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Simon TA, Suissa S, Skovron ML, Frisell T, Askling J, Michaud K, Pedro S, Strangfeld A, Meissner Y, Boers M, Hoffman V, Dominique A, Gomez A, Hochberg MC. Infection outcomes in patients with rheumatoid arthritis treated with abatacept and other disease-modifying antirheumatic drugs: Results from a 10-year international post-marketing study. Semin Arthritis Rheum 2024; 64:152313. [PMID: 38044241 DOI: 10.1016/j.semarthrit.2023.152313] [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: 10/07/2022] [Revised: 09/15/2023] [Accepted: 11/07/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVE To evaluate risk of infections requiring hospitalization and opportunistic infections, including tuberculosis, in patients with rheumatoid arthritis (RA) treated with abatacept versus conventional synthetic (cs) disease-modifying antirheumatic drugs (DMARDs) and other biologic/targeted synthetic (b/ts) DMARDs. METHODS Five international observational data sources were used: two biologic registries (Sweden, Germany), a disease registry (USA) and two healthcare claims databases (Canada, USA). Crude incidence rates (IRs) per 1000 patient-years, with 95 % CIs, were used to estimate rate ratios (RRs) comparing abatacept versus csDMARDs or other b/tsDMARDs. RRs were adjusted for demographic factors, comorbidities, and other potential confounders and then pooled across data sources using a random effects model (REM). RESULTS The data sources included 6450 abatacept users, 136,636 csDMARD users and 54,378 other b/tsDMARD users, with a mean follow-up range of 2.2-6.2 years. Across data sources, the IRs for infections requiring hospitalization ranged from 16 to 56 for abatacept, 19-46 for csDMARDs, and 18-40 for other b/tsDMARDs. IRs for opportunistic infections were 0.4-7.8, 0.3-4.3, and 0.5-3.8; IRs for tuberculosis were 0.0-8.4, 0.0-6.0, and 0.0-6.3, respectively. The pooled adjusted RR (95 % CI), only reported for infections requiring hospitalization, was 1.2 (0.6-2.2) for abatacept versus csDMARDs and 0.9 (0.6-1.3) versus other b/tsDMARDs. CONCLUSIONS Data from this international, observational study showed similar hospitalized infection risk for abatacept versus csDMARDs or other b/tsDMARDs. IRs for opportunistic infections, including tuberculosis, were low. These data are consistent with the known safety profile of abatacept.
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Affiliation(s)
- Teresa A Simon
- Bristol Myers Squibb, 7 Haines Cove Drive, Toms River, Princeton, NJ 08753, USA.
| | | | - Mary Lou Skovron
- Bristol Myers Squibb, 7 Haines Cove Drive, Toms River, Princeton, NJ 08753, USA
| | - Thomas Frisell
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Johan Askling
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Kaleb Michaud
- University of Nebraska Medical Center, Omaha, NE, USA; FORWARD, The National Databank for Rheumatic Diseases, Wichita, KS, USA
| | - Sofia Pedro
- FORWARD, The National Databank for Rheumatic Diseases, Wichita, KS, USA
| | - Anja Strangfeld
- Pharmacoepidemiology and Health Services Research, German Rheumatism Research Center, Berlin, Germany; Charité University Medicine, Berlin, Germany
| | - Yvette Meissner
- Pharmacoepidemiology and Health Services Research, German Rheumatism Research Center, Berlin, Germany
| | - Maarten Boers
- Department of Epidemiology & Data Science, Amsterdam Rheumatology and Immunology Center, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, Netherlands
| | | | - Alyssa Dominique
- Bristol Myers Squibb, 7 Haines Cove Drive, Toms River, Princeton, NJ 08753, USA
| | - Andres Gomez
- Bristol Myers Squibb, 7 Haines Cove Drive, Toms River, Princeton, NJ 08753, USA
| | - Marc C Hochberg
- Departments of Medicine and Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
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Hauser B, Raterman H, Ralston SH, Lems WF. The Effect of Anti-rheumatic Drugs on the Skeleton. Calcif Tissue Int 2022; 111:445-456. [PMID: 35771255 PMCID: PMC9560949 DOI: 10.1007/s00223-022-01001-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/11/2022] [Indexed: 12/27/2022]
Abstract
The therapeutic armamentarium for rheumatoid arthritis has increased substantially over the last 20 years. Historically antirheumatic treatment was started late in the disease course and frequently included prolonged high-dose glucocorticoid treatment which was associated with accelerated generalised bone loss and increased vertebral and non-vertebral fracture risk. Newer biologic and targeted synthetic treatments and a combination of conventional synthetic DMARDs prevent accelerated systemic bone loss and may even allow repair of cortical bone erosions. Emerging data also gives new insight on the impact of long-term conventional synthetic DMARDs on bone health and fracture risk and highlights the need for ongoing studies for better understanding of "established therapeutics". An interesting new antirheumatic treatment effect is the potential of erosion repair with the use of biologic DMARDs and janus kinase inhibitors. Although several newer anti-rheumatic drugs seem to have favorable effects on bone mineral density in RA patients, these effects are modest and do not seem to influence the fracture risk thus far. We summarize recent developments and findings of the impact of anti-rheumatic treatments on localized and systemic bone integrity and health.
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Affiliation(s)
- B Hauser
- Rheumatic Disease Unit, Western General Hospital, Edinburgh, UK.
- Rheumatology and Bone Disease Unit, Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK.
| | - H Raterman
- Department of Rheumatology, Northwest Clinics, Alkmaar, The Netherlands
| | - S H Ralston
- Rheumatic Disease Unit, Western General Hospital, Edinburgh, UK
- Rheumatology and Bone Disease Unit, Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - W F Lems
- Amsterdam Rheumatology and Immunology Centre, Amsterdam, The Netherlands
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3
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Takatani A, Tamai M, Ohki N, Okamoto M, Endo Y, Tsuji S, Shimizu T, Umeda M, Fukui S, Sumiyoshi R, Nishino A, Koga T, Kawashiri SY, Iwamoto N, Igawa T, Ichinose K, Arima K, Nakamura H, Origuchi T, Uetani M, Kawakami A. Prediction of Radiographic Progression During a Treat-to-Target Strategy by the Sequential Application of MRI-Proven Bone Marrow Edema and Power-Doppler Grade ≥2 Articular Synovitis in Rheumatoid Arthritis: Retrospective Observational Study. Mod Rheumatol 2022:6646948. [PMID: 35856575 DOI: 10.1093/mr/roac077] [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: 04/19/2022] [Revised: 07/10/2022] [Accepted: 07/20/2022] [Indexed: 11/14/2022]
Abstract
OBJECTIVES To investigate the appropriate timing, useful findings and combination of magnetic resonance imaging (MRI) and ultrasound (US) for predicting the radiographic progression in early rheumatoid arthritis (RA). METHODS Forty-four active RA patients, who examined by both of MRI and US in the symptomatic wrist and finger joints, were recruited in Nagasaki University Hospital from 2010 to 2017 and treated by the T2T therapeutic strategy for 1 year. MRI was evaluated by RA MRI scoring and US by Outcomes Measures in Rheumatology Clinical Trial, respectively. Plain radiographs were assessed by the Genant-modified Sharp score for the symptomatic side in the same manner as MRI and US. Radiographic progression was defined as an annual increase ≥0.75 at 1 year. Factors associated with radiographic progression were analyzed. Also, the optimal combination of MRI and US at each timepoint was considered. RESULTS Logistic regression model revealed that MRI-proven BME at baseline and 6 month and joint counts of PD grade ≥2 articular synovitis at 3 or 6 month were significantly associated with radiographic progression at 1 year. CONCLUSION This study may suggest the favorable timing and combination of MRI and US at each point to predict radiographic progression in patients with early-stage RA.
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Affiliation(s)
- Ayuko Takatani
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki-c, Nagasaki, 852-8501, JAPAN
| | - Mami Tamai
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki-c, Nagasaki, 852-8501, JAPAN
| | - Nozomi Ohki
- Department of Radiological Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, JAPAN
| | - Momoko Okamoto
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki-c, Nagasaki, 852-8501, JAPAN
| | - Yushiro Endo
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki-c, Nagasaki, 852-8501, JAPAN
| | - Sousuke Tsuji
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki-c, Nagasaki, 852-8501, JAPAN
| | - Toshimasa Shimizu
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki-c, Nagasaki, 852-8501, JAPAN
| | - Masataka Umeda
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki-c, Nagasaki, 852-8501, JAPAN
| | - Shoichi Fukui
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki-c, Nagasaki, 852-8501, JAPAN
| | - Remi Sumiyoshi
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki-c, Nagasaki, 852-8501, JAPAN
| | - Ayako Nishino
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki-c, Nagasaki, 852-8501, JAPAN
| | - Tomohiro Koga
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki-c, Nagasaki, 852-8501, JAPAN
| | - Shin-Ya Kawashiri
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki-c, Nagasaki, 852-8501, JAPAN.,Department of Community Medicine, Division of Advanced Preventive Medical Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, JAPAN
| | - Naoki Iwamoto
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki-c, Nagasaki, 852-8501, JAPAN
| | - Takashi Igawa
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki-c, Nagasaki, 852-8501, JAPAN
| | - Kunihiro Ichinose
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki-c, Nagasaki, 852-8501, JAPAN
| | - Kazuhiko Arima
- Department of Public Health, Division of Advanced Preventive Medical Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, JAPAN
| | - Hideki Nakamura
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki-c, Nagasaki, 852-8501, JAPAN.,Department of Medicine, Division of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, JAPAN
| | - Tomoki Origuchi
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki-c, Nagasaki, 852-8501, JAPAN.,Department of Locomotive and Rehabilitation Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, JAPAN
| | - Masataka Uetani
- Department of Radiological Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, JAPAN
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki-c, Nagasaki, 852-8501, JAPAN
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Mysler E, Caubet M, Lizarraga A. Current and Emerging DMARDs for the Treatment of Rheumatoid Arthritis. Open Access Rheumatol 2021; 13:139-152. [PMID: 34104009 PMCID: PMC8179789 DOI: 10.2147/oarrr.s282627] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/22/2021] [Indexed: 01/13/2023] Open
Abstract
Rheumatoid arthritis (RA) is the most prevalent form of inflammatory arthritis. It is a profoundly serious and severe disease that if it goes untreated could have severe consequences to the joints and health of the patient who carries this diagnosis. The treatment of RA has dramatically changed since the year 2000, with the discovery of the TNFis, then other biologics, and finally the JAKi. All these new medications with or without methotrexate in combination, tight control and treat to target have produced a revolution in the outcome of this disease. We reviewed and summarized the treatment options, and the most significant papers for each one of these new drugs. The reader could have a full picture with all the references of the recent publications. We also updated the biosimilar situation in RA, as well as the new drugs that will be coming to the market in the next 5 years.
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Affiliation(s)
- Eduardo Mysler
- Organización Medica de Investigación, Buenos Aires, Argentina
| | - Mariana Caubet
- Organización Medica de Investigación, Buenos Aires, Argentina
| | - Ana Lizarraga
- Organización Medica de Investigación, Buenos Aires, Argentina
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Simon TA, Dong L, Winthrop KL. Risk of opportunistic infections in patients with rheumatoid arthritis initiating abatacept: cumulative clinical trial data. Arthritis Res Ther 2021; 23:17. [PMID: 33430948 PMCID: PMC7798209 DOI: 10.1186/s13075-020-02399-2] [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] [Received: 03/03/2020] [Accepted: 12/13/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND To evaluate incidence of opportunistic infections (OIs) in patients with rheumatoid arthritis (RA) treated with abatacept in clinical trials. METHODS This pooled analysis of 16 randomized, double-blind/open-label trials, with ≥ 1 abatacept (intravenous or subcutaneous) arm, and with/without placebo control covered cumulative (controlled short-term and open-label long-term) abatacept exposure periods. OIs were analyzed separately in controlled (abatacept and placebo individually) and cumulative periods. OIs were identified using a prespecified list; events were independently adjudicated. Unadjusted incidence rates (IRs; per 100 patient-years) with 95% confidence intervals (CIs) were calculated. RESULTS In cumulative periods, 7044 patients received abatacept, with a mean (standard deviation) duration of exposure of 36.9 (26.2) months (21,274 patient-years of exposure). IRs (95% CIs) of OIs were 0.17 (0.05-0.43) for abatacept and 0.56 (0.22-1.15) for placebo during the controlled periods and 0.21 (0.15-0.28) for abatacept during the cumulative periods. There was 1 case of tuberculosis in both the abatacept (IR [95% CI] 0.04 [0.00-0.24]) and placebo (IR [95% CI] 0.08 [0.00-0.44]) groups during the controlled periods; 13 verified tuberculosis cases (IR [95% CI] 0.06 [0.03-0.10]) were reported in the cumulative period. Herpes zoster was reported numerically more often with abatacept (IR 1.9 [1.4-2.5]), versus placebo (1.7 [1.1-2.6]) in the controlled periods; within the cumulative period, herpes zoster IR (95% CI) was 1.53 (1.36-1.71) for abatacept-treated patients. CONCLUSION In controlled periods of the clinical trials, abatacept-treated patients had similarly low rates of OIs compared with placebo-treated patients. Overall, OI rates were similar among abatacept-treated patients in the controlled and cumulative periods and consistent with the ranges reported in the literature.
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Affiliation(s)
- Teresa A Simon
- Bristol Myers Squibb, Princeton, NJ, 08543, USA. .,Current affiliation: Physicians Research Center, LLC, Toms River, NJ, 08753, USA.
| | - Lixian Dong
- Bristol Myers Squibb, Princeton, NJ, 08543, USA
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Novel human immunomodulatory T cell receptors and their double-edged potential in autoimmunity, cardiovascular disease and cancer. Cell Mol Immunol 2020; 18:919-935. [PMID: 33235388 DOI: 10.1038/s41423-020-00586-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 10/28/2020] [Indexed: 12/15/2022] Open
Abstract
In the last decade, approaches based on T cells and their immunomodulatory receptors have emerged as a solid improvement in treatments for various types of cancer. However, the roles of these molecules in the therapeutic context of autoimmune and cardiovascular diseases are still relatively unexplored. Here, we review the best known and most commonly used immunomodulatory T cell receptors in clinical practice (PD-1 and CTLA-4), along with the rest of the receptors with known functions in animal models, which have great potential as modulators in human pathologies in the medium term. Among these other receptors is the receptor CD69, which has recently been described to be expressed in mouse and human T cells in autoimmune and cardiovascular diseases and cancer. However, inhibition of these receptors individually or in combination by drugs or monoclonal antibodies generates a loss of immunological tolerance and can trigger multiple autoimmune disorders in different organs and immune-related adverse effects. In the coming decades, knowledge on the functions of different immunomodulatory receptors will be pivotal for the development of new and better therapies with less harmful side effects. In this review, we discuss the roles of these receptors in the control of immunity from a perspective focused on therapeutic potential in not only cancer but also autoimmune diseases, such as systemic lupus erythematosus, autoimmune diabetes and rheumatoid arthritis, and cardiovascular diseases, such as atherosclerosis, acute myocardial infarction, and myocarditis.
