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Goupille P, Carvajal Alegria G, Verhoeven F, Wendling D. Treatment with Targeted Therapy in Patients with Psoriatic Arthritis and Inadequate Response to Methotrexate: Proposal for a Rational Strategy. Rheumatol Ther 2024; 11:1065-1079. [PMID: 39134832 PMCID: PMC11422401 DOI: 10.1007/s40744-024-00704-y] [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: 06/05/2024] [Accepted: 07/18/2024] [Indexed: 09/25/2024] Open
Abstract
INTRODUCTION The therapeutic arsenal for psoriatic arthritis (PsA) is gradually being expanded, but the use of these targeted treatments must be optimal. Our objective was to guide the choice of targeted therapy to use as first-line treatment in a patient with PsA in whom methotrexate (MTX) has failed. METHODS We searched for literature data in PubMed with the appropriate keywords for the six points of our argument: (1) the tolerance of MTX; (2) the efficacy of targeted therapies combined with MTX vs monotherapy; (3) immunogenicity of anti-tumor necrosis alpha (TNFα) monoclonal antibodies (mAbs); (4) immunogenicity of anti-interleukin (IL)-17, anti-IL-12/23, and anti-IL-23 mAbs; (5) the therapeutic maintenance of anti-TNFα mAbs when combined or not with MTX; (6) the therapeutic maintenance of anti-IL-17 vs anti-TNFα mAbs as first-line targeted therapy. RESULTS The proposed rational strategy is as follows: in case of initiation of an anti-TNFα agent, maintaining treatment with MTX seems preferable, even in the absence of evidence of the superior efficacy of the combination, to avoid immunization and reduced therapeutic maintenance; in case of initiation of anti-IL-17, anti-IL-12/23, anti-IL-23 agents, or Janus kinase (JAK) inhibitors, again in the absence of evidence of the superior efficacy of the combination, discontinuing MTX therapy may be possible, at least in two steps, after verifying the efficacy of the targeted therapy initiated on the joints and skin. CONCLUSION We have data from the literature to guide the choice of targeted therapy to use as first-line treatment in a patient with PsA in whom MTX has failed.
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Affiliation(s)
- Philippe Goupille
- Rheumatology Department, CHU de Tours, UPR CNRS 4301 CBM, NMNS, University of Tours, 37044, Tours Cedex 9, France.
| | - Guillermo Carvajal Alegria
- Rheumatology Department, CHU de Tours, UPR CNRS 4301 CBM, NMNS, University of Tours, 37044, Tours Cedex 9, France
| | - Frank Verhoeven
- Rheumatology Department, CHU de Besançon, University of Franche-Comté, Besançon, France
| | - Daniel Wendling
- Rheumatology Department, CHU de Besançon, University of Franche-Comté, Besançon, France
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Freites-Nuñez D, Leon L, Toledano E, Candelas G, Martinez C, Rodriguez-Laguna M, Rubio D, Fernandez-Gutierrez B, Abasolo L. Switching related to inefficacy in biologics and targeted synthetic therapies for psoriatic arthritis: a comparative real-life study. Ther Adv Musculoskelet Dis 2024; 16:1759720X241273083. [PMID: 39219744 PMCID: PMC11366104 DOI: 10.1177/1759720x241273083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 07/12/2024] [Indexed: 09/04/2024] Open
Abstract
Background Switching between therapies is a recommended strategy for psoriatic arthritis (PsA) patients who experience treatment failure; however, studies including real-life data are scarce. Objectives To assess the incidence rate (IR) of switching between biologics and targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs) due to inefficacy in PsA, and to compare the risk of switching due to inefficacy across different b/tsDMARDs groups. Design A longitudinal retrospective study, spanning from 2007 to 2022, was conducted on patients with PsA treated with b/tsDMARDs at an outpatient rheumatology clinic. Methods The primary outcome was switching between b/tsDMARDs due to inefficacy. The independent variable was the exposure to b/tsDMARDs during follow-up. As covariates, clinical, treatment-related, and sociodemographic variables were considered. Survival techniques were run to estimate the IR of switching due to inefficacy per 100 patients*year and confidence interval at 95% (95% CI). Cox multivariate regression analyses were run to assess the risk of b/tsDMARDs switching due to inefficacy, expressed as hazard ratio (HR) and 95% CI. Results In all, 141 patients were included, with 893.09 patients*year follow-ups. 52.48% of them were females in their fifties. In total, 262 courses of treatment were recorded. During the study period, 56 patients presented 121 switches and 103 related to inefficacy (IR: 11.53 (9.51-13.98)). Tumor necrosis factor-alpha inhibitors (TNFi) showed the lowest IR. In the bivariate analysis, all b/tsDMARDs had more risk of switching compared to TNFi (HR: anti-lL-17 vs TNFi: 2.26 (1.17-4.36); others vs TNFi: 3.21 (1.59-6.45)); however, this statistical significance was no longer present in the multivariate analysis once adjustments were made for the covariates. Still, the final model achieved statistical significance in the following variables: gender, clinical symptoms, prescription year, therapy courses, glucocorticoids, and sulfasalazine. Conclusion In this study, we did not find differences in the rate of switching due to inefficacy among different groups of b/tsDMARDs. Other concomitant treatments, sociodemographic, and clinical variables were identified as risk factors for switching due to inefficacy.
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Affiliation(s)
| | - Leticia Leon
- Leon Musculoskeletal Pathology Group, Rheumatology Department, IdISSC, Hospital Clínico San Carlos, Madrid, Spain
- Faculty of Health Sciences - HM Hospitals, University Camilo José Cela, Calle Martín Lagos, s/n. Madrid 28040, Spain
| | - Esther Toledano
- Rheumatology Department, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Gloria Candelas
- Rheumatology Department, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Cristina Martinez
- Rheumatology Department, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | | | - Daniel Rubio
- Medicine Department, Universidad Complutense de Madrid, Madrid, Spain
| | - Benjamin Fernandez-Gutierrez
- Medicine Department, Universidad Complutense de Madrid, Madrid, Spain
- Musculoskeletal Pathology Group, Rheumatology Department, IdISSC, Hospital Clínico San Carlos, Madrid, Spain
| | - Lydia Abasolo
- Musculoskeletal Pathology Group, Rheumatology Department, IdISSC, Hospital Clínico San Carlos, Madrid, Spain
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Alkaabi MMS, Rabbani SA, Rao PGM, Mohamedelhassan MI. Treatment patterns and factors associated with discontinuation of monoclonal antibodies. SAGE Open Med 2024; 12:20503121241271817. [PMID: 39165864 PMCID: PMC11334246 DOI: 10.1177/20503121241271817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 07/03/2024] [Indexed: 08/22/2024] Open
Abstract
Background Biological agents have revolutionized care in specialties such as oncology, immunology, infectious diseases, and genetic disorders, offering targeted actions on specific molecules or select immune cells. Monoclonal antibodies, known for their high specificity and precision, represent one of the most significant and rapidly expanding categories of these agents. Understanding the drug utilization patterns of monoclonal antibodies is crucial to ensure their optimal use, especially given their high cost and potential adverse effects. Methods This analytical cross-sectional study was conducted in a secondary hospital in the United Arab Emirates. Patients of either gender receiving monoclonal antibodies at the study site were included. Treatment patterns, utilization, and factors associated with the discontinuation of monoclonal antibodies were assessed. Results Hyperlipidemia (136, 39.1%) was the most common indication for monoclonal antibodies, followed by prophylaxis of respiratory syncytial virus infection in congenital heart disease (104, 29.9%) and osteoporosis (42, 12.1%). Evolocumab was the most commonly prescribed monoclonal antibody (135, 38.8%), followed by palivizumab (104, 29.9%), and dupilumab (38, 10.9%). The majority of monoclonal antibodies demonstrated a prescribed daily dose to defined daily dose ratio of 1.0, reflecting their appropriate utilization. One hundred twenty-nine patients (37.0%) discontinued their treatment during the study. Patient's level of education (OR: 0.416, 95% CI: 0.183-0.943, p = 0.036), BMI (OR: 2.358, 95% CI: 1.164-4.777, p = 0.017), number of concomitant medications (OR: 2.457, 95% CI: 1.202-5.025, p = 0.014), and treatment duration (OR: 9.180, 95% CI: 4.909-17.165, p < 0.001) were identified as predictors of discontinuation of monoclonal antibodies. Conclusion This study represents the first comprehensive investigation in the United Arab Emirates focused on treatment patterns, utilization, and discontinuation of monoclonal antibodies among the local population. Monoclonal antibodies were prescribed for the management of a wide range of clinical conditions. The study reports appropriate utilization of most monoclonal antibodies and identifies factors such as patient education level, BMI, concomitant medications, and treatment duration as independent predictors of monoclonal antibody treatment discontinuation.
