably lethal if untreated and still has a high mortality rate with treatment. In this chapter, we discuss several aspects of MAS in the context of SLE and in particular, the pathogenesis of MAS in SLE, how MAS presents in pediatric versus adult SLE, and, finally, MAS treatment in SLE and future directions.
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12
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Hinze CH, Foell D, Kessel C. Treatment of systemic juvenile idiopathic arthritis. Nat Rev Rheumatol 2023; 19:778-789. [PMID: 37923864 DOI: 10.1038/s41584-023-01042-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 11/06/2023]
Abstract
Systemic juvenile idiopathic arthritis (sJIA) is an inflammatory disease with hallmarks of severe systemic inflammation, which can be accompanied by arthritis. Contemporary scientific insights set this paediatric disorder on a continuum with its counterpart, adult-onset Still disease (AOSD). Patients with sJIA are prone to complications, including life-threatening hyperinflammation (macrophage activation syndrome (sJIA-MAS)) and sJIA-associated lung disease (sJIA-LD). Meanwhile, the treatment arsenal in sJIA has expanded markedly. State-of-the-art therapeutic approaches include biologic agents that target the IL-1 and IL-6 pathways. Beyond these, a range of novel agents are on the horizon, some of them already being used on a compassionate use basis, including JAK inhibitors and biologic agents that target IL-18, IFNγ, or IL-1β and IL-18 simultaneously. However, sJIA, sJIA-MAS and sJIA-LD still pose challenging conundrums to rheumatologists treating paediatric and adult patients worldwide. Although national and international consensus treatment plans exist for the treatment of 'classic' sJIA, the treatment approaches for early sJIA without arthritis, and for refractory or complicated sJIA, are not well defined. Therefore, in this Review we outline current approaches for the treatment of sJIA and provide an outlook on knowledge gaps.
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Affiliation(s)
- Claas H Hinze
- Department of Paediatric Rheumatology and Immunology, Münster University Hospital, Münster, Germany
| | - Dirk Foell
- Department of Paediatric Rheumatology and Immunology, Münster University Hospital, Münster, Germany.
| | - Christoph Kessel
- Department of Paediatric Rheumatology and Immunology, Münster University Hospital, Münster, Germany
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13
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Iwata N, Nishimura K, Hara R, Imagawa T, Shimizu M, Tomiita M, Umebayashi H, Takei S, Seko N, Wakabayashi R, Yokota S. Long-term efficacy and safety of canakinumab in the treatment of systemic juvenile idiopathic arthritis in Japanese patients: Results from an open-label Phase III study. Mod Rheumatol 2023; 33:1162-1170. [PMID: 36399020 DOI: 10.1093/mr/roac128] [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: 05/11/2022] [Accepted: 10/07/2022] [Indexed: 11/08/2023]
Abstract
OBJECTIVES The objective of the study was to report the efficacy and safety of canakinumab treatment in Japanese patients with systemic juvenile idiopathic arthritis (sJIA) over a 48-week study period. METHODS Patients were administered canakinumab 4 mg/kg (maximum dose 300 mg) every 4 weeks, with no dose adjustments. The key outcome measures included adapted American College of Rheumatology paediatric (aACR pedi) 30/50/70/90/100 response, proportion of patients with inactive disease, and corticosteroid (CS) tapering. RESULTS In total, 16/19 (84.2%) patients received canakinumab for ≥96 weeks reaching end-of-study (EOS) visit without premature discontinuation. Regardless of the level of joint involvement at baseline, high aACR pedi responses were observed throughout the study; at the EOS, aACR pedi 90/100 response rates were 84.2%/63.2%, respectively. The proportion of patients who successfully tapered CSs at EOS was 66.7% (12/18), of which 10 patients were steroid-free. The most common adverse events were infections (238.3 events/100 patient-years). Serious adverse events were observed in 52.6%. The event (n=1) adjudicated as possible macrophage activation syndrome was preceded by sJIA flare. No deaths were reported. CONCLUSIONS Canakinumab treatment resulted in a sustained treatment response in sJIA patients over 48 weeks and was associated with CS tapering in majority of patients. No new safety findings were reported.
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Affiliation(s)
- Naomi Iwata
- Department of Infection and Immunology, Aichi Children's Health and Medical Center, Obu, Japan
| | - Kenichi Nishimura
- Department of Pediatrics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Ryoki Hara
- Department of Pediatrics, National Hospital Organization Yokohama Medical Center, Yokohama, Japan
| | - Tomoyuki Imagawa
- Department of Infection and Immunology, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Masaki Shimizu
- Department of Child Health and Development, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Minako Tomiita
- Department of Clinical Research/Pediatric Allergy and Rheumatology Center, National Hospital Organisation Shimoshizu National Hospital, Chiba, Japan
| | - Hiroaki Umebayashi
- Department of Rheumatology and Infectious disease, Miyagi Children's Hospital, Sendai, Japan
| | - Syuji Takei
- Department of Pediatrics, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | | | | | - Shumpei Yokota
- Tokyo University and Graduate School of Social Welfare, Isesaki, Japan
- Yokohama City University, Yokohama, Japan
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14
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Maller J, Morgan T, Morita M, McCarthy F, Jung Y, Svensson KJ, Elias JE, Macaubas C, Mellins E. Extracellular vesicles in systemic juvenile idiopathic arthritis. J Leukoc Biol 2023; 114:387-403. [PMID: 37201912 PMCID: PMC10602196 DOI: 10.1093/jleuko/qiad059] [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: 10/21/2022] [Revised: 04/28/2023] [Accepted: 05/11/2023] [Indexed: 05/20/2023] Open
Abstract
Systemic juvenile idiopathic arthritis is a chronic pediatric inflammatory disease of unknown etiology, characterized by fever, rash, hepatosplenomegaly, serositis, and arthritis. We hypothesized that intercellular communication, mediated by extracellular vesicles, contributes to systemic juvenile idiopathic arthritis pathogenesis and that the number and cellular sources of extracellular vesicles would differ between inactive and active states of systemic juvenile idiopathic arthritis and healthy controls. We evaluated plasma from healthy pediatric controls and patients with systemic juvenile idiopathic arthritis with active systemic flare or inactive disease. We isolated extracellular vesicles by size exclusion chromatography and determined total extracellular vesicle abundance and size distribution using microfluidic resistive pulse sensing. Cell-specific extracellular vesicle subpopulations were measured by nanoscale flow cytometry. Isolated extracellular vesicles were validated using a variety of ways, including nanotracking and cryo-electron microscopy. Extracellular vesicle protein content was analyzed in pooled samples using mass spectrometry. Total extracellular vesicle concentration did not significantly differ between controls and patients with systemic juvenile idiopathic arthritis. Extracellular vesicles with diameters <200 nm were the most abundant, including the majority of cell-specific extracellular vesicle subpopulations. Patients with systemic juvenile idiopathic arthritis had significantly higher levels of extracellular vesicles from activated platelets, intermediate monocytes, and chronically activated endothelial cells, with the latter significantly more elevated in active systemic juvenile idiopathic arthritis relative to inactive disease and controls. Protein analysis of isolated extracellular vesicles from active patients showed a proinflammatory profile, uniquely expressing heat shock protein 47, a stress-inducible protein. Our findings indicate that multiple cell types contribute to altered extracellular vesicle profiles in systemic juvenile idiopathic arthritis. The extracellular vesicle differences between systemic juvenile idiopathic arthritis disease states and healthy controls implicate extracellular vesicle-mediated cellular crosstalk as a potential driver of systemic juvenile idiopathic arthritis disease activity.
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Affiliation(s)
- Justine Maller
- Department of Pediatrics, Stanford University School of Medicine, 269 Campus Drive, CCSR Rm 2105c, Stanford, CA 94305, United States
| | - Terry Morgan
- Departments of Pathology and Biomedical Engineering, Oregon Health & Sciences University, 3181 SW Sam Jackson Portland, OR 97239, United States
| | - Mayu Morita
- Departments of Pathology and Biomedical Engineering, Oregon Health & Sciences University, 3181 SW Sam Jackson Portland, OR 97239, United States
| | - Frank McCarthy
- Chan Zuckerberg Biohub, 265 Campus Drive, Palo Alto, CA 94305, United States
| | - Yunshin Jung
- Department of Pathology, Stanford University School of Medicine, 300 Pasteur Dr, Edwards R238, Stanford, CA 94305, United States
| | - Katrin J Svensson
- Department of Pathology, Stanford University School of Medicine, 300 Pasteur Dr, Edwards R238, Stanford, CA 94305, United States
- Stanford Diabetes Research Center, Stanford, CA 94305, United States
- Stanford Cardiovascular Institute, Stanford, CA 94305, United States
| | - Joshua E Elias
- Chan Zuckerberg Biohub, 265 Campus Drive, Palo Alto, CA 94305, United States
| | - Claudia Macaubas
- Department of Pediatrics, Stanford University School of Medicine, 269 Campus Drive, CCSR Rm 2105c, Stanford, CA 94305, United States
- Department of Pediatrics, Program in Immunology, Stanford University School of Medicine, 269 Campus Drive, CCSR Rm 2105c, Stanford, CA 94305, United States
| | - Elizabeth Mellins
- Department of Pediatrics, Stanford University School of Medicine, 269 Campus Drive, CCSR Rm 2105c, Stanford, CA 94305, United States
- Department of Pediatrics, Program in Immunology, Stanford University School of Medicine, 269 Campus Drive, CCSR Rm 2105c, Stanford, CA 94305, United States
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15
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Cho S, Ying F, Sweeney G. Sterile inflammation and the NLRP3 inflammasome in cardiometabolic disease. Biomed J 2023; 46:100624. [PMID: 37336361 PMCID: PMC10539878 DOI: 10.1016/j.bj.2023.100624] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/11/2023] [Accepted: 06/14/2023] [Indexed: 06/21/2023] Open
Abstract
Inflammation plays an important role in the pathophysiology of cardiometabolic diseases. Sterile inflammation, a non-infectious and damage-associated molecular pattern (DAMP)-induced innate response, is now well-established to be closely associated with development and progression of cardiometabolic diseases. The NOD-like receptor (NLR) family pyrin domain-containing 3 (NLRP3) inflammasome is well-established as a major player in sterile inflammatory responses. It is a multimeric cytosolic protein complex which regulates the activation of caspase-1 and subsequently promotes cleavage and release of interleukin (IL)-1 family cytokines, which have a deleterious impact on the development of cardiometabolic diseases. Therefore, targeting NLRP3 itself or the downstream consequences of NLRP3 activation represent excellent potential therapeutic targets in inflammatory cardiometabolic diseases. Here, we review our current understanding of the role which NLRP3 inflammasome regulation plays in cardiometabolic diseases such as obesity, diabetes, non-alcoholic steatohepatitis (NASH), atherosclerosis, ischemic heart disease and cardiomyopathy. Finally, we highlight the potential of targeting NLPR3 or related signaling molecules as a therapeutic approach.
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Affiliation(s)
- Sungji Cho
- Department of Biology, York University, Toronto, Ontario, Canada
| | - Fan Ying
- Department of Biology, York University, Toronto, Ontario, Canada
| | - Gary Sweeney
- Department of Biology, York University, Toronto, Ontario, Canada.
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16
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Long AM, Marston B. Juvenile Idiopathic Arthritis. Pediatr Rev 2023; 44:565-577. [PMID: 37777651 DOI: 10.1542/pir.2022-005623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Abstract
Juvenile idiopathic arthritis (JIA) comprises a group of heterogenous disorders characterized by childhood-onset chronic joint inflammation. It is the most common rheumatologic disease in the pediatric population and an important cause of chronic illness in children. Early recognition and treatment are vital to prevent sequelae of uncontrolled inflammation on the developing skeleton. JIA can have significant complications that general pediatricians should be aware of, especially uveitis, which can be insidious and asymptomatic in very young children, and macrophage activation syndrome, which can be life-threatening if not recognized and appropriately treated. Although advances have been made in the past few decades, the etiology of JIA remains incompletely understood. Efforts are underway to refine the classification of JIA. The currently accepted classification scheme identifies subsets of JIA that are important clinically in terms of prognosis and tailoring treatment approaches. However, it is limited in identifying homogenous groups of children with early childhood onset and antinuclear antibody positivity, which may have different pathogenic mechanisms that could be important in developing more targeted and effective treatment approaches in the future. Treatment strategies for JIA have changed significantly in recent years with the availability of multiple newer targeted therapies, often modeled after medications used in adult-onset forms of arthritis. These treatments, and likely many others to come, have markedly improved symptom control and reduced complications in patients with JIA.
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Affiliation(s)
- Andrew M Long
- Division of Pediatric Rheumatology, Golisano Children's Hospital, Rochester, NY
- Division of Allergy, Immunology, and Rheumatology, University of Rochester Medical Center, Rochester, NY
| | - Bethany Marston
- Division of Pediatric Rheumatology, Golisano Children's Hospital, Rochester, NY
- Division of Allergy, Immunology, and Rheumatology, University of Rochester Medical Center, Rochester, NY
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17
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Coşkuner T, Çağlayan Ş, Akgün Ö, Torun R, Yayla ENS, Bagrul IL, Kılbaş G, Yener GO, Köse H, Öztürk K, Baba Ö, Çakan M, Demir F, Sönmez HE, Kalyoncu M, Kılıç SS, Yüksel S, Bağlan E, Bakkaloğlu SA, Ünsal E, Aktay Ayaz N, Sözeri B. The safety of canakinumab in systemic juvenile idiopathic arthritis and autoinflammatory diseases in pediatric patients: a multicenter study. Expert Opin Biol Ther 2023; 23:1299-1306. [PMID: 37970654 DOI: 10.1080/14712598.2023.2282133] [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: 06/07/2023] [Accepted: 11/07/2023] [Indexed: 11/17/2023]
Abstract
OBJECTIVE To evaluate the safety of canakinumab using real-world data in patients with systemic juvenile idiopathic arthritis (sJIA) and autoinflammatory diseases (AID). RESEARCH DESIGN AND METHODS This was a cross-sectional observational, multicenter study. Patients diagnosed with AID and sJIA treated with canakinumab were included in the study. The participating 13 centers retrospectively collected their patients' data. RESULTS A total of 335 patients were involved in the study. Among these patients, 280 were in the AID group and 55 were in the sJIA group. Canakinumab was administered at a median dose of 3 (2.5-4) mg/kg. The median total exposure time to canakinumab was 1.9 (0.8-3.2) years, corresponding to 759.5 patient-years. Seven hundred and seventy-nine total adverse events (AE) were identified. The total incidence of AE, and serious adverse events (SAE) throughout the study period was 1.02 per patient-years. The upper respiratory tract infection rate was 0.7 per patient-years, while the other infection rate was 0.13 per patient-years. While no death was observed in any patient, SAE were observed in 8 patients. Interstitial lung disease, anaphylaxis, or anaphylactoid reactions were not observed in any patient. CONCLUSIONS Real-life data from a large cohort of patients suggests that canakinumab is as safe as claimed in clinical trials.