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7
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Youssef SR, Elsalakawy WA. First report of expansion of CD4 +/CD28 null T-helper lymphocytes in adult patients with idiopathic autoimmune hemolytic anemia. Hematol Transfus Cell Ther 2020; 43:396-401. [PMID: 32709527 PMCID: PMC8572999 DOI: 10.1016/j.htct.2020.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 04/27/2020] [Indexed: 01/09/2023] Open
Abstract
CD28 null T helper (Th) cells are rare in healthy individuals, but they are increased in various inflammatory and immune-mediated diseases. In this study, we determined the size of the CD4+/CD28 null T lymphocyte compartment in the peripheral blood of 40 autoimmune hemolytic anemia (AIHA) patients (idiopathic and secondary) and 20 healthy control subjects, using tri-color flow cytometry. The frequency and absolute count of CD4+/CD28 null T helper (Th) cells was significantly higher in idiopathic AIHA patients, compared to healthy controls (p = 0.001 and 0.001, respectively) and to patients with secondary AIHA (p = 0.04 and 0.01, respectively). The percentage of CD4+/CD28 null Th cells was also negatively correlated to the hemoglobin (Hb) level (p = 0.03). These findings demonstrate, for the first time, the expansion of this phenotypically-defined population of T lymphocytes in patients with idiopathic AIHA and indicate that it likely plays an etiological role in the development of this disease. However, establishing the use of this marker for diagnosis or monitoring treatment of such patients needs further studies.
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Affiliation(s)
- Soha R Youssef
- Departments of Clinical Pathology, faculty of medicine, Ain Shams University, Cairo; Egypt
| | - Walaa A Elsalakawy
- Internal Medicine department, Clinical Hematology and BMT unit (2), faculty of medicine, Ain Shams University, Cairo; Egypt.
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Abstract
In recent years tremendous progress has been made in the therapeutic management of rheumatoid arthritis. Rheumatologists now have a large armamentarium of highly efficient drugs with different mechanisms of action at their disposal. These new drugs consist of biologicals (biological disease-modifying antirheumatic drugs, bDMARDs) as well as targeted synthetic DMARDs (tsDMARD). A common feature of these new drugs for treatment of rheumatoid arthritis is that the molecular target of the drug is known, which is not the case for conventional DMARDs. With the help of the new drugs, the therapeutic goal of inducing remission in patients with rheumatoid arthritis has become reality for many patients. Nevertheless, there is still a significant proportion of patients who do not adequately respond to all available drugs, leaving room for still further improvement. This review gives a short overview on the currently available and effective substances for the treatment of rheumatoid arthritis.
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Affiliation(s)
- Stephan Blüml
- Klinik für Innere Medizin III/Abteilung für Rheumatologie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
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9
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Abstract
INTRODUCTION Rheumatoid arthritis (RA) is a complex disease in which different mechanisms are involved. Studies suggest a key role for aberrant pathways of T-cell activation in the initiation and perpetuation of disease. Abatacept is a fusion protein composed of the Fc region of the immunoglobulin G1 (IgG1) fused to the extracellular domain of cytotoxic T lymphocyte-associated antigen (CTLA4). It has the ability to modulate T-cell activation by interfering with co-stimulation of these cells, a necessary step to become activated. This suggests that abatacept may play a role in the progression and/or even the initiation of RA. Areas covered: a review of the different studies carried out during clinical development of abatacept was performed. Both formulations, intravenous (IV) and subcutaneous (SC), showed a similar and consistent efficacy and safety profile. Abatacept was effective both in RA patients not responding to methotrexate (MTX) and to tumor necrosis factor (TNF) inhibitors. Expert commentary: abatacept, with its unique mechanism of action, proved to be a useful therapeutic alternative in RA, also having an acceptable safety profile. Evidence points out that abatacept may be able to alter the RA disease course. Ongoing studies will clarify this issue.
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Affiliation(s)
- Manuel Pombo-Suarez
- a Rheumatology Service , Hospital Clinico Universitario , Santiago de Compostela , Spain
| | - Juan J Gomez-Reino
- b Fundacion Ramon Dominguez, Hospital Clinico Universitario , Santiago de Compostela , Spain
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Murray E, Ellis A, Butylkova Y, Skup M, Kalabic J, Garg V. Systematic review and network meta-analysis: effect of biologics on radiographic progression in rheumatoid arthritis. J Comp Eff Res 2018; 7:959-974. [PMID: 30129776 DOI: 10.2217/cer-2017-0106] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM To evaluate the comparative effectiveness of biologics in inhibiting radiographic progression among rheumatoid arthritis (RA) patients. MATERIALS & METHODS Bayesian network meta-analysis of published trials investigating the USA FDA approved biologics treatment in RA patients, using methotrexate (MTX) as the reference comparator. RESULTS Nine trials met the inclusion criteria for base case analysis. Compared with MTX, most biologics (except golimumab) + MTX had significantly lower rates of radiographic progression at 1 year. Mean difference in radiographic progression rates between MTX monotherapy and biologics + MTX was highest for adalimumab + MTX (-3.8) and lowest for tocilizumab + MTX (-0.7). Inhibition of radiographic progression was sustained. CONCLUSION Biologics inhibit radiographic progression in patients with RA at 1 year; however, published evidence beyond 1 year is limited.
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Affiliation(s)
- Erin Murray
- Doctor Evidence, Santa Monica, CA, 90401, USA
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11
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Ishikawa K, Ishikawa J. Iguratimod, a synthetic disease modifying anti-rheumatic drug inhibiting the activation of NF-κB and production of RANKL: Its efficacy, radiographic changes, safety and predictors over two years’ treatment for Japanese rheumatoid arthritis patients. Mod Rheumatol 2018; 29:418-429. [DOI: 10.1080/14397595.2018.1481565] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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12
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Zizzo G, Gremese E, Ferraccioli G. Abatacept in the treatment of psoriatic arthritis: biological and clinical profiles of the responders. Immunotherapy 2018; 10:807-821. [PMID: 29737909 DOI: 10.2217/imt-2018-0014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Abatacept (CTLA4Ig), a selective T-cell costimulation modulator, has been approved for the treatment of psoriatic arthritis patients with an inadequate response to conventional synthetic disease-modifying antirheumatic drugs, but not for those with uncontrolled skin lesions, nor with axial involvement. In this review, we will try to interpret such a differential efficacy of abatacept on the psoriatic arthritis clinical domains, on the basis of its differential effectiveness on the diverse T-cell subsets at different sites. Clinical and biological profiles of possible responders to abatacept will be provided.
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Affiliation(s)
- Gaetano Zizzo
- Institute of Rheumatology & Affine Sciences, Fondazione Policlinico Universitario Agostino Gemelli - Catholic University of the Sacred Heart, via Giuseppe Moscati 31, Rome 00168, Italy.,Rheumatology Clinic, Medical Department, ASST Monza, via Giuseppe Mazzini 1, Desio 20832, Italy
| | - Elisa Gremese
- Institute of Rheumatology & Affine Sciences, Fondazione Policlinico Universitario Agostino Gemelli - Catholic University of the Sacred Heart, via Giuseppe Moscati 31, Rome 00168, Italy
| | - Gianfranco Ferraccioli
- Institute of Rheumatology & Affine Sciences, Fondazione Policlinico Universitario Agostino Gemelli - Catholic University of the Sacred Heart, via Giuseppe Moscati 31, Rome 00168, Italy
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13
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Louthrenoo W, Kasitanon N, Katchamart W, Aiewruengsurat D, Chevaisrakul P, Chiowchanwisawakit P, Dechanuwong P, Hanvivadhanakul P, Mahakkanukrauh A, Manavathongchai S, Muangchan C, Narongroeknawin P, Phumethum V, Siripaitoon B, Suesuwan A, Suwannaroj S, Uea-Areewongsa P, Ukritchon S, Asavatanabodee P, Koolvisoot A, Nanagara R, Totemchokchyakarn K, Nuntirooj K, Kitumnuaypong T. 2016 updated Thai Rheumatism Association Recommendations for the use of biologic and targeted synthetic disease-modifying anti-rheumatic drugs in patients with rheumatoid arthritis. Int J Rheum Dis 2017; 20:1166-1184. [DOI: 10.1111/1756-185x.13130] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Worawit Louthrenoo
- Division of Rheumatology; Department of Internal Medicine; Faculty of Medicine; Chiang Mai University; Chiang Mai Thailand
| | - Nuntana Kasitanon
- Division of Rheumatology; Department of Internal Medicine; Faculty of Medicine; Chiang Mai University; Chiang Mai Thailand
| | - Wanruchada Katchamart
- Division of Rheumatology; Department of Medicine; Faculty of Medicine; Siriraj Hospital, Mahidol University; Bangkok Thailand
| | - Duangkamol Aiewruengsurat
- Division of Rheumatology; Department of Internal Medicine; Faculty of Medicine; Prince of Songkla University; Songkla Thailand
| | - Parawee Chevaisrakul
- Division of Allergy Immunology and Rheumatology; Department of Internal Medicine; Faculty of Medicine; Ramathibodi Hospital, Mahidol University; Bangkok Thailand
| | - Praveena Chiowchanwisawakit
- Division of Rheumatology; Department of Medicine; Faculty of Medicine; Siriraj Hospital, Mahidol University; Bangkok Thailand
| | - Pornchai Dechanuwong
- Department of Internal Medicine; Faculty of Medicine; Vajira Hospital, Navamindradhiraj University; Bangkok Thailand
| | - Punchong Hanvivadhanakul
- Division of Rheumatology; Department of Internal Medicine; Faculty of Medicine; Thammasat University; Pathum Thani Thailand
| | - Ajanee Mahakkanukrauh
- Division of Allergy Immunology and Rheumatology; Department of Medicine, Faculty of Medicine; Khon Kaen University; Khon Kaen Thailand
| | - Siriporn Manavathongchai
- Department of Internal Medicine; Faculty of Medicine; Vajira Hospital, Navamindradhiraj University; Bangkok Thailand
| | - Chayawee Muangchan
- Division of Rheumatology; Department of Medicine; Faculty of Medicine; Siriraj Hospital, Mahidol University; Bangkok Thailand
| | - Pongthorn Narongroeknawin
- Division of Rheumatology, Department of Internal Medicine; Phramongkutklao Hospital and College of Medicine; Bangkok Thailand
| | - Veerapong Phumethum
- Division of Rheumatology, Department of Internal Medicine; Pha Pok Klao Hospital; Chanthaburi Thailand
| | - Boonjing Siripaitoon
- Division of Rheumatology; Department of Internal Medicine; Faculty of Medicine; Prince of Songkla University; Songkla Thailand
| | | | - Siraphop Suwannaroj
- Division of Allergy Immunology and Rheumatology; Department of Medicine, Faculty of Medicine; Khon Kaen University; Khon Kaen Thailand
| | - Parichat Uea-Areewongsa
- Division of Rheumatology; Department of Internal Medicine; Faculty of Medicine; Prince of Songkla University; Songkla Thailand
| | - Sittichai Ukritchon
- Division of Rheumatology, Department of Medicine; Faculty of Medicine; Chulalongkorn University; Bangkok Thailand
| | - Paijit Asavatanabodee
- Rheumatic Disease Unit; Department of Medicine; Phramongkutklao Hospital; Bangkok Thailand
| | - Ajchara Koolvisoot
- Division of Rheumatology; Department of Medicine; Faculty of Medicine; Siriraj Hospital, Mahidol University; Bangkok Thailand
| | - Ratanavadee Nanagara
- Division of Allergy Immunology and Rheumatology; Department of Medicine, Faculty of Medicine; Khon Kaen University; Khon Kaen Thailand
| | - Kitti Totemchokchyakarn
- Division of Allergy Immunology and Rheumatology; Department of Internal Medicine; Faculty of Medicine; Ramathibodi Hospital, Mahidol University; Bangkok Thailand
| | - Kanokrut Nuntirooj
- Division of Allergy Immunology and Rheumatology; Department of Internal Medicine; Faculty of Medicine; Ramathibodi Hospital, Mahidol University; Bangkok Thailand
| | - Tasanee Kitumnuaypong
- Rheumatology Unit; Department of Medicine; Rajavithi Hospital, Ministry of Public Health; Bangkok Thailand
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Crepeau RL, Ford ML. Challenges and opportunities in targeting the CD28/CTLA-4 pathway in transplantation and autoimmunity. Expert Opin Biol Ther 2017; 17:1001-1012. [PMID: 28525959 DOI: 10.1080/14712598.2017.1333595] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION T cell activation is a complex process that requires multiple cell signaling pathways, including a primary recognition signal and additional costimulatory signals. One of the best-characterized costimulatory pathways includes the Ig superfamily members CD28 and CTLA-4 and their ligands CD80 and CD86. Areas covered: This review discusses past, current and future biological therapies that have been utilized to block the CD28/CTLA-4 cosignaling pathway in the settings of autoimmunity and transplantation, as well the challenges facing successful implementation of these therapies. Expert opinion: The development of CD28 blockers Abatacept and Belatacept provided a more targeted therapy approach for transplant rejection and autoimmune disease relative to calcineurin inhibitors and anti-proliferatives, but overall efficacy may be limited due to their collateral effect of simultaneously blocking CTLA-4 coinhibitory signals. As such, current investigations into the potential of selective CD28 blockade to block the costimulatory potential of CD28 while exploiting the coinhibitory effects of CTLA-4 are promising. However, as selective CD28 blockade inhibits the activity of both effector and regulatory T cells, an important goal for the future is the design of therapies that will maximize the attenuation of effector responses while preserving the suppressive function of T regulatory cells.
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Affiliation(s)
- Rebecca L Crepeau
- a Emory Transplant Center and Department of Surgery , Emory University , Atlanta , GA , USA
| | - Mandy L Ford
- a Emory Transplant Center and Department of Surgery , Emory University , Atlanta , GA , USA
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15
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Tamai M, Arima K, Nakashima Y, Kita J, Umeda M, Fukui S, Nishino A, Suzuki T, Horai Y, Okada A, Koga T, Kawashiri SY, Iwamoto N, Ichinose K, Yamasaki S, Nakamura H, Origuchi T, Aoyagi K, Uetani M, Eguchi K, Kawakami A. Baseline MRI bone erosion predicts the subsequent radiographic progression in early rheumatoid arthritis patients who achieved sustained good clinical response. Mod Rheumatol 2017; 27:961-966. [PMID: 28269999 DOI: 10.1080/14397595.2017.1294280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To examine whether magnetic resonance imaging (MRI) findings at baseline predict radiographic progression in early-stage rheumatoid arthritis (RA) patients who have achieved sustained good clinical response. METHODS This is a sub-analysis from the one-year observational study of Nagasaki University Early Arthritis Cohort. Definition of 'good clinical response' was a decrement of disease activity score (DAS) 28 ≧ 1.2 at three months with achievement of DAS28 remission through 6-12 months. Gd-enhanced MRI of both wrists and finger joints were examined at baseline and scored using rheumatoid arthritis magnetic resonance imaging score (RAMRIS). Annual increment of Genant-modified Sharp score (GSS) > 0 was defined as 'radiographic progression'. Predictors of radiographic progression were determined by logistic regression analysis. RESULTS Twenty-four subjects were selected in the present study. Each median RAMRIS synovitis, bone edema, bone erosion, and GSS at baseline were 6.5, 0.5, 0, and 0, respectively. Five patients developed radiographic progression at one year. Multivariate logistic regression analysis has shown that RAMRIS bone erosion at baseline is the only independent predictor of radiographic progression at one year (p = .032). CONCLUSIONS Our data suggest that MRI bone erosion predicts poor radiographic outcome of early-stage RA even if it has been successfully treated.