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Affiliation(s)
- Muzoon Matar Saleh Alkaabi
- Department of Clinical Pharmacy and Pharmacology, RAK College of Pharmacy, RAK Medical and Health Sciences University, Ras Al Khaimah, UAE
| | - Syed Arman Rabbani
- Department of Clinical Pharmacy and Pharmacology, RAK College of Pharmacy, RAK Medical and Health Sciences University, Ras Al Khaimah, UAE
| | - Padma GM Rao
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, MAHE, Manipal, Karnataka, India
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Parisi S, Andrea B, Chiara DM, Alberto LG, Maddalena L, Palma S, Olga A, Massimo R, Marino P, Rosalba C, Elisa V, Rosario F, Giorgio A, Francesco DL, Ylenia DB, Roberta F, Antonella F, Francesco G, Simone B, Dario C, Gerolamo B, Matteo C, Romina A, Natalia M, Giulio F, Patrizia DM, Aldo MC, Veronica F, Francesco MC, Federica L, Gilda S, Carlo S, Marta P, Aurora I, Valeria N, Daniele S, Gianluca L, Adorni G, Eleonora DD, Elena B, Ilaria P, Eugenio A, Alessandra B, Cristina FM, Fabio M, Vincenzo B, Viviana R, Alessia F, Guido R, Rosetta V, Antonio M, Alessandro V, Francesca O, Alarico A, Enrico F. Analysis of survival rate and persistence predictors of baricitinib in real-world data from a large cohort of rheumatoid arthritis patients. CURRENT RESEARCH IN PHARMACOLOGY AND DRUG DISCOVERY 2024; 6:100178. [PMID: 38419949 PMCID: PMC10899020 DOI: 10.1016/j.crphar.2024.100178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/23/2024] [Accepted: 02/12/2024] [Indexed: 03/02/2024] Open
Abstract
Objectives The persistence in therapy of rheumatoid arthritis drugs and particularly bDMARD is a limiting factor for their long-term use. The randomized controlled trials (RCTs) may not reflect real-world contexts due to strict inclusion and exclusion criteria. Baricitinib, which targets both JAK1 and JAK2, has been used in Italy for several years. The aim of this multi-center study is to assess the real world persistence on therapy of baricitinib in RA patients and to identify predictive factors of baricitinib's survival rate. Methods This is a retrospective, multicentric, Italian, longitudinal study. All patients were enrolled according to the following criteria: a) age ≥ 18 years old; b) diagnosed with RA according 2010 ACR/EULAR classification criteria; c) treated with baricitinib. In order to describe baricitinib clinical efficacy, the survival rate was evaluated by The Kaplan-Meier curve. Then, predictive factors of drug retention rate were assessed by performing the Cox analysis, identifying which risk factors influenced treatment persistence. Results Overall, we included 478 patients treated with baricitinib. Among them, 380 (79.5%) were females. Baricitinib's survival rate was 94.6% at 6 months, 87.9% at 12 months, 81.7% at 24 months and 53.4% at 48 months. The Cox analysis regression showed that a higher bDMARDs/tsDMARD line of therapy seems to be a negative prognostic factor for the drug retention rate (HR 1.26 CI 95% 1.07-1.49, p = 0.006. Conclusion Real-life study confirms baricitinib effectiveness up to 4 years, but previous treatment with bDMARDs was a negative prognostic factor for its survival rate.
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Affiliation(s)
- Simone Parisi
- Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Rheumatology Unit, Turin, Italy
| | - Becciolini Andrea
- Azienda Ospedaliero-Universitaria di Parma, Department of Medicine, Internal Medicine and Rheumatology Unit, Parma, Italy
| | - Ditto Maria Chiara
- Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Rheumatology Unit, Turin, Italy
| | - Lo Gullo Alberto
- Azienda Ospedaliera di Rilievo Nazionale e di Alta Specializzazione Garibaldi Ospedale Garibaldi-Nesima, Rheumatology Unit, Catania, Italy
| | - Larosa Maddalena
- Azienda Sanitaria Locale 3 Genovese, Division of Rheumatology - Medical Specialties Department, Genoa, Italy
| | - Scolieri Palma
- Ospedale Nuovo Regina Margherita, Internal Medicine and Rheumatology Unit, Rome, Italy
| | - Addimanda Olga
- IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola, Department of Internal Medicine-Rheumatology, Bologna, Italy
| | - Reta Massimo
- IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola, Department of Internal Medicine-Rheumatology, Bologna, Italy
| | - Paroli Marino
- University of Rome La Sapienza, Department of Clinical, Anesthesiological and Cardiovascular Sciences, Polo Pontino, Latina, Italy
| | - Caccavale Rosalba
- University of Rome La Sapienza, Department of Clinical, Anesthesiological and Cardiovascular Sciences, Polo Pontino, Latina, Italy
| | - Visalli Elisa
- Azienda Ospedaliero Universitaria Policlinico Vittorio Emanuele Catania, Division of Rheumatology, A.O.U. "Policlinico San Marco", Catania, Italy
| | - Foti Rosario
- Azienda Ospedaliero Universitaria Policlinico Vittorio Emanuele Catania, Division of Rheumatology, A.O.U. "Policlinico San Marco", Catania, Italy
| | - Amato Giorgio
- Azienda Ospedaliero Universitaria Policlinico Vittorio Emanuele Catania, Division of Rheumatology, A.O.U. "Policlinico San Marco", Catania, Italy
| | - De Lucia Francesco
- Azienda Ospedaliero Universitaria Policlinico Vittorio Emanuele Catania, Division of Rheumatology, A.O.U. "Policlinico San Marco", Catania, Italy
| | - Dal Bosco Ylenia
- Azienda Ospedaliero Universitaria Policlinico Vittorio Emanuele Catania, Division of Rheumatology, A.O.U. "Policlinico San Marco", Catania, Italy
| | - Foti Roberta
- Azienda Ospedaliero Universitaria Policlinico Vittorio Emanuele Catania, Division of Rheumatology, A.O.U. "Policlinico San Marco", Catania, Italy
| | - Farina Antonella
- ASUR Area Vasta 4 Fermo, Ospedale A Murri, Internal Medicine Unit, Rheumatology outpatient clinic, Fermo, Italy
| | | | - Bernardi Simone
- Morgagni-Pierantoni Hospital, Rheumatology Unit, Forlì, Italy
| | - Camellino Dario
- Azienda Sanitaria Locale 3 Genovese, Division of Rheumatology - Medical Specialties Department, Genoa, Italy
| | - Bianchi Gerolamo
- Azienda Sanitaria Locale 3 Genovese, Division of Rheumatology - Medical Specialties Department, Genoa, Italy
| | - Colina Matteo
- Azienda USL di Imola, Department of Internal Medicine and Oncology. Service of Rheumatology, Imola, Italy
- University of Bologna, Department of Biomedical and Neuromotor Sciences, Imola, Italy
| | - Andracco Romina
- Hospital Santa Corona Pietra Ligure, Internal Medicine Unit, Rheumatology outpatient clinic, Unit of Diagnostic and Interventional Radiology, Pietra Ligure, Italy
| | - Mansueto Natalia
- Hospital Santa Corona Pietra Ligure, Internal Medicine Unit, Rheumatology outpatient clinic, Unit of Diagnostic and Interventional Radiology, Pietra Ligure, Italy
| | - Ferrero Giulio
- Hospital Santa Corona Pietra Ligure, Internal Medicine Unit, Rheumatology outpatient clinic, Unit of Diagnostic and Interventional Radiology, Pietra Ligure, Italy
| | - Del Medico Patrizia
- Civitanova Marche Hospital, Rheumatology outpatient clinic, Internal Medicine Unit, Civitanova Marche, Italy
| | | | | | | | | | - Sandri Gilda
- University of Modena and Reggio Emilia, Rheumatology Unit, Modena and Reggio Emilia, Italy
| | - Salvarani Carlo
- University of Modena and Reggio Emilia, Rheumatology Unit, Modena and Reggio Emilia, Italy
| | - Priora Marta
- ASL 15 Cuneo, Rheumatology Day Hospital and outpatient clinic, Mondovì, Italy
| | | | - Nucera Valeria
- ASL 13 Novara, Rheumatology Outpatient Unit, Novara, Italy
| | - Santilli Daniele
- Azienda Ospedaliero-Universitaria di Parma, Department of Medicine, Internal Medicine and Rheumatology Unit, Parma, Italy
| | - Lucchini Gianluca
- Azienda Ospedaliero-Universitaria di Parma, Department of Medicine, Internal Medicine and Rheumatology Unit, Parma, Italy
| | - Giuditta Adorni