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Affiliation(s)
| | - Şengül Çağlayan
- Department of Pediatric Rheumatology, Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Özlem Akgün
- Department of Pediatric Rheumatology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Rüya Torun
- Department of Pediatric Rheumatology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Emine Nur Sunar Yayla
- Department of Pediatric Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - I Lknur Bagrul
- Department of Pediatric Rheumatology, University of Health Sciences Turkey, Ankara, Turkey
| | - Gülşah Kılbaş
- Department of Pediatric Rheumatology, School of Medicine, Pamukkale University, Denizli, Turkey
| | - Gülçin Otar Yener
- Department of Pediatric Rheumatology, Şanlıurfa Research and Training Hospital, Şanlıurfa, Turkey
| | - Hülya Köse
- Department of Pediatrics, Division of Immunology and Rheumatology, Uludağ University Faculty of Medicine, Bursa, Turkey
| | - Kübra Öztürk
- Department of Pediatric Rheumatology, Göztepe Research and Training Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Özge Baba
- Department of Pediatric Rheumatology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Mustafa Çakan
- Department of Pediatric Rheumatology, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey
| | - Ferhat Demir
- Department of Pediatric Rheumatology, Acıbadem University Faculty of Medicine, Istanbul, Turkey
| | - Hafize Emine Sönmez
- Department of Pediatric Rheumatology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Mukaddes Kalyoncu
- Department of Pediatric Rheumatology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Sara Sebnem Kılıç
- Department of Pediatrics, Division of Immunology and Rheumatology, Uludağ University Faculty of Medicine, Bursa, Turkey
| | - Selçuk Yüksel
- Department of Pediatric Rheumatology, School of Medicine, Pamukkale University, Denizli, Turkey
| | - Esra Bağlan
- Department of Pediatric Rheumatology, University of Health Sciences Turkey, Ankara, Turkey
| | - Sevcan A Bakkaloğlu
- Department of Pediatric Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Erbil Ünsal
- Department of Pediatric Rheumatology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Nuray Aktay Ayaz
- Department of Pediatric Rheumatology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Betül Sözeri
- Department of Pediatric Rheumatology, Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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18
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Cannon L, Pan A, Kovalick L, Sarkissian A, Wu EY. Secondary immunodeficiencies and infectious considerations of biologic immunomodulatory therapies. Ann Allergy Asthma Immunol 2023; 130:718-726. [PMID: 36801438 PMCID: PMC10247415 DOI: 10.1016/j.anai.2023.02.010] [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: 12/22/2022] [Revised: 02/02/2023] [Accepted: 02/13/2023] [Indexed: 02/19/2023]
Abstract
Biologic immunomodulatory medications have rapidly expanded in the previous decades, providing new treatment options for individuals with a spectrum of oncologic, allergic, rheumatologic, and neurologic conditions. Biologic therapies alter immune function and can impair key host defense mechanisms, resulting in secondary immunodeficiency and increased infectious risks. Biologic medications can increase general risk for upper respiratory tract infections but can also be associated with unique infectious risks owing to distinct mechanisms of action. With the widespread use of these medications, providers in every area of medicine will likely care for individuals receiving biologic therapies and understanding their potential infectious complications can help mitigate these risks. This practical review discusses the infectious implications of biologics by class of medication and provides recommendations regarding the examination and screening both before therapy initiation and while the patient is receiving the medication. With this knowledge and background, providers can reduce risk whereas patients receive the treatment benefits of these biologic medications.
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Affiliation(s)
- Laura Cannon
- Division of Pediatric Rheumatology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Alice Pan
- Division of Pediatric Rheumatology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Pharmacy, UNC Health, Chapel Hill, North Carolina
| | - Leonard Kovalick
- Division of Pediatric Rheumatology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Aliese Sarkissian
- Division of Pediatric Rheumatology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Eveline Y Wu
- Division of Pediatric Rheumatology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Division of Pediatric Allergy/Immunology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
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Tanatar A, Akgün Ö, Çağlayan Ş, Bağlan E, Otar Yener G, Öztürk K, Çakan M, Sönmez HE, Sözeri B, Aktay Ayaz N. Withdrawal of biologic therapy in juvenile idiopathic arthritis due to remission: predictors of flare and outcomes. Expert Opin Biol Ther 2023; 23:305-313. [PMID: 36825474 DOI: 10.1080/14712598.2023.2185132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
OBJECTIVES To investigate patients who flared after discontinuation of biological disease-modifying anti-rheumatic agents (bDMARDs) and identify risk factors associated with flare. METHODS A multicenter study evaluating systemic and non-systemic juvenile idiopathic arthritis (sJIA and non-sJIA) patients whose bDMARDs were ceased after remission. RESULTS A total of 101 patients whose bDMARDs were ceased after remission was evaluated. Children with sJIA had the lowest risk of flare and 11.1% of 36 sJIA patients experienced flare after a median of 9 (4-24) months of bDMARDs cessation with three of them flaring in the first year. High leukocyte counts in sJIA patients were associated with inactive disease at 1-year after the start of treatment (p = 0.004). In the non-sJIA group, 46.1% patients experienced flare after a median of 7 (1-32) months of biologic cessation, and of these, 25 flared in the first year. Antinuclear antibody positivity (p = 0.02), earlier disease onset (p = 0.03), long disease duration (p = 0.01), and follow-up (p = 0.02) and extended time from diagnosis to first biological onset (p = 0.03) were more common among patients with flare. CONCLUSIONS When considering discontinuation of bDMARDs, it should be kept in mind that the risk of exacerbation requiring re-initiation therapy is quite significant within the first year after discontinuation of therapy.
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Affiliation(s)
- Ayşe Tanatar
- Faculty of Medicine, Department of Pediatric Rheumatology, Istanbul University, Fatih, Turkey
| | - Özlem Akgün
- Faculty of Medicine, Department of Pediatric Rheumatology, Istanbul University, Fatih, Turkey
| | - Şengül Çağlayan
- Department of Pediatric Rheumatology, University of Health Sciences, Ümraniye Research and Training Hospital, Ümraniye, Turkey
| | - Esra Bağlan
- Department of Pediatric Rheumatology, University of Health Sciences, Dr. Sami Ulus Maternity and Child Health and Diseases Research and Training Hospital, Altındağ, Turkey
| | - Gülçin Otar Yener
- Department of Pediatric Rheumatology, Şanlıurfa Research and Training Hospital, Haliliye, Turkey
| | - Kübra Öztürk
- Department of Pediatric Rheumatology, Istanbul Medeniyet University, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Kadıköy, Turkey
| | - Mustafa Çakan
- Department of Pediatric Rheumatology, University of Health Sciences, Ümraniye Research and Training Hospital, Ümraniye, Turkey
| | - Hafize Emine Sönmez
- Faculty of Medicine, Department of Pediatric Rheumatology, Kocaeli University, İzmit, Turkey
| | - Betül Sözeri
- Department of Pediatric Rheumatology, University of Health Sciences, Ümraniye Research and Training Hospital, Ümraniye, Turkey
| | - Nuray Aktay Ayaz
- Faculty of Medicine, Department of Pediatric Rheumatology, Istanbul University, Fatih, Turkey
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Vitale A, Caggiano V, Maggio MC, Lopalco G, Emmi G, Sota J, La Torre F, Ruscitti P, Bartoloni E, Conti G, Fabiani C, Mattioli I, Gaggiano C, Cardinale F, Dagna L, Campochiaro C, Giacomelli R, Balistreri A, Laskari K, Tufan A, Ragab G, Almaghlouth IA, Więsik-Szewczyk E, Pereira RM, Frediani B, Iannone F, Sfikakis PP, Cantarini L. Canakinumab as first-line biological therapy in Still's disease and differences between the systemic and the chronic-articular courses: Real-life experience from the international AIDA registry. Front Med (Lausanne) 2022; 9:1071732. [PMID: 36619631 PMCID: PMC9813488 DOI: 10.3389/fmed.2022.1071732] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022] Open
Abstract
Objective Interleukin (IL)-1 inhibitors are largely employed in patients with Still's disease; in cases with refractory arthritis, IL-6 inhibitors have shown to be effective on articular inflammatory involvement. The aim of the present study is to assess any difference in the effectiveness of the IL-1β antagonist canakinumab prescribed as first-line biologic agent between the systemic and the chronic-articular Still's disease. Methods Data were drawn from the retrospective phase of the AutoInflammatory Disease Alliance (AIDA) international registry dedicated to Still's disease. Patients with Still's disease classified according to internationally accepted criteria (Yamaguchi criteria and/or Fautrel criteria) and treated with canakinumab as first-line biologic agent were enrolled. Results A total of 26 patients (17 females, 9 males; 18 patients developing Still's disease after the age of 16 years) were enrolled; 16 (61.5%) patients suffered from the systemic pattern of the disease; 10 (38.5%) patients suffered from the chronic-articular type. No differences were observed between the systemic and the chronic-articular Still's disease in the frequency of complete response, of flares after the start of canakinumab (p = 0.701) and in the persistence in therapy (p = 0.62). No statistical differences were observed between the two groups after 3 months, 12 months and at the last assessment in the decrease of: the systemic activity score (p = 0.06, p = 0.17, p = 0.17, respectively); the disease activity score on 28 joints (p = 0.54, p = 0.77, p = 0.98, respectively); the glucocorticoid dosage (p = 0.15, p = 0.50, and p = 0.50, respectively); the use of concomitant disease modifying anti-rheumatic drugs (p = 0.10, p = 1.00, and p = 1.00, respectively). No statistically significant differences were observed in the decrease of erythrocyte sedimentation rate (p = 0.34), C reactive protein (p = 0.48), and serum ferritin levels (p = 0.34) after the start of canakinumab. Conclusion Canakinumab used for Still's disease has been effective in controlling both clinical and laboratory manifestations disregarding the type of disease course when used as first-line biotechnological agent. These excellent results might have been further enhanced by the early start of IL-1 inhibition.
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Affiliation(s)
- Antonio Vitale
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet’s Disease Clinic, University of Siena, Siena, Italy
| | - Valeria Caggiano
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet’s Disease Clinic, University of Siena, Siena, Italy
| | - Maria Cristina Maggio
- University Department Pro.Sa.M.I. “G. D’Alessandro”, University of Palermo, Palermo, Italy
| | - Giuseppe Lopalco
- Rheumatology Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy,Centre for Inflammatory Diseases, Monash Medical Centre, Monash University Department of Medicine, Melbourne, VIC, Australia
| | - Jurgen Sota
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet’s Disease Clinic, University of Siena, Siena, Italy
| | - Francesco La Torre
- Pediatric Rheumatology Center, Department of Pediatrics, Ospedale “Giovanni XXIII”, Azienda Ospedaliero Universitaria Consorziale Policlinico, Bari, Italy
| | - Piero Ruscitti
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| | - Elena Bartoloni
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | - Giovanni Conti
- Pediatric Nephrology and Rheumatology Unit, Azienda Ospedaliera Universitaria (AOU), “G. Martino” Messina, Italy
| | - Claudia Fabiani
- Ophthalmology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Irene Mattioli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Carla Gaggiano
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet’s Disease Clinic, University of Siena, Siena, Italy
| | - Fabio Cardinale
- Pediatric Rheumatology Center, Department of Pediatrics, Ospedale “Giovanni XXIII”, Azienda Ospedaliero Universitaria Consorziale Policlinico, Bari, Italy
| | - Lorenzo Dagna
- Division of Immunology, Transplants and Infectious Diseases, Università Vita-Salute San Raffaele, Milan, Italy,Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Corrado Campochiaro
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Roberto Giacomelli
- Rheumatology, Immunology and Clinical Medicine Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Selcetta, Italy
| | - Alberto Balistreri
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet’s Disease Clinic, University of Siena, Siena, Italy
| | - Katerina Laskari
- Joint Academic Rheumatology Program, The First Department of Propaedeutic and Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Abdurrahman Tufan
- Division of Rheumatology, Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Gaafar Ragab
- Rheumatology and Clinical Immunology Unit, Department of Internal Medicine, Faculty of Medicine, Cairo University, Giza, Egypt,Faculty of Medicine, New Giza University, Giza, Egypt
| | - Ibrahim A. Almaghlouth
- Rheumatology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia,College of Medicine Research Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ewa Więsik-Szewczyk
- Department of Internal Medicine, Pulmonology, Allergy and Clinical Immunology, Central Clinical Hospital of the Ministry of National Defence, Military Institute of Medicine, Warsaw, Poland
| | - Rosa Maria Pereira
- Rheumatology Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, Brazil
| | - Bruno Frediani
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet’s Disease Clinic, University of Siena, Siena, Italy
| | - Florenzo Iannone
- Rheumatology Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Petros P. Sfikakis
- Joint Academic Rheumatology Program, The First Department of Propaedeutic and Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Luca Cantarini
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet’s Disease Clinic, University of Siena, Siena, Italy,*Correspondence: Luca Cantarini,
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Ailioaie LM, Ailioaie C, Litscher G. Biomarkers in Systemic Juvenile Idiopathic Arthritis, Macrophage Activation Syndrome and Their Importance in COVID Era. Int J Mol Sci 2022; 23:12757. [PMID: 36361547 PMCID: PMC9655921 DOI: 10.3390/ijms232112757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 08/30/2023] Open
Abstract
Systemic juvenile idiopathic arthritis (sJIA) and its complication, macrophage activation syndrome (sJIA-MAS), are rare but sometimes very serious or even critical diseases of childhood that can occasionally be characterized by nonspecific clinical signs and symptoms at onset-such as non-remitting high fever, headache, rash, or arthralgia-and are biologically accompanied by an increase in acute-phase reactants. For a correct positive diagnosis, it is necessary to rule out bacterial or viral infections, neoplasia, and other immune-mediated inflammatory diseases. Delays in diagnosis will result in late initiation of targeted therapy. A set of biomarkers is useful to distinguish sJIA or sJIA-MAS from similar clinical entities, especially when arthritis is absent. Biomarkers should be accessible to many patients, with convenient production and acquisition prices for pediatric medical laboratories, as well as being easy to determine, having high sensitivity and specificity, and correlating with pathophysiological disease pathways. The aim of this review was to identify the newest and most powerful biomarkers and their synergistic interaction for easy and accurate recognition of sJIA and sJIA-MAS, so as to immediately guide clinicians in correct diagnosis and in predicting disease outcomes, the response to treatment, and the risk of relapses. Biomarkers constitute an exciting field of research, especially due to the heterogeneous nature of cytokine storm syndromes (CSSs) in the COVID era. They must be selected with utmost care-a fact supported by the increasingly improved genetic and pathophysiological comprehension of sJIA, but also of CSS-so that new classification systems may soon be developed to define homogeneous groups of patients, although each with a distinct disease.
