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Fox RI, Fox CM, McCoy SS. Emerging treatment for Sjögren's disease: a review of recent phase II and III trials. Expert Opin Emerg Drugs 2023:1-14. [PMID: 37127914 DOI: 10.1080/14728214.2023.2209720] [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: 05/03/2023]
Abstract
INTRODUCTION Sjögren's Disease, SjD, is a systemic autoimmune disorder characterized by reduced function of the salivary and lacrimal glands. Patients suffer from dryness, fatigue, and pain and may present with or without extra-glandular organ involvement. Symptoms limit SjD patients' quality of life and are the most difficult to improve with therapy. SjD patients are heterogeneous and clustering them into biologically similar subgroups might improve the efficacy of therapies. The need for therapies that address both the symptoms and extra glandular organ involvement of SjD presents an unmet opportunity that has recently attracted a growing interest in the pharmaceutical industry. AREAS COVERED The goal of this report is to review recent phase II/III studies in SjD. To accomplish our goal, we performed a literature search for phase II/III studies and abstracts recently presented at conferences. EXPERT OPINION This review allows updates the reader on the multitude of recent phase II/III clinical trials. We speculate on how subtypes of SjD will drive future therapeutic targeting and inform pathogenesis.
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Affiliation(s)
- Robert I Fox
- Scripps Memorial Hospital and Research Foundation, San Diego, CA, United States
| | - Carla M Fox
- Scripps Memorial Hospital and Research Foundation, San Diego, CA, United States
| | - Sara S McCoy
- University of Wisconsin-Madison Ringgold standard institution, Madison, United States
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2
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Schulze-Koops H, Skapenko A, Krause A, Krueger K, Lorenz HM, Sewerin P, Specker C, Wagner UG, Voormann A, Mueller-Ladner U, Voll RE. Correspondence to 'Risk factors for hospital admissions related to COVID-19 in patients with autoimmune inflammatory rheumatic diseases'. Ann Rheum Dis 2023; 82:e1. [PMID: 33127664 DOI: 10.1136/annrheumdis-2020-218997] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 09/27/2020] [Accepted: 09/30/2020] [Indexed: 02/03/2023]
Affiliation(s)
- Hendrik Schulze-Koops
- Division of Rheumatology and Clinical Immunology, Department of Internal Medicine IV, Ludwig Maximilians University of Munich, Munich, Germany
| | - Alla Skapenko
- Division of Rheumatology and Clinical Immunology, Department of Internal Medicine IV, Ludwig Maximilians University of Munich, Munich, Germany
| | - Andreas Krause
- Department of Rheumatology, Clinical Immunology and Osteology, Immanuel Hospital Berlin-Wannsee Branch, Berlin, Germany
| | | | - Hanns-Martin Lorenz
- Division of Rheumatology, Department of Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Philipp Sewerin
- Department and Hiller-Research-Unit fpr Rheumatology, University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Christof Specker
- Klinik für Rheumatologie und Klinische Immunologie, Kliniken Essen-Mitte-KEM, Essen, Germany
| | - Ulf G Wagner
- Division of Rheumatology, Department for Endocrinology, Nephrology, Rheumatology, University Hospital Leipzig, Leipzig, Germany
| | - Anna Voormann
- Deutsche Gesellschaft für Rheumatologie eV, Berlin, Germany
| | - Ulf Mueller-Ladner
- Department of Rheumatology and Clinical Immunology, Campus Kerckhoff, Justus-Liebig-University Giessen, Giessen, Germany
| | - Reinhard E Voll
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, Medical Center-University of Freiburg, Freiburg, Germany.,Centre for Chronic Immunodeficiency, Faculty of Medicine, Medical Center-University of Freiburg, Freiburg, Germany
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Kiltz U, Celik A, Tsiami S, Buehring B, Baraliakos X, Andreica I, Kiefer D, Braun J. Are patients with rheumatic diseases on immunosuppressive therapies protected against preventable infections? A cross-sectional cohort study. RMD Open 2021; 7:rmdopen-2020-001499. [PMID: 33832974 PMCID: PMC8039255 DOI: 10.1136/rmdopen-2020-001499] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/25/2021] [Accepted: 03/23/2021] [Indexed: 11/10/2022] Open
Abstract