- Azienda Ospedaliero-Universitaria di Parma, Department of Medicine, Internal Medicine and Rheumatology Unit, Parma, Italy
| | - Di Donato Eleonora
- Azienda Ospedaliero-Universitaria di Parma, Department of Medicine, Internal Medicine and Rheumatology Unit, Parma, Italy
| | - Bravi Elena
- Guglielmo da Saliceto Hospital, Department of Medicine, Internal Medicine and Rheumatology Unit, Piacenza, Italy
| | - Platè Ilaria
- Guglielmo da Saliceto Hospital, Department of Medicine, Internal Medicine and Rheumatology Unit, Piacenza, Italy
| | - Arrigoni Eugenio
- Guglielmo da Saliceto Hospital, Department of Medicine, Internal Medicine and Rheumatology Unit, Piacenza, Italy
| | - Bezzi Alessandra
- ASL 13 Rimini, Internal Medicine and Rheumatology Unit, Rimini, Italy
| | | | - Mascella Fabio
- ASL 13 Rimini, Internal Medicine and Rheumatology Unit, Rimini, Italy
| | - Bruzzese Vincenzo
- Ospedale Nuovo Regina Margherita, Internal Medicine and Rheumatology Unit, Rome, Italy
| | | | | | - Rovera Guido
- PO S Andrea di Vercelli, Unit of Rheumatology, Vercelli, Italy
| | - Vitetta Rosetta
- PO S Andrea di Vercelli, Unit of Rheumatology, Vercelli, Italy
| | - Marchetta Antonio
- IRCCS Ospedale Sacro Cuore Don Calabria, Rheumatology Unit, Negrar, Italy
| | - Volpe Alessandro
- IRCCS Ospedale Sacro Cuore Don Calabria, Rheumatology Unit, Negrar, Italy
| | - Ometto Francesca
- Azienda ULSS 6 Euganea, Rheumatology Outpatient Clinic, Padova, Italy
| | - Ariani Alarico
- Azienda Ospedaliero-Universitaria di Parma, Department of Medicine, Internal Medicine and Rheumatology Unit, Parma, Italy
| | - Fusaro Enrico
- Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Rheumatology Unit, Turin, Italy
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Exposito L, Sánchez-Piedra C, Vela-Casasempere P, Moreno-Ramos MJ, Campos C, Bohorquez C, Manero J, Calvo-Gutiérrez J, Rodríguez-Lozano C, Ruiz-Montesino D, Busquets N, García-González J, Castrejón I, Alonso F, Bustabad S, Díaz-González F. Real-world persistence of initial targeted therapy strategy in monotherapy versus combination therapy in patients with chronic inflammatory arthritis. Eur J Clin Invest 2024; 54:e14095. [PMID: 37715584 DOI: 10.1111/eci.14095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/15/2023] [Accepted: 09/07/2023] [Indexed: 09/17/2023]
Abstract
OBJECTIVE The persistence of biologic (b) and targeted synthetic (ts) disease-modifying antirheumatic drugs(DMARDs) in monotherapy versus in combination with conventional synthetic (cs) DMARDs is still a controversial topic in rheumatic diseases. To clarify this issue, the retention of the initial treatment strategy of b/tsDMARD in combination with csDMARD versus monotherapy in rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS) patients under real-life conditions was evaluated. Factors associated with maintenance of the initial strategy were analysed. METHODS Nested cohort study within the Spanish BIOBADASER III registry. Bivariate comparisons and multivariate Cox proportional hazards models were used for the analyses. RESULTS A total of 2521 patients were included in the study. In the multivariate model, the initial strategy of combination therapy was associated with shorter persistence in patients with RA (hazard ratio [HR] 1.58;95% confidence interval [CI] 1.00-2.50; p = .049), PsA (HR 2.48; 95% CI 1.65-3.72) and AS (HR 16.77; 95% CI 7.37-38.16; p < .001), regardless of sex, time of disease progression, baseline disease activity, glucocorticoid use or type of b/tsDMARD. Overall, the combination strategy was associated with an increased incidence of adverse events (incidence rate ratio [IRR] 1.13; 95% CI 1.05-1.21). CONCLUSIONS In this real-life study, the strategy of combining a b/tsDMARD with a csDMARD is associated with lower persistence and worse safety profile compared to monotherapy in RA and especially in PsA and AS, suggesting that combination therapy should be rethought as first choice in RA patients, but especially in PsA and AS patients.
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Affiliation(s)
- Lorena Exposito
- Rheumatology Unit, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Carlos Sánchez-Piedra
- Health Technology Assessment Agency (AETS), Instituto de Salud Carlos III, Madrid, Spain
| | | | | | - Cristina Campos
- Rheumatology Unit, Hospital General Universitario de Valencia, Valencia, Spain
| | - Cristina Bohorquez
- Rheumatology Unit, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Javier Manero
- Rheumatology Unit, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | | | | | - Noemí Busquets
- Rheumatology Unit, Hospital de Granollers, Barcelona, Spain
| | | | - Isabel Castrejón
- Rheumatology Unit, Hospital General Universitario Gregorio Marañón, Spain
| | - Fernando Alonso
- Research Unit, Spanish Society of Rheumatology, Madrid, Spain
| | - Sagrario Bustabad
- Rheumatology Unit, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Federico Díaz-González
- Rheumatology Unit, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
- Department of Internal Medicine, Dermatology and Psychiatry, Universidad de La Laguna, Santa Cruz de Tenerife, Spain
- Instituto Universitario de Tecnologías Biomédicas (ITB), Universidad de La Laguna, Santa Cruz de Tenerife, Spain
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Bredemeier M, Duarte ÂL, Pinheiro MM, Kahlow BS, Macieira JC, Ranza R, Miranda JR, Valim V, de Castro GR, Bértolo MB, Sauma MF, Fernandes V, Ribeiro AC, Teodoro RB, Brenol CV, Carvalho HM, Studart SA, Pinheiro GR, da Rocha LF, de Lima HD, Pereira IA, Gazzeta MO, Kakehasi AM, Louzada P, Hayata AL, Lupo CM, da Silveira IG, Kowalski SC, Titton DC, Chakr RM, Ranzolin A, Xavier RM, Laurindo IM. The effect of antimalarials on the safety and persistence of treatment with biologic agents or Janus kinase inhibitors in rheumatoid arthritis. Rheumatology (Oxford) 2024; 63:456-465. [PMID: 37216912 DOI: 10.1093/rheumatology/kead232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 04/27/2023] [Accepted: 05/10/2023] [Indexed: 05/24/2023] Open
Abstract
OBJECTIVES To test the association of use of antimalarials with the overall safety of treatment in RA patients receiving one or multiple courses of biologic (b)DMARDs or a Janus kinase inhibitor (JAKi). METHODS BiobadaBrasil is a multicentric registry-based cohort study of Brazilian patients with rheumatic diseases starting their first bDMARD or JAKi. The present analysis includes RA patients recruited from January 2009 to October 2019, followed up over one or multiple (up to six) courses of treatment (latest date, 19 November 2019). The primary outcome was the incidence of serious adverse events (SAEs). Total and system-specific adverse events (AEs) and treatment interruption served as secondary outcomes. Negative binomial regression with generalized estimating equations (to estimate multivariate incidence rate ratios, mIRR) and frailty Cox proportional hazards models were used for statistical analyses. RESULTS The number of patients enrolled was 1316 (2335 treatment courses, 6711 patient-years [PY]; 1254.5 PY on antimalarials). The overall incidence of SAEs was 9.2/100 PY. Antimalarials were associated with reduced risk of SAEs (mIRR: 0.49; 95% CI: 0.36, 0.68; P < 0.001), total AEs (0.68; 95% CI: 0.56, 0.81; P < 0.001), serious infections (0.53; 95% CI: 0.34, 0.84; P = 0.007) and total hepatic AEs (0.21; 95% CI: 0.05, 0.85; P = 0.028). Antimalarials were also related to better survival of treatment course (P = 0.003). There was no significant increase in the risk of cardiovascular AEs. CONCLUSION Among RA patients on treatment with bDMARDs or JAKi, concomitant use of antimalarials was associated with reduced the incidence of serious and total AEs and with longer treatment course survival.