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Affiliation(s)
- Laura Marinela Ailioaie
- Department of Medical Physics, Alexandru Ioan Cuza University, 11 Carol I Boulevard, 700506 Iasi, Romania
| | - Constantin Ailioaie
- Department of Medical Physics, Alexandru Ioan Cuza University, 11 Carol I Boulevard, 700506 Iasi, Romania
| | - Gerhard Litscher
- Research Unit of Biomedical Engineering in Anesthesia and Intensive Care Medicine, Research Unit for Complementary and Integrative Laser Medicine, Traditional Chinese Medicine (TCM) Research Center Graz, Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 39, 8036 Graz, Austria
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22
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Muacevic A, Adler JR. Myocarditis as the Initial Presentation of a Refractory Adult-Onset Still’s Disease. Cureus 2022; 14:e29821. [PMID: 36337832 PMCID: PMC9623201 DOI: 10.7759/cureus.29821] [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] [Accepted: 10/01/2022] [Indexed: 11/05/2022] Open
Abstract
We present a case of adult-onset Still’s disease, a rare disease that presented with a rare complication, myocarditis. After initial therapy with prednisolone 1 mg/kg/day, the patient experienced dyspnea due to severe pleural effusion and palpitations on account of new-onset supraventricular tachycardia. Therapy with three consecutive pulses of 1000 mg of methylprednisolone and anakinra 100 mg/day proved to be effective, with a progressive resolution of all symptoms. However, at three months follow-up, oligoarthritis recurred along with high serum ferritin. Secondary failure to anakinra was assumed, and a switch to tocilizumab 162 mg was made. Nevertheless, arthralgia of the wrists and knees as well as high serum ferritin still persisted after two months of therapy. Chronic disease was assumed, and the patient switched to canakinumab 4 mg/kg/dose q4week, and a complete resolution of symptoms occurred with normalization of inflammation markers. Follow-up cardiac magnetic resonance showed a complete resolution of heart involvement.
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23
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Gleeson TA, Nordling E, Kaiser C, Lawrence CB, Brough D, Green JP, Allan SM. Looking into the IL-1 of the storm: are inflammasomes the link between immunothrombosis and hyperinflammation in cytokine storm syndromes? DISCOVERY IMMUNOLOGY 2022; 1:kyac005. [PMID: 38566906 PMCID: PMC10917224 DOI: 10.1093/discim/kyac005] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/17/2022] [Accepted: 09/13/2022] [Indexed: 04/04/2024]
Abstract
Inflammasomes and the interleukin (IL)-1 family of cytokines are key mediators of both inflammation and immunothrombosis. Inflammasomes are responsible for the release of the pro-inflammatory cytokines IL-1β and IL-18, as well as releasing tissue factor (TF), a pivotal initiator of the extrinsic coagulation cascade. Uncontrolled production of inflammatory cytokines results in what is known as a "cytokine storm" leading to hyperinflammatory disease. Cytokine storms can complicate a variety of diseases and results in hypercytokinemia, coagulopathies, tissue damage, multiorgan failure, and death. Patients presenting with cytokine storm syndromes have a high mortality rate, driven in part by disseminated intravascular coagulation (DIC). While our knowledge on the factors propagating cytokine storms is increasing, how cytokine storm influences DIC remains unknown, and therefore treatments for diseases, where these aspects are a key feature are limited, with most targeting specific cytokines. Currently, no therapies target the immunothrombosis aspect of hyperinflammatory syndromes. Here we discuss how targeting the inflammasome and pyroptosis may be a novel therapeutic strategy for the treatment of hyperinflammation and its associated pathologies.
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Affiliation(s)
- Tara A Gleeson
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Geoffrey Jefferson Brain Research Centre, The Manchester Academic Health Science Centre, Northern Care Alliance NHS Group, University of Manchester, Manchester, UK
- Lydia Becker Institute of Immunology and Inflammation, University of Manchester, Manchester, UK
| | - Erik Nordling
- Swedish Orphan Biovitrum AB, Stockholm 112 76, Sweden
| | | | - Catherine B Lawrence
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Geoffrey Jefferson Brain Research Centre, The Manchester Academic Health Science Centre, Northern Care Alliance NHS Group, University of Manchester, Manchester, UK
- Lydia Becker Institute of Immunology and Inflammation, University of Manchester, Manchester, UK
| | - David Brough
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Geoffrey Jefferson Brain Research Centre, The Manchester Academic Health Science Centre, Northern Care Alliance NHS Group, University of Manchester, Manchester, UK
- Lydia Becker Institute of Immunology and Inflammation, University of Manchester, Manchester, UK
| | - Jack P Green
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Geoffrey Jefferson Brain Research Centre, The Manchester Academic Health Science Centre, Northern Care Alliance NHS Group, University of Manchester, Manchester, UK
- Lydia Becker Institute of Immunology and Inflammation, University of Manchester, Manchester, UK
| | - Stuart M Allan
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Geoffrey Jefferson Brain Research Centre, The Manchester Academic Health Science Centre, Northern Care Alliance NHS Group, University of Manchester, Manchester, UK
- Lydia Becker Institute of Immunology and Inflammation, University of Manchester, Manchester, UK
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Ruperto N, Lovell DJ, Berman A, Ávila-Zapata F, Horneff G, Alessio M, Becker ML, Belot A, Burgos-Vargas R, Gamir ML, Goldenstein-Schainberg C, Scheibel IM, Terreri MT, Zemel L, Zhuo J, Askelson M, Wong R, Martini A, Brunner HI. Patient-Reported Outcomes Among Patients Ages Two to Seventeen Years With Polyarticular-Course Juvenile Idiopathic Arthritis Treated With Subcutaneous Abatacept: Two-Year Results From an International Phase III Study. Arthritis Care Res (Hoboken) 2022. [PMID: 36710243 DOI: 10.1002/acr.24989] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 07/07/2022] [Accepted: 07/26/2022] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To describe longitudinal changes in patient-reported outcomes (PROs) in children with polyarticular-course juvenile idiopathic arthritis (pJIA) treated with subcutaneous abatacept. METHODS Secondary analysis of a single-arm, open-label 24-month study of patients ages 6-17 years and 2-5 years. PROs included Childhood Health Assessment Questionnaire-Disability Index (CHAQ-DI), parent global assessment of child well-being (PaGA), pain assessment, and Activity Limitation Questionnaire (ALQ). Clinical outcomes included 50% or greater improvement in JIA American College of Rheumatology (ACR) criteria, clinically inactive disease, and Juvenile Arthritis Disease Activity Score. RESULTS For the 6- to 17-year-old (n = 173) and 2- to 5-year-old (n = 46) cohorts, respectively, median (Q1, Q3) changes from baseline in CHAQ-DI at months 4 and 24 were -0.3 (-0.8, 0.0) and -0.5 (-1.0, -0.1), and -0.4 (-0.8, 0.0) and -0.5 (-1.0--0.1). Median pain scores were below cutoff threshold for clinically relevant pain (<35 mm) by month 1 (6 to 17 years, 32.3 mm; 2 to 5 years, 25.7 mm), reaching a nadir at month 24 (6 to 17 years, 6.0 mm; 2 to 5 years, 2.0 mm). For the 6- to 17-year-old and 2- to 5-year-old cohorts, respectively, median PaGA scores were 47.8 (n = 172) and 42.1 (n = 46) at baseline and 6.3 (n = 107) and 2.0 (n = 37) at month 24. In both cohorts, ALQ components improved from baseline to month 4 and were largely maintained to month 24. Clinical outcomes improved through to month 24. CONCLUSION Early and sustained PRO improvements were reported in this phase III, open-label trial of subcutaneous abatacept in patients with pJIA.
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Affiliation(s)
- Nicolino Ruperto
- IRCCS Istituto G. Gaslini Clinica Pediatrica e Reumatologia, UOSID Centro Trial, PRINTO, Genova, Italy
| | - Daniel J Lovell
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Alberto Berman
- Universidad Nacional de Tucuman, San Miguel de Tucumán, Argentina
| | | | - Gerd Horneff
- Asklepios Clinical Sankt Augustin, Sankt Augustin, Germany, and University of Cologne, Cologne, Germany
| | | | - Mara L Becker
- Duke University School of Medicine, Durham, North Carolina
| | | | | | | | | | | | | | | | - Joe Zhuo
- Bristol Myers Squibb, Princeton, New Jersey
| | | | | | | | - Hermine I Brunner
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
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Arnold DD, Yalamanoglu A, Boyman O. Systematic Review of Safety and Efficacy of IL-1-Targeted Biologics in Treating Immune-Mediated Disorders. Front Immunol 2022; 13:888392. [PMID: 35874710 PMCID: PMC9296857 DOI: 10.3389/fimmu.2022.888392] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/28/2022] [Indexed: 12/03/2022] Open
Abstract
Background The cytokine interleukin (IL)-1 plays a pivotal role in immune-mediated disorders, particularly in autoinflammatory diseases. Targeting this cytokine proved to be efficacious in treating numerous IL-1-mediated pathologies. Currently, three IL-1 blockers are approved, namely anakinra, canakinumab and rilonacept, and two additional ones are expected to receive approval, namely gevokizumab and bermekimab. However, there is no systematic review on the safety and efficacy of these biologics in treating immune-mediated diseases. Objective To evaluate safety and efficacy of anakinra, canakinumab, rilonacept, gevokizumab, and bermekimab for the treatment of immune-mediated disorders compared to placebo, standard-of-care treatment or other biologics. Methods The PRISMA checklist guided the reporting of the data. We searched the PubMed database between 1 January 1984 and 31 December 2020 focusing on immune-mediated disorders. Our PubMed literature search identified 7363 articles. After screening titles and abstracts for the inclusion and exclusion criteria and assessing full texts, 75 articles were included in a narrative synthesis. Results Anakinra was both efficacious and safe in treating cryopyrin-associated periodic syndromes (CAPS), familial Mediterranean fever (FMF), gout, macrophage activation syndrome, recurrent pericarditis, rheumatoid arthritis (RA), and systemic juvenile idiopathic arthritis (sJIA). Conversely, anakinra failed to show efficacy in graft-versus-host disease, Sjögren’s syndrome, and type 1 diabetes mellitus (T1DM). Canakinumab showed efficacy in treating CAPS, FMF, gout, hyper-IgD syndrome, RA, Schnitzler’s syndrome, sJIA, and TNF receptor-associated periodic syndrome. However, use of canakinumab in the treatment of adult-onset Still’s disease and T1DM revealed negative results. Rilonacept was efficacious and safe for the treatment of CAPS, FMF, recurrent pericarditis, and sJIA. Contrarily, Rilonacept did not reach superiority compared to placebo in the treatment of T1DM. Gevokizumab showed mixed results in treating Behçet’s disease-associated uveitis and no benefit when assessed in T1DM. Bermekimab achieved promising results in the treatment of hidradenitis suppurativa. Conclusions This systematic review of IL-1-targeting biologics summarizes the current state of research, safety, and clinical efficacy of anakinra, bermekimab, canakinumab, gevokizumab, and rilonacept in treating immune-mediated disorders. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42021228547.
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Affiliation(s)
- Dennis D. Arnold
- Department of Immunology, University Hospital Zurich, Zurich, Switzerland
| | - Ayla Yalamanoglu
- Department of Immunology, University Hospital Zurich, Zurich, Switzerland
| | - Onur Boyman
- Department of Immunology, University Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- *Correspondence: Onur Boyman,
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Moura RA, Fonseca JE. B Cells on the Stage of Inflammation in Juvenile Idiopathic Arthritis: Leading or Supporting Actors in Disease Pathogenesis? Front Med (Lausanne) 2022; 9:851532. [PMID: 35449805 PMCID: PMC9017649 DOI: 10.3389/fmed.2022.851532] [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: 01/10/2022] [Accepted: 02/09/2022] [Indexed: 11/13/2022] Open
Abstract
Juvenile idiopathic arthritis (JIA) is a term that collectively refers to a group of chronic childhood arthritides, which together constitute the most common rheumatic condition in children. The International League of Associations for Rheumatology (ILAR) criteria define seven categories of JIA: oligoarticular, polyarticular rheumatoid factor (RF) negative (RF-), polyarticular RF positive (RF+), systemic, enthesitis-related arthritis, psoriatic arthritis, and undifferentiated arthritis. The ILAR classification includes persistent and extended oligoarthritis as subcategories of oligoarticular JIA, but not as distinct categories. JIA is characterized by a chronic inflammatory process affecting the synovia that begins before the age of 16 and persists at least 6 weeks. If not treated, JIA can cause significant disability and loss of quality of life. Treatment of JIA is adjusted according to the severity of the disease as combinations of non-steroidal anti-inflammatory drugs (NSAIDs), synthetic and/ or biological disease modifying anti-rheumatic drugs (DMARDs). Although the disease etiology is unknown, disturbances in innate and adaptive immune responses have been implicated in JIA development. B cells may have important roles in JIA pathogenesis through autoantibody production, antigen presentation, cytokine release and/ or T cell activation. The study of B cells has not been extensively explored in JIA, but evidence from the literature suggests that B cells might have indeed a relevant role in JIA pathophysiology. The detection of autoantibodies such as antinuclear antibodies (ANA), RF and anti-citrullinated protein antibodies (ACPA) in JIA patients supports a breakdown in B cell tolerance. Furthermore, alterations in B cell subpopulations have been documented in peripheral blood and synovial fluid from JIA patients. In fact, altered B cell homeostasis, B cell differentiation and B cell hyperactivity have been described in JIA. Of note, B cell depletion therapy with rituximab has been shown to be an effective and well-tolerated treatment in children with JIA, which further supports B cell intervention in disease development.