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Affiliation(s)
- Mami Tamai
- a Department of Immunology and Rheumatology , Unit of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Kazuhiko Arima
- b Department of Public Health , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Yoshikazu Nakashima
- a Department of Immunology and Rheumatology , Unit of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Junko Kita
- a Department of Immunology and Rheumatology , Unit of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Masataka Umeda
- a Department of Immunology and Rheumatology , Unit of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Shoichi Fukui
- a Department of Immunology and Rheumatology , Unit of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Ayako Nishino
- a Department of Immunology and Rheumatology , Unit of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Takahisa Suzuki
- a Department of Immunology and Rheumatology , Unit of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan.,b Department of Public Health , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Yoshiro Horai
- a Department of Immunology and Rheumatology , Unit of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Akitomo Okada
- a Department of Immunology and Rheumatology , Unit of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan.,c Department of Rheumatology , Japanese Red Cross Nagasaki Genbaku Hospital , Nagasaki , Japan
| | - Tomohiro Koga
- a Department of Immunology and Rheumatology , Unit of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Shin-Ya Kawashiri
- a Department of Immunology and Rheumatology , Unit of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan.,d Department of Community Medicine , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Naoki Iwamoto
- a Department of Immunology and Rheumatology , Unit of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Kunihiro Ichinose
- a Department of Immunology and Rheumatology , Unit of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Satoshi Yamasaki
- e Division of Rheumatology , Kurume University Medical Center , Kurume , Japan
| | - Hideki Nakamura
- a Department of Immunology and Rheumatology , Unit of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Tomoki Origuchi
- a Department of Immunology and Rheumatology , Unit of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan.,f Department of Locomotive and Rehabilitation Sciences , Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University , Nagasaki , Japan
| | - Kiyoshi Aoyagi
- b Department of Public Health , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Masataka Uetani
- g Department of Radiological Sciences , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Katsumi Eguchi
- a Department of Immunology and Rheumatology , Unit of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan.,h Department of Rheumatology , Sasebo Chuo Hospital , Sasebo , Japan
| | - Atsushi Kawakami
- a Department of Immunology and Rheumatology , Unit of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
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Costimulation pathway blockade in kidney transplant recipients with de-novo rheumatoid arthritis. Clin Nephrol Case Stud 2017; 5:16-19. [PMID: 29043142 PMCID: PMC5438010 DOI: 10.5414/cncs108875] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 05/27/2016] [Indexed: 12/30/2022] Open
Abstract
The best approach to treatment of de-novo rheumatoid arthritis in solid organ transplant recipients on typical immunosuppression is not well established. The use of biologics targeting specific cell types, cytokines, and immunological pathways has been gaining interest in the treatment of both, auto- and alloimmunity. We present a case of de-novo rheumatoid arthritis in a kidney transplant recipient 10 years post-transplant while receiving cyclosporine, mycophenolate mofetil, and also prednisone. Initial presentation included features of polymyalgia rheumatica and nephrotic range proteinuria. Kidney biopsy showed membranous nephropathy. The patient was initially treated with methotrexate, while mycophenolate mofetil was discontinued. Clinical symptoms improved, but creatinine significantly increased, which led to discontinuation of methotrexate and mycophenolate mofetil was restarted. The kidney function improved, but the patient experienced a flare of rheumatoid arthritis. Costimulatory blocker, abatacept, was initiated and cyclosporine was gradually tapered off. Graft function remained stable for a follow-up period of 7 years. Joint pain, weakness, and stiffness resolved. Follow-up plain film radiographs at 5 years post initial presentation showed no new joint erosions in hands or feet. Costimulatory blockers may broaden the therapeutic choices of transplant recipients with de-novo autoimmune diseases.
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17
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Ali AH, Tabibian JH, Carey EJ, Lindor KD. Emerging drugs for the treatment of Primary Biliary Cholangitis. Expert Opin Emerg Drugs 2016; 21:39-56. [PMID: 26901615 DOI: 10.1517/14728214.2016.1150999] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Primary biliary cholangitis (PBC) is an autoimmune chronic disease of the liver that can progress to cirrhosis and hepatocellular carcinoma. It affects approximately 1 in 4,000 with a 10:1 female to male ratio. The diagnosis of PBC can be made based on serum antimitochondrial antibodies (AMA) in a patient with abnormally high serum alkaline phosphatase after ruling out other causes of cholestasis and biliary obstruction. Genome-wide association studies have revealed several human leukocyte antigen (HLA) and non-HLA risk loci in PBC, and complex environmental-host immunogenetic interactions are believed to underlie the etiopathogenesis of the disease. Fatigue and pruritus are the most common and often problematic symptoms; although often mild, these can be severe and life-alternating in a subset of patients. Ursodeoxycholic acid (UDCA) is the only drug approved by the United States Food and Drug Administration for the treatment of PBC. Clinical trials have shown that UDCA significantly improves transplant-free survival. However, nearly 40% of PBC patients do not respond adequately to PBC and are at higher risk for serious complications when compared to PBC patients with complete response to UDCA. AREAS COVERED Here we provide a detailed discussion regarding novel therapeutic agents and potential areas for further investigation in PBC-related research. EXPERT OPINION Results of ongoing clinical trials and emerging treatment paradigms for PBC will likely further improve medical management of this disorder in the near future.
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Birolo C, Zannin ME, Arsenyeva S, Cimaz R, Miserocchi E, Dubko M, Deslandre CJ, Falcini F, Alessio M, La Torre F, Denisova E, Martini G, Nikishina I, Zulian F. Comparable Efficacy of Abatacept Used as First-line or Second-line Biological Agent for Severe Juvenile Idiopathic Arthritis-related Uveitis. J Rheumatol 2016; 43:2068-2073. [DOI: 10.3899/jrheum.151389] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2016] [Indexed: 11/22/2022]
Abstract
Objective.Abatacept (ABA) has recently been proposed as second-line treatment in patients with juvenile idiopathic arthritis (JIA)–associated uveitis refractory to anti–tumor necrosis factor-α (anti-TNF) agents, but little is known about its efficacy as a first-line approach. The aim of the present study was to compare the safety and efficacy of ABA as a first-line biological agent (ABA-1) with that of ABA as a second-line treatment after 1 or more anti-TNF agents (ABA-2), in patients with severe JIA-related uveitis.Methods.In this multicenter study, we collected data on patients with severe JIA-related uveitis treated with ABA as a first-line or second-line biological agent. Changes in frequency of uveitis flares/year and ocular complications before and after ABA treatment, clinical remission, and side effects were recorded.Results.Thirty-five patients with a mean age of 10.8 years were treated with ABA for a mean period of 19.6 months. In 4 patients, ABA administration was discontinued, owing to inefficacy on arthritis in 3 cases and allergic reaction in 1. Thirty-one patients, 14 in the ABA-1 group and 17 in the ABA-2 group, completed the 12-month followup period; of these, 17 (54.8%) had clinical remission. The mean frequency of uveitis flares decreased from 4.1 to 1.2 in the ABA-1 group (p = 0.002) and from 3.7 to 1.2 in the ABA-2 group (p = 0.004). Preexisting ocular complications improved or remained stable in all but 5 patients, all in the ABA-2 group. No significant difference was found between the efficacy of the 2 treatment modalities. ABA confirmed its good safety profile.Conclusion.ABA, used as first-line biological treatment or after 1 or more anti-TNF agents, induces a comparable improvement in severe refractory JIA-related uveitis.
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Alves CH, Farrell E, Vis M, Colin EM, Lubberts E. Animal Models of Bone Loss in Inflammatory Arthritis: from Cytokines in the Bench to Novel Treatments for Bone Loss in the Bedside-a Comprehensive Review. Clin Rev Allergy Immunol 2016; 51:27-47. [PMID: 26634933 PMCID: PMC4961736 DOI: 10.1007/s12016-015-8522-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Throughout life, bone is continuously remodelled. Bone is formed by osteoblasts, from mesenchymal origin, while osteoclasts induce bone resorption. This process is tightly regulated. During inflammation, several growth factors and cytokines are increased inducing osteoclast differentiation and activation, and chronic inflammation is a condition that initiates systemic bone loss. Rheumatoid arthritis (RA) is a chronic inflammatory auto-immune disease that is characterised by active synovitis and is associated with early peri-articular bone loss. Peri-articular bone loss precedes focal bone erosions, which may progress to bone destruction and disability. The incidence of generalised osteoporosis is associated with the severity of arthritis in RA and increased osteoporotic vertebral and hip fracture risk. In this review, we will give an overview of different animal models of inflammatory arthritis related to RA with focus on bone erosion and involvement of pro-inflammatory cytokines. In addition, a humanised endochondral ossification model will be discussed, which can be used in a translational approach to answer osteoimmunological questions.
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Affiliation(s)
- C Henrique Alves
- Department of Rheumatology, Erasmus MC, University Medical Center, Wytemaweg 80, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Eric Farrell
- Department of Oral and Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus MC, University Medical Center, Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Marijn Vis
- Department of Rheumatology, Erasmus MC, University Medical Center, Wytemaweg 80, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Edgar M Colin
- Department of Rheumatology, Erasmus MC, University Medical Center, Wytemaweg 80, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Rheumatology, ZGT Almelo, Zilvermeeuw 1, 7600 SZ, Almelo, The Netherlands
| | - Erik Lubberts
- Department of Rheumatology, Erasmus MC, University Medical Center, Wytemaweg 80, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
- Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
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Abstract
The treatment of rheumatoid arthritis (RA) has changed dramatically over the past two decades. The combination of better insights into the pathophysiological and immunological mechanisms of RA and the possibilities offered by biotechnology led to the development and introduction into clinical practice of a new class of antirheumatic biologic therapies, which along with earlier and more aggressive treatment contributed to dramatically better outcomes for patients with RA. To date, nine biologic agents have been approved for the treatment for RA, and a first Janus kinase (JAK) inhibitor has also been approved in the United States and various other countries in the world (but not by the European Medicines Agency [EMA]). Many additional molecules with distinct mechanisms of action are currently being tested in laboratories and in clinical trials. In addition, considerable improvements have been made in the optimal use of all these agents through treatment strategies such as treating-to-target, induction-maintenance, and dose individualization.
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Affiliation(s)
- Ronald F van Vollenhoven
- Department of Medicine, Karolinska Institute, Unit for Clinical Research Therapy, Inflammatory Diseases (ClinTrid), D1:00, Karolinska Universitetssjukhustet 171 76, Stockholm, Sweden.
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21
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Nakashima Y, Tamai M, Kita J, Michitsuji T, Shimizu T, Fukui S, Umeda M, Nishino A, Suzuki T, Horai Y, Okada A, Nishimura T, Koga T, Kawashiri SY, Iwamoto N, Ichinose K, Hirai Y, Arima K, Yamasaki S, Nakamura H, Origuchi T, Takao S, Uetani M, Aoyagi K, Eguchi K, Kawakami A. Magnetic Resonance Imaging Bone Edema at Enrollment Predicts Rapid Radiographic Progression in Patients with Early RA: Results from the Nagasaki University Early Arthritis Cohort. J Rheumatol 2016; 43:1278-84. [PMID: 27134251 DOI: 10.3899/jrheum.150988] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To clarify whether magnetic resonance imaging (MRI) bone edema predicts the development of rapid radiographic progression (RRP) in the Nagasaki University Early Arthritis Cohort of patients with early-stage rheumatoid arthritis (RA). METHODS Patients with early-stage RA (n = 76) were enrolled and underwent 1.5-T MRI of both wrists and finger joints. Synovitis, bone edema, and bone erosion were evaluated using the Rheumatoid Arthritis Magnetic Resonance Imaging Scoring (RAMRIS). RRP was defined as an annual increment > 3 at 1 year by the Genant-modified Sharp score of plain radiographs. A multivariate logistic regression analysis was performed to establish the risk factors for RRP. RESULTS Median disease duration at enrollment was 3 months. RRP was found in 12 of the 76 patients at 1 year. A univariate analysis revealed that matrix metalloprotease-3, RAMRIS bone edema score, and RAMRIS bone erosion score were associated with RRP. Multivariate logistic regression analyses demonstrated that the RAMRIS bone edema score at enrollment (5-point increase, OR 2.18, 95% CI 1.32-3.59, p = 0.002) was the only independent predictor of the development of RRP at 1 year. A receiver-operating characteristic analysis identified the best cutoff value for RAMRIS bone edema score as 5. RRP was significantly rare among the patients with a RAMRIS bone edema score < 5 at enrollment (2 from 50 patients). CONCLUSION Our findings suggest that MRI bone edema is closely associated with the development of RRP in patients with early-stage RA. Physicians should carefully control the disease activity when MRI bone edema is observed in patients with early RA.