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Affiliation(s)
- Markus Bredemeier
- Hospital Nossa Senhora da Conceição, Grupo Hospitalar Conceição, Porto Alegre, RS, Brazil
| | - Ângela L Duarte
- Hospital das Clinicas da Universidade Federal de Pernambuco, Recife, PE, Brazil
| | - Marcelo M Pinheiro
- Universidade Federal de São Paulo/Escola Paulista de Medicina, São Paulo, SP, Brazil
| | - Bárbara S Kahlow
- Hospital Universitário Evangélico Mackenzie, Curitiba, PR, Brazil
| | - José C Macieira
- Hospital Universitário da Universidade Federal de Sergipe, Aracajú, SE, Brazil
| | - Roberto Ranza
- Hospital das Clínicas da Universidade Federal de Uberlândia, Uberlândia, MG, Brazil
| | | | - Valéria Valim
- Hospital Universitário Cassiano Antônio de Moraes, Universidade Federal do Espírito Santo, Vitória, ES, Brazil
| | | | - Manoel B Bértolo
- Hospital das Clínicas da Universidade Estadual de Campinas, Campinas, SP, Brazil
| | | | | | - Ana C Ribeiro
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Reginaldo B Teodoro
- Hospital de Clínicas da Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brazil
| | - Claiton V Brenol
- Universidade Federal do Rio Grande do Sul/Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | | | | | - Geraldo R Pinheiro
- Universidade Estadual do Rio de Janeiro/Hospital Universitário Pedro Ernesto, Rio de Janeiro, RJ, Brazil
| | - Laurindo F da Rocha
- Instituto de Medicina Integral Professor Fernando Figueira, Recife, PE, Brazil
| | - Hugo D de Lima
- Instituto de Medicina Integral Professor Fernando Figueira, Recife, PE, Brazil
| | - Ivânio A Pereira
- Hospital Universitário da Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Morgana O Gazzeta
- Santa Casa de Misericórdia do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Adriana M Kakehasi
- Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Paulo Louzada
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | | | - Cristiano M Lupo
- Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brazil
| | - Inês G da Silveira
- Faculdade de Medicina da Pontifícia Universidade Católica do Rio Grande do Sul/Hospital São Lucas, Porto Alegre, RS, Brazil
| | - Sergio C Kowalski
- Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, PR, Brazil
| | - David C Titton
- Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, PR, Brazil
| | - Rafael M Chakr
- Universidade Federal do Rio Grande do Sul/Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Aline Ranzolin
- Hospital das Clinicas da Universidade Federal de Pernambuco, Recife, PE, Brazil
| | - Ricardo M Xavier
- Universidade Federal do Rio Grande do Sul/Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Ieda M Laurindo
- Faculdade de Medicina da Universidade Nove de Julho, São Paulo, SP, Brazil
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7
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Edwards CJ, Mount J, Meeks A, Gulati T, Zaremba-Pechmann L, Sheesh M, Larsson E, Dennison E. Characteristics of patients initiating treatment with baricitinib and outcomes at follow-up: analysis of BSRBR-RA Registry data. Rheumatology (Oxford) 2023; 62:3400-3408. [PMID: 36825824 PMCID: PMC10547529 DOI: 10.1093/rheumatology/kead074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/17/2023] [Accepted: 02/05/2023] [Indexed: 02/25/2023] Open
Abstract
OBJECTIVES To describe selected baseline characteristics, continuation with baricitinib and disease activity over time in patients initiating treatment with baricitinib in a UK real-world rheumatology setting. METHODS Baseline and follow-up data were analysed from baricitinib-treated patients newly recruited to the British Society for Rheumatology Biologics Registry-RA (BSRBR-RA) baricitinib cohort between 1 January 2018 and 31 March 2020. The primary objective was to evaluate continuation of baricitinib treatment in patients with at least one follow-up. Analyses were performed using the full baricitinib cohort, overall and by patient subgroup: biologic DMARD (bDMARD)/targeted synthetic (ts)DMARD-naive vs -experienced, baricitinib 4 vs 2 mg, age ≥65 vs <65 years, monotherapy vs combination therapy and male vs female. RESULTS At baseline, the study cohort (n = 561) was 76.5% female, mean age 60.0 years, had longstanding (mean 13.1 years) and severe RA, and 54.0% had previously received a bDMARD/tsDMARD. Of 265 and 110 patients completing the 6- and 12-month follow-ups with available data, 77.7 and 69.1% remained on baricitinib at each time, respectively. In all Kaplan-Meier analyses, >60% of patients remained on baricitinib at 540 days. Continuation of baricitinib therapy differed between some subgroup pairs (bDMARD/tsDMARD naive/experienced, baricitinib 2 mg/4 mg). Disease activity was lower at both follow-ups than at baseline, overall and in all subgroups. CONCLUSION In the early years of real-world baricitinib use in the UK, a high proportion of patients continued with treatment at both 6 and 12 months, at which times disease activity was lower than at baseline.
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Affiliation(s)
- Christopher J Edwards
- NIHR Southampton Clinical Research Facility, University Hospital Southampton, Southampton, UK
| | - Julie Mount
- Eli Lilly and Company Limited, Basingstoke, Hampshire, UK
| | | | - Tania Gulati
- Eli Lilly and Company (India) Pvt. Ltd, Gurgaon, Haryana, India
| | | | - Mohamed Sheesh
- Eli Lilly and Company Limited, Basingstoke, Hampshire, UK
| | | | - Elaine Dennison
- Faculty of Medicine, University of Southampton, Southampton, UK
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8
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Movahedi M, Choquette D, Coupal L, Cesta A, Li X, Keystone EC, Bombardier C, Investigators O. Discontinuation of tofacitinib and TNF inhibitors in patients with rheumatoid arthritis: analysis of pooled data from two registries in Canada. BMJ Open 2023; 13:e063198. [PMID: 36878650 PMCID: PMC9990670 DOI: 10.1136/bmjopen-2022-063198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 02/05/2023] [Indexed: 03/08/2023] Open
Abstract
OBJECTIVES The similarity in retention of tumour necrosis factor inhibitors (TNFi) and tofacitinib (TOFA) was previously reported separately by the Ontario Best Practices Research Initiative and the Quebec cohort Rhumadata. However, because of small sample sizes in each registry, we aimed to confirm the findings by repeating the analysis of discontinuation of TNFi compared with TOFA, using pooled data from both these registries. DESIGN Retrospective cohort study. SETTING Pooled data from two rheumatoid arthritis (RA) registries in Canada. PARTICIPANTS Patients with RA starting TOFA or TNFi between June 2014 and December 2019 were included. A total of 1318 patients were included TNFi (n=825) or TOFA (n=493). OUTCOME MEASURES Time to discontinuation was assessed using Kaplan-Meier survival and Cox proportional hazards regression analysis. Propensity score (PS) stratification (deciles) and PS weighting were used to estimate treatment effects. RESULTS The mean disease duration in the TNFi group was shorter (8.9 years vs 13 years, p<0.001). Prior biological use (33.9% vs 66.9%, p<0.001) and clinical disease activity index (20.0 vs 22.1, p=0.02) were lower in the TNFi group.Discontinuation was reported in 309 (37.5%) and 181 (36.7%) TNFi and TOFA patients, respectively. After covariate adjustment using PS, there was no statistically significant difference between the two groups in discontinuation due to any reason HR=0.96 (95% CI 0.78 to 1.19, p=0.74)) as well as discontinuation due to ineffectiveness only HR=1.08 (95% CI 0.81 to 1.43, p=0.61)).TNFi users were less likely to discontinue due to adverse events (AEs) (adjusted HRs: 0.46, 95% CI 0.29 to 0.74; p=0.001). Results remained consistent for firstline users. CONCLUSIONS In this pooled real-world data study, the discontinuation rates overall were similar. However, discontinuation due to AEs was higher in TOFA compared with TNFi users.
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Affiliation(s)
- Mohammad Movahedi
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
- IHMPE, Univeristy of Toronto, Toronto, Ontario, Canada
| | - Denis Choquette
- Department of Rheumatology, Institut de Rhumatologie de Montréal, Montreal, Québec, Canada
| | - Louis Coupal
- Department of Rheumatology, Institut de Rhumatologie de Montréal, Montreal, Québec, Canada
| | - Angela Cesta
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Xiuying Li
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Edward C Keystone
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Claire Bombardier
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
- IHMPE, Univeristy of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Obri Investigators
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
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9
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Terabe K, Takahashi N, Asai S, Hirano Y, Kanayama Y, Yabe Y, Oguchi T, Fujibayashi T, Ishikawa H, Hanabayashi M, Hattori Y, Suzuki M, Kishimoto K, Ohashi Y, Imaizumi T, Imagama S, Kojima T. Effectiveness of tacrolimus concomitant with biological disease-modifying antirheumatic drugs in patients with rheumatoid arthritis. Mod Rheumatol 2023; 33:292-301. [PMID: 35289372 DOI: 10.1093/mr/roac025] [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: 11/09/2021] [Revised: 01/22/2022] [Accepted: 02/09/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVES The study aimed to investigate the effectiveness and tolerance of biological disease-modifying antirheumatic drugs (bDMARDs) therapy administered concomitantly with tacrolimus (TAC) treatment in patients with rheumatoid arthritis. METHODS 2792 patients who underwent therapy with five bDMARDs (etanercept: ETN, adalimumab, golimumab, tocilizumab, and abatacept: ABT) were enrolled. Among the study subjects, 1582 were concomitant methotrexate (MTX group), 147 were concomitant TAC (TAC group), and 1063 were non-concomitant MTX and TAC (non-MTX/TAC group). The primary outcome was the incident rate of discontinuation of bDMARDs by adverse events (AEs) or loss of efficacy. RESULTS Concerning the analysis for each reasons of discontinuation, including AEs and loss of efficacy, the hazards ratio (HR) was significantly lower in the TAC group than in non-MTX/TAC groups (AEs: HR = 0.39, 95% confidence interval, 0.23-0.68, loss of efficacy: HR = 0.49, 95% confidence interval, 0.30-0.78). The loss of efficacy with the use of ETN and ABT was lower in the TAC group than in non-MTX/TAC groups. Concomitant TAC did not induce elevated risk for discontinuation of AEs in all bDMARD analyses. CONCLUSIONS Concomitant TAC with ABT or ETN showed higher retention rates than bDMARDs therapy without TAC or MTX. AEs did not increase over long-term observation.