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Affiliation(s)
- Rita A Moura
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - João Eurico Fonseca
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN), Lisbon Academic Medical Centre, Lisbon, Portugal
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Giancane G, Papa R, Vastert S, Bagnasco F, Swart JF, Quartier P, Antón J, Kamphuis S, Sanner H, Glerup M, De Benedetti F, Tsitsami E, Remesal A, Moreno E, De Inocencio J, Myrup C, Pallotti C, Koné-Paut I, Franck-Larsson K, Malmström H, Cederholm S, Pistorio A, Wulffraat N, Ruperto N. Anakinra in Patients With Systemic Juvenile Idiopathic Arthritis: Long-term Safety From the Pharmachild Registry. J Rheumatol 2022; 49:398-407. [PMID: 35105709 DOI: 10.3899/jrheum.210563] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To evaluate the long-term safety profile of anakinra in patients with systemic juvenile idiopathic arthritis (sJIA). METHODS Data from patients with sJIA enrolled in the Pharmachild registry (ClinicalTrials.gov: NCT03932344) prior to September 30, 2018, and treated with anakinra were analyzed. The study endpoints were the occurrence of non-serious adverse events (SAEs) of at least moderate severity and SAEs, including macrophage activation syndrome (MAS), and the duration of anakinra treatment with reasons for discontinuation. All endpoints were analyzed overall by 6-month time windows, and in different treatment sets represented by those patients treated continuously with anakinra for at least 12, 18, and 24 months (set-12, -18, and -24, respectively). RESULTS Three hundred six patients were enrolled. Of these patients, 46%, 34%, and 28% had been treated for at least 12, 18, and 24 months, respectively. Two hundred and one AEs, mostly represented by infections, were reported for 509.3 patient-years (PY) with an overall incidence rate (IR) of 39.5 per 100 PY. Among 56 SAEs (IR 11.0/100 PY), 23.2% were infections and 19.6% MAS episodes. The IR of AEs was higher during the first 6 months of anakinra treatment, followed by decreasing IRs in the long-term treatment sets. Treatment discontinuation occurred in 76% of patients, most frequently in the first 6 months, because of inefficacy (43%), remission (31%), or AEs/intolerance (15%). No deaths or malignancies occurred during anakinra treatment. CONCLUSION The results of the present study confirm the long-term safety profile of anakinra in patients with sJIA and demonstrate an overall decreasing incidence of AEs over time. [ClinicalTrials.gov: NCT01399281 and NCT03932344].
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Affiliation(s)
- Gabriella Giancane
- G. Giancane, MD, PhD, Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, and Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DiNOGMI), Università degli Studi di Genova, Genoa, Italy;
| | - Riccardo Papa
- R. Papa, MD, C. Pallotti, MA, Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Sebastiaan Vastert
- S. Vastert, MD, Department of Pediatric Immunology and Rheumatology, Wilhelmina Kinderziekenhuis, Utrecht, the Netherlands
| | - Francesca Bagnasco
- F. Bagnasco, MSc, A. Pistorio, MD, Servizio di Epidemiologia e Biostatistica, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Joost F Swart
- J.F. Swart, MD, N. Wulffraat, Professor, Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - Pierre Quartier
- P. Quartier, MD, Université de Paris, Institut IMAGINE, Centre de référence national pour les Rhumatismes inflammatoires et les maladies Auto-Immunes Systémiques rares de l'Enfant (RAISE), Unité d'Immunologie, Hématologie et Rhumatologie Pédiatrique, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - Jordi Antón
- J. Antón, MD, Division of Pediatric Rheumatology, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues de Llobregat (Barcelona), Spain
| | - Sylvia Kamphuis
- S. Kamphuis, MD, Department of Paediatric Rheumatology/Department of Rheumatology, Sophia Children's Hospital, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Helga Sanner
- H. Sanner, MD, Department of Rheumatology - Norwegian National Advisory Unit on Rheumatic Diseases in Children and Adolescents, Oslo University Hospital, Oslo, Norway
| | - Mia Glerup
- M. Glerup, MD, Pediatric rheumatology unit, Aarhus University Hospital, Aarhus, Denmark
| | - Fabrizio De Benedetti
- F. De Benedetti, MD, Division of Rheumatology, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Elena Tsitsami
- E. Tsitsami, MD, First Department of Pediatrics, Aghia Sophia Children's Hospital, University of Athens Medical School, Athens, Greece
| | - Agustin Remesal
- A. Remesal, MD, Rheumatology Unit, University Hospital La Paz, Madrid, Spain
| | - Estefania Moreno
- E. Moreno, MD, Rheumatology Unit, University Hospital Valle de Hebron, Barcelona, Spain
| | - Jaime De Inocencio
- J. De Inocencio, MD, Department of Pediatric Rheumatology, 12 de Octubre University Hospital, Madrid, Spain
| | - Charlotte Myrup
- C. Myrup, MD, Pediatric rheumatology unit 4272, Rigshospitalet, Copenhagen, Denmark
| | - Chiara Pallotti
- R. Papa, MD, C. Pallotti, MA, Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Isabelle Koné-Paut
- I. Koné-Paut, MD, Department of Pediatric Rheumatology, National Referral Centre of Auto-Inflammatory Diseases and inflammatory amyloidosis, CEREMAIA, CHU de Biĉetre, AP-HP, University of Paris Sud Saclay, le Kremlin Bicêtre, France
| | - Karin Franck-Larsson
- K. Franck-Larsson, MD, PhD, H. Malmström, PhD, S. Cederholm, MSc Pharm, Sobi, Stockholm, Sweden
| | - Håkan Malmström
- K. Franck-Larsson, MD, PhD, H. Malmström, PhD, S. Cederholm, MSc Pharm, Sobi, Stockholm, Sweden
| | - Susanna Cederholm
- K. Franck-Larsson, MD, PhD, H. Malmström, PhD, S. Cederholm, MSc Pharm, Sobi, Stockholm, Sweden
| | - Angela Pistorio
- F. Bagnasco, MSc, A. Pistorio, MD, Servizio di Epidemiologia e Biostatistica, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Nico Wulffraat
- J.F. Swart, MD, N. Wulffraat, Professor, Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, Utrecht, the Netherlands
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Similar Clinical Outcomes in Patients with Systemic Juvenile Idiopathic Arthritis and Adult-Onset Still's Disease Treated with Canakinumab: Bayesian and Population Model-Based Analyses. Rheumatol Ther 2022; 9:753-762. [PMID: 35044647 PMCID: PMC8964916 DOI: 10.1007/s40744-021-00422-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 12/22/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Systemic juvenile idiopathic arthritis (sJIA) and adult-onset Still’s disease (AOSD) represent pediatric and adult variants of the Still’s disease continuum. To determine whether clinical outcomes between patients with sJIA and AOSD were similar, Bayesian and population model-based analyses were conducted on endpoints from studies of canakinumab in both patient populations. The objective was to further support the efficacy of canakinumab in patients with AOSD. Methods A Bayesian analysis of endpoints from a study of canakinumab in AOSD was conducted borrowing information from five pooled sJIA studies using a robust meta-analytic predictive (MAP) approach. Similarity of clinical outcomes across populations was fulfilled if the AOSD study posterior median fell within the 95% predicted credible interval for the outcome of interest, based on the pooled sJIA data. Population model-based analyses (pharmacokinetic [PK] and PK/pharmacodynamic [PKPD]) were conducted to compare the pharmacokinetics and exposure–response relationships between populations. Results The AOSD study posterior medians for adapted American College of Rheumatology (ACR)30 response, continuous adapted ACR response, number of active joints, C-reactive protein, and absence of fever were within the 95% credible interval for the prediction of the MAP analysis from the pooled sJIA data, supporting the similarity in outcomes between patient populations. PK analysis demonstrated comparable exposure across sJIA age groups and patients with AOSD. PKPD relationships were consistent across patient populations. Analyses indicated that no therapeutic benefit can be expected from a dose increase in patients with AOSD. Conclusion The analyses presented support the similarity of clinical outcomes following treatment with canakinumab in patients with sJIA and AOSD. Supplementary Information The online version contains supplementary material available at 10.1007/s40744-021-00422-9.
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Cliff CL, Williams BM, Chadjichristos CE, Mouritzen U, Squires PE, Hills CE. Connexin 43: A Target for the Treatment of Inflammation in Secondary Complications of the Kidney and Eye in Diabetes. Int J Mol Sci 2022; 23:600. [PMID: 35054783 PMCID: PMC8776095 DOI: 10.3390/ijms23020600] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/03/2022] [Accepted: 01/04/2022] [Indexed: 02/06/2023] Open
Abstract
Of increasing prevalence, diabetes is characterised by elevated blood glucose and chronic inflammation that precedes the onset of multiple secondary complications, including those of the kidney and the eye. As the leading cause of end stage renal disease and blindness in the working population, more than ever is there a demand to develop clinical interventions which can both delay and prevent disease progression. Connexins are membrane bound proteins that can form pores (hemichannels) in the cell membrane. Gated by cellular stress and injury, they open under pathophysiological conditions and in doing so release 'danger signals' including adenosine triphosphate into the extracellular environment. Linked to sterile inflammation via activation of the nod-like receptor protein 3 inflammasome, targeting aberrant hemichannel activity and the release of these danger signals has met with favourable outcomes in multiple models of disease, including secondary complications of diabetes. In this review, we provide a comprehensive update on those studies which document a role for aberrant connexin hemichannel activity in the pathogenesis of both diabetic eye and kidney disease, ahead of evaluating the efficacy of blocking connexin-43 specific hemichannels in these target tissues on tissue health and function.
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Affiliation(s)
- Chelsy L. Cliff
- Joseph Banks Laboratories, School of Life, Sciences University of Lincoln, Lincoln LN6 7DL, UK; (C.L.C.); (B.M.W.); (P.E.S.)
| | - Bethany M. Williams
- Joseph Banks Laboratories, School of Life, Sciences University of Lincoln, Lincoln LN6 7DL, UK; (C.L.C.); (B.M.W.); (P.E.S.)
| | - Christos E. Chadjichristos
- National Institutes for Health and Medical Research, UMR-S1155, Batiment Recherche, Tenon Hospital, 4 Rue de la Chine, 75020 Paris, France;
| | - Ulrik Mouritzen
- Ciana Therapeutics, Ole Maaloes Vej 3, 2200 Copenhagen N, Denmark;
| | - Paul E. Squires
- Joseph Banks Laboratories, School of Life, Sciences University of Lincoln, Lincoln LN6 7DL, UK; (C.L.C.); (B.M.W.); (P.E.S.)
| | - Claire E. Hills
- Joseph Banks Laboratories, School of Life, Sciences University of Lincoln, Lincoln LN6 7DL, UK; (C.L.C.); (B.M.W.); (P.E.S.)
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Hinze T, Kessel C, Hinze CH, Seibert J, Gram H, Foell D. A dysregulated interleukin-18-interferon-γ-CXCL9 axis impacts treatment response to canakinumab in systemic juvenile idiopathic arthritis. Rheumatology (Oxford) 2021; 60:5165-5174. [PMID: 33576397 DOI: 10.1093/rheumatology/keab113] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 01/18/2021] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES The monoclonal IL-1β antibody canakinumab is approved for the treatment of systemic juvenile idiopathic arthritis (SJIA). Its efficacy has been proven in several trials, but not all patients show a complete and sustained response to therapy. We aimed to analyse the association of baseline serum biomarkers with treatment outcome in patients with SJIA treated with canakinumab. METHODS Serum samples from 54 patients with active SJIA without recent macrophage activation syndrome (MAS) treated with canakinumab in an open-label response characterization study were subjected to a multiplexed bead array assay. Interesting targets from these analyses were validated by ELISA. Clinical treatment outcomes included modified paediatric ACR (pACR) 30 and 90 responses, clinically inactive disease (CID) within 15 days of treatment and sustained complete response, defined as pACR100 or CID within 15 days of treatment plus no future flare or MAS. RESULTS In canakinumab-naïve patients most biomarkers were elevated when compared with healthy controls at baseline and some rapidly decreased by day 15 [IL-1 receptor antagonist (IL-1RA), IL-6, IL-18 and S100A12]. Responders had higher IL-18 and IFN-γ levels and lower chemokine (C-X-C motif) ligand 9 (CXCL9) levels at baseline, emphasized by the IL-18: CXCL9 and IFN-γ: CXCL9 ratios. These ratios had significant accuracy in predicting treatment responses. CONCLUSION Differential regulation of the IL-18-IFN-γ-CXCL9 axis is observed in patients with SJIA. Higher IL-18: CXCL9 and IFN-γ: CXCL9 ratios at baseline are associated with a better clinical response to canakinumab treatment in SJIA. Future studies are needed to validate these findings and determine their generalizability to patients with recent MAS.
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Affiliation(s)
- Tanja Hinze
- Department of Pediatric Rheumatology and Immunology, University Hospital Münster, Münster, Germany
| | - Christoph Kessel
- Department of Pediatric Rheumatology and Immunology, University Hospital Münster, Münster, Germany
| | - Claas H Hinze
- Department of Pediatric Rheumatology and Immunology, University Hospital Münster, Münster, Germany
| | | | | | - Dirk Foell
- Department of Pediatric Rheumatology and Immunology, University Hospital Münster, Münster, Germany
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Reiff DD, Stoll ML, Cron RQ. Precision medicine in juvenile idiopathic arthritis-has the time arrived? THE LANCET. RHEUMATOLOGY 2021; 3:e808-e817. [PMID: 38297525 DOI: 10.1016/s2665-9913(21)00252-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/07/2021] [Accepted: 07/28/2021] [Indexed: 12/14/2022]
Abstract
The introduction of disease-modifying anti-rheumatic drug therapies for treating children and adolescents with chronic arthritis (ie, juvenile idiopathic arthritis [JIA]) has revolutionised care and outcomes. The biologic revolution continues to expand, with ever-changing immunological targets coming to market after basic research and clinical trials. The first class of biologics that was beneficial for children with JIA was tumour necrosis factor (TNF) inhibitors. If used early and aggressively, TNF inhibitors are capable of inducing disease remission for most of the seven subtypes of JIA, with the exception of systemic JIA (which more frequently responds to interleukin [IL]-1 or IL-6 inhibition). Nevertheless, there are still subsets of patients with JIA with disease that is difficult to treat or who develop extra-articular features that require a different therapeutic approach. Although finding an effective biological therapy for individual children with JIA can be trial and error, ongoing research and clinical trials are providing insight into a more personalised approach to care. In addition, redefining the JIA classification, in part based on shared similarities with various adult arthritides, could allow for extrapolation of knowledge from studies in adults with chronic arthritis.