Objective To evaluate the prevalence of infections, prevalence of hospitalisation due to infections, the vaccination status and perceived screening of infections prior to the start of biologic disease modifying antirheumatic drugs (bDMARDs) of a patient cohort with chronic inflammatory rheumatic diseases (CIRD). Methods Consecutive CIRD patients reporting to our specialised centre were prospectively included (n=975) in this cross-sectional study. Data on comorbidities including infections, treatment, vaccination status, screening for latent tuberculosis infection (LTBI) and hepatitis B (HepB) were collected. Antibodies against measles and HepB were measured by ELISA. The vaccination status was assessed by a predefined vaccination score (0–26) categorising patients into four immunisation states: low (0–6), moderate (7–13), good (14–20), high (21–26). Results All patients on bDMARDs (n=499) were screened for LTBI, and 469 for HepB (94%). All LTBI patients (n=16) received isoniazid (3.2%) and 16 chronic HepB patients received lamivudine (3.4%). Protective measles specific IgG-antibodies were found in 901 patients (92.4%). Although 629 patients were educated about vaccination strategies (64.5%), only 540 showed a vaccination card (55.4%). Only 49% of patients had undergone pneumococcal vaccination and less than 30% were protected against HepB and influenza, while 7.6% have not protective antibody titres against measles. No patient met the German national vaccination recommendations requiring a complete documentation of vaccines. The mean vaccination score was 13.3±4.2 with 5.7% of patients having a low, 43.9% a moderate, 47.0% a good and 3.3% a high score. Conclusions The majority of CIRD patients are n0t sufficiently vaccinated against pneumococci, HepB, influenza and measles. Although CIRD patients and general practitioners regularly receive professional information about the need of vaccination, vaccination rates were low to moderate. Interdisciplinary quality projects should be planned to change that inacceptable result.
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Affiliation(s)
- Uta Kiltz
- Rheumatology, Rheumazentrum Ruhrgebiet, Herne, Germany .,Ruhr Universität Bochum, Bochum, Germany
| | - Aylin Celik
- Department of Internal Medicine, Klinikum Westfalen GmbH, Dortmund, Germany
| | - Styliani Tsiami
- Rheumatology, Rheumazentrum Ruhrgebiet, Herne, Germany.,Ruhr Universität Bochum, Bochum, Germany
| | - Bjoern Buehring
- Rheumatology, Rheumazentrum Ruhrgebiet, Herne, Germany.,Ruhr Universität Bochum, Bochum, Germany
| | | | - Ioana Andreica
- Rheumatology, Rheumazentrum Ruhrgebiet, Herne, Germany.,Ruhr Universität Bochum, Bochum, Germany
| | - David Kiefer
- Rheumatology, Rheumazentrum Ruhrgebiet, Herne, Germany.,Ruhr Universität Bochum, Bochum, Germany
| | - Juergen Braun
- Rheumatology, Rheumazentrum Ruhrgebiet, Herne, Germany.,Ruhr Universität Bochum, Bochum, Germany
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Conway R, Konig MF, Graef ER, Webb K, Yazdany J, Kim AHJ. Inflammatory arthritis in patients with COVID-19. Transl Res 2021; 232:49-59. [PMID: 33626415 PMCID: PMC7897406 DOI: 10.1016/j.trsl.2021.02.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 02/17/2021] [Accepted: 02/19/2021] [Indexed: 12/12/2022]
Abstract
Patients with inflammatory arthritis represent a possible high-risk group to COVID-19 due to their immunosuppressive regimen designed to maintain low disease activity. Thus, substantial effort has been put forth to understand the impact of COVID-19 on these patients. Patients with rheumatic diseases as a whole do not appear to be more susceptible to acquiring COVID-19. Furthermore, immunosuppression generally did not increase the likelihood of developing severe COVID-19, with the important exception of medium and high-dose glucocorticoid use. In addition, a small number of COVID-19 patients have developed new inflammatory arthritis; whether this represents an unmasking of previous subclinical disease or a bone fide virus-induced arthritis is unclear. Nevertheless, it appears that inflammatory arthritis patients currently on immunosuppression should continue their medication to prevent future flares and limit glucocorticoid usage. While this continues to be a rapidly evolving field, these data are reassuring to both patients with and providers treating inflammatory arthritides.