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Affiliation(s)
- Yoshikazu Nakashima
- From the Department of Immunology and Rheumatology, and Department of Public Health, and Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences; Japanese Red Cross Nagasaki Genbaku Hospital; Department of Radiology and Radiation Research, Nagasaki University Hospital, Nagasaki; Department of Clinical Immunology and Rheumatology, Hiroshima University, Hiroshima; Department of Radiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima; Sasebo Chuo Hospital, Sasebo, Japan.Y. Nakashima, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Tamai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; J. Kita, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Michitsuji, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Shimizu, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Fukui, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Umeda, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Nishino, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Suzuki, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; Y. Horai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Okada, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; T. Nishimura, PhD, Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences; T. Koga, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Kawashiri, MD
| | - Mami Tamai
- From the Department of Immunology and Rheumatology, and Department of Public Health, and Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences; Japanese Red Cross Nagasaki Genbaku Hospital; Department of Radiology and Radiation Research, Nagasaki University Hospital, Nagasaki; Department of Clinical Immunology and Rheumatology, Hiroshima University, Hiroshima; Department of Radiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima; Sasebo Chuo Hospital, Sasebo, Japan.Y. Nakashima, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Tamai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; J. Kita, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Michitsuji, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Shimizu, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Fukui, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Umeda, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Nishino, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Suzuki, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; Y. Horai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Okada, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; T. Nishimura, PhD, Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences; T. Koga, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Kawashiri, MD
| | - Junko Kita
- From the Department of Immunology and Rheumatology, and Department of Public Health, and Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences; Japanese Red Cross Nagasaki Genbaku Hospital; Department of Radiology and Radiation Research, Nagasaki University Hospital, Nagasaki; Department of Clinical Immunology and Rheumatology, Hiroshima University, Hiroshima; Department of Radiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima; Sasebo Chuo Hospital, Sasebo, Japan.Y. Nakashima, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Tamai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; J. Kita, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Michitsuji, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Shimizu, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Fukui, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Umeda, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Nishino, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Suzuki, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; Y. Horai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Okada, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; T. Nishimura, PhD, Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences; T. Koga, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Kawashiri, MD
| | - Toru Michitsuji
- From the Department of Immunology and Rheumatology, and Department of Public Health, and Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences; Japanese Red Cross Nagasaki Genbaku Hospital; Department of Radiology and Radiation Research, Nagasaki University Hospital, Nagasaki; Department of Clinical Immunology and Rheumatology, Hiroshima University, Hiroshima; Department of Radiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima; Sasebo Chuo Hospital, Sasebo, Japan.Y. Nakashima, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Tamai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; J. Kita, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Michitsuji, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Shimizu, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Fukui, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Umeda, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Nishino, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Suzuki, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; Y. Horai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Okada, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; T. Nishimura, PhD, Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences; T. Koga, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Kawashiri, MD
| | - Toshimasa Shimizu
- From the Department of Immunology and Rheumatology, and Department of Public Health, and Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences; Japanese Red Cross Nagasaki Genbaku Hospital; Department of Radiology and Radiation Research, Nagasaki University Hospital, Nagasaki; Department of Clinical Immunology and Rheumatology, Hiroshima University, Hiroshima; Department of Radiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima; Sasebo Chuo Hospital, Sasebo, Japan.Y. Nakashima, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Tamai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; J. Kita, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Michitsuji, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Shimizu, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Fukui, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Umeda, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Nishino, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Suzuki, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; Y. Horai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Okada, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; T. Nishimura, PhD, Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences; T. Koga, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Kawashiri, MD
| | - Shoichi Fukui
- From the Department of Immunology and Rheumatology, and Department of Public Health, and Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences; Japanese Red Cross Nagasaki Genbaku Hospital; Department of Radiology and Radiation Research, Nagasaki University Hospital, Nagasaki; Department of Clinical Immunology and Rheumatology, Hiroshima University, Hiroshima; Department of Radiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima; Sasebo Chuo Hospital, Sasebo, Japan.Y. Nakashima, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Tamai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; J. Kita, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Michitsuji, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Shimizu, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Fukui, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Umeda, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Nishino, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Suzuki, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; Y. Horai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Okada, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; T. Nishimura, PhD, Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences; T. Koga, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Kawashiri, MD
| | - Masataka Umeda
- From the Department of Immunology and Rheumatology, and Department of Public Health, and Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences; Japanese Red Cross Nagasaki Genbaku Hospital; Department of Radiology and Radiation Research, Nagasaki University Hospital, Nagasaki; Department of Clinical Immunology and Rheumatology, Hiroshima University, Hiroshima; Department of Radiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima; Sasebo Chuo Hospital, Sasebo, Japan.Y. Nakashima, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Tamai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; J. Kita, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Michitsuji, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Shimizu, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Fukui, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Umeda, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Nishino, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Suzuki, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; Y. Horai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Okada, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; T. Nishimura, PhD, Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences; T. Koga, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Kawashiri, MD
| | - Ayako Nishino
- From the Department of Immunology and Rheumatology, and Department of Public Health, and Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences; Japanese Red Cross Nagasaki Genbaku Hospital; Department of Radiology and Radiation Research, Nagasaki University Hospital, Nagasaki; Department of Clinical Immunology and Rheumatology, Hiroshima University, Hiroshima; Department of Radiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima; Sasebo Chuo Hospital, Sasebo, Japan.Y. Nakashima, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Tamai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; J. Kita, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Michitsuji, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Shimizu, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Fukui, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Umeda, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Nishino, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Suzuki, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; Y. Horai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Okada, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; T. Nishimura, PhD, Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences; T. Koga, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Kawashiri, MD
| | - Takahisa Suzuki
- From the Department of Immunology and Rheumatology, and Department of Public Health, and Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences; Japanese Red Cross Nagasaki Genbaku Hospital; Department of Radiology and Radiation Research, Nagasaki University Hospital, Nagasaki; Department of Clinical Immunology and Rheumatology, Hiroshima University, Hiroshima; Department of Radiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima; Sasebo Chuo Hospital, Sasebo, Japan.Y. Nakashima, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Tamai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; J. Kita, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Michitsuji, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Shimizu, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Fukui, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Umeda, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Nishino, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Suzuki, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; Y. Horai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Okada, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; T. Nishimura, PhD, Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences; T. Koga, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Kawashiri, MD
| | - Yoshiro Horai
- From the Department of Immunology and Rheumatology, and Department of Public Health, and Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences; Japanese Red Cross Nagasaki Genbaku Hospital; Department of Radiology and Radiation Research, Nagasaki University Hospital, Nagasaki; Department of Clinical Immunology and Rheumatology, Hiroshima University, Hiroshima; Department of Radiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima; Sasebo Chuo Hospital, Sasebo, Japan.Y. Nakashima, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Tamai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; J. Kita, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Michitsuji, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Shimizu, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Fukui, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Umeda, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Nishino, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Suzuki, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; Y. Horai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Okada, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; T. Nishimura, PhD, Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences; T. Koga, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Kawashiri, MD
| | - Akitomo Okada
- From the Department of Immunology and Rheumatology, and Department of Public Health, and Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences; Japanese Red Cross Nagasaki Genbaku Hospital; Department of Radiology and Radiation Research, Nagasaki University Hospital, Nagasaki; Department of Clinical Immunology and Rheumatology, Hiroshima University, Hiroshima; Department of Radiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima; Sasebo Chuo Hospital, Sasebo, Japan.Y. Nakashima, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Tamai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; J. Kita, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Michitsuji, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Shimizu, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Fukui, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Umeda, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Nishino, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Suzuki, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; Y. Horai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Okada, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; T. Nishimura, PhD, Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences; T. Koga, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Kawashiri, MD
| | - Takayuki Nishimura
- From the Department of Immunology and Rheumatology, and Department of Public Health, and Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences; Japanese Red Cross Nagasaki Genbaku Hospital; Department of Radiology and Radiation Research, Nagasaki University Hospital, Nagasaki; Department of Clinical Immunology and Rheumatology, Hiroshima University, Hiroshima; Department of Radiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima; Sasebo Chuo Hospital, Sasebo, Japan.Y. Nakashima, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Tamai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; J. Kita, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Michitsuji, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Shimizu, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Fukui, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Umeda, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Nishino, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Suzuki, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; Y. Horai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Okada, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; T. Nishimura, PhD, Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences; T. Koga, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Kawashiri, MD
| | - Tomohiro Koga
- From the Department of Immunology and Rheumatology, and Department of Public Health, and Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences; Japanese Red Cross Nagasaki Genbaku Hospital; Department of Radiology and Radiation Research, Nagasaki University Hospital, Nagasaki; Department of Clinical Immunology and Rheumatology, Hiroshima University, Hiroshima; Department of Radiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima; Sasebo Chuo Hospital, Sasebo, Japan.Y. Nakashima, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Tamai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; J. Kita, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Michitsuji, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Shimizu, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Fukui, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Umeda, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Nishino, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Suzuki, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; Y. Horai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Okada, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; T. Nishimura, PhD, Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences; T. Koga, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Kawashiri, MD
| | - Shin-Ya Kawashiri
- From the Department of Immunology and Rheumatology, and Department of Public Health, and Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences; Japanese Red Cross Nagasaki Genbaku Hospital; Department of Radiology and Radiation Research, Nagasaki University Hospital, Nagasaki; Department of Clinical Immunology and Rheumatology, Hiroshima University, Hiroshima; Department of Radiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima; Sasebo Chuo Hospital, Sasebo, Japan.Y. Nakashima, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Tamai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; J. Kita, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Michitsuji, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Shimizu, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Fukui, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Umeda, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Nishino, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Suzuki, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; Y. Horai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Okada, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; T. Nishimura, PhD, Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences; T. Koga, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Kawashiri, MD
| | - Naoki Iwamoto
- From the Department of Immunology and Rheumatology, and Department of Public Health, and Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences; Japanese Red Cross Nagasaki Genbaku Hospital; Department of Radiology and Radiation Research, Nagasaki University Hospital, Nagasaki; Department of Clinical Immunology and Rheumatology, Hiroshima University, Hiroshima; Department of Radiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima; Sasebo Chuo Hospital, Sasebo, Japan.Y. Nakashima, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Tamai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; J. Kita, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Michitsuji, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Shimizu, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Fukui, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Umeda, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Nishino, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Suzuki, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; Y. Horai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Okada, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; T. Nishimura, PhD, Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences; T. Koga, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Kawashiri, MD
| | - Kunihiro Ichinose
- From the Department of Immunology and Rheumatology, and Department of Public Health, and Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences; Japanese Red Cross Nagasaki Genbaku Hospital; Department of Radiology and Radiation Research, Nagasaki University Hospital, Nagasaki; Department of Clinical Immunology and Rheumatology, Hiroshima University, Hiroshima; Department of Radiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima; Sasebo Chuo Hospital, Sasebo, Japan.Y. Nakashima, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Tamai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; J. Kita, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Michitsuji, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Shimizu, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Fukui, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Umeda, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Nishino, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Suzuki, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; Y. Horai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Okada, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; T. Nishimura, PhD, Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences; T. Koga, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Kawashiri, MD
| | - Yasuko Hirai
- From the Department of Immunology and Rheumatology, and Department of Public Health, and Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences; Japanese Red Cross Nagasaki Genbaku Hospital; Department of Radiology and Radiation Research, Nagasaki University Hospital, Nagasaki; Department of Clinical Immunology and Rheumatology, Hiroshima University, Hiroshima; Department of Radiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima; Sasebo Chuo Hospital, Sasebo, Japan.Y. Nakashima, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Tamai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; J. Kita, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Michitsuji, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Shimizu, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Fukui, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Umeda, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Nishino, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Suzuki, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; Y. Horai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Okada, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; T. Nishimura, PhD, Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences; T. Koga, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Kawashiri, MD
| | - Kazuhiko Arima
- From the Department of Immunology and Rheumatology, and Department of Public Health, and Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences; Japanese Red Cross Nagasaki Genbaku Hospital; Department of Radiology and Radiation Research, Nagasaki University Hospital, Nagasaki; Department of Clinical Immunology and Rheumatology, Hiroshima University, Hiroshima; Department of Radiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima; Sasebo Chuo Hospital, Sasebo, Japan.Y. Nakashima, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Tamai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; J. Kita, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Michitsuji, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Shimizu, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Fukui, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Umeda, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Nishino, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Suzuki, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; Y. Horai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Okada, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; T. Nishimura, PhD, Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences; T. Koga, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Kawashiri, MD
| | - Satoshi Yamasaki
- From the Department of Immunology and Rheumatology, and Department of Public Health, and Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences; Japanese Red Cross Nagasaki Genbaku Hospital; Department of Radiology and Radiation Research, Nagasaki University Hospital, Nagasaki; Department of Clinical Immunology and Rheumatology, Hiroshima University, Hiroshima; Department of Radiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima; Sasebo Chuo Hospital, Sasebo, Japan.Y. Nakashima, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Tamai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; J. Kita, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Michitsuji, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Shimizu, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Fukui, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Umeda, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Nishino, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Suzuki, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; Y. Horai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Okada, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; T. Nishimura, PhD, Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences; T. Koga, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Kawashiri, MD
| | - Hideki Nakamura
- From the Department of Immunology and Rheumatology, and Department of Public Health, and Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences; Japanese Red Cross Nagasaki Genbaku Hospital; Department of Radiology and Radiation Research, Nagasaki University Hospital, Nagasaki; Department of Clinical Immunology and Rheumatology, Hiroshima University, Hiroshima; Department of Radiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima; Sasebo Chuo Hospital, Sasebo, Japan.Y. Nakashima, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Tamai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; J. Kita, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Michitsuji, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Shimizu, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Fukui, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Umeda, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Nishino, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Suzuki, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; Y. Horai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Okada, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; T. Nishimura, PhD, Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences; T. Koga, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Kawashiri, MD
| | - Tomoki Origuchi
- From the Department of Immunology and Rheumatology, and Department of Public Health, and Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences; Japanese Red Cross Nagasaki Genbaku Hospital; Department of Radiology and Radiation Research, Nagasaki University Hospital, Nagasaki; Department of Clinical Immunology and Rheumatology, Hiroshima University, Hiroshima; Department of Radiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima; Sasebo Chuo Hospital, Sasebo, Japan.Y. Nakashima, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Tamai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; J. Kita, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Michitsuji, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Shimizu, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Fukui, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Umeda, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Nishino, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Suzuki, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; Y. Horai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Okada, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; T. Nishimura, PhD, Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences; T. Koga, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Kawashiri, MD
| | - Shoichiro Takao
- From the Department of Immunology and Rheumatology, and Department of Public Health, and Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences; Japanese Red Cross Nagasaki Genbaku Hospital; Department of Radiology and Radiation Research, Nagasaki University Hospital, Nagasaki; Department of Clinical Immunology and Rheumatology, Hiroshima University, Hiroshima; Department of Radiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima; Sasebo Chuo Hospital, Sasebo, Japan.Y. Nakashima, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Tamai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; J. Kita, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Michitsuji, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Shimizu, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Fukui, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Umeda, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Nishino, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Suzuki, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; Y. Horai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Okada, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; T. Nishimura, PhD, Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences; T. Koga, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Kawashiri, MD
| | - Masataka Uetani
- From the Department of Immunology and Rheumatology, and Department of Public Health, and Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences; Japanese Red Cross Nagasaki Genbaku Hospital; Department of Radiology and Radiation Research, Nagasaki University Hospital, Nagasaki; Department of Clinical Immunology and Rheumatology, Hiroshima University, Hiroshima; Department of Radiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima; Sasebo Chuo Hospital, Sasebo, Japan.Y. Nakashima, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Tamai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; J. Kita, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Michitsuji, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Shimizu, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Fukui, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Umeda, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Nishino, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Suzuki, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; Y. Horai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Okada, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; T. Nishimura, PhD, Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences; T. Koga, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Kawashiri, MD
| | - Kiyoshi Aoyagi
- From the Department of Immunology and Rheumatology, and Department of Public Health, and Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences; Japanese Red Cross Nagasaki Genbaku Hospital; Department of Radiology and Radiation Research, Nagasaki University Hospital, Nagasaki; Department of Clinical Immunology and Rheumatology, Hiroshima University, Hiroshima; Department of Radiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima; Sasebo Chuo Hospital, Sasebo, Japan.Y. Nakashima, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Tamai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; J. Kita, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Michitsuji, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Shimizu, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Fukui, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Umeda, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Nishino, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Suzuki, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; Y. Horai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Okada, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; T. Nishimura, PhD, Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences; T. Koga, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Kawashiri, MD
| | - Katsumi Eguchi
- From the Department of Immunology and Rheumatology, and Department of Public Health, and Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences; Japanese Red Cross Nagasaki Genbaku Hospital; Department of Radiology and Radiation Research, Nagasaki University Hospital, Nagasaki; Department of Clinical Immunology and Rheumatology, Hiroshima University, Hiroshima; Department of Radiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima; Sasebo Chuo Hospital, Sasebo, Japan.Y. Nakashima, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Tamai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; J. Kita, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Michitsuji, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Shimizu, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Fukui, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Umeda, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Nishino, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Suzuki, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; Y. Horai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Okada, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; T. Nishimura, PhD, Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences; T. Koga, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Kawashiri, MD
| | - Atsushi Kawakami
- From the Department of Immunology and Rheumatology, and Department of Public Health, and Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences; Japanese Red Cross Nagasaki Genbaku Hospital; Department of Radiology and Radiation Research, Nagasaki University Hospital, Nagasaki; Department of Clinical Immunology and Rheumatology, Hiroshima University, Hiroshima; Department of Radiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima; Sasebo Chuo Hospital, Sasebo, Japan.Y. Nakashima, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Tamai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; J. Kita, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Michitsuji, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Shimizu, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Fukui, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Umeda, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Nishino, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Suzuki, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; Y. Horai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Okada, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; T. Nishimura, PhD, Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences; T. Koga, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Kawashiri, MD
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Schiotis RE, Buzoianu AD, Mureșanu DF, Suciu S. New pharmacological strategies in rheumatic diseases. J Med Life 2016; 9:227-234. [PMID: 27974925 PMCID: PMC5154305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Targeting the pathogenic pathway of chronic inflammation represents an unmet challenge for controlling disease activity, preventing functional disability, and maintaining an adequate quality of life in patients with rheumatic diseases. Abatacept, a novel molecule that inhibits co-stimulation signal, induces an inhibitory effect on the T-cells. This will further interfere with the activity of several cell lines, leading to the normalization of the immune response. In the latest years, abatacept has been extensively investigated in studies of rheumatoid arthritis for which it was recently approved as a second line biologic treatment in Romania. This review presents the clinical efficacy of abatacept in several rheumatic diseases and highlights the safety profile of this biological agent. Abbreviations: ACR = American College of Rheumatology, ADR = Adverse drug reaction, APC = antigen presenting cell, ApS = psoriatic arthritis, CRP = C reactive protein, CTLA-4 = Cytotoxic T-Cell Lymphocyte Antigen-4, DAS = Disease activity score, DMARDs = Disease modifying antirheumatic drugs, EMA = European Medicine Agency, EULAR = European League Against Rheumatism, FDA = Food and Drugs Administration, HBV = Hepatitis B virus, JIA = Juvenile Idiopathic Arthritis, LDA = low disease activity (LDA), MRI = magnetic resonance imaging (MRI), MTX = methotrexate, RA = rheumatoid arthritis, RCT = randomized controlled trial, SS = Sjogren's syndrome, TCR = T cell receptor.