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Affiliation(s)
- Daniel D Reiff
- Department of Pediatrics, Division of Rheumatology, University of Alabama, Birmingham, AL, USA
| | - Matthew L Stoll
- Department of Pediatrics, Division of Rheumatology, University of Alabama, Birmingham, AL, USA
| | - Randy Q Cron
- Department of Pediatrics, Division of Rheumatology, University of Alabama, Birmingham, AL, USA.
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Abstract
PURPOSE OF REVIEW Biologics and novel targeted therapeutics have transformed the management of pediatric rheumatic diseases over the past two decades; however, questions about short-term and long-term safety remain. Safety data gathered from recent clinical trials, long-term extensions of prior trials, registries, and other real-world evidence are summarized here for biologics and novel therapeutics commonly prescribed for pediatric rheumatic diseases. RECENT FINDINGS With nearly 20 years of therapeutic experience, tumor necrosis inhibitors (TNFi) are generally well tolerated, although infections, malignancy, and development of new autoimmunity remain a concern. Risk of infections may be higher in IL-1 and IL-6 inhibitors, and lower in abatacept, compared with TNFi. Safety data for B-cell-targeted therapeutics and janus kinase inhibitors are emerging, but remain limited, especially in children. SUMMARY Biologic and novel targeted therapeutics offer a promising future for children with pediatric rheumatic disease. However, long-term safety data in children remain limited for several agents. With any therapeutic option, both short-term and long-term safety concerns must be weighed against individual clinical needs when choosing the optimal treatment for each child.
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Affiliation(s)
- Rachel L. Randell
- Department of Pediatrics, Division of Rheumatology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Mara L. Becker
- Department of Pediatrics, Division of Rheumatology, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
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Verweyen EL, Schulert GS. Interfering with interferons: targeting the JAK-STAT pathway in complications of systemic juvenile idiopathic arthritis (SJIA). Rheumatology (Oxford) 2021; 61:926-935. [PMID: 34459891 PMCID: PMC9123899 DOI: 10.1093/rheumatology/keab673] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/27/2021] [Accepted: 08/23/2021] [Indexed: 02/06/2023] Open
Abstract
Systemic JIA (SJIA) is distinguished from other forms of JIA by the prevalence of the severe, life-threatening complications macrophage activation syndrome (SJIA-MAS) and lung disease (SJIA-LD). Alternative therapeutics are urgently needed, as disease pathogenesis diverges from what is observed in SJIA, and currently available biologics are insufficient. SJIA-MAS, defined by a cytokine storm and dysregulated proliferation of T-lymphocytes, and SJIA-LD which presents with lymphocytic interstitial inflammation and pulmonary alveolar proteinosis, are both thought to be driven by IFNs, in particular the type II IFN-γ. Involvement of IFNs and a possible crosstalk of type I IFNs with existing biologics indicate a distinct role for the JAK-STAT signalling pathway in the pathogenesis of SJIA-MAS and SJIA-LD. Here, we review this role of JAK-STATs and IFNs in SJIA complications and discuss how new insights of ongoing research are shaping future therapeutic advances in the form of JAK inhibitors and antibodies targeting IFNs.
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Affiliation(s)
- Emely L Verweyen
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center
| | - Grant S Schulert
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA,Correspondence to: Grant Schulert, Division of Rheumatology, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, MLC 4010, 3333 Burnet Avenue, Cincinnati, OH 45208, USA.
E-mail:
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Cota-Arce JM, Cota J, De León-Nava MA, Hernández-Cáceres A, Moncayo-Salazar LI, Valle-Alvarado F, Cordero-Moreno VL, Bonfil-Solis KL, Bichara-Figueroa JE, Hernández-Hernández J, Villela L. Efficacy and safety of canakinumab in the treatment of adult-onset Still's disease: A systematic review. Semin Arthritis Rheum 2021; 51:1282-1290. [PMID: 34493394 DOI: 10.1016/j.semarthrit.2021.08.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 08/02/2021] [Accepted: 08/17/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Adult-onset Still's disease (AOSD) is a rare inflammatory disease, typically characterized by spiking fever, skin rash, and arthralgia or arthritis. Its conventional treatment includes NSAIDs and corticosteroids, and DMARDs as second-line therapy. Frequently, IL-1 inhibitors are also required, mainly in patients refractory to traditional therapy. Canakinumab is a monoclonal antibody that binds IL-1β with high affinity and specificity, making it appropriate for therapeutic purposes in AOSD. OBJECTIVE The aim of this systematic review was to identify and compile the current data on the efficacy and safety of canakinumab in the treatment of AOSD. METHODS Following the guidelines established by the PRISMA statement, we searched Scopus, Web of Science, Pubmed, and Cochrane Library for relevant literature up to March 2021. The inclusion criteria comprised: randomized controlled trials, pooled analyses, observational studies, case series, and case reports. RESULTS Seventeen studies published from 2012 to 2021 were evaluated; 11 of these correspond to case series or case reports, four observational studies, one placebo-controlled phase II trial, and one analysis of pooled systemic juvenile idiopathic arthritis data. In general, out of a total of 99 patients, 68.7% of these presented a complete remission of the systemic and arthritic manifestations at the end of the observation period, while 16.2% of the patients showed a partial improvement of the symptoms and the remaining (15.1%) did not show clinical improvement or were excluded. Moreover, 210 adverse events were reported in 69 patients during canakinumab treatment, of which the majority correspond to respiratory tract infections, arthralgia, disease flares, abdominal pain, nausea, and diarrhea, whereas the most common severe adverse events included macrophage activation syndrome and serious infections. Also, a corticosteroid-sparing effect was observed in a large percentage of patients. CONCLUSION More studies with solid evidence are needed to support the efficacy of canakinumab in AOSD, although its use is encouraged by the increasing favorable results reported and the efficacy of other IL-1 inhibitors. It was also associated with an acceptable safety profile, similar to expected in IL-1 inhibitor therapy. However, future studies with well-defined endpoints are warranted to examine further the usefulness of canakinumab in AOSD.
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Affiliation(s)
- Julián M Cota-Arce
- Hospital General "Dr. Fernando Ocaranza" - Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Hermosillo, Son., México
| | - Jonhatan Cota
- Hospital General de Zona 4 - Instituto Mexicano del Seguro Social (IMSS), Guadalupe, N.L., México
| | - Marco A De León-Nava
- Departamento de Innovación Biomédica, Centro de Investigación Científica y de Educación Superior de Ensenada (CICESE), Ensenada, B.C., México
| | - Alexia Hernández-Cáceres
- Hospital General "Dr. Fernando Ocaranza" - Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Hermosillo, Son., México
| | - Leopoldo I Moncayo-Salazar
- Centro Médico "Dr. Ignacio Chávez" - Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado de Sonora (ISSSTESON), Hermosillo, Son., México
| | - Fidel Valle-Alvarado
- Hospital General "Dr. Fernando Ocaranza" - Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Hermosillo, Son., México
| | - Vera L Cordero-Moreno
- Hospital General "Dr. Fernando Ocaranza" - Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Hermosillo, Son., México
| | - Karen L Bonfil-Solis
- Hospital General "Dr. Fernando Ocaranza" - Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Hermosillo, Son., México
| | - Jesús E Bichara-Figueroa
- Hospital General "Dr. Fernando Ocaranza" - Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Hermosillo, Son., México
| | - José Hernández-Hernández
- Escuela de Medicina y Ciencias de la Salud, Instituto Tecnológico y de Estudios Superiores de Monterrey (ITESM), Monterrey, N.L., México
| | - Luis Villela
- Hospital General "Dr. Fernando Ocaranza" - Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Hermosillo, Son., México; Centro Médico "Dr. Ignacio Chávez" - Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado de Sonora (ISSSTESON), Hermosillo, Son., México; Escuela de Ciencias de la Salud, Universidad del Valle de México (UVM) Campus Hermosillo, Hermosillo, Son., México.
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Zaripova LN, Midgley A, Christmas SE, Beresford MW, Baildam EM, Oldershaw RA. Juvenile idiopathic arthritis: from aetiopathogenesis to therapeutic approaches. Pediatr Rheumatol Online J 2021; 19:135. [PMID: 34425842 PMCID: PMC8383464 DOI: 10.1186/s12969-021-00629-8] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/25/2021] [Indexed: 12/11/2022] Open
Abstract
Juvenile idiopathic arthritis (JIA) is the most common paediatric rheumatological disorder and is classified by subtype according to International League of Associations for Rheumatology criteria. Depending on the number of joints affected, presence of extra-articular manifestations, systemic symptoms, serology and genetic factors, JIA is divided into oligoarticular, polyarticular, systemic, psoriatic, enthesitis-related and undifferentiated arthritis. This review provides an overview of advances in understanding of JIA pathogenesis focusing on aetiology, histopathology, immunological changes associated with disease activity, and best treatment options. Greater understanding of JIA as a collective of complex inflammatory diseases is discussed within the context of therapeutic interventions, including traditional non-biologic and up-to-date biologic disease-modifying anti-rheumatic drugs. Whilst the advent of advanced therapeutics has improved clinical outcomes, a considerable number of patients remain unresponsive to treatment, emphasising the need for further understanding of disease progression and remission to support stratification of patients to treatment pathways.
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Affiliation(s)
- Lina N Zaripova
- Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, University of Liverpool, William Henry Duncan Building, 6 West Derby Street, Liverpool, L7 8TX, UK
| | - Angela Midgley
- Department of Women and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, University Department, Liverpool Women's Hospital, First Floor, Crown Street, Liverpool, L8 7SS, UK
| | - Stephen E Christmas
- Department of Clinical Infection, Microbiology and Immunology, Faculty of Health and Life Sciences, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, The Ronald Ross Building, 8 West Derby Street, Liverpool, L69 7BE, UK
| | - Michael W Beresford
- Department of Women and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, University Department, Liverpool Women's Hospital, First Floor, Crown Street, Liverpool, L8 7SS, UK
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, East Prescott Road, Liverpool, L14 5AB, UK
| | - Eileen M Baildam
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, East Prescott Road, Liverpool, L14 5AB, UK
| | - Rachel A Oldershaw
- Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, University of Liverpool, William Henry Duncan Building, 6 West Derby Street, Liverpool, L7 8TX, UK.
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De Matteis A, Bracaglia C, Pires Marafon D, Piscitelli AL, Alessio M, Naddei R, Orlando F, Filocamo G, Minoia F, Ravelli A, Tibaldi J, Cimaz R, Marino A, Simonini G, Mastrolia MV, La Torre F, Tricarico I, Licciardi F, Montin D, Maggio MC, Alizzi C, Martini G, Civino A, Gallizzi R, Olivieri AN, Ardenti Morini F, Conti G, De Benedetti F, Pardeo M. CANAKINUMAB IN SYSTEMIC JUVENILE IDIOPATHIC ARTHRITIS: REAL-LIFE DATA FROM A RETROSPECTIVE ITALIAN COHORT. Rheumatology (Oxford) 2021; 61:1621-1629. [PMID: 34343275 DOI: 10.1093/rheumatology/keab619] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/16/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To evaluate in real-life the effectiveness and safety of canakinumab in Italian patients with systemic juvenile idiopathic arthritis (sJIA). METHODS A retrospective multicentre study of children with sJIA was performed. Clinical features, laboratory parameters and adverse events were collected at baseline, after 6 and 12 months from starting canakinumab. The effectiveness primary outcome was clinical inactive disease (CID) off glucocorticoids (GCs) treatment at 6 months. RESULTS A total of 80 children were analyzed from 15 Italian centers. Of the 12 patients who started canakinumab in CID while receiving anakinra, all maintained CID. Of the 68 with active disease at baseline, 57.4% achieved CID off GCs at 6 months and 63.8% at 12 months. In univariate analysis, the variables significantly related with non-response were number of active joints (NAJ) ≥5, history of macrophage activation syndrome (MAS) and disease duration. Multivariate analysis confirmed the association with non-response of NAJ ≥5 (OR 6.37 (95%CI 1.69-24.02), p= 0.006) and history of MAS (OR 3.53 (95%CI 1.06-11.70), p= 0.039). No serious adverse events were recorded in this series. There were two cases of MAS during canakinumab, leading to a rate of 2.9 episodes per 100 patient year. CONCLUSION We confirm, in real-life, the efficacy of canakinumab in sJIA in a multicentric cohort. History of MAS and higher NAJ were associated with lower probability of achieving clinical inactive disease.