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Affiliation(s)
- Kenya Terabe
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nobunori Takahashi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shuji Asai
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuji Hirano
- Department of Rheumatology, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Yasuhide Kanayama
- Department of Orthopedic Surgery, Toyota Kosei Hospital, Toyota, Japan
| | - Yuichiro Yabe
- Department of Rheumatology, Tokyo Shinjuku Medical Center, Tokyo, Japan
| | - Takeshi Oguchi
- Department of Orthopedic Surgery, Anjo Kosei Hospital, Anjo, Japan
| | | | - Hisato Ishikawa
- Department of Orthopedic Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan
| | - Masahiro Hanabayashi
- Department of Orthopedic Surgery, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Yosuke Hattori
- Department of Orthopedic Surgery, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Mochihito Suzuki
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenji Kishimoto
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshifumi Ohashi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takahiro Imaizumi
- Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toshihisa Kojima
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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10
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Comparison of Biological Agent Monotherapy and Associations Including Disease-Modifying Antirheumatic Drugs for Rheumatoid Arthritis: Literature Review and Meta-Analysis of Randomized Trials. J Clin Med 2022; 12:jcm12010286. [PMID: 36615086 PMCID: PMC9821556 DOI: 10.3390/jcm12010286] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/20/2022] [Accepted: 12/26/2022] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE Update the available evidence comparing biologic disease-modifying antirheumatic drugs (bDMARDs) in combination with conventional synthetic disease-modifying antirheumatic drugs (CsDMARDs) to bDMARDs in monotherapy in patients with rheumatoid arthritis. METHODS Research was limited to randomized controlled trials. Major outcome: ACR 20 response criteria at 24 weeks. SECONDARY OUTCOMES clinical and radiographic criteria at week 24, 52 and 104. RESULTS 23 trials (6358 patients), including seven bDMARDs and one other molecule: Anbainuo (anti-TNF-R). No study satisfied our search criteria for anakinra, certolizumab and infliximab. Compared to bDMARD monotherapy, combination therapy gives a better ACR 20 at 24 weeks (RR: 0.88 (0.84-0.94)) in fixed and random effect models, and this result is sustained at 52 and 104 weeks. The results were mostly similar for all other outcomes without increasing the risk of adverse effects. CONCLUSION This meta-analysis confirms the superiority of combination therapy over monotherapy in rheumatoid arthritis, in accordance to the usual guidelines.
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11
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Malange KF, Navia-Pelaez JM, Dias EV, Lemes JBP, Choi SH, Dos Santos GG, Yaksh TL, Corr M. Macrophages and glial cells: Innate immune drivers of inflammatory arthritic pain perception from peripheral joints to the central nervous system. FRONTIERS IN PAIN RESEARCH 2022; 3:1018800. [PMID: 36387416 PMCID: PMC9644179 DOI: 10.3389/fpain.2022.1018800] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 10/03/2022] [Indexed: 07/22/2023] Open
Abstract
Millions of people suffer from arthritis worldwide, consistently struggling with daily activities due to debilitating pain evoked by this disease. Perhaps the most intensively investigated type of inflammatory arthritis is rheumatoid arthritis (RA), where, despite considerable advances in research and clinical management, gaps regarding the neuroimmune interactions that guide inflammation and chronic pain in this disease remain to be clarified. The pain and inflammation associated with arthritis are not isolated to the joints, and inflammatory mechanisms induced by different immune and glial cells in other tissues may affect the development of chronic pain that results from the disease. This review aims to provide an overview of the state-of-the-art research on the roles that innate immune, and glial cells play in the onset and maintenance of arthritis-associated pain, reviewing nociceptive pathways from the joint through the dorsal root ganglion, spinal circuits, and different structures in the brain. We will focus on the cellular mechanisms related to neuroinflammation and pain, and treatments targeting these mechanisms from the periphery and the CNS. A comprehensive understanding of the role these cells play in peripheral inflammation and initiation of pain and the central pathways in the spinal cord and brain will facilitate identifying new targets and pathways to aide in developing therapeutic strategies to treat joint pain associated with RA.
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Affiliation(s)
- Kaue Franco Malange
- Department of Anesthesiology, University of California, San Diego, CA, United States
| | | | - Elayne Vieira Dias
- Department of Neurology, University of California, San Francisco, CA, United States
| | | | - Soo-Ho Choi
- Department of Medicine, University of California, San Diego, CA, United States
| | | | - Tony L. Yaksh
- Department of Anesthesiology, University of California, San Diego, CA, United States
| | - Maripat Corr
- Department of Medicine, University of California, San Diego, CA, United States
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12
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Zhao J, Zhou W, Wu Y, Yan X, Yang L, Zhang Z. Efficacy, safety, and cost-effectiveness of triple therapy in preventing relapse in rheumatoid arthritis: A randomized controlled trial (ESCoRT study). Chin Med J (Engl) 2022; 135:2200-2209. [PMID: 36525606 PMCID: PMC9771172 DOI: 10.1097/cm9.0000000000002336] [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] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Biological agents, such as tumor necrosis factor inhibitors (TNFi), have been widely used in rheumatoid arthritis (RA) patients and greatly improved goal achievement. The aim of this study was to investigate whether conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) combination was better in reducing relapse than methotrexate (MTX) monotherapy, and more cost-effective than continuing TNFi plus MTX in RA patients who achieved low disease activity (LDA) with TNFi and MTX therapy. METHODS RA patients who failed to csDMARDs received an induction therapy of MTX plus TNFi for maximally 12 weeks. Those achieving LDA in 12 weeks were randomly assigned at a 1:1:1 ratio into three groups: (A) adding hydroxychloroquine and sulfasalazine for the first 12 weeks and then discontinuing TNFi for the following 48 weeks; (B) maintaining TNFi and MTX for 60 weeks; and (C) maintaining TNFi and MTX for the first 12 weeks and then discontinuing TNFi for the following 48 weeks. The primary outcome was relapse. RESULTS A total of 117 patients were enrolled for induction therapy and 67 patients who achieved LDA within 12 weeks were randomized, with 24, 21, and 22 patients in groups A, B, and C, respectively. The relapse rates of groups A and B during the entire 60 weeks were comparable [10/22 (45.5%) vs. 7/20 (35.0%), χ2 = 0.475, P = 0.491], however, significantly lower than that of group C [10/22 (45.5%) vs. 17/20 (85.0%), χ2 = 5.517, P = 0.019; 7/20 (35.0%) vs. 17/20 (85.0%), χ2 = 11.035, P = 0.004, respectively]. Taking RMB 100,000 Yuan as the threshold of willingness to pay, compared to MTX monotherapy (group C), both TNFi maintenance and triple csDMARDs therapies were cost-effective, but triple csDMARDs therapy was better. CONCLUSION For RA patients who have achieved LDA with TNFi and MTX, csDMARDs triple therapy was a cost-effective option in favor of reducing relapse. TRIAL REGISTRATION ClinicalTrials.gov, NCT02320630.