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Affiliation(s)
- RE Schiotis
- Department of Pharmacology, Toxicology, and Clinical Pharmacology,
“Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
,Department of Rheumatology, Clinical Hospital of Infectious Diseases, Cluj-Napoca, Romania
| | - AD Buzoianu
- Department of Pharmacology, Toxicology, and Clinical Pharmacology,
“Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - DF Mureșanu
- Department of Neurosciences, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - S Suciu
- Department of Physiology “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
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23
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Abstract
Type 1 diabetes (T1D) affects 1.93 in 1000 youth in the USA. Over the last 40 years, a combination of genetic and immunological markers has been developed allowing for the accurate prediction of progression to T1D. Despite our abilities to predict disease and the marked improvement in our understanding of the natural history of T1D, therapies capable of preventing or reversing T1D remain elusive. This article will review recent and ongoing efforts to understand the causes of T1D and related efforts to study potential therapies aimed at preventing T1D.
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Affiliation(s)
| | - Michael J Haller
- University of Florida, PO Box 100296, Gainesville, FL, 32610, USA.
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24
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Risk of infection with biologic antirheumatic therapies in patients with rheumatoid arthritis. Best Pract Res Clin Rheumatol 2015; 29:290-305. [PMID: 26362745 DOI: 10.1016/j.berh.2015.05.009] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 05/08/2015] [Indexed: 12/11/2022]
Abstract
There are currently 10 licensed biologic therapies for the treatment of rheumatoid arthritis in 2014. In this article, we review the risk of serious infection (SI) for biologic therapies. This risk has been closely studied over the last 15 years within randomised controlled trials, long-term extension studies and observational drug registers, especially for the first three antitumour necrosis factor (TNF) drugs, namely infliximab, etanercept and adalimumab. The risk of SI with the newer biologics rituximab, tocilizumab, abatacept and tofacitinib is also reviewed, although further data from long-term observational studies are awaited. Beyond all-site SI, we review the risk of tuberculosis, other opportunistic infections and herpes zoster, and the effect of screening on TB rates. Lastly, we review emerging opportunities for stratifying the risk. Patients can be risk-stratified based on both modifiable and non-modifiable patient characteristics such as age, co-morbidity, glucocorticoid use, functional status and recent previous SI.
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25
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van der Heijde D. Use of imaging as an outcome measure in rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis in clinical trials. Rheumatology (Oxford) 2015. [DOI: 10.1016/b978-0-323-09138-1.00045-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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26
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Takeuchi T, Matsubara T, Ohta S, Mukai M, Amano K, Tohma S, Tanaka Y, Yamanaka H, Miyasaka N. Biologic-free remission of established rheumatoid arthritis after discontinuation of abatacept: a prospective, multicentre, observational study in Japan. Rheumatology (Oxford) 2014; 54:683-91. [PMID: 25257039 PMCID: PMC4372674 DOI: 10.1093/rheumatology/keu338] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Objective. The aim of this study was to determine whether biologic-free remission of RA is possible with discontinuation of abatacept. Methods. Japanese RA patients in 28-joint DAS with CRP (DAS28-CRP) remission (<2.3) after >2 years of abatacept treatment in a phase II study and its long-term extension entered this 52 week, multicentre, non-blinded, prospective, observational study. At enrolment, the patients were offered the option to continue abatacept or not. The primary endpoint was the proportion of patients who remained biologic-free at 52 weeks after discontinuation. Clinical, functional and structural outcomes were compared between those who continued and those who discontinued abatacept. Results. Of 51 patients enrolled, 34 discontinued and 17 continued abatacept treatment. After 52 weeks, 22 of the 34 patients (64.7%) remained biologic-free. Compared with the continuation group, the discontinuation group had a similar remission rate (41.2% vs 64.7%, P = 0.144) although they had a significantly higher mean DAS28-CRP score at week 52 (2.9 vs 2.0, P = 0.012). The two groups were also similar with regard to mean HAQ Disability Index (HAQ-DI) score (0.6 for both, P = 0.920), mean change in total Sharp score (ΔTSS; 0.80 vs 0.32, P = 0.374) and proportion of patients in radiographic remission (ΔTSS ≤ 0.5) at the endpoint (64.3% vs 70.6%, P = 0.752). Those attaining DAS28-CRP < 2.3 or < 2.7 without abatacept at the endpoint had significantly lower HAQ-DI score and/or CRP at enrolment. Non-serious adverse events occurred in three patients who continued or resumed abatacept. Conclusion. Biologic-free remission of RA is possible in some patients after attaining clinical remission with abatacept. Lower baseline HAQ-DI or CRP may predict maintenance of remission or low disease activity after discontinuation of abatacept. Trial registration: UMIN Clinical Trials Registry, http://www.umin.ac.jp/ctr/ (UMIN000004137).
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Affiliation(s)
- Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Department of Rheumatology, Matsubara Mayflower Hospital, Kato, Department of Rheumatology, Taga General Hospital, Hitachi, Division of Rheumatology and Clinical Immunology, Department of Medicine, Sapporo City General Hospital, Sapporo, Department of Rheumatology and Clinical Immunology, Saitama Medical Center, Saitama Medical University, Kawagoe, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health Hospital, Kitakyushu, Institute of Rheumatology, Tokyo Women's Medical University, Tokyo and Tokyo Medical and Dental University, Tokyo, Japan.
| | - Tsukasa Matsubara
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Department of Rheumatology, Matsubara Mayflower Hospital, Kato, Department of Rheumatology, Taga General Hospital, Hitachi, Division of Rheumatology and Clinical Immunology, Department of Medicine, Sapporo City General Hospital, Sapporo, Department of Rheumatology and Clinical Immunology, Saitama Medical Center, Saitama Medical University, Kawagoe, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health Hospital, Kitakyushu, Institute of Rheumatology, Tokyo Women's Medical University, Tokyo and Tokyo Medical and Dental University, Tokyo, Japan
| | - Shuji Ohta
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Department of Rheumatology, Matsubara Mayflower Hospital, Kato, Department of Rheumatology, Taga General Hospital, Hitachi, Division of Rheumatology and Clinical Immunology, Department of Medicine, Sapporo City General Hospital, Sapporo, Department of Rheumatology and Clinical Immunology, Saitama Medical Center, Saitama Medical University, Kawagoe, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health Hospital, Kitakyushu, Institute of Rheumatology, Tokyo Women's Medical University, Tokyo and Tokyo Medical and Dental University, Tokyo, Japan
| | - Masaya Mukai
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Department of Rheumatology, Matsubara Mayflower Hospital, Kato, Department of Rheumatology, Taga General Hospital, Hitachi, Division of Rheumatology and Clinical Immunology, Department of Medicine, Sapporo City General Hospital, Sapporo, Department of Rheumatology and Clinical Immunology, Saitama Medical Center, Saitama Medical University, Kawagoe, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health Hospital, Kitakyushu, Institute of Rheumatology, Tokyo Women's Medical University, Tokyo and Tokyo Medical and Dental University, Tokyo, Japan
| | - Koichi Amano
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Department of Rheumatology, Matsubara Mayflower Hospital, Kato, Department of Rheumatology, Taga General Hospital, Hitachi, Division of Rheumatology and Clinical Immunology, Department of Medicine, Sapporo City General Hospital, Sapporo, Department of Rheumatology and Clinical Immunology, Saitama Medical Center, Saitama Medical University, Kawagoe, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health Hospital, Kitakyushu, Institute of Rheumatology, Tokyo Women's Medical University, Tokyo and Tokyo Medical and Dental University, Tokyo, Japan
| | - Shigeto Tohma
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Department of Rheumatology, Matsubara Mayflower Hospital, Kato, Department of Rheumatology, Taga General Hospital, Hitachi, Division of Rheumatology and Clinical Immunology, Department of Medicine, Sapporo City General Hospital, Sapporo, Department of Rheumatology and Clinical Immunology, Saitama Medical Center, Saitama Medical University, Kawagoe, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health Hospital, Kitakyushu, Institute of Rheumatology, Tokyo Women's Medical University, Tokyo and Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshiya Tanaka
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Department of Rheumatology, Matsubara Mayflower Hospital, Kato, Department of Rheumatology, Taga General Hospital, Hitachi, Division of Rheumatology and Clinical Immunology, Department of Medicine, Sapporo City General Hospital, Sapporo, Department of Rheumatology and Clinical Immunology, Saitama Medical Center, Saitama Medical University, Kawagoe, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health Hospital, Kitakyushu, Institute of Rheumatology, Tokyo Women's Medical University, Tokyo and Tokyo Medical and Dental University, Tokyo, Japan
| | - Hisashi Yamanaka
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Department of Rheumatology, Matsubara Mayflower Hospital, Kato, Department of Rheumatology, Taga General Hospital, Hitachi, Division of Rheumatology and Clinical Immunology, Department of Medicine, Sapporo City General Hospital, Sapporo, Department of Rheumatology and Clinical Immunology, Saitama Medical Center, Saitama Medical University, Kawagoe, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health Hospital, Kitakyushu, Institute of Rheumatology, Tokyo Women's Medical University, Tokyo and Tokyo Medical and Dental University, Tokyo, Japan
| | - Nobuyuki Miyasaka
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Department of Rheumatology, Matsubara Mayflower Hospital, Kato, Department of Rheumatology, Taga General Hospital, Hitachi, Division of Rheumatology and Clinical Immunology, Department of Medicine, Sapporo City General Hospital, Sapporo, Department of Rheumatology and Clinical Immunology, Saitama Medical Center, Saitama Medical University, Kawagoe, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health Hospital, Kitakyushu, Institute of Rheumatology, Tokyo Women's Medical University, Tokyo and Tokyo Medical and Dental University, Tokyo, Japan
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27
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Esposito L, Hunter KMD, Clark J, Rainbow DB, Stevens H, Denesha J, Duley S, Dawson S, Coleman G, Nutland S, Bell GL, Moran C, Pekalski M, Todd JA, Wicker LS. Investigation of soluble and transmembrane CTLA-4 isoforms in serum and microvesicles. THE JOURNAL OF IMMUNOLOGY 2014; 193:889-900. [PMID: 24928993 PMCID: PMC4082723 DOI: 10.4049/jimmunol.1303389] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Expression of the CTLA-4 gene is absolutely required for immune homeostasis, but aspects of its molecular nature remain undefined. In particular, the characterization of the soluble CTLA-4 (sCTLA-4) protein isoform generated by an alternatively spliced mRNA of CTLA4 lacking transmembrane-encoding exon 3 has been hindered by the difficulty in distinguishing it from the transmembrane isoform of CTLA-4, Tm-CTLA-4. In the current study, sCTLA-4 has been analyzed using novel mAbs and polyclonal Abs specific for its unique C-terminal amino acid sequence. We demonstrate that the sCTLA-4 protein is secreted at low levels following the activation of primary human CD4+ T cells and is increased only rarely in the serum of autoimmune patients. Unexpectedly, during our studies aimed to define the kinetics of sCTLA-4 produced by activated human CD4+ T cells, we discovered that Tm-CTLA-4 is associated with microvesicles produced by the activated cells. The functional roles of sCTLA-4 and microvesicle-associated Tm-CTLA-4 warrant further investigation, especially as they relate to the multiple mechanisms of action described for the more commonly studied cell-associated Tm-CTLA-4.