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Affiliation(s)
- Arianna De Matteis
- Division of Rheumatology, ERN RITA Center, IRCCS Ospedale Pediatrico Bambino Gesù, Roma
| | - Claudia Bracaglia
- Division of Rheumatology, ERN RITA Center, IRCCS Ospedale Pediatrico Bambino Gesù, Roma
| | - Denise Pires Marafon
- Division of Rheumatology, ERN RITA Center, IRCCS Ospedale Pediatrico Bambino Gesù, Roma
| | - Anna Lucia Piscitelli
- Division of Rheumatology, ERN RITA Center, IRCCS Ospedale Pediatrico Bambino Gesù, Roma
| | - Maria Alessio
- Department of Translational Medical Sciences, Pediatrics Section, University of Naples Federico II
| | - Roberta Naddei
- Department of Translational Medical Sciences, Pediatrics Section, University of Naples Federico II
| | - Francesca Orlando
- Unit of Pediatrics 2, Santobono-Pausilipon Children's Hospital, Napoli
| | - Giovanni Filocamo
- Pediatric Rheumatology, Fondazione IRCCS Ca' Grande Ospedale Maggiore Policlinico, Milano
| | - Francesca Minoia
- Pediatric Rheumatology, Fondazione IRCCS Ca' Grande Ospedale Maggiore Policlinico, Milano
| | - Angelo Ravelli
- Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genova
| | - Jessica Tibaldi
- Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genova
| | | | | | - Gabriele Simonini
- Pediatric Rheumatology Unit, Meyer Children's University Hospital, Firenze
| | | | - Francesco La Torre
- Pediatric Rheumatology Center, Department of Pediatrics, Ospedale 'Giovanni XXIII', AOU Consorziale Policlinico, Bari
| | - Ilaria Tricarico
- Pediatric Rheumatology Center, Department of Pediatrics, Ospedale 'Giovanni XXIII', AOU Consorziale Policlinico, Bari
| | - Francesco Licciardi
- Department of Pediatrics and Infectious Diseases, School of Medicine, University of Turin, Regina Margherita Children's Hospital, Torino
| | - Davide Montin
- Department of Pediatrics and Infectious Diseases, School of Medicine, University of Turin, Regina Margherita Children's Hospital, Torino
| | | | - Clotilde Alizzi
- University Department Pro.Sa.M.I. 'G. D'Alessandro', University of Palermo, Palermo
| | - Giorgia Martini
- Department of Women's and Children's Health, University of Padua, Padova
| | - Adele Civino
- Department of Pediatrics, Division of Rheumatology and Immunology, Ospedale 'Vito Fazzi', Lecce
| | - Romina Gallizzi
- Unit of Pediatric Nephrology and Rheumatology, University of Messina, Messina
| | - Alma Nunzia Olivieri
- Department of General and Specialized Surgery for Women and Children, University 'Luigi Vanvitelli', Napoli
| | | | - Giovanni Conti
- Pediatric Nephrology and Rheumatology Unit, AOU Policlinico 'G. Martino', Messina, Italy
| | - Fabrizio De Benedetti
- Division of Rheumatology, ERN RITA Center, IRCCS Ospedale Pediatrico Bambino Gesù, Roma
| | - Manuela Pardeo
- Division of Rheumatology, ERN RITA Center, IRCCS Ospedale Pediatrico Bambino Gesù, Roma
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Rosina S, Natoli V, Santaniello S, Trincianti C, Consolaro A, Ravelli A. Novel biomarkers for prediction of outcome and therapeutic response in juvenile idiopathic arthritis. Expert Rev Clin Immunol 2021; 17:853-870. [PMID: 34139935 DOI: 10.1080/1744666x.2021.1945441] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The search for biomarkers in juvenile idiopathic arthritis (JIA) is a promising and rapidly expanding field of investigation. The biomarkers identified so far may help to dissect the clinical heterogeneity of the illness, measure the level of disease activity, predict clinical remission, relapse, response to medications, course over time, complications, and forestall disease flares. AREAS COVERED We provide a summary of the most recent advances in the development and application of biomarkers in JIA. We performed a PubMed search for significant articles combining predetermined keywords related to biomarkers in non-systemic and systemic JIA, chronic uveitis, and macrophage activation syndrome (MAS). The biomarkers available or under study are presented and discussed separately for non-systemic and systemic subtypes and for the two main disease complications, uveitis and MAS. EXPERT OPINION The incorporation of valid and reliable biomarkers in standard clinical care may help to design better patient-tailored treatment regimens and to improve the therapeutic strategies based on the treat-to-target approach. The establishment of biomarkers that predict the risk of disease flare may lead to define the optimal modalities for treatment discontinuation after the achievement of clinical remission.
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Affiliation(s)
- Silvia Rosina
- UOC Clinica Pediatrica E Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Valentina Natoli
- Dipartimento Di Neuroscienze, Riabilitazione, Oftalmologia, Genetica E Scienze Materno-Infantili (Dinogmi), Università Degli Studi Di Genova, Genoa, Italy
| | - Stefania Santaniello
- Dipartimento Di Neuroscienze, Riabilitazione, Oftalmologia, Genetica E Scienze Materno-Infantili (Dinogmi), Università Degli Studi Di Genova, Genoa, Italy
| | - Chiara Trincianti
- Dipartimento Di Neuroscienze, Riabilitazione, Oftalmologia, Genetica E Scienze Materno-Infantili (Dinogmi), Università Degli Studi Di Genova, Genoa, Italy
| | - Alessandro Consolaro
- UOC Clinica Pediatrica E Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy.,Dipartimento Di Neuroscienze, Riabilitazione, Oftalmologia, Genetica E Scienze Materno-Infantili (Dinogmi), Università Degli Studi Di Genova, Genoa, Italy
| | - Angelo Ravelli
- UOC Clinica Pediatrica E Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy.,Dipartimento Di Neuroscienze, Riabilitazione, Oftalmologia, Genetica E Scienze Materno-Infantili (Dinogmi), Università Degli Studi Di Genova, Genoa, Italy.,Sechenov First Moscow State Medical University, Moscow, Russian Federation
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Kanemasa H, Ishimura M, Eguchi K, Tanaka T, Nanishi E, Shiraishi A, Goto M, Motomura Y, Ohga S. The immunoregulatory function of peripheral blood CD71 + erythroid cells in systemic-onset juvenile idiopathic arthritis. Sci Rep 2021; 11:14396. [PMID: 34257378 PMCID: PMC8277864 DOI: 10.1038/s41598-021-93831-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 06/30/2021] [Indexed: 12/18/2022] Open
Abstract
CD71+ erythroid cells (CECs) are recognized to have an immunoregulatory function via direct cell-cell interaction and soluble mediators. Circulating CECs appear in newborns or patients with hemolytic and cardiopulmonary disorders. To assess the biological role of CECs in systemic inflammation, we studied the gene expression and function in systemic-onset juvenile idiopathic arthritis (SoJIA). Peripheral blood mononuclear cells of SoJIA patients expressed upregulated erythropoiesis-related genes. It represented the largest expansion of CECs during active phase SoJIA among other inflammatory diseases. Despite the opposing roles of erythropoietin and hepcidin in erythropoiesis, both serum levels were in concert with the amounts of SoJIA-driven CECs. Circulating CECs counts in inflammatory diseases were positively correlated with the levels of C-reactive protein, IL-6, IL-18, or soluble TNF receptors. Co-culture with active SoJIA-driven CECs suppressed secretions of IL-1β, IL-6, and IL-8 from healthy donor monocytes. The top upregulated gene in SoJIA-driven CECs was ARG2 compared with CECs from cord blood controls, although cytokine production from monocytes was suppressed by co-culture, even with an arginase inhibitor. CECs are driven to the periphery during the acute phase of SoJIA at higher levels than other inflammatory diseases. Circulating CECs may control excessive inflammation via the immunoregulatory pathways, partly involving arginase-2.
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Affiliation(s)
- Hikaru Kanemasa
- Departments of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Masataka Ishimura
- Departments of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Katsuhide Eguchi
- Departments of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Tamami Tanaka
- Departments of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Etsuro Nanishi
- Departments of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Akira Shiraishi
- Departments of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Motohiro Goto
- Departments of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yoshitomo Motomura
- Departments of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Shouichi Ohga
- Departments of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Tomelleri A, Campochiaro C, De Luca G, Farina N, Cavalli G, Dagna L. Canakinumab injection for the treatment of active Still’s disease, including adult-onset Still’s disease. Expert Opin Orphan Drugs 2021. [DOI: 10.1080/21678707.2021.1904395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Alessandro Tomelleri
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (Unirar), IRCCS San Raffaele Hospital, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Corrado Campochiaro
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (Unirar), IRCCS San Raffaele Hospital, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Giacomo De Luca
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (Unirar), IRCCS San Raffaele Hospital, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Nicola Farina
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (Unirar), IRCCS San Raffaele Hospital, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Giulio Cavalli
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (Unirar), IRCCS San Raffaele Hospital, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (Unirar), IRCCS San Raffaele Hospital, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
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Lainka E, Baehr M, Raszka B, Haas JP, Hügle B, Fischer N, Foell D, Hinze C, Weissbarth-Riedel E, Kallinich T, Horneff G, Windschall D, Lilienthal E, Niehues T, Neudorf U, Berendes R, Küster RM, Oommen PT, Rietschel C, Lutz T, Weller-Heinemann F, Tenbrock K, Heubner GL, Klotsche J, Wittkowski H. Experiences with IL-1 blockade in systemic juvenile idiopathic arthritis - data from the German AID-registry. Pediatr Rheumatol Online J 2021; 19:38. [PMID: 33752669 PMCID: PMC7986520 DOI: 10.1186/s12969-021-00510-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 02/24/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Systemic juvenile idiopathic arthritis (sJIA) is a complex disease with dysregulation of the innate immune system driven by cytokines. A major role is ascribed to interleukin-1β (IL-1β), supporting the autoinflammatory character of the disease and offering an effective blocking mechanism for treatment. Here we present clinical practice data from the German AID-registry for patients treated with IL-1 inhibition (IL-1i). METHODS In 2009 a clinical and research consortium (AID-Net) was established, including an online AID-registry. Patients with documented sJIA diagnosis were identified. Data for this retrospective IL-1i study were recorded by 17 centers. Response to treatment was evaluated according to Wallace criteria and additionally by an own classifying clinical response system. RESULTS In 6 years, 202 patients with confirmed sJIA were recorded in the AID-registry. Out of these, 111 children received therapy with Anakinra (ANA) (n = 84, 39 f) and/or Canakinumab (CANA) (n = 27, 15 f) at a median age of 8.7 y (range 0.6-19.1). During the first 12 months 75/111 (ANA 55, CANA 20) patients were evaluated according to Wallace criteria (achievement of inactive disease 28/55 and 17/20, remission over 6 months under medication 13/55 and 7/20 cases). Over the whole period of time, clinical response was preserved in the majority of patients (ANA 54/80, CANA 20/27). Arthritis mostly persisted in polyarticular (PA) courses. During treatment with IL-1i concomitant medication could be tapered in about 15%. IL-1i was discontinued in 59/111 patients. 45 (15) adverse events (AE)s in ANA (CANA) treated patients (19.7 (26.6) AE/100 ANA (CANA) exposure years, 95%CI: 14.4-26.4 (14.9-43.9)) were reported. CONCLUSION In a large cohort of sJIA patients from Germany, we can confirm an overall favorable clinical response to both available IL-1 blocking agents. IL-1i was well tolerated with acceptable safety and effectiveness in a real-life clinical setting.
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Affiliation(s)
- Elke Lainka
- Department of Pediatric Rheumatology, University Children's Hospital Essen, Essen, Germany.
| | - Melanie Baehr
- Department of Pediatric Rheumatology, University Children’s Hospital Essen, Essen, Germany
| | - Bernadette Raszka
- Department of Pediatric Rheumatology, University Children’s Hospital Essen, Essen, Germany
| | - Johannes-Peter Haas
- grid.500039.fGerman Center for Pediatric and Adolescent Rheumatology, Garmisch-Partenkirchen, Germany
| | - Boris Hügle
- grid.500039.fGerman Center for Pediatric and Adolescent Rheumatology, Garmisch-Partenkirchen, Germany
| | - Nadine Fischer
- grid.500039.fGerman Center for Pediatric and Adolescent Rheumatology, Garmisch-Partenkirchen, Germany
| | - Dirk Foell
- grid.5949.10000 0001 2172 9288Department of Pediatric Rheumatology and Immunology, University of Muenster, Muenster, Germany
| | - Claas Hinze
- grid.5949.10000 0001 2172 9288Department of Pediatric Rheumatology and Immunology, University of Muenster, Muenster, Germany
| | - Elisabeth Weissbarth-Riedel
- grid.13648.380000 0001 2180 3484Pediatric Rheumatology, University Children’s Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Tilmann Kallinich
- grid.6363.00000 0001 2218 4662Department of Pediatric Pneumology, Immunology and Intensive Medicine and Center for Chronically Sick Children, Charité University Medicine Berlin and German Rheumatism Research Centre Berlin, Berlin, Germany
| | - Gerd Horneff
- grid.6190.e0000 0000 8580 3777Department of Pediatrics, Asklepios Clinic, Centre for Pediatric Rheumatology, St. Augustin and Medical Faculty, University of Cologne, Cologne, Germany
| | - Daniel Windschall
- grid.416438.cDepartment of Pediatric Rheumatology, St. Josef Hospital, Sendenhorst, Germany
| | - Eggert Lilienthal
- grid.5570.70000 0004 0490 981XDepartment of Pediatrics, Ruhr-University Bochum, Bochum, Germany
| | - Tim Niehues
- HELIOS Children’s Hospital, Pediatric Immunology and Rheumatology, Krefeld, Germany
| | - Ulrich Neudorf
- Department of Pediatric Rheumatology, University Children’s Hospital Essen, Essen, Germany
| | - Rainer Berendes
- Department of Pediatric Rheumatology, St. Marien’s Children’s Hospital Landshut, Landshut, Germany
| | | | - Prasad Thomas Oommen
- grid.411327.20000 0001 2176 9917Department of Pediatric Oncology, Hematology and Clinical Immunology, Center for Child and Adolescent Health, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Christoph Rietschel
- Department of Pediatrics, Clementine Children’s Hospital Frankfurt, Frankfurt, Germany
| | - Thomas Lutz
- grid.5253.10000 0001 0328 4908Center for Pediatric and Adolescent Medicine/Pediatric Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Klaus Tenbrock
- grid.1957.a0000 0001 0728 696XDepartment of Pediatric Pneumology, Allergology and Immunology, RWTH Aachen, Aachen, Germany
| | | | - Jens Klotsche
- grid.418217.90000 0000 9323 8675German Rheumatism Research Centre Berlin, Berlin, Germany
| | - Helmut Wittkowski
- grid.5949.10000 0001 2172 9288Department of Pediatric Rheumatology and Immunology, University of Muenster, Muenster, Germany
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Choida V, Hall-Craggs M, Jebson BR, Fisher C, Leandro M, Wedderburn LR, Ciurtin C. Biomarkers of Response to Biologic Therapy in Juvenile Idiopathic Arthritis. Front Pharmacol 2021; 11:635823. [PMID: 33603671 PMCID: PMC7884612 DOI: 10.3389/fphar.2020.635823] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 12/31/2020] [Indexed: 01/22/2023] Open
Abstract
Background: Juvenile idiopathic arthritis (JIA) is the most common chronic inflammatory arthritis of childhood, characterized by various clinical phenotypes associated with variable prognosis. Significant progress has been achieved with the use of biologic treatments, which specifically block pro-inflammatory molecules involved in the disease pathogenesis. The most commonly used biologics in JIA are monoclonal antibodies and recombinant proteins targeting interleukins 1 (IL-1) and 6 (IL-6), and tumor necrosis factor α (TNF-α). Several biomarkers have been investigated in JIA. Aims: To assess the level of evidence available regarding the role of biomarkers in JIA related to guiding clinical and therapeutic decisions, providing disease prognostic information, facilitating disease activity monitoring and assessing biologic treatment response in JIA, as well as propose new strategies for biologic therapy-related biomarker use in JIA. Methods: We searched PubMed for relevant literature using predefined key words corresponding to several categories of biomarkers to assess their role in predicting and assessing biologic treatment response and clinical remission in JIA. Results: We reviewed serological, cellular, genetic, transcriptomic and imaging biomarkers, to identify candidates that are both well-established and widely used, as well as newly investigated in JIA on biologic therapy. We evaluated their role in management of JIA as well as identified the unmet needs for new biomarker discovery and better clinical applications. Conclusion: Although there are no ideal biomarkers in JIA, we identified serological biomarkers with potential clinical utility. We propose strategies of combining biomarkers of response to biologics in JIA, as well as routine implementation of clinically acceptable imaging biomarkers for improved disease assessment performance.