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Affiliation(s)
- Juan Zhao
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing 100034, China
| | - Wei Zhou
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing 100034, China
| | - Yangfeng Wu
- Peking University Clinical Research Institute (PUCRI), Beijing 100083, China
| | - Xiaoyan Yan
- Peking University Clinical Research Institute (PUCRI), Beijing 100083, China
| | - Li Yang
- Peking University School of Public Health, Beijing 100083, China
| | - Zhuoli Zhang
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing 100034, China
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13
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Huang JY, Leong PY, Ker A, Chen HH, Wei JCC, Ying LP. The long-term persistence of tumor necrosis factor inhibitors in patients with moderate to severe immune-mediated rheumatic diseases: A nation-wide, population-based real-world study. Int J Rheum Dis 2022; 25:1295-1305. [PMID: 35975402 DOI: 10.1111/1756-185x.14423] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES We aimed to compare the long-term persistence between different tumor necrosis factor-alpha inhibitors (TNFis) with immune-mediated rheumatic diseases (IMRD). This study can potentially provide insights into the real-world evidence regarding safety and effectiveness of TNFi treatment in a Chinese population. METHODS We enrolled newly diagnosed IMRD patients in this active comparator, retrospective cohort study by using National Taiwan insurance claim datasets. The drug survivals of first-line TNFi agents, including etanercept, golimumab, and adalimumab were compared. Propensity score matching was conducted to control the confounding effect from the observed covariates. The cumulative proportion of discontinuation was calculated over 5 years. The multiple-variable regression and propensity score analysis was used for confounding adjustment. RESULTS After propensity score matching, there were 2267 patients identified in each etanercept, golimumab, and adalimumab group. We observed the 5-year cumulative proportion of discontinuation was 52.80%, 45.85%, and 56.86% in etanercept, golimumab, and adalimumab, respectively. Compared with golimumab, increase of 31% (95% CI: 20-43) and 38% (95% CI: 26-50) risk of discontinuation were observed in etanercept and adalimumab. The factors including female gender, increasing age, long hospital stays, without co-medication with nonsteroidal anti-inflammatory drugs or methotrexate were associated were discontinuation of first-line TNFi treatment. CONCLUSION Golimumab had better drug survival than etanercept or adalimumab over 5 years of observation in Asian IMRD patients. Gender, age, longer hospital stays, concomitant use of disease-modifying antirheumatic drugs were associated with survival with TNFis.
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Affiliation(s)
- Jing-Yang Huang
- Center for Health Data Science, Chung Shan Medical University Hospital, Taichung, Taiwan.,Institute of Medicine, College of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Pui-Ying Leong
- Institute of Medicine, College of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Amy Ker
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Hsin-Hua Chen
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.,Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,Institute of Biomedical Science and Rong Hsing Research Center for Translational Medicine, Chung Hsing University, Taichung, Taiwan.,Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan.,School of Medicine, China Medical University, Taichung, Taiwan
| | - James Cheng-Chung Wei
- Institute of Medicine, College of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| | - Leong-Pui Ying
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
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14
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de Castro CT, de Queiroz MJ, Albuquerque FC, Brandão CC, Gerlack LF, Pereira DCR, Barros SC, Andrade WW, Bastos EDA, Azevedo JDNB, Carreiro R, Barreto ML, dos Santos DB. Real-world effectiveness of biological therapy in patients with rheumatoid arthritis: Systematic review and meta-analysis. Front Pharmacol 2022; 13:927179. [PMID: 36034836 PMCID: PMC9402894 DOI: 10.3389/fphar.2022.927179] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 07/08/2022] [Indexed: 11/18/2022] Open
Abstract
Background: The treatment of rheumatoid arthritis (RA), a chronic systemic inflammatory autoimmune disease, is based on disease-modifying anti-rheumatic drugs (DMARDs). Typically, it starts with conventional synthetic DMARDs (csDMARDs), and depending on the patient's response to the treatment and the adverse events experienced, biological DMARDs (bDMARDs) are initiated. bDMARDs are more specific to inflammatory factors than csDMARDs and more efficient in inducing remission and low disease activity. Thus, this study aimed to assess the effectiveness of biological therapy in patients with rheumatoid arthritis in administrative health databases. Methods: PubMed, Embase, Lilacs, Ovid, Scopus, and Web of Science databases were searched from inception to 21 October 2021, to identify observational studies that evaluated the effectiveness of biological therapy in patients with rheumatoid arthritis using administrative databases and real-world data. The methodological quality was assessed by the methodological index for non-randomized studies (MINORS). A fixed or random-effects model estimated risk ratios with 95% confidence intervals. The analysis was divided into four groups: tumor necrosis factor inhibitors (TNFi) versus non-TNFi; TNFi versus TNFi (adalimumab, etanercept, and golimumab versus infliximab); bDMARDs versus Janus kinase inhibitors (JAKi); and bDMARDs monotherapy versus combination therapy (bDMARDs and MTX). Results: Twenty-one records were eligible for inclusion in this systematic review and meta-analysis; seven population-based cohorts, eight prospective, and six retrospective cohort studies. Overall, 182,098 rheumatoid arthritis patients were evaluated. In the meta-analysis, lower effectiveness was observed among TNFi users than in non-TNFi (RR: 0.88; 95% CI: 0.81-0.95; p < 0.01; I2 = 94.0%) and bDMARDs than in JAKi (RR: 0.86; 95% CI: 0.79-0.94; p < 0.01; I2 = 93.0%). Higher effectiveness among adalimumab, etanercept, and golimumab than in infliximab (RR: 1.19; 95% CI: 1.05-1.36; p < 0.01; I2 = 96.0%) was found. No significant differences in the effectiveness of bDMARD monotherapy compared to combination therapy (RR: 0.83; 95% CI: 0.68-1.00; p < 0.01; I2 = 81.0%) was observed. E-value analysis indicated that the estimates were not robust against unmeasured confounding. Conclusion: According to the available real-world data, our results suggest that biological therapy effectively treats patients with rheumatoid arthritis, indicating higher effectiveness with non-TNFi and JAKi than with TNFi. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID#CRD42020190838, identifier CRD42020190838.
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Affiliation(s)
| | - Mariana Jorge de Queiroz
- Department of Pharmaceutical Assistance and Strategic Inputs, Ministry of Health, Rio de Janeiro, Brazil
| | - Flavia Caixeta Albuquerque
- Department of Pharmaceutical Assistance and Strategic Inputs, Ministry of Health, Rio de Janeiro, Brazil
| | - Celmário Castro Brandão
- Department of Pharmaceutical Assistance and Strategic Inputs, Ministry of Health, Rio de Janeiro, Brazil
| | - Leticia Farias Gerlack
- Department of Pharmaceutical Assistance and Strategic Inputs, Ministry of Health, Rio de Janeiro, Brazil
| | | | - Sandra Castro Barros
- Department of Pharmaceutical Assistance and Strategic Inputs, Ministry of Health, Rio de Janeiro, Brazil
| | - Wenderson Walla Andrade
- Department of Pharmaceutical Assistance and Strategic Inputs, Ministry of Health, Rio de Janeiro, Brazil
| | | | | | - Roberto Carreiro
- Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil
| | - Mauricio Lima Barreto
- Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil
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15
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Mensink M, Tran TNM, Zaal EA, Schrama E, Berkers CR, Borst J, de Kivit S. TNFR2 Costimulation Differentially Impacts Regulatory and Conventional CD4 + T-Cell Metabolism. Front Immunol 2022; 13:881166. [PMID: 35844585 PMCID: PMC9282886 DOI: 10.3389/fimmu.2022.881166] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/04/2022] [Indexed: 12/26/2022] Open
Abstract
CD4+ conventional T cells (Tconvs) mediate adaptive immune responses, whereas regulatory T cells (Tregs) suppress those responses to safeguard the body from autoimmunity and inflammatory diseases. The opposing activities of Tconvs and Tregs depend on the stage of the immune response and their environment, with an orchestrating role for cytokine- and costimulatory receptors. Nutrient availability also impacts T-cell functionality via metabolic and biosynthetic processes that are largely unexplored. Many data argue that costimulation by Tumor Necrosis Factor Receptor 2 (TNFR2) favors support of Treg over Tconv responses and therefore TNFR2 is a key clinical target. Here, we review the pertinent literature on this topic and highlight the newly identified role of TNFR2 as a metabolic regulator for thymus-derived (t)Tregs. We present novel transcriptomic and metabolomic data that show the differential impact of TNFR2 on Tconv and tTreg gene expression and reveal distinct metabolic impact on both cell types.