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Affiliation(s)
- Laura Esposito
- Juvenile Diabetes Research Foundation/Wellcome Trust Diabetes and Inflammation Laboratory, Department of Medical Genetics, Cambridge Institute for Medical Research, University of Cambridge, Cambridge CB2 0XY, United Kingdom; National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; and
| | - Kara M D Hunter
- Juvenile Diabetes Research Foundation/Wellcome Trust Diabetes and Inflammation Laboratory, Department of Medical Genetics, Cambridge Institute for Medical Research, University of Cambridge, Cambridge CB2 0XY, United Kingdom; National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; and
| | - Jan Clark
- Juvenile Diabetes Research Foundation/Wellcome Trust Diabetes and Inflammation Laboratory, Department of Medical Genetics, Cambridge Institute for Medical Research, University of Cambridge, Cambridge CB2 0XY, United Kingdom; National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; and
| | - Daniel B Rainbow
- Juvenile Diabetes Research Foundation/Wellcome Trust Diabetes and Inflammation Laboratory, Department of Medical Genetics, Cambridge Institute for Medical Research, University of Cambridge, Cambridge CB2 0XY, United Kingdom; National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; and
| | - Helen Stevens
- Juvenile Diabetes Research Foundation/Wellcome Trust Diabetes and Inflammation Laboratory, Department of Medical Genetics, Cambridge Institute for Medical Research, University of Cambridge, Cambridge CB2 0XY, United Kingdom; National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; and
| | - Jennifer Denesha
- Juvenile Diabetes Research Foundation/Wellcome Trust Diabetes and Inflammation Laboratory, Department of Medical Genetics, Cambridge Institute for Medical Research, University of Cambridge, Cambridge CB2 0XY, United Kingdom; National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; and
| | - Simon Duley
- Juvenile Diabetes Research Foundation/Wellcome Trust Diabetes and Inflammation Laboratory, Department of Medical Genetics, Cambridge Institute for Medical Research, University of Cambridge, Cambridge CB2 0XY, United Kingdom; National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; and
| | - Sarah Dawson
- Juvenile Diabetes Research Foundation/Wellcome Trust Diabetes and Inflammation Laboratory, Department of Medical Genetics, Cambridge Institute for Medical Research, University of Cambridge, Cambridge CB2 0XY, United Kingdom; National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; and
| | - Gillian Coleman
- Juvenile Diabetes Research Foundation/Wellcome Trust Diabetes and Inflammation Laboratory, Department of Medical Genetics, Cambridge Institute for Medical Research, University of Cambridge, Cambridge CB2 0XY, United Kingdom; National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; and
| | - Sarah Nutland
- Juvenile Diabetes Research Foundation/Wellcome Trust Diabetes and Inflammation Laboratory, Department of Medical Genetics, Cambridge Institute for Medical Research, University of Cambridge, Cambridge CB2 0XY, United Kingdom; National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; and
| | - Gwynneth L Bell
- Juvenile Diabetes Research Foundation/Wellcome Trust Diabetes and Inflammation Laboratory, Department of Medical Genetics, Cambridge Institute for Medical Research, University of Cambridge, Cambridge CB2 0XY, United Kingdom; National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; and
| | - Carla Moran
- National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; and Institute of Metabolic Science, University of Cambridge, Addenbrooke's Hospital, Cambridge, CB2 0QQ, United Kingdom
| | - Marcin Pekalski
- Juvenile Diabetes Research Foundation/Wellcome Trust Diabetes and Inflammation Laboratory, Department of Medical Genetics, Cambridge Institute for Medical Research, University of Cambridge, Cambridge CB2 0XY, United Kingdom; National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; and
| | - John A Todd
- Juvenile Diabetes Research Foundation/Wellcome Trust Diabetes and Inflammation Laboratory, Department of Medical Genetics, Cambridge Institute for Medical Research, University of Cambridge, Cambridge CB2 0XY, United Kingdom; National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; and
| | - Linda S Wicker
- Juvenile Diabetes Research Foundation/Wellcome Trust Diabetes and Inflammation Laboratory, Department of Medical Genetics, Cambridge Institute for Medical Research, University of Cambridge, Cambridge CB2 0XY, United Kingdom; National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; and
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Kremer JM, Peterfy C, Russell AS, Emery P, Abud-Mendoza C, Sibilia J, Becker JC, Westhovens R, Genant HK. Longterm safety, efficacy, and inhibition of structural damage progression over 5 years of treatment with abatacept in patients with rheumatoid arthritis in the abatacept in inadequate responders to methotrexate trial. J Rheumatol 2014; 41:1077-87. [PMID: 24786925 DOI: 10.3899/jrheum.130263] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Evaluate the safety and efficacy of longterm abatacept (ABA) treatment over 5 years in methotrexate (MTX)-refractory patients with rheumatoid arthritis (RA). METHODS Patients from the 1-year, double-blind Abatacept in Inadequate Responders to Methotrexate (AIM) study (NCT00048568) received open-label ABA (∼10 mg/kg) in the longterm extension (LTE). Safety was assessed for patients who received ≥ 1 ABA dose, and efficacy for patients randomized to ABA and treated in the LTE. Radiographs were evaluated for changes in Genant-modified Sharp scores. RESULTS Out of 652 patients, 539 entered the LTE (ABA, n = 378; placebo, n = 161). At Year 5, 72.4% were ongoing; discontinuation rates declined over time. Incidence rates of serious adverse events, serious infections, malignancies, and autoimmune events were 13.87, 2.84, 1.45, and 0.99 events/100 patient-years exposure, respectively. American College of Rheumatology 20 response was 82.3% (n = 373) and 83.6% (n = 268) at years 1 and 5, respectively. Disease Activity Score 28 C-reactive protein (DAS28-CRP) < 2.6 and ≤ 3.2 were achieved by 25.4% and 44.1% of patients at Year 1 (n = 370), and 33.7% and 54.7% at Year 5 (n = 267), respectively. Mean changes in DAS28-CRP and Health Assessment Questionnaire-Disability Index at Year 1 [-2.83 (n = 365) and -0.68 (n = 369)] were maintained at Year 5 [-3.14 (n = 264) and -0.77 (n = 271)] for patients continuing treatment. Of them, 59.5% (n = 291) and 45.1% (n = 235) remained free from radiographic progression at years 1 and 5, respectively. CONCLUSION In MTX-refractory patients with RA, longterm ABA treatment was well tolerated and provided consistent safety and sustained efficacy, with high patient retention. Radiographic progression continued to be inhibited with ongoing treatment.
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Affiliation(s)
- Joel M Kremer
- From the Center for Rheumatology, Albany Medical College, Albany, New York; Spire Sciences Inc., Boca Raton, Florida, USA; Division of Rheumatology, University of Alberta Hospital, Edmonton, Alberta, Canada; Division of Rheumatic and Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, UK; Regional Unit of Rheumatology, Faculty of Medicine and Central Hospital, University of San Luis Potosí, San Luis Potosí, México; Service de Rhumatologie, CHU de Strasbourg, Hôpital de Hautepierre, Strasbourg, France; Bristol-Myers Squibb, Princeton, New Jersey, USA; Department of Rheumatology, Universitaire Ziekenhuizenn Leuven, Leuven, Belgium; UCSF/Synarc, San Francisco, California, USA.Professional medical writing and editorial assistance funded by Bristol-Myers Squibb, Princeton, New Jersey, USA, and provided by Eve Guichard BSc (hons) of Caudex Medical, Oxford, UK.J.M. Kremer, MD, Center for Rheumatology, Albany Medical College; C. Peterfy, MD, PhD, FRCPC, Spire Sciences Inc.; A.S. Russell, FRCP, FRCPC, Division of Rheumatology, University of Alberta Hospital; P. Emery, MA, MD, FRCP, FRCPE, Division of Rheumatic and Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust; C. Abud-Mendoza, MD, Regional Unit of Rheumatology, Faculty of Medicine and Central Hospital, University of San Luis Potosí; J. Sibilia, MD, Service de Rhumatologie, CHU de Strasbourg, Hôpital de Hautepierre; J-C. Becker, MD, Bristol-Myers Squibb*; R. Westhovens, MD, Department of Rheumatology, Universitaire Ziekenhuizenn Leuven; H.K. Genant, MD, UCSF/Synarc.
| | - Charles Peterfy
- From the Center for Rheumatology, Albany Medical College, Albany, New York; Spire Sciences Inc., Boca Raton, Florida, USA; Division of Rheumatology, University of Alberta Hospital, Edmonton, Alberta, Canada; Division of Rheumatic and Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, UK; Regional Unit of Rheumatology, Faculty of Medicine and Central Hospital, University of San Luis Potosí, San Luis Potosí, México; Service de Rhumatologie, CHU de Strasbourg, Hôpital de Hautepierre, Strasbourg, France; Bristol-Myers Squibb, Princeton, New Jersey, USA; Department of Rheumatology, Universitaire Ziekenhuizenn Leuven, Leuven, Belgium; UCSF/Synarc, San Francisco, California, USA.Professional medical writing and editorial assistance funded by Bristol-Myers Squibb, Princeton, New Jersey, USA, and provided by Eve Guichard BSc (hons) of Caudex Medical, Oxford, UK.J.M. Kremer, MD, Center for Rheumatology, Albany Medical College; C. Peterfy, MD, PhD, FRCPC, Spire Sciences Inc.; A.S. Russell, FRCP, FRCPC, Division of Rheumatology, University of Alberta Hospital; P. Emery, MA, MD, FRCP, FRCPE, Division of Rheumatic and Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust; C. Abud-Mendoza, MD, Regional Unit of Rheumatology, Faculty of Medicine and Central Hospital, University of San Luis Potosí; J. Sibilia, MD, Service de Rhumatologie, CHU de Strasbourg, Hôpital de Hautepierre; J-C. Becker, MD, Bristol-Myers Squibb*; R. Westhovens, MD, Department of Rheumatology, Universitaire Ziekenhuizenn Leuven; H.K. Genant, MD, UCSF/Synarc
| | - Anthony S Russell
- From the Center for Rheumatology, Albany Medical College, Albany, New York; Spire Sciences Inc., Boca Raton, Florida, USA; Division of Rheumatology, University of Alberta Hospital, Edmonton, Alberta, Canada; Division of Rheumatic and Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, UK; Regional Unit of Rheumatology, Faculty of Medicine and Central Hospital, University of San Luis Potosí, San Luis Potosí, México; Service de Rhumatologie, CHU de Strasbourg, Hôpital de Hautepierre, Strasbourg, France; Bristol-Myers Squibb, Princeton, New Jersey, USA; Department of Rheumatology, Universitaire Ziekenhuizenn Leuven, Leuven, Belgium; UCSF/Synarc, San Francisco, California, USA.Professional medical writing and editorial assistance funded by Bristol-Myers Squibb, Princeton, New Jersey, USA, and provided by Eve Guichard BSc (hons) of Caudex Medical, Oxford, UK.J.M. Kremer, MD, Center for Rheumatology, Albany Medical College; C. Peterfy, MD, PhD, FRCPC, Spire Sciences Inc.; A.S. Russell, FRCP, FRCPC, Division of Rheumatology, University of Alberta Hospital; P. Emery, MA, MD, FRCP, FRCPE, Division of Rheumatic and Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust; C. Abud-Mendoza, MD, Regional Unit of Rheumatology, Faculty of Medicine and Central Hospital, University of San Luis Potosí; J. Sibilia, MD, Service de Rhumatologie, CHU de Strasbourg, Hôpital de Hautepierre; J-C. Becker, MD, Bristol-Myers Squibb*; R. Westhovens, MD, Department of Rheumatology, Universitaire Ziekenhuizenn Leuven; H.K. Genant, MD, UCSF/Synarc
| | - Paul Emery
- From the Center for Rheumatology, Albany Medical College, Albany, New York; Spire Sciences Inc., Boca Raton, Florida, USA; Division of Rheumatology, University of Alberta Hospital, Edmonton, Alberta, Canada; Division of Rheumatic and Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, UK; Regional Unit of Rheumatology, Faculty of Medicine and Central Hospital, University of San Luis Potosí, San Luis Potosí, México; Service de Rhumatologie, CHU de Strasbourg, Hôpital de Hautepierre, Strasbourg, France; Bristol-Myers Squibb, Princeton, New Jersey, USA; Department of Rheumatology, Universitaire Ziekenhuizenn Leuven, Leuven, Belgium; UCSF/Synarc, San Francisco, California, USA.Professional medical writing and editorial assistance funded by Bristol-Myers Squibb, Princeton, New Jersey, USA, and provided by Eve Guichard BSc (hons) of Caudex Medical, Oxford, UK.J.M. Kremer, MD, Center for Rheumatology, Albany Medical College; C. Peterfy, MD, PhD, FRCPC, Spire Sciences Inc.; A.S. Russell, FRCP, FRCPC, Division of Rheumatology, University of Alberta Hospital; P. Emery, MA, MD, FRCP, FRCPE, Division of Rheumatic and Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust; C. Abud-Mendoza, MD, Regional Unit of Rheumatology, Faculty of Medicine and Central Hospital, University of San Luis Potosí; J. Sibilia, MD, Service de Rhumatologie, CHU de Strasbourg, Hôpital de Hautepierre; J-C. Becker, MD, Bristol-Myers Squibb*; R. Westhovens, MD, Department of Rheumatology, Universitaire Ziekenhuizenn Leuven; H.K. Genant, MD, UCSF/Synarc
| | - Carlos Abud-Mendoza
- From the Center for Rheumatology, Albany Medical College, Albany, New York; Spire Sciences Inc., Boca Raton, Florida, USA; Division of Rheumatology, University of Alberta Hospital, Edmonton, Alberta, Canada; Division of Rheumatic and Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, UK; Regional Unit of Rheumatology, Faculty of Medicine and Central Hospital, University of San Luis Potosí, San Luis Potosí, México; Service de Rhumatologie, CHU de Strasbourg, Hôpital de Hautepierre, Strasbourg, France; Bristol-Myers Squibb, Princeton, New Jersey, USA; Department of Rheumatology, Universitaire Ziekenhuizenn Leuven, Leuven, Belgium; UCSF/Synarc, San Francisco, California, USA.Professional medical writing and editorial assistance funded by Bristol-Myers Squibb, Princeton, New Jersey, USA, and provided by Eve Guichard BSc (hons) of Caudex Medical, Oxford, UK.J.M. Kremer, MD, Center for Rheumatology, Albany Medical College; C. Peterfy, MD, PhD, FRCPC, Spire Sciences Inc.; A.S. Russell, FRCP, FRCPC, Division of Rheumatology, University of Alberta Hospital; P. Emery, MA, MD, FRCP, FRCPE, Division of Rheumatic and Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust; C. Abud-Mendoza, MD, Regional Unit of Rheumatology, Faculty of Medicine and Central Hospital, University of San Luis Potosí; J. Sibilia, MD, Service de Rhumatologie, CHU de Strasbourg, Hôpital de Hautepierre; J-C. Becker, MD, Bristol-Myers Squibb*; R. Westhovens, MD, Department of Rheumatology, Universitaire Ziekenhuizenn Leuven; H.K. Genant, MD, UCSF/Synarc
| | - Jean Sibilia
- From the Center for Rheumatology, Albany Medical College, Albany, New York; Spire Sciences Inc., Boca Raton, Florida, USA; Division of Rheumatology, University of Alberta Hospital, Edmonton, Alberta, Canada; Division of Rheumatic and Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, UK; Regional Unit of Rheumatology, Faculty of Medicine and Central Hospital, University of San Luis Potosí, San Luis Potosí, México; Service de Rhumatologie, CHU de Strasbourg, Hôpital de Hautepierre, Strasbourg, France; Bristol-Myers Squibb, Princeton, New Jersey, USA; Department of Rheumatology, Universitaire Ziekenhuizenn Leuven, Leuven, Belgium; UCSF/Synarc, San Francisco, California, USA.Professional medical writing and editorial assistance funded by Bristol-Myers Squibb, Princeton, New Jersey, USA, and provided by Eve Guichard BSc (hons) of Caudex Medical, Oxford, UK.J.M. Kremer, MD, Center for Rheumatology, Albany Medical College; C. Peterfy, MD, PhD, FRCPC, Spire Sciences Inc.; A.S. Russell, FRCP, FRCPC, Division of Rheumatology, University of Alberta Hospital; P. Emery, MA, MD, FRCP, FRCPE, Division of Rheumatic and Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust; C. Abud-Mendoza, MD, Regional Unit of Rheumatology, Faculty of Medicine and Central Hospital, University of San Luis Potosí; J. Sibilia, MD, Service de Rhumatologie, CHU de Strasbourg, Hôpital de Hautepierre; J-C. Becker, MD, Bristol-Myers Squibb*; R. Westhovens, MD, Department of Rheumatology, Universitaire Ziekenhuizenn Leuven; H.K. Genant, MD, UCSF/Synarc
| | - Jean-Claude Becker