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Affiliation(s)
- Varvara Choida
- Centre for Adolescent Rheumatology Versus Arthritis at UCL UCLH and GOSH, Division of Medicine, University College London, London, United Kingdom
- Department of Adolescent Rheumatology, University College London Hospital, London, United Kingdom
| | | | - Bethany R. Jebson
- Centre for Adolescent Rheumatology Versus Arthritis at UCL UCLH and GOSH, Division of Medicine, University College London, London, United Kingdom
- University College London Great Ormond Street Institute for Child Health, London, United Kingdom
| | - Corinne Fisher
- Centre for Adolescent Rheumatology Versus Arthritis at UCL UCLH and GOSH, Division of Medicine, University College London, London, United Kingdom
- Department of Adolescent Rheumatology, University College London Hospital, London, United Kingdom
| | - Maria Leandro
- Centre for Adolescent Rheumatology Versus Arthritis at UCL UCLH and GOSH, Division of Medicine, University College London, London, United Kingdom
- Department of Adolescent Rheumatology, University College London Hospital, London, United Kingdom
| | - Lucy R. Wedderburn
- Centre for Adolescent Rheumatology Versus Arthritis at UCL UCLH and GOSH, Division of Medicine, University College London, London, United Kingdom
- University College London Great Ormond Street Institute for Child Health, London, United Kingdom
- NIHR Biomedical Research Centre at Great Ormond Street Hospital, London, United Kingdom
| | - Coziana Ciurtin
- Centre for Adolescent Rheumatology Versus Arthritis at UCL UCLH and GOSH, Division of Medicine, University College London, London, United Kingdom
- Department of Adolescent Rheumatology, University College London Hospital, London, United Kingdom
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Malcova H, Milota T, Strizova Z, Cebecauerova D, Striz I, Sediva A, Horvath R. Interleukin-1 Blockade in Polygenic Autoinflammatory Disorders: Where Are We now? Front Pharmacol 2021; 11:619273. [PMID: 33708123 PMCID: PMC7941751 DOI: 10.3389/fphar.2020.619273] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 12/16/2020] [Indexed: 12/14/2022] Open
Abstract
Polygenic autoinflammatory diseases (AIDs), such as systemic juvenile idiopathic arthritis (sJIA), adult-onset Still's disease, Kawasaki disease, idiopathic recurrent pericarditis (IRP), Behçet’s Syndrome, Crystal-induced arthropatihes such as gout or Calcium pyrophosphate deposition disease are characterized by the overexpression of inflammasome-associated genes, leading to a dysregulation of the innate immune response. The IL-1 cytokine family (IL-1α, IL-1β, IL-1Ra, IL-18, IL-36Ra, IL-36α, IL-37, IL-36β, IL-36g, IL-38, IL-33) was defined to be principally responsible for the inflammatory nature of polygenic AIDs. Several clinical trials were initiated, and IL-1 blockade has been proven to cause a rapid reduction of clinical symptoms and normalization of laboratory parameters in the majority of cases. Randomized, placebo-controlled, clinical trials, together with registry-based clinical trials and open-label, retrospective and prospective observational studies, supported the efficacy and safety of IL-1 inhibitors in the treatment of polygenic AIDs. Most of the current data are focused on the therapeutic use of anakinra, an IL-1 receptor antagonist, canakinumab, an anti-IL-1β monoclonal antibody, and rilonacept, a soluble decoy receptor. However, other promising agents, such as gevokizumab, IL-1β blocking monoclonal antibody, tadekinig alfa, a human recombinant IL-18-binding protein, and tranilast, an analog of a tryptophan metabolite, are currently being tested. Anakinra, canakinumab and rilonacept caused impressive improvements in both systemic and musculoskeletal symptoms. Furthermore, the anti-IL-1 therapy allowed corticosteroid tapering and, in some cases, even withdrawal. This article reviews the current IL-1 inhibitors and the results of all clinical trials in which they have been tested for the management of broad spectrum of polygenic AIDs.
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Affiliation(s)
- Hana Malcova
- Department of Paediatric and Adult Rheumatology, University Hospital Motol, Prague, Czechia
| | - Tomas Milota
- Department of Paediatric and Adult Rheumatology, University Hospital Motol, Prague, Czechia.,Department of Immunology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czechia
| | - Zuzana Strizova
- Department of Immunology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czechia
| | - Dita Cebecauerova
- Department of Paediatric and Adult Rheumatology, University Hospital Motol, Prague, Czechia
| | - Ilja Striz
- Department of Clinical Immunology and Allergology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Anna Sediva
- Department of Immunology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czechia
| | - Rudolf Horvath
- Department of Paediatric and Adult Rheumatology, University Hospital Motol, Prague, Czechia
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Ruperto N, Brunner HI, Pacheco-Tena C, Louw I, Vega-Cornejo G, Spindler AJ, Kingsbury DJ, Schmeling H, Borzutzky A, Cuttica R, Inman CJ, Malievskiy V, Scott C, Keltsev V, Terreri MT, Viola DO, Xavier RM, Fernandes TAP, Velázquez MDRM, Henrickson M, Clark MB, Bensley KA, Li X, Lo KH, Leu JH, Hsu CH, Hsia EC, Xu Z, Martini A, Lovell DJ. Open-Label Phase 3 Study of Intravenous Golimumab in Patients With Polyarticular Juvenile Idiopathic Arthritis. Rheumatology (Oxford) 2021; 60:4495-4507. [PMID: 33493312 PMCID: PMC8487314 DOI: 10.1093/rheumatology/keab021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 12/23/2020] [Indexed: 11/12/2022] Open
Abstract
Objectives To assess efficacy, pharmacokinetics (PK) and safety of intravenous (i.v.) golimumab in patients with polyarticular-course JIA (pc-JIA). Methods Children aged 2 to <18 years with active pc-JIA despite MTX therapy for ≥2 months received 80 mg/m2 golimumab at weeks 0, 4, then every 8 weeks through week 52 plus MTX weekly through week 28. The primary and major secondary endpoints were PK exposure and model-predicted steady-state area under the curve (AUCss) over an 8-week dosing interval at weeks 28 and 52, respectively. JIA ACR response and safety were also assessed. Results In total, 127 children were treated with i.v. golimumab. JIA ACR 30, 50, 70, and 90 response rates were 84%, 80%, 70% and 47%, respectively, at week 28 and were maintained through week 52. Golimumab serum concentrations and AUCss were 0.40 µg/ml and 399 µg ⋅ day/ml at week 28. PK exposure was maintained at week 52. Steady-state trough golimumab concentrations and AUCss were consistent across age categories and comparable to i.v. golimumab dosed 2 mg/kg in adults with rheumatoid arthritis. Golimumab antibodies and neutralizing antibodies were detected via a highly sensitive drug-tolerant assay in 31% (39/125) and 19% (24/125) of patients, respectively. Median trough golimumab concentration was lower in antibody-positive vs antibody-negative patients. Serious infections were reported in 6% of patients, including one death due to septic shock. Conclusion Body surface area-based dosing of i.v. golimumab was well tolerated and provided adequate PK exposure for clinical efficacy in paediatric patients with active pc-JIA. ClinicalTrials.gov number NCT02277444
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Affiliation(s)
- Nicolino Ruperto
- IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO, Genoa, Italy
| | - Hermine I Brunner
- Cincinnati Children's Hospital Medical Center, Division of Rheumatology, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - César Pacheco-Tena
- Facultad de Medicina, Universidad Autónoma de Chihuahua, Circuito Universitario Campus II, Chihuahua, México
| | - Ingrid Louw
- Panorama Medical Centre, Rheumatology Private Practice, Cape Town, South Africa
| | - Gabriel Vega-Cornejo
- Centro de Reumatología y Autoinmunidad (CREA)/Hospital México Americano, Guadalajara, Jalisco, México
| | - Alberto J Spindler
- Centro Médico Privado de Reumatología, Rheumatology Section, San Miguel de Tucuman, Tucuman, Argentina
| | - Daniel J Kingsbury
- Randall Children's Hospital at Legacy Emanuel, Portland, Oregon, United States of America
| | - Heinrike Schmeling
- Alberta Children's Hospital and Department of Pediatrics, Cumming School of Medicine/University of Calgary, Calgary, Alberta, Canada
| | - Arturo Borzutzky
- Department of Pediatric Infectious Diseases and Immunology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rubén Cuttica
- Rheumatology Section, Hospital Pedro de Elizalde, Buenos Aires, Argentina
| | - C J Inman
- Pediatric Rheumatology, University of Utah, Salt Lake City, Utah, United States of America
| | - Victor Malievskiy
- Federal State Budget Educational Institution of Higher Education, Bashkir State Medical University of the Ministry of Healthcare of Russian Federation, Cape Town, South Africa
| | - Christiaan Scott
- Red Cross War Memorial Children's Hospital and Groote Schuur Hospital, Paediatric Rheumatology, University of Cape Town, Cape Town, South Africa
| | - Vladimir Keltsev
- Pediatric Department, Togliatti City Clinical Hospital No. 5, Togliatti, Russian Federation
| | - Maria Teresa Terreri
- Escola Paulista de Medicina/Universidade Federal de São Paulo, Pediatrics, São Paulo, Brazil
| | | | - Ricardo M Xavier
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | - Michael Henrickson
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America
| | - Michael B Clark
- Janssen Research & Development, LLC, Spring House, Pennsylvania, United States of America
| | - Karen A Bensley
- Janssen Research & Development, LLC, Spring House, Pennsylvania, United States of America
| | - Xiaoming Li
- Janssen Research & Development, LLC, Spring House, Pennsylvania, United States of America
| | - Kim Hung Lo
- Janssen Research & Development, LLC, Spring House, Pennsylvania, United States of America
| | - Jocelyn H Leu
- Janssen Research & Development, LLC, Spring House, Pennsylvania, United States of America
| | - Chyi-Hung Hsu
- Janssen Research & Development, LLC, Raritan, New Jersey, United States of America
| | - Elizabeth C Hsia
- Janssen Research & Development, LLC, Spring House, Pennsylvania, United States of America
| | - Zhenhua Xu
- Janssen Research & Development, LLC, Spring House, Pennsylvania, United States of America
| | - Alberto Martini
- Università degli Studi di Genova, Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DiNOGMI), Genova, Italy
| | - Daniel J Lovell
- Cincinnati Children's Hospital Medical Center, Division of Rheumatology, University of Cincinnati, Cincinnati, Ohio, United States of America
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Laskari K, Tektonidou MG, Katsiari C, Athanassiou P, Dimopoulou D, Gerodimos C, Salamaliki C, Papagoras C, Settas L, Vassilopoulos D, Voulgari PV, Zakalka M, Georgiadis A, Gkoni G, Daoussis D, Dimitroulas T, Iliou C, Kallitsakis I, Grika EP, Mavragani C, Pikazis D, Raftakis J, Sarikoudis T, Kougkas N, Soukera D, Theodorou E, Tsatsani P, Tsiakou E, Vlachoyiannopoulos P, Vosvotekas G, Sfikakis PP. Outcome of refractory to conventional and/or biologic treatment adult Still's disease following canakinumab treatment: Countrywide data in 50 patients. Semin Arthritis Rheum 2020; 51:137-143. [PMID: 33383289 DOI: 10.1016/j.semarthrit.2020.10.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/23/2020] [Accepted: 10/16/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the efficacy and safety of the IL-1b inhibitor canakinumab in all adults with refractory Still's disease identified from the National Organization For Medicines for off-label drug use. METHODS In a retrospective longitudinal multicenter cohort of 50 patients (median age 39 years) with active Still's disease despite treatment with corticosteroids (n = 11), conventional and synthetic (n = 34) and/or biologic disease modifying anti-rheumatic drugs (n = 30), we assessed the efficacy of canakinumab 150-300 mg administered every 4 (n = 47) or 8 weeks (n = 3) as combination therapy or monotherapy (n = 7) during a median follow-up of 27 (3-84) months. RESULTS Α complete response was initially observed in 78% of patients within 3 months (median), irrespective of age at disease onset. A partial response was evident in 20%. One patient had resistant disease. Treatment de-escalation was attempted in 15 of 39 complete responders and a complete drug discontinuation in 21 patients for 8 months (median). Eleven patients (22%) relapsed during treatment, one during de-escalation process, and 11 after treatment discontinuation. Overall, 9 of 11 relapses were successfully treated with canakinumab treatment intensification or re-introduction. At last visit, 18% of patients were off treatment due to remission and 26% due to disease activity. Canakinumab had a significant corticosteroid sparing effect allowing weaning in 21 of 41 cases. Infections (20%, severe 4%) and leucopenia (6%) led to treatment cessation in one patient. CONCLUSION High rates of sustained remission were observed in this, largest so far, real-life cohort of adult patients with refractory Still's disease treated with canakinumab.