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Key Words
- ace-2, angiotensin converting enzyme-2
- acr, american college of rheumatology
- c1, complement component 1
- ci, confidence interval
- covid-19, coronavirus disease-2019
- dmard, disease-modifying antirheumatic drugs
- eular, european league against rheumatism
- gra, global rheumatology alliance
- hcq, hydroxychloroquine
- hiv, human immunodeficiency virus
- hla, human leukocyte antigen
- hr, hazard ratio
- mis-c, multisystem inflammatory syndrome in children
- mri, magnetic resonance imaging
- nhs, national health service
- or, odds ratio
- pcr, polymerase chain reaction
- ra, rheumatoid arthritis
- sars-cov-2, severe acute respiratory syndrome coronavirus 2
- sle, systemic lupus erythematosus
- slicc, systemic lupus erythematosus international collaborating clinics
- tnfi, tumor necrosis factor inhibitor
- tracr, trinity rheumatology and covid-19 registry
- uk, united kingdom
- us, united states
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Affiliation(s)
- Richard Conway
- Department of Rheumatology, St. James's Hospital, Dublin, Ireland
| | - Maximilian F Konig
- Division of Rheumatology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Kate Webb
- Division of Paediatric Rheumatology, School of Child and Adolescent Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa; Crick African Network, Francis Crick Institute, London, UK
| | - Jinoos Yazdany
- Division of Rheumatology, Department of Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, California.
| | - Alfred H J Kim
- Division of Rheumatology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
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[Threat of a SARS-CoV-2 endemic in a large hospital specialized in rheumatic diseases-relative all clear through consistent testing]. Z Rheumatol 2021; 80:45-47. [PMID: 33495854 PMCID: PMC7832413 DOI: 10.1007/s00393-021-00959-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2020] [Indexed: 11/10/2022]
Abstract
Die SARS-CoV-2-Pandemie hält die meisten Länder der Welt anhaltend in Atem. In Deutschland liegt die Prävalenz von SARS-CoV-2-Infektionen zwar noch unter 2 %, die Zahlen steigen aber seit Wochen auch in Deutschland wieder an. Die rheumatologische Versorgung wurde durch die 1. Welle der Pandemie vorübergehend beeinträchtigt. Wir berichten über die Infektionssituation in der größten deutschen Rheumaspezialklinik, dem Rheumazentrum Ruhrgebiet, weil es hier vor Kurzem während der 2. Welle erstmals zum Auftreten von mehreren SARS-CoV-2-Infektionen an einem Wochenende gekommen ist, was zu einer erheblichen Unruhe bei vielen Beteiligten führte. Die Situation konnte durch konsequentes Testen von Patienten und Mitarbeitern mit dem Antigenschnelltest aufgeklärt und die Lage beruhigt werden. Letztlich waren nur wenige Getestete positiv, und die Verläufe bei den Patienten blieben bis jetzt blande. Dies zeigt auch die Effektivität der seit April konsequent durchgeführten hygienischen Schutzmaßnahmen.
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Gianfrancesco M, Hyrich KL, Yazdany J, Machado PM, Robinson PC. COVID-19 Global Rheumatology Alliance Registry, anti-IL-6 therapy, shared decision-making and patient outcomes. Response to: 'Correspondence on 'Characteristics associated with hospitalisation for COVID-19 in people with rheumatic disease: data from the COVID-19 Global Rheumatology Alliance physician-reported registry' by Gianfrancesco et al. Compassionate use of tocilizumab in severe COVID-19 with hyperinflammation prior to advent of clinical trials - a real-world district general hospital experience' by Khan et al, 'Comment on 'Characteristics associated with hospitalisation for COVID-19 in people with rheumatic disease: data from the COVID-19 global rheumatology alliance physician-reported registry' by Gianfrancesco M et al' by Andreica et al and 'COVID-19 outcomes in patients with systemic autoimmune diseases treated with immunomodulatory drugs' by Ansarin et al. Ann Rheum Dis 2020; 81:e191. [PMID: 32796043 DOI: 10.1136/annrheumdis-2020-218713] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Milena Gianfrancesco
- Department of Medicine, Division of Rheumatology, University of California, San Francisco, San Francisco, California, USA
| | - Kimme L Hyrich
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK
| | - Jinoos Yazdany
- Department of Medicine, Division of Rheumatology, University of California, San Francisco, San Francisco, California, USA
| | - Pedro M Machado
- MRC Centre for Neuromuscular Diseases, University College London, London, UK.,Rheumatology, University College London Centre for Rheumatology, London, UK
| | - Philip C Robinson
- Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia .,Metro North Hospital & Health Service, Royal Brisbane and Woman's Hospital Health Service District, Herston, Queensland, Australia
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