- From the Center for Rheumatology, Albany Medical College, Albany, New York; Spire Sciences Inc., Boca Raton, Florida, USA; Division of Rheumatology, University of Alberta Hospital, Edmonton, Alberta, Canada; Division of Rheumatic and Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, UK; Regional Unit of Rheumatology, Faculty of Medicine and Central Hospital, University of San Luis Potosí, San Luis Potosí, México; Service de Rhumatologie, CHU de Strasbourg, Hôpital de Hautepierre, Strasbourg, France; Bristol-Myers Squibb, Princeton, New Jersey, USA; Department of Rheumatology, Universitaire Ziekenhuizenn Leuven, Leuven, Belgium; UCSF/Synarc, San Francisco, California, USA.Professional medical writing and editorial assistance funded by Bristol-Myers Squibb, Princeton, New Jersey, USA, and provided by Eve Guichard BSc (hons) of Caudex Medical, Oxford, UK.J.M. Kremer, MD, Center for Rheumatology, Albany Medical College; C. Peterfy, MD, PhD, FRCPC, Spire Sciences Inc.; A.S. Russell, FRCP, FRCPC, Division of Rheumatology, University of Alberta Hospital; P. Emery, MA, MD, FRCP, FRCPE, Division of Rheumatic and Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust; C. Abud-Mendoza, MD, Regional Unit of Rheumatology, Faculty of Medicine and Central Hospital, University of San Luis Potosí; J. Sibilia, MD, Service de Rhumatologie, CHU de Strasbourg, Hôpital de Hautepierre; J-C. Becker, MD, Bristol-Myers Squibb*; R. Westhovens, MD, Department of Rheumatology, Universitaire Ziekenhuizenn Leuven; H.K. Genant, MD, UCSF/Synarc
| | - Rene Westhovens
- From the Center for Rheumatology, Albany Medical College, Albany, New York; Spire Sciences Inc., Boca Raton, Florida, USA; Division of Rheumatology, University of Alberta Hospital, Edmonton, Alberta, Canada; Division of Rheumatic and Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, UK; Regional Unit of Rheumatology, Faculty of Medicine and Central Hospital, University of San Luis Potosí, San Luis Potosí, México; Service de Rhumatologie, CHU de Strasbourg, Hôpital de Hautepierre, Strasbourg, France; Bristol-Myers Squibb, Princeton, New Jersey, USA; Department of Rheumatology, Universitaire Ziekenhuizenn Leuven, Leuven, Belgium; UCSF/Synarc, San Francisco, California, USA.Professional medical writing and editorial assistance funded by Bristol-Myers Squibb, Princeton, New Jersey, USA, and provided by Eve Guichard BSc (hons) of Caudex Medical, Oxford, UK.J.M. Kremer, MD, Center for Rheumatology, Albany Medical College; C. Peterfy, MD, PhD, FRCPC, Spire Sciences Inc.; A.S. Russell, FRCP, FRCPC, Division of Rheumatology, University of Alberta Hospital; P. Emery, MA, MD, FRCP, FRCPE, Division of Rheumatic and Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust; C. Abud-Mendoza, MD, Regional Unit of Rheumatology, Faculty of Medicine and Central Hospital, University of San Luis Potosí; J. Sibilia, MD, Service de Rhumatologie, CHU de Strasbourg, Hôpital de Hautepierre; J-C. Becker, MD, Bristol-Myers Squibb*; R. Westhovens, MD, Department of Rheumatology, Universitaire Ziekenhuizenn Leuven; H.K. Genant, MD, UCSF/Synarc
| | - Harry K Genant
- From the Center for Rheumatology, Albany Medical College, Albany, New York; Spire Sciences Inc., Boca Raton, Florida, USA; Division of Rheumatology, University of Alberta Hospital, Edmonton, Alberta, Canada; Division of Rheumatic and Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, UK; Regional Unit of Rheumatology, Faculty of Medicine and Central Hospital, University of San Luis Potosí, San Luis Potosí, México; Service de Rhumatologie, CHU de Strasbourg, Hôpital de Hautepierre, Strasbourg, France; Bristol-Myers Squibb, Princeton, New Jersey, USA; Department of Rheumatology, Universitaire Ziekenhuizenn Leuven, Leuven, Belgium; UCSF/Synarc, San Francisco, California, USA.Professional medical writing and editorial assistance funded by Bristol-Myers Squibb, Princeton, New Jersey, USA, and provided by Eve Guichard BSc (hons) of Caudex Medical, Oxford, UK.J.M. Kremer, MD, Center for Rheumatology, Albany Medical College; C. Peterfy, MD, PhD, FRCPC, Spire Sciences Inc.; A.S. Russell, FRCP, FRCPC, Division of Rheumatology, University of Alberta Hospital; P. Emery, MA, MD, FRCP, FRCPE, Division of Rheumatic and Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust; C. Abud-Mendoza, MD, Regional Unit of Rheumatology, Faculty of Medicine and Central Hospital, University of San Luis Potosí; J. Sibilia, MD, Service de Rhumatologie, CHU de Strasbourg, Hôpital de Hautepierre; J-C. Becker, MD, Bristol-Myers Squibb*; R. Westhovens, MD, Department of Rheumatology, Universitaire Ziekenhuizenn Leuven; H.K. Genant, MD, UCSF/Synarc
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Vicente Rabaneda EF, Herrero-Beaumont G, Castañeda S. Update on the use of abatacept for the treatment of rheumatoid arthritis. Expert Rev Clin Immunol 2014; 9:599-621. [PMID: 23899231 DOI: 10.1586/1744666x.2013.811192] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Abatacept is approved for the treatment of moderate-to-severe active rheumatoid arthritis (RA) patients with inadequate response to one or more disease-modifying antirheumatic drugs (DMARDs), including methotrexate or a TNF antagonist, and can be used either as monotherapy or concomitantly with nonbiologic DMARDs. It can be administered either intravenously or subcutaneously. It has demonstrated to improve signs and symptoms of RA, physical function and health-related quality of life, and it inhibits radiographic progression of structural damage across a wide range of early and long-standing RA populations. The safety profile appears good and close to RA patients treated with nonbiologic DMARDs. Meta-analysis and real-world studies support these findings. This article reviews published data on clinical and radiographic efficacy as well as the safety of this drug, incorporating recent relevant information reported at scientific meetings.
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Affiliation(s)
- Esther F Vicente Rabaneda
- Rheumatology Department, Hospital Universitario de La Princesa, IIS-Princesa, Universidad Autónoma de Madrid, C/ Diego de León 62, 28006 Madrid, Spain
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Abstract
The biological disease-modifying antirheumatic drug abatacept (Orencia) has a novel mechanism of action; its activity is mediated via the selective modulation of T cell co-stimulation. This article reviews the clinical efficacy and tolerability of intravenous and subcutaneous abatacept in patients with rheumatoid arthritis (RA) and intravenous abatacept in patients with juvenile idiopathic arthritis (JIA), as well as summarizing its pharmacological properties. In patients with RA, the beneficial effects of intravenous or subcutaneous abatacept on signs and symptoms, disease activity, the progression of structural damage, physical function and/or health-related quality of life were seen in a number of well-designed trials, including in methotrexate-naive patients with early RA and poor prognostic factors and in patients with established RA and an inadequate response to either methotrexate or anti-tumour necrosis factor therapy. Subcutaneous abatacept plus methotrexate was also noninferior to subcutaneous adalimumab plus methotrexate in patients with active RA who were naive to biological therapy and had an inadequate response to methotrexate. In paediatric patients with JIA, intravenous abatacept improved signs and symptoms and delayed the time to flare. Abatacept was generally well tolerated in RA and JIA and was associated with low rates of immunogenicity. In conclusion, abatacept is an important option for use in the treatment of RA and JIA.
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Affiliation(s)
- Gillian M Keating
- Adis, 41 Centorian Drive, Private Bag 65901, Mairangi Bay, North Shore, 0754 Auckland, New Zealand.
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Jani M, Hyrich KL. Abatacept in the long-term treatment of rheumatoid arthritis. Expert Rev Clin Immunol 2014; 8:231-4. [DOI: 10.1586/eci.11.98] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Fujii W, Kohno M, Ishino H, Nakabayashi A, Fujioka K, Kida T, Nagahara H, Murakami K, Nakamura K, Seno T, Yamamoto A, Kawahito Y. The rapid efficacy of abatacept in a patient with rheumatoid vasculitis. Mod Rheumatol 2014. [DOI: 10.3109/s10165-011-0559-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Hashimoto J, Garnero P, van der Heijde D, Miyasaka N, Yamamoto K, Kawai S, Takeuchi T, Yoshikawa H, Nishimoto N. Humanized anti-interleukin-6-receptor antibody (tocilizumab) monotherapy is more effective in slowing radiographic progression in patients with rheumatoid arthritis at high baseline risk for structural damage evaluated with levels of biomarkers, radiography, and BMI: data from the SAMURAI study. Mod Rheumatol 2014. [DOI: 10.3109/s10165-010-0325-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
INTRODUCTION With the introduction of biologic therapies, tremendous progress has been made in the treatment of rheumatoid arthritis (RA). However, up to 40% of patients do not respond to these treatments. AREAS COVERED Several new treatment strategies are discussed, with brief overview of currently performed clinical trials. The development of molecules targeting cytokines other than TNF is discussed, as well as chemokine-directed drugs. Finally, the area of small molecular inhibitors is explored. EXPERT OPINION Since RA is a life-long disease often evolving into disability, development of new treatment strategies remains crucial. Especially small molecules targeting JAK, Syk and PDE4 may provide novel therapeutic options.
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Affiliation(s)
- Peggy Jacques
- Ghent University Hospital, Department of Rheumatology, De Pintelaan 185, Gent, Belgium
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Vis M, Güler-Yüksel M, Lems WF. Can bone loss in rheumatoid arthritis be prevented? Osteoporos Int 2013; 24:2541-53. [PMID: 23775419 DOI: 10.1007/s00198-013-2334-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 02/20/2013] [Indexed: 01/01/2023]
Abstract
Rheumatoid arthritis (RA) is a systemic inflammatory disease that can lead to local joint deformations (bone erosions and joint space narrowing) and to extra-articular phenomena, including generalized osteoporosis. In addition, in patients with RA, the risk of vertebral and nonvertebral fractures is doubled. High disease activity (inflammation), immobility, and glucocorticoid use are common factors that substantially increase fracture risk in these patients, on top of the background fracture risk based on classical risk factors such as high age, low body mass, and female gender. New insights on the links between the immune system and the bone system, the field of osteoimmunology, have shown that local and generalized bone loss share common pathways. The receptor activator of nuclear factor κB ligand/osteoprotegerin pathway (RANKl/OPG) is one of the most important pathways, as it is (strongly) upregulated by inflammation. In modern treatment of RA with biologics, for example, TNFα-blocking agents and combination therapy of conventional disease-modifying antirheumatic drugs (DMARDs), clinical remission is a realistic treatment goal. As a consequence, in recent studies, it has been documented that both local and generalized bone loss is absent or minimal in those patients who are in clinical remission.
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Affiliation(s)
- M Vis
- Department of Rheumatology, Erasmus MC, Dr. Molewaterplein 50, 3015, GE, Rotterdam, the Netherlands,
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Schiff M, Weinblatt ME, Valente R, van der Heijde D, Citera G, Elegbe A, Maldonado M, Fleischmann R. Head-to-head comparison of subcutaneous abatacept versus adalimumab for rheumatoid arthritis: two-year efficacy and safety findings from AMPLE trial. Ann Rheum Dis 2013; 73:86-94. [PMID: 23962455 PMCID: PMC3888617 DOI: 10.1136/annrheumdis-2013-203843] [Citation(s) in RCA: 205] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objectives To compare over 2 years the safety, efficacy and radiographic outcomes of subcutaneous abatacept versus adalimumab, in combination with methotrexate (MTX), in patients with rheumatoid arthritis (RA). Methods AMPLE is a phase IIIb, 2-year, randomised, investigator-blinded study with a 1-year primary endpoint. Biologic-naive patients with active RA and an inadequate response to MTX were randomised to 125 mg abatacept weekly or 40 mg adalimumab bi-weekly, both with a stable dose of MTX. Results Of 646 patients randomised, 79.2% abatacept and 74.7% adalimumab patients completed year 2. At year 2, efficacy outcomes, including radiographic, remained comparable between groups and with year 1 results. The American College Rheumatology 20, 50 and 70 responses at year 2 were 59.7%, 44.7% and 31.1% for abatacept and 60.1%, 46.6% and 29.3% for adalimumab. There were similar rates of adverse events (AEs) and serious adverse events (SAEs). More serious infections occurred with adalimumab (3.8% vs 5.8%) including two cases of tuberculosis with adalimumab. There were fewer discontinuations due to AEs (3.8% vs 9.5%), SAEs (1.6% vs 4.9%) and serious infections (0/12 vs 9/19 patients) in the abatacept group. Injection site reactions (ISRs) occurred less frequently with abatacept (4.1% vs 10.4%). Conclusions Through 2 years of blinded treatment in this first head-to-head study between biologic disease-modifying antirheumatic drugs in RA patients with an inadequate response to MTX, subcutaneous abatacept and adalimumab were similarly efficacious based on clinical, functional and radiographic outcomes. Overall, AE frequency was similar in both groups but there were less discontinuations due to AEs, SAEs, serious infections and fewer local ISRs with abatacept. ClinicalTrials.gov Identifier NCT00929864.
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Affiliation(s)
- Michael Schiff
- Department of Rheumatology, University of Colorado, , Denver, Colorado, USA
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Savage LJ, McGonagle DG. The Role of Biological and Small Molecule Therapy in the Management of Psoriatic Arthritis. BIOLOGICS IN THERAPY 2013. [PMCID: PMC4079095 DOI: 10.1007/s13554-013-0010-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
The therapy of psoriatic arthritis (PsA) has blossomed in the past decade. Inhibition of tumor necrosis factor (TNF) has been at the fore of this approach and has paved the way for the investigation of many other potential pro-inflammatory and signaling pathways. Most of the initial studies of TNF inhibitors in PsA have been conducted in specific populations, largely focusing on those with established, peripheral joint disease. That said, in excess of 10 years’ worth of real world clinical experience has led to increased confidence in the wider use of these agents. We are now faced with an exciting time of discovery of many new molecules; these not only include new, large protein biological agents, but also smaller synthetic chemical molecules, many of which can be administered orally. Those currently under development are discussed within this article. Whilst there is scarce data about their real world efficacy and safety profile, it is evident that the therapeutic armamentarium for treating PsA will greatly increase in the foreseeable future and this is anticipated to improve patient outcomes.
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Affiliation(s)
- Laura J. Savage
- Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, West Yorkshire UK
| | - Dennis G. McGonagle
- Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, West Yorkshire UK
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Fujii W, Ashihara E, Hirai H, Nagahara H, Kajitani N, Fujioka K, Murakami K, Seno T, Yamamoto A, Ishino H, Kohno M, Maekawa T, Kawahito Y. Myeloid-derived suppressor cells play crucial roles in the regulation of mouse collagen-induced arthritis. THE JOURNAL OF IMMUNOLOGY 2013; 191:1073-81. [PMID: 23804709 DOI: 10.4049/jimmunol.1203535] [Citation(s) in RCA: 122] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Myeloid-derived suppressor cells (MDSCs) are of myeloid origin and are able to suppress T cell responses. The role of MDSCs in autoimmune diseases remains controversial, and little is known about the function of MDSCs in autoimmune arthritis. In this study, we clarify that MDSCs play crucial roles in the regulation of proinflammatory immune response in a collagen-induced arthritis (CIA) mouse model. MDSCs accumulated in the spleens of mice with CIA when arthritis severity peaked. These MDSCs inhibited the proliferation of CD4(+) T cells and their differentiation into Th17 cells in vitro. Moreover, MDSCs inhibited the production of IFN-γ, IL-2, TNF-α, and IL-6 by CD4(+) T cells in vitro, whereas they promoted the production of IL-10. Adoptive transfer of MDSCs reduced the severity of CIA in vivo, which was accompanied by a decrease in the number of CD4(+) T cells and Th17 cells in the draining lymph nodes. However, depletion of MDSCs abrogated the spontaneous improvement of CIA. In conclusion, MDSCs in CIA suppress the progression of CIA by inhibiting the proinflammatory immune response of CD4(+) T cells. These observations suggest that MDSCs play crucial roles in the regulation of autoimmune arthritis, which could be exploited in new cell-based therapies for human rheumatoid arthritis.