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Affiliation(s)
- K Laskari
- Joint Rheumatology Program, NKUA Medical School, Athens, Greece.
| | - M G Tektonidou
- Joint Rheumatology Program, NKUA Medical School, Athens, Greece
| | - C Katsiari
- Dept. of Rheumatology, Thessaly University, Larissa, Greece
| | - P Athanassiou
- Dept. of Rheumatology, St. Paul's Hospital, Thessaloniki, Greece
| | - D Dimopoulou
- 4th Dept. of Internal Medicine, Aristotle University, Thessaloniki, Greece
| | | | - C Salamaliki
- Dept. of Rheumatology, University of Patras, Patras
| | - C Papagoras
- 1st Dept. of Internal Medicine, Democritus University of Thrace, Alexandroupolis
| | - L Settas
- First Dept. of Internal Medicine, Rheumatology Section, Aristotle University, Thessaloniki, Greece
| | - D Vassilopoulos
- Joint Rheumatology Program, NKUA Medical School, Athens, Greece
| | - P V Voulgari
- Rheumatology Clinic, Department of Internal Medicine, University of Ioannina, Ioannina, Greece
| | - M Zakalka
- First Dept. of Internal Medicine, Rheumatology Section, Aristotle University, Thessaloniki, Greece
| | | | - G Gkoni
- Rheumatologist, Metropolitan Hospital, Athens, Greece
| | - D Daoussis
- Dept. of Rheumatology, University of Patras, Patras
| | - T Dimitroulas
- 4th Dept. of Internal Medicine, Aristotle University, Thessaloniki, Greece
| | - C Iliou
- Private rheumatologist, Kozani, Greece
| | | | - E P Grika
- Rheumatology Clinic, Evangelismos Hospital, Athens, Greece
| | - C Mavragani
- Joint Rheumatology Program, NKUA Medical School, Athens, Greece
| | - D Pikazis
- Joint Rheumatology Program, NKUA Medical School, Athens, Greece
| | - J Raftakis
- Rheumatology Clinic, Asklepion Hospital, Athens, Greece
| | | | - N Kougkas
- Dept. of Rheumatology, Clinical Immunology and Allergy, University of Crete, Heraklion, Greece
| | - D Soukera
- Private rheumatologist, Corinth, Greece
| | - E Theodorou
- Dept. of Rheumatology, 251 Air Force General Hospital, Athens, Greece
| | - P Tsatsani
- Dept. of Rheumatology, KAT General Hospital, Athens, Greece
| | - E Tsiakou
- Private rheumatologist, Patras, Greece
| | | | | | - P P Sfikakis
- Joint Rheumatology Program, NKUA Medical School, Athens, Greece
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Quartier P, Alexeeva E, Constantin T, Chasnyk V, Wulffraat N, Palmblad K, Wouters C, I Brunner H, Marzan K, Schneider R, Horneff G, Martini A, Anton J, Wei X, Slade A, Ruperto N, Abrams K. Tapering Canakinumab Monotherapy in Patients With Systemic Juvenile Idiopathic Arthritis in Clinical Remission: Results From a Phase IIIb/IV Open-Label, Randomized Study. Arthritis Rheumatol 2020; 73:336-346. [PMID: 32783351 PMCID: PMC7898684 DOI: 10.1002/art.41488] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 07/27/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of 2 canakinumab monotherapy tapering regimens in order to maintain complete clinical remission in children with systemic juvenile idiopathic arthritis (JIA). METHODS The study was designed as a 2-part phase IIIb/IV open-label, randomized trial. In the first part, patients received 4 mg/kg of canakinumab subcutaneously every 4 weeks and discontinued glucocorticoids and/or methotrexate as appropriate. Patients in whom clinical remission was achieved (inactive disease for at least 24 weeks) with canakinumab monotherapy were entered into the second part of the trial, in which they were randomized 1:1 into 1 of 2 treatment arms. In arm 1, the dose of canakinumab was reduced from 4 mg/kg to 2 mg/kg and then to 1 mg/kg, followed by discontinuation. In arm 2, the 4 mg/kg dose interval was prolonged from every 4 weeks, to every 8 weeks, and then to every 12 weeks, followed by discontinuation. In both arms, canakinumab exposure could be reduced provided systemic JIA remained in clinical remission for 24 weeks with each step. The primary objective was to assess whether >40% of randomized patients in either arm maintained clinical remission of systemic JIA for 24 weeks in the first part of the study. RESULTS In part 1 of the study, 182 patients were enrolled, with 75 of those patients randomized before entering part 2 of the trial. Among the 75 randomized patients, clinical remission was maintained for 24 weeks in 27 (71%) of 38 patients in arm 1 (2 mg/kg every 4 weeks) and 31 (84%) of 37 patients in arm 2 (4 mg/kg every 8 weeks) (P ≤ 0.0001 for arm 1 versus arm 2 among those meeting the 40% threshold). Overall, 25 (33%) of 75 patients discontinued canakinumab, and clinical remission was maintained for at least 24 weeks in all 25 of these patients. No new safety signals were identified. CONCLUSION Reduction of canakinumab exposure may be feasible in patients who have achieved clinical remission of systemic JIA, but consistent interleukin-1 inhibition appears necessary to maintain this response.
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Affiliation(s)
- Pierre Quartier
- RAISE Reference Centre for Rare Diseases, Necker-Enfants Malades, AP-HP, Imagine Institute, Paris University, Paris, France
| | - Ekaterina Alexeeva
- National Medical Research Center of Children's Health of the Ministry of Health of the Russian Federation, Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia
| | | | - Vyacheslav Chasnyk
- Saint-Petersburg State Pediatric Medical University, Saint-Petersburg, Russian Federation
| | - Nico Wulffraat
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - Karin Palmblad
- Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | | | - Hermine I Brunner
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | - Katherine Marzan
- Children's Hospital Los Angeles, Los Angeles, California, United States
| | - Rayfel Schneider
- University of Toronto and Hospital for Sick Children, Toronto, Ontario, Canada
| | - Gerd Horneff
- Asklepios Klinik Sankt Augustin, and University Hospital Cologne, Sankt Augustin, Cologne, Germany
| | | | - Jordi Anton
- Hospital Sant Joan de Déu, Esplugues de Llobregat, Spain, and Universitat de Barcelona, Barcelona, Spain
| | - Xiaoling Wei
- China Novartis Institutes for Biomedical Research, Ltd, Beijing, China
| | - Alan Slade
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, United States
| | - Nicolino Ruperto
- Clinica Pediatrica e Reumatologia, PRINTO, Istituto Giannina Gaslini, IRCCS, Genoa, Italy
| | - Ken Abrams
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, United States
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Brunner HI, Quartier P, Alexeeva E, Constantin T, Koné-Paut I, Marzan K, Schneider R, Wulffraat NM, Chasnyk V, Tirosh I, Kallinich T, Kuemmerle-Deschner J, Wouters C, Lauwerys B, Nikishina I, Trachana M, Vougiouka O, Martini A, Lovell DJ, Levy J, Vritzali E, Ruperto N. Efficacy and Safety of Canakinumab in Patients With Systemic Juvenile Idiopathic Arthritis With and Without Fever at Baseline: Results From an Open-Label, Active-Treatment Extension Study. Arthritis Rheumatol 2020; 72:2147-2158. [PMID: 32648697 DOI: 10.1002/art.41436] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 06/27/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To evaluate the long-term efficacy and safety of canakinumab and explore prediction of response in patients with systemic juvenile idiopathic arthritis (JIA) with or without fever at treatment initiation. METHODS At enrollment, patients with active systemic JIA (ages 2 to <20 years) started open-label canakinumab (4 mg/kg every 4 weeks subcutaneously). Efficacy measures included the adapted American College of Rheumatology (ACR) Pediatric 50/70/90 criteria, the Juvenile Arthritis Disease Activity Score (JADAS), and clinically inactive disease and clinical remission on medication, evaluated by either the JADAS or ACR criteria. RESULTS Of the 123 patients (70 with fever and 52 without fever [fever status was not reported for 1 patient]), 84 (68.3%) completed the study (median duration 1.8 years). Comparable efficacy (adapted ACR Pediatric 50/70/90/100) was observed by day 15 in both subgroups (60.0%/48.6%/37.1%/24.3% in those with fever and 67.3%/48.1%/34.6%/19.2% in those without fever), and further increased thereafter. By month 6, clinical remission according to the JADAS or the ACR criteria was achieved in 17 (24.3%) and 26 (37.1%), respectively, of patients with fever and 9 (17.3%) and 12 (23.1%), respectively, of patients without fever. Median time to onset of clinical remission according to the JADAS or ACR criteria was 57 and 30 days, respectively, in those with fever, and 58 and 142 days, respectively, in those without fever. An adapted ACR Pediatric 50 response by day 15 was the strongest predictor of achieving clinical remission according to the JADAS (odds ratio [OR] 13 [95% confidence interval (95% CI) 4, 42]; P < 0.0001) or glucocorticoid discontinuation (OR 19 [95% CI 3, 114]; P = 0.002). Of the 71 of 123 patients (57.7%) who received glucocorticoids at study entry, 27 (38.0%) discontinued glucocorticoids and 21 (29.6%) reached a dose of <0.2 mg/kg/day, with no difference between those with and those without fever; 13 patients (10.6%) tolerated a sustained canakinumab dose reduction to 2 mg/kg every 4 weeks. No new safety findings were observed. CONCLUSION Canakinumab provided rapid and sustained improvement of active systemic JIA irrespective of the presence of fever at treatment initiation.
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Affiliation(s)
- Hermine I Brunner
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
| | - Pierre Quartier
- Université de Paris, Institut IMAGINE, Centre de référence national pour les Rhumatismes inflammatoires et les maladies Auto-Immunes Systémiques rares de l'Enfant, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - Ekaterina Alexeeva
- Federal State Autonomous Institution National Medical Research Center of Children's Health of the Ministry of Health of the Russian Federation, Federal State Autonomous Educational Institution of Higher Education, I. M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia
| | | | - Isabelle Koné-Paut
- Centre de Référence des Maladies Auto-Inflammatoires rares et des Amyloses, CHU de Biĉetre, AP-HP, University of Paris Sud, Paris, France
| | | | - Rayfel Schneider
- University of Toronto and Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Vyacheslav Chasnyk
- Saint-Petersburg State Pediatric Medical University, Saint-Petersburg, Russia
| | - Irit Tirosh
- The Edmond and Lily Safra Children's Hospital, Ramat Gan, Israel
| | - Tilmann Kallinich
- Charité University Medicine Berlin and Leibniz Institut, Berlin, Germany
| | | | - Carine Wouters
- Universitair Ziekenhuis Leuven and Katholieke Universiteit Leuven, Leuven, Belgium
| | - Bernard Lauwerys
- Université catholique de Louvain and Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Irina Nikishina
- VA Nasonova Research Institute of Rheumatology, Moscow, Russia
| | - Maria Trachana
- Hippokration General Hospital and Thessaloniki University School of Medicine, Thessaloniki, Greece
| | - Olga Vougiouka
- P&A Kyriakou Children's Hospital and Athens University School of Medicine, Athens, Greece
| | | | - Daniel J Lovell
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
| | - Jeremy Levy
- Biometrical Practice BIOP, Basel, Switzerland
| | | | - Nicolino Ruperto
- IRCCS, Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO, Genoa, Italy
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Trincianti C, Consolaro A. Outcome Measures for Juvenile Idiopathic Arthritis Disease Activity. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:150-162. [PMID: 33091249 DOI: 10.1002/acr.24192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 03/17/2020] [Indexed: 01/17/2023]
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Lactate Arterial-Central Venous Gradient among COVID-19 Patients in ICU: A Potential Tool in the Clinical Practice. Crit Care Res Pract 2020; 2020:4743904. [PMID: 33014462 PMCID: PMC7519437 DOI: 10.1155/2020/4743904] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/16/2020] [Accepted: 08/03/2020] [Indexed: 01/06/2023] Open
Abstract
Objective In physiological conditions, arterial blood lactate concentration is equal to or lower than central venous blood lactate concentration. A reversal in this rate (i.e., higher lactate concentration in central venous blood), which could reflect a derangement in the mitochondrial metabolism of lung cells induced by inflammation, has been previously reported in patients with ARDS but has been never explored in COVID-19 patients. The aim of this study was to explore if the COVID-19-induced lung cell damage was mirrored by an arterial lactatemia higher than the central venous one; then if the administration of anti-inflammatory therapy (i.e., canakinumab 300 mg subcutaneous) could normalize such abnormal lactate a-cv difference. Methods A prospective cohort study was conducted, started on March 25, 2020, for a duration of 10 days, enrolling 21 patients affected by severe COVID-19 pneumonia undergoing mechanical ventilation consecutively admitted to the ICU of the Rimini Hospital, Italy. Arterial and central venous blood samples were contemporarily collected to calculate the difference between arterial and central venous lactate (Delta a-cv lactate) concentrations within 24 h from tracheal intubation (T 0) and 24 hours after canakinumab administration (T 1). Results At T 0, 19 of 21 (90.5%) patients showed a pathologic Delta a-cv lactate (median 0.15 mmol/L; IQR 0.07-0.25). In the 13 patients undergoing canakinumab administration, at T 1, Delta a-cv lactate decreased in 92.3% of cases, the decrease being statistically significant (T 0: median 0.24, IQR 0.09-0.31 mmol/L; T 1: median -0.01, IQR -0.08-0.04 mmol/L; p=0.002). Conclusion A reversed Delta a-cv lactate might be interpreted as one of the effects of COVID-19-related cytokine storm, which could reflect a derangement in the mitochondrial metabolism of lung cells induced by severe inflammation or other uncoupling mediators. In addition, Delta a-cv lactate decrease might also reflect the anti-inflammatory activity of canakinumab. Our preliminary findings need to be confirmed by larger outcome studies.
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Saougou IG, Markatseli TE, Voulgari PV, Drosos AA. Current Therapeutic Options for the Treatment of Juvenile Idiopathic Arthritis. Curr Rheumatol Rev 2020; 17:41-57. [PMID: 32942977 DOI: 10.2174/1573403x16999200917151805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 07/21/2020] [Accepted: 07/21/2020] [Indexed: 12/15/2022]
Abstract
Juvenile idiopathic arthritis (JIA) is a chronic inflammatory disease and an exclusion diagnosis that includes all forms of arthritis that persists for more than 6 weeks under the age of 16. Although there is not yet a cure for JIA, and recent advances in the therapeutic field have created a more hopeful present and future for the patients. In the past, therapies for JIA have depended on non-steroidal medication, conventional synthetic disease-modifying antirheumatic drugs and corticosteroids. However, over the last decades, the advent of biologic therapies in JIA contributed to the preservation of functional activity, control of pain, avoidance of joint damage, and extra-articular manifestations. Furthermore, over the last years, international institutions, such as the American College of Rheumatology, have released recommendations and guidelines for rheumatologists for optimal JIA management. All the above have revolutionized the treatment of JIA with promising outcomes. To this end, the relevant literature is reviewed and discussed appropriately.
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Affiliation(s)
- Ioanna G Saougou
- Department of Internal Medicine, Rheumatology Clinic, Medical School, University of Ioannina, Ioannina, Greece
| | - Theodora E Markatseli
- Department of Internal Medicine, Rheumatology Clinic, Medical School, University of Ioannina, Ioannina, Greece
| | - Paraskevi V Voulgari
- Department of Internal Medicine, Rheumatology Clinic, Medical School, University of Ioannina, Ioannina, Greece
| | - Alexandros A Drosos
- Department of Internal Medicine, Rheumatology Clinic, Medical School, University of Ioannina, Ioannina, Greece
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Abstract
Joint pain is a common symptom in children and adolescents. While there are many causes of joint pain in children, most of these are acute or not related to underlying joint inflammation. Chronic arthritis, however, can be one of the reasons behind the joint pain. The most common causes of chronic arthritis in children are categorized under juvenile idiopathic arthritis (JIA). The purpose of this review is to highlight the most important clinical features, work-up, and medical management of the different subtypes of JIA.
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