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Affiliation(s)
- Mark Mensink
- Department of Immunology and Oncode Institute, Leiden University Medical Center, Leiden, Netherlands
| | - Thi Ngoc Minh Tran
- Division of Cell Biology, Metabolism & Cancer, Department Biomolecular Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
- Biomolecular Mass Spectrometry and Proteomics, Bijvoet Center for Biomolecular Research, Utrecht University, Utrecht, Netherlands
| | - Esther A. Zaal
- Division of Cell Biology, Metabolism & Cancer, Department Biomolecular Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | - Ellen Schrama
- Department of Immunology and Oncode Institute, Leiden University Medical Center, Leiden, Netherlands
| | - Celia R. Berkers
- Division of Cell Biology, Metabolism & Cancer, Department Biomolecular Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
- Biomolecular Mass Spectrometry and Proteomics, Bijvoet Center for Biomolecular Research, Utrecht University, Utrecht, Netherlands
| | - Jannie Borst
- Department of Immunology and Oncode Institute, Leiden University Medical Center, Leiden, Netherlands
| | - Sander de Kivit
- Department of Immunology and Oncode Institute, Leiden University Medical Center, Leiden, Netherlands
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Hernández-Cruz B, Rosas J, Díaz-Torné C, Belzunegui J, García-Vicuña R, Inciarte-Mundo J, Pons A, Millán AM, Jeria-Navarro S, Valero JA, García-Castañeda N, Valero C, Llorente I, Calvo A, Díaz-Cerezo S, Núñez M. Real-World Treatment Patterns and Clinical Outcomes of Baricitinib in Rheumatoid Arthritis Patients in Spain: Results of a Multicenter, Observational Study in Routine Clinical Practice (The ORBIT-RA Study). Rheumatol Ther 2022; 9:589-608. [PMID: 35041155 PMCID: PMC8964893 DOI: 10.1007/s40744-021-00423-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 12/22/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Baricitinib is an oral Janus kinase (JAK)1/JAK2 inhibitor approved to treat rheumatoid arthritis (RA). This study aimed to investigate patients' characteristics, prescription patterns, effectiveness, and treatment persistence in patients receiving baricitinib in real-world practice in Spain. METHODS This retrospective longitudinal cohort study conducted in five rheumatology units included adults with RA initiating baricitinib (Sep-2017-May-19) with at least a 6-month-follow-up. Demographic/clinical characteristics, prescription patterns, and changes in disease activity and pain level were collected until treatment discontinuation/end of follow-up. Treatment persistence was estimated by Kaplan-Meier methods. RESULTS Data from 182 patients were included (mean (SD)): 83.5% women, 62.2 (12.3) years, body mass index 26.8 (5.1), disease duration 13.2 (10.8) years and Charlson Comorbidity Index score 2.4 (2.0). All patients had received at least one conventional synthetic disease-modifying anti-rheumatic drugs (csDMARD) before starting baricitinib and 78.0% at least one biologic disease-modifying anti-rheumatic drugs (bDMARD). Furthermore, 90.1% started with baricitinib 4 mg/day; 43.4% in monotherapy. One hundred and twelve (61.5%) of patients continued baricitinib at data collection time; mean persistence was 14.1 (0.5) months. Overall treatment persistence was 79.7/64.8/59.1% at 6/12/18 months. Seventy (38.5%) patients discontinued baricitinib during follow-up due to loss of efficacy (68.6%) or adverse events (18.6%). In those patients with available scores at the different observed cut-off points, remission or low disease activity was reported in 71.6 and 76.3% of patients at 6/12 months at any index: Disease Activity Score 28 joints using erythrocyte sedimentation rate (DAS28-ESR) (73.1 and 73.5%), Simplified Disease Activity Index (SDAI) (62.4 and 75.0%), and Clinical Disease Activity Index (CDAI) (66.7 and 78.1%). Good or moderate European League Against Rheumatism (EULAR)-response was noted in 80.0 and 78.2% of patients, respectively. Improvement from baseline in pain (Visual Analog Scale) was 2.5 cm and 3.0 cm at 6/12 months, respectively. CONCLUSIONS This Spanish cohort of patients treated with baricitinib had a long-standing and refractory disease. Nevertheless, high persistence and improvements in disease activity and pain were found at 6 and 12 months after treatment initiation, independently of the composite disease activity measure used, reinforcing the effectiveness of baricitinib in routine clinical practice.
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Affiliation(s)
- Blanca Hernández-Cruz
- Rheumatology Department, University Hospital Virgen Macarena, Calle Dr. Fedriani, 3, 41009, Seville, Spain.
| | - José Rosas
- Rheumatology Department, Marina Baixa Hospital, Av. Alcalde En Jaume Botella Mayor, 7, Villajoyosa, 03570, Alicante, Spain
| | - César Díaz-Torné
- Arthritis Unit, Rheumatology and Autoimmune Diseases Department, Santa Creu i Sant Pau Hospital, Carrer de Sant Quintí, 89, 08041, Barcelona, Spain
| | - Joaquín Belzunegui
- Rheumatology Department, Donostia University Hospital, Begiristain Doktorea Pasealekua, 20014, Guipúzcoa, Spain
| | - Rosario García-Vicuña
- Rheumatology Department, University Hospital La Princesa, IIS-IP, Calle de Diego de León, 62, 28006, Madrid, Spain
| | - José Inciarte-Mundo
- Arthritis Unit, Rheumatology Department, Hospital Clinic of Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - Ana Pons
- Rheumatology Department, Marina Baixa Hospital, Av. Alcalde En Jaume Botella Mayor, 7, Villajoyosa, 03570, Alicante, Spain
| | - Ana M Millán
- Arthritis Unit, Rheumatology and Autoimmune Diseases Department, Santa Creu i Sant Pau Hospital, Carrer de Sant Quintí, 89, 08041, Barcelona, Spain
| | - Sicylle Jeria-Navarro
- Arthritis Unit, Rheumatology and Autoimmune Diseases Department, Santa Creu i Sant Pau Hospital, Carrer de Sant Quintí, 89, 08041, Barcelona, Spain
| | - Jesús A Valero
- Rheumatology Department, Donostia University Hospital, Begiristain Doktorea Pasealekua, 20014, Guipúzcoa, Spain
| | - Noelia García-Castañeda
- Rheumatology Department, University Hospital La Princesa, IIS-IP, Calle de Diego de León, 62, 28006, Madrid, Spain
| | - Cristina Valero
- Rheumatology Department, University Hospital La Princesa, IIS-IP, Calle de Diego de León, 62, 28006, Madrid, Spain
| | - Irene Llorente
- Rheumatology Department, University Hospital La Princesa, IIS-IP, Calle de Diego de León, 62, 28006, Madrid, Spain
| | - Alberto Calvo
- Rheumatology Department, University Hospital La Princesa, IIS-IP, Calle de Diego de León, 62, 28006, Madrid, Spain
| | - Silvia Díaz-Cerezo
- Medical Department, Lilly Spain, Av de la Industria 30, Alcobendas, 28108, Madrid, Spain
| | - Mercedes Núñez
- Medical Department, Lilly Spain, Av de la Industria 30, Alcobendas, 28108, Madrid, Spain
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The beneficial effect of csDMARDs co-medication on drug persistence of first-line TNF inhibitor in rheumatoid arthritis patients: data from Czech ATTRA registry. Rheumatol Int 2022; 42:803-814. [PMID: 35338383 PMCID: PMC9007799 DOI: 10.1007/s00296-021-05072-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/15/2021] [Indexed: 10/31/2022]
Abstract
The study aimed to compare treatment retention for first-line TNF inhibitor (TNFi) in the ATTRA registry patients receiving either combination with conventional synthetic DMARDs or TNFi as monotherapy. A retrospective multicenter study analyzed data of all adult patients with rheumatoid arthritis (n = 3032) starting TNF inhibitor as the first-line biological therapy in combination with csDMARDs or in monotherapy from January 1st 2012 to December 31st 2020. Kaplan-Meier method was employed to calculate drug retentions. Survival curves of treatment retentions were compared through Log-rank test between the studied subgroups. The hazard ratio for drug discontinuation was assessed through univariate cox regression models. In patients who started the first line TNFi therapy, the median treatment retention was 47.7 (42.2; 53.1) months for combination therapy and 22.7 (14.9; 30.6) months for TNFi monotherapy (p < 0.001). Estimated one-year survival was higher in patients on TNFi combined with csDMARDs as compared with TNFi monotherapy (75.3% vs 65.7%); two-year survival rate was 63.2% vs 49.2%, three-year survival rate was 55.4% vs 42.4% and five-year survival 44.9% vs 26.4% of patients. The estimated survival on the first TNFi was higher in patients taking combination therapy with methotrexate than with other csDMARDs (p = 0.003). Use of csDMARDs co-medication was associated with significantly better first TNFi drug survival compared to monotherapy. The combination of TNFi with MTX is more effective than the combination with leflunomide, which did not demonstrate a significant effect.