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Affiliation(s)
- Wataru Fujii
- Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
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Caporali R, Bugatti S, Cavagna L, Antivalle M, Atzeni F, Puttini PS. WITHDRAWN: Abatacept as a first-line biological therapy. Autoimmun Rev 2013:S1568-9972(13)00114-6. [PMID: 23806564 DOI: 10.1016/j.autrev.2013.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 01/21/2013] [Indexed: 12/16/2022]
Abstract
The Publisher regrets that this article is an accidental duplication of an article that has already been published, http://dx.doi.org/10.1016/j.autrev.2013.06.008. The duplicate article has therefore been withdrawn.
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Affiliation(s)
- Roberto Caporali
- Division of Rheumatology, University of Pavia, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy.
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Caporali R, Bugatti S, Cavagna L, Antivalle M, Sarzi-Puttini P. Modulating the co-stimulatory signal for T cell activation in rheumatoid arthritis: could it be the first step of the treatment? Autoimmun Rev 2013; 13:49-53. [PMID: 23777823 DOI: 10.1016/j.autrev.2013.06.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Advances in our understanding of the key mediators of chronic inflammation and tissue damage in rheumatoid arthritis (RA) have fostered the development of targeted therapies and greatly expanded the available treatment options. Abatacept, a soluble human fusion protein that selectively modulates the co-stimulatory signal required for full T-cell activation, is approved for the treatment of moderate to severe RA in the United States, Canada, and the European Union. This review summarises the data on efficacy (disease activity, quality of life, prevention of structural damage) and safety from randomised clinical trials of abatacept plus methotrexate in patients with: i) active RA and an inadequate response to methotrexate who are naïve to biological disease-modifying anti-rheumatic drugs; and ii) methotrexate-naïve early RA with poor prognostic factors. Novel imaging outcomes and biological changes induced by abatacept treatment are also briefly reviewed. Optimal use of abatacept as a first-line biological therapy is discussed in light of the current recommendations and guidelines.
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Affiliation(s)
- Roberto Caporali
- Division of Rheumatology, University of Pavia, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy.
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Walker AE, Khanna M, Kinderlerer AR. Imaging in rheumatology. IMAGING 2013. [DOI: 10.1259/imaging.20120008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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Upchurch KS, Kay J. Evolution of treatment for rheumatoid arthritis. Rheumatology (Oxford) 2013; 51 Suppl 6:vi28-36. [PMID: 23221584 DOI: 10.1093/rheumatology/kes278] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Treatment for RA has changed profoundly over the past 25 years, evolving from a strategy of providing symptomatic relief, to implementation of therapeutic regimens that impact disease activity and ultimately have been shown to slow or arrest structural joint damage. Drug therapy for RA has evolved from salicylates, to NSAIDs, CSs, DMARDs, MTX, and finally to biologic response modifiers. MTX has become the initial drug of choice in most patients with RA, and some do well on MTX monotherapy without the addition of other agents. Combination regimens including MTX and other conventional DMARDs may be an effective early approach to treatment of RA. The biologic response modifiers (biologics) became available in the late 1990s, based on our understanding of the molecular mediators of synovial inflammation in RA. The first biologics inhibited TNF-α, a cytokine active in host defences against some infections and malignancies, but which also promotes inflammation and bone erosion. Inhibitors of TNF-α are mostly given with MTX, although some can be given as monotherapy. Studies consistently show that combination MTX + TNF-α inhibitor therapy leads to better outcomes than with either agent alone. Tight control strategies, employing objective measures, also lead to improved outcomes. When patients fail treatment with one or more TNF-α inhibitor + MTX, a number of other possible alternatives may be tried, including treatment with biologics having other mechanisms, such as antibodies to certain ILs, other cytokines and inflammatory mediators. Current therapy for RA is such that progression from symptom onset to significant disability is now no longer inevitable, and RA patients can anticipate comfortable and productive lives on medical therapy.
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Affiliation(s)
- Katherine S Upchurch
- Division of Rheumatology, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01605, USA.
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Peterfy CG, Olech E, DiCarlo JC, Merrill JT, Countryman PJ, Gaylis NB. Monitoring cartilage loss in the hands and wrists in rheumatoid arthritis with magnetic resonance imaging in a multi-center clinical trial: IMPRESS (NCT00425932). Arthritis Res Ther 2013; 15:R44. [PMID: 23514433 PMCID: PMC4060230 DOI: 10.1186/ar4202] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 01/28/2013] [Accepted: 03/20/2013] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Magnetic resonance imaging (MRI) is increasingly being used in clinical trials of rheumatoid arthritis (RA) because of its superiority over x-ray radiography (XR) in detecting and monitoring change in bone erosion, osteitis and synovitis. However, in contrast to XR, the MRI scoring method that was used in most clinical trials did not include cartilage loss. This limitation has been an obstacle to accepting MRI as a potential alternative to XR in clinical trials. Cross-sectional studies have shown MRI to be sensitive for cartilage loss in the hands and wrist; although, longitudinal sensitivity to change has not yet been confirmed. In this study we examined the ability of MRI to monitor change in cartilage loss in patients with RA in a multi-site clinical trial setting. METHODS Thirty-one active RA patients from a clinical trial (IMPRESS) who were randomized equally into treatment with either rituximab + methotrexate or placebo + methotrexate had MRI of the dominant hand/wrist at baseline, 12 weeks and 24 weeks at 3 clinical sites in the US. Twenty-seven of these patients also had XR of both hands/wrists and both feet at baseline and 24 weeks. One radiologist scored all XR images using the van der Heijde-modified Sharp method blinded to visit order. The same radiologist scored MR images for cartilage loss using a previously validated 9-point scale, and bone erosion using the Outcome Measures in Rheumatology Clinical Trials (OMERACT) RA MRI Score (RAMRIS) blinded to visit order and XR scores. Data from the two treatment arms were pooled for this analysis. RESULTS Mean MRI cartilage score increased at 12 and 24 weeks, and reached statistical significance at 24 weeks. XR total Sharp score, XR erosion score and XR joint-space narrowing (JSN) score all increased at 24 weeks, but only XR total Sharp score increased significantly. CONCLUSIONS To our knowledge, this is the first publication of a study demonstrating MRI's ability to monitor cartilage loss in a multi-site clinical trial. Combined with MRI's established performance in monitoring bone erosions in RA, these findings suggest that MRI may offer a superior alternative to XR in multi-site clinical trials of RA.
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Affiliation(s)
| | - Ewa Olech
- Division of Rheumatology, School of Medicine, University of Nevada, 1707 W. Charleston Blvd, Las Vegas, Nevada, 89102, USA
| | - Julie C DiCarlo
- Spire Sciences, Inc., 5314 Boca Marina Cir N, Boca Raton, FL, USA
| | - Joan T Merrill
- Oklahoma Medical Research Foundation, 825 NE 13th St, Oklahoma City, Oklahoma, 73104, USA
| | | | - Norman B Gaylis
- Arthritis & Rheumatic Disease Specialties, 21097 NE 27th Court, Suite 200, Aventura, Florida, 33180, USA
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Weinblatt ME, Schiff M, Valente R, van der Heijde D, Citera G, Zhao C, Maldonado M, Fleischmann R. Head-to-head comparison of subcutaneous abatacept versus adalimumab for rheumatoid arthritis: findings of a phase IIIb, multinational, prospective, randomized study. ACTA ACUST UNITED AC 2013; 65:28-38. [PMID: 23169319 PMCID: PMC3572583 DOI: 10.1002/art.37711] [Citation(s) in RCA: 186] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Accepted: 09/13/2012] [Indexed: 12/29/2022]
Abstract
OBJECTIVE There is a need for comparative studies to provide evidence-based treatment guidance for biologic agents in rheumatoid arthritis (RA). Therefore, this study was undertaken as the first head-to-head comparison of subcutaneous (SC) abatacept and SC adalimumab, both administered along with background methotrexate (MTX), for the treatment of RA. METHODS Patients with active RA who were naive to treatment with biologic agents and had an inadequate response to MTX were randomly assigned to receive 125 mg SC abatacept weekly or 40 mg SC adalimumab biweekly, both given in combination with MTX, in a 2-year study. The primary end point was treatment noninferiority, assessed according to the American College of Rheumatology 20% improvement response (ACR20) at 1 year. RESULTS Of the 646 patients who were randomized and treated, 86.2% receiving SC abatacept and 82% receiving SC adalimumab completed 12 months of treatment. At 1 year, 64.8% of patients in the SC abatacept group and 63.4% in the SC adalimumab group demonstrated an ACR20 response; the estimated difference between groups was 1.8% (95% confidence interval -5.6%, 9.2%), thus demonstrating the noninferiority of abatacept compared to adalimumab. All efficacy measures showed similar results and kinetics of response between treatments. The rate of radiographic nonprogression (defined as a total modified Sharp/van der Heijde score [SHS] less than or equal to the smallest detectable change) was 84.8% for SC abatacept-treated patients and 88.6% for SC adalimumab-treated patients, while the mean change from baseline in the total SHS was 0.58 and 0.38, respectively. In the SC abatacept and SC adalimumab groups, the incidence of serious adverse events (SAEs) was 10.1% and 9.1%, respectively, and the rate of serious infections was 2.2% and 2.7%, respectively. In patients treated with SC abatacept, the frequency of discontinuations due to AEs was 3.5% and discontinuations due to SAEs was 1.3%, while in patients treated with SC adalimumab, the frequencies were 6.1% and 3%, respectively. Injection site reactions occurred in 3.8% of patients receiving SC abatacept compared to 9.1% of patients receiving SC adalimumab (P=0.006). CONCLUSION The results demonstrate that SC abatacept and SC adalimumab have comparable efficacy in patients with RA, as shown by similar kinetics of response and comparable inhibition of radiographic progression over 1 year of treatment. The safety was generally similar, other than the occurrence of significantly more local injection site reactions in patients treated with SC adalimumab.
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Different effects of biological drugs in rheumatoid arthritis. Autoimmun Rev 2013; 12:575-9. [DOI: 10.1016/j.autrev.2012.10.020] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2012] [Indexed: 12/20/2022]
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Venson R, Wiens A, Correr CJ, Pontarolo R. Efficacy, safety and tolerability of using abatacept for the treatment of rheumatoid arthritis. BRAZ J PHARM SCI 2012. [DOI: 10.1590/s1984-82502012000400022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The objective is to provide an update on the clinical efficacy, safety and tolerability of the use of abatacept for treating rheumatoid arthritis. A systematic review (up to June 2011) followed by meta-analyses was performed. Randomized controlled clinical trials comparing abatacept at a dose of 10 mg/kg with a placebo, both with concomitant methotrexate, were used. Only high- or moderate-quality studies were included. The efficacy was evaluated based on changes in the ACR, DAS and HAQ; safety was assessed based on serious adverse events, serious infections, malignancies and deaths; tolerability was evaluated based on the withdrawals due to adverse events, serious adverse events and lack of efficacy. All these parameters were evaluated within one year of treatment. Nine studies met the inclusion criteria, comprising 4,219 patients. For all of the efficacy parameters, the abatacept group had better results than the placebo group, except in the case of HAQ improvement >0.3, which presented no statistically significant difference. None of the safety parameters presented a significant difference between the groups. The tolerability parameters were also similar between groups, with the exception of withdrawals due to lack of efficacy. For this criterion, the abatacept group presented favorably compared to the control group. Abatacept showed a higher efficacy compared to placebo without significant differences between the abatacept and control group in terms of safety.
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Coinhibitory molecules in autoimmune diseases. Clin Dev Immunol 2012; 2012:269756. [PMID: 22997525 PMCID: PMC3446788 DOI: 10.1155/2012/269756] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 08/21/2012] [Indexed: 12/30/2022]
Abstract
Coinhibitory molecules such as CTLA-4, PD-1 and BTLA negatively regulate immune responses. Multiple studies indicate that the deficiency or mutation of coinhibitory molecules leads to the development of autoimmune diseases in mice and humans, indicating that the negative signals from coinhibitory molecules are crucial for the prevention of autoimmunity. In some conditions, the administration of decoy coinhibitory receptors (e.g., CTLA-4 Ig) or mAb against coinhibitory molecules suppresses the responses of self-reactive T cells in autoimmune diseases. Therefore, modulation of coinhibitory signals seems to be an attractive approach to induce tolerance in autoimmune diseases in humans where the disease-inducing self-antigens are not known. Particularly, administration of CTLA-4 Ig has shown great promise in animal models of autoimmune diseases and has been gaining increasing attention in clinical investigation in several autoimmune diseases in humans.
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Banham-Hall E, Clatworthy MR, Okkenhaug K. The Therapeutic Potential for PI3K Inhibitors in Autoimmune Rheumatic Diseases. Open Rheumatol J 2012; 6:245-58. [PMID: 23028409 PMCID: PMC3460535 DOI: 10.2174/1874312901206010245] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Revised: 11/16/2011] [Accepted: 11/20/2011] [Indexed: 12/14/2022] Open
Abstract
The class 1 PI3Ks are lipid kinases with key roles in cell surface receptor-triggered signal transduction pathways. Two isoforms of the catalytic subunits, p110γ and p110δ, are enriched in leucocytes in which they promote activation, cellular growth, proliferation, differentiation and survival through the generation of the second messenger PIP3. Genetic inactivation or pharmaceutical inhibition of these PI3K isoforms in mice result in impaired immune responses and reduced susceptibility to autoimmune and inflammatory conditions. We review the PI3K signal transduction pathways and the effects of inhibition of p110γ and/or p110δ on innate and adaptive immunity. Focusing on rheumatoid arthritis and systemic lupus erythematosus we discuss the preclinical evidence and prospects for small molecule inhibitors of p110γ and/or p110δ in autoimmune disease.
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Affiliation(s)
- Edward Banham-Hall
- Laboratory of Lymphocyte Signalling and Development, The Babraham Institute, Babraham Research Campus, CB22
3AT, UK
| | - Menna R Clatworthy
- Cambridge Institute for Medical Research and the Department of Medicine, University of Cambridge School of Clinical
Medicine, Cambridge CB2 0XY, UK
| | - Klaus Okkenhaug
- Laboratory of Lymphocyte Signalling and Development, The Babraham Institute, Babraham Research Campus, CB22
3AT, UK
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Westhovens R, Verschueren P. The efficacy and safety of abatacept in rheumatoid arthritis. Ther Adv Musculoskelet Dis 2012; 2:89-94. [PMID: 22870440 DOI: 10.1177/1759720x09360429] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Despite important progress in the treatment of rheumatoid arthritis in the last decade, even in the era of tumour necrosis factor (TNF) blockade there is a need for additional therapeutic options in many patients. In recent years three therapies with a distinct mode of action became available: rituximab, an anti-B cell therapy, tocilizumab, an anti IL-6 therapy, and abatacept, a costimulation blocker. Primary efficacy results of all three therapies are comparable at 6 months, nevertheless they have distinct efficacy and safety profiles. In the current review we focus on specific aspects of efficacy and safety of abatacept: increasing clinical and X-ray improvements over time, important and stable responses over several years, timing of response, improvements in patient-centered outcomes, and also long-term safety and easy administration with low rates of perfusion reactions. Currently, head to head comparisons between biologics are still lacking and registry data of drugs with a mode of action different to TNF blockade are still rare. In the meantime detailed analysis of all trials with a drug such as abatacept provides important information for the practicing rheumatologist.
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Affiliation(s)
- Rene Westhovens
- Division of Rheumatology, Department of Musculoskeletal Sciences, UZ Kuleuven, Herestraat 49, B-3000 Leuven, Belgium
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