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Serrano-Benavente B, Valor L, Del Río Blasco T, Janta I, González Benítez R, Nieto-González JC, Martínez-Barrio J, Ovalles Bonilla JG, Ariza A, López-Longo FJ, Álvaro-Gracia JM, Monteagudo I, González-Fernández CM. Long-Term Retention Rate of Golimumab in Patients With Rheumatoid Arthritis, Psoriatic Arthritis, and Spondyloarthritis in a Real-Life Setting. J Clin Rheumatol 2022; 28:e150-e155. [PMID: 33492028 DOI: 10.1097/rhu.0000000000001695] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
METHODS We conducted a single-center, medical records review study of all patients with RA, PsA, and SpA on GLM treatment attending a large rheumatology department from 2010 to 2017. Times from start to end of GLM treatment were collected, as well as sociodemographic, clinical, and safety variables. Golimumab retention rate was estimated by the Kaplan-Meier method, and comparison across diseases was analyzed with the Mantel-Haenszel statistic (log-rank test). Cox proportional hazards regression models were used to identify factors associated with GLM discontinuation. RESULTS In the study period, a total of 212 patients (61 RA, 48 PsA, 103 SpA) were prescribed GLM. Retention rates were 72% in the first year, 61% in the second, 56% in the third, and 38% at 5 years. Differences were statistically significant across diseases (median times to GLM discontinuation were 50.2, 46.0, and 38.7 months for RA, SpA, and PsA, respectively) and according to the number of previous biologic therapies (55.2 months in biologic-naive patients vs 14.0 months in patients with ≥2 previous biologics; p < 0.001). The use of concomitant conventional synthetic disease-modifying antirheumatic drugs was associated with a lower probability of discontinuation (hazards ratio [HR], 0.57; 95% confidence interval [CI], 0.33-0.97). Female sex (HR, 1.84; 95% CI, 1.07-3.17) and having used 2 biologics before GLM (HR, 2.99; 95% CI, 1.76-5.06) were associated with increased discontinuation rates. Twenty-three patients (10.9%) had at least 1 serious adverse event. CONCLUSIONS In a real-life setting, GLM shows appropriate long-term safety-effectiveness ratio.
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Affiliation(s)
- Belén Serrano-Benavente
- From the Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Larissa Valor
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Tamara Del Río Blasco
- From the Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Iustina Janta
- Servicio de Reumatología, Hospital Clínico de Valladolid, Valladolid
| | - Roberto González Benítez
- Sección de Reumatología, Servicio de Medicina Interna, Complejo Asistencial de Palencia, Palencia, Spain
| | | | - Julia Martínez-Barrio
- From the Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Alfonso Ariza
- From the Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Jose María Álvaro-Gracia
- From the Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Indalecio Monteagudo
- From the Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Kumei S, Sakurai T, So S, Itaba S, Akiho H, Nakamura S, Kim H, Yamasaki M, Takatsu N, Maekawa R, Sakemi R, Watanabe T, Shibata M, Kume K, Yoshikawa I, Takaki Y, Harada M. Impact of the Concomitant Use of Immunomodulator and a Lower Week 8 Partial Mayo Score on the Persistence of Adalimumab in Refractory Ulcerative Colitis. Intern Med 2021; 60:3849-3856. [PMID: 34121007 PMCID: PMC8758447 DOI: 10.2169/internalmedicine.7279-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective Real-world data of adalimumab (ADA) in the treatment of ulcerative colitis (UC) are scarce. We aimed to study the ADA response rates and predictors of response in UC treatment. Methods This observational, prospective and multi-center study assessed the clinical outcome of refractory UC patients treated with ADA who previously had an inadequate response to either conventional therapies or other anti-TNF antibodies or tacrolimus. The primary endpoint was the proportion of UC patients achieving a clinical response and remission at 8 and 52 weeks. We also evaluated the parameters which were associated with a clinical response at 8 and 52 weeks. Results A total of 35 patients were enrolled from 11 centers. The clinical responses at 8 and 52 weeks were 60.0% and 51.4%, respectively. The clinical remission rates at 8 and 52 weeks were 45.7% and 48.6%, respectively. Positive predictors for week 52 response were combination of ADA with immunomodulator (IM) (OR: 27.229; 95% CI; 1.897-390.76; p=0.015) and a week 8 lower partial Mayo score (OR: 0.406; 95% CI; 0.204-0.809; p=0.010). A receiver operation characteristic curve analysis revealed the optimal week 8 partial Mayo score to be 2.5, therefore a partial Mayo score of ≤2 was a positive predictor for the continuation of ADA. No malignancy or death occurred during this study. Conclusion ADA was effective for inducing and maintaining both a clinical response and remission in patients with refractory UC. It remains possible that the concomitant use of IM and a week 8 partial Mayo score of ≤2 may predict the long-term response of ADA.
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Affiliation(s)
- Shinsuke Kumei
- Third Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Japan
| | | | - Suketo So
- Department of Gastroenterology, Tobata Kyoritsu Hospital, Japan
| | - Soichi Itaba
- Department of Gastroenterology, Kyushu Rosai Hospital, Japan
| | - Hirotada Akiho
- Department of Gastroenterology, Kitakyushu Municipal Medical Center, Japan
| | - Shigeo Nakamura
- Department of Gastroenterology, Steel Memorial Yawata Hospital, Japan
| | - Hyonji Kim
- Department of Gastroenterology, JCHO Fukuoka Yutaka Central Hospital, Japan
| | | | - Noritaka Takatsu
- Department of Gastroenterology, Tagawa Municipal Hospital, Japan
- Department of Gastroenterology, Fukuoka University Chikushi Hospital, Japan
| | - Ryuichiro Maekawa
- Department of Gastroenterology, Tagawa Social Insurance Hospital, Japan
| | - Ryosuke Sakemi
- Department of Gastroenterology, Tobata Kyoritsu Hospital, Japan
| | - Tatsuyuki Watanabe
- Third Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Japan
| | - Michihiko Shibata
- Third Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Japan
| | - Keiichiro Kume
- Third Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Japan
| | - Ichiro Yoshikawa
- Department of Endoscopy, University of Occupational and Environmental Health, School of Medicine, Japan
| | - Yasuhiro Takaki
- Department of Gastroenterology, Ashiya Central Hospital, Japan
| | - Masaru Harada
- Third Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Japan
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Mease PJ, Stryker S, Liu M, Salim B, Rebello S, Gharaibeh M, Collier DH. Treatment patterns in rheumatoid arthritis patients newly initiated on biologic and conventional synthetic disease-modifying antirheumatic drug therapy and enrolled in a North American clinical registry. Arthritis Res Ther 2021; 23:236. [PMID: 34496952 PMCID: PMC8424897 DOI: 10.1186/s13075-021-02599-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 08/03/2021] [Indexed: 02/07/2023] Open
Abstract
Background Understanding the evolving treatment patterns in patients with rheumatoid arthritis (RA) is important for rheumatologists to make the best practice decisions and optimize treatment. Here, we describe treatment patterns among patients newly initiated on biologic and/or nonbiologic RA therapy over time after enrollment in the US Corrona RA registry. Methods This was a retrospective, cohort study of adult patients with RA enrolled in the Corrona RA registry. Patients were included in this study if they initiated therapy with conventional synthetic disease-modifying antirheumatic drug (csDMARD) monotherapy, TNF inhibitor (TNFi) monotherapy, other (non-TNFi) biologic monotherapy, or combination therapy (index therapy); initiated therapy between January 1, 2004, and December 31, 2015 (index date), after enrollment in the Corrona RA registry; had at least 6 months of follow-up time after the index date; and had at least one follow-up visit. Time periods of interest were based on the year of index therapy initiation: 2004–2007, 2008–2011, and 2012–2015. Results This study included 8027 patients. csDMARD monotherapy and TNFi + csDMARD combination therapy were the most common index therapies in the registry (39.9% and 44.9%, respectively, in the 2004–2007 period; 38.6% and 38.2%, respectively, in the 2008–2011 period; and 35.2% for both in the 2012–2015 period). At therapy initiation, a higher proportion of patients who initiated other biologics, whether as monotherapies (54.0%) or in combination with csDMARD (49.9%), had high disease activity than those who initiated csDMARD monotherapy (28.4%). For 2012–2015 vs 2004–2007 and 2008–2011 periods, persistence on a given therapy appeared to decrease for the TNFi monotherapy cohort (48.2% vs 64.3% and 52.4%) and other biologic monotherapy cohort (52.3% vs 71.4% and 54.5%) over 12 months; switching from one therapy to another was common in the Corrona RA registry. Conclusions Increased switching from one therapy to another and decreased time on a given therapy was observed in the Corrona RA registry in the 2012–2015 period. This observation is most likely due to the increased availability of additional treatment options and/or the change in clinical focus, particularly the emphasis on achievement of treat-to-target goals of remission or low disease activity along with more aggressive treatment. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-021-02599-4.
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Affiliation(s)
- Philip J Mease
- Swedish Medical Center/Providence St. Joseph Health and the University of Washington, Seattle, WA, 98122, USA.
| | | | - Mei Liu
- Corrona LLC., Waltham, MA, USA
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Decarriere G, Barnetche T, Combe B, Gaujoux-Viala C, Lukas C, Morel J, Daien C. Most Appropriate Conventional Disease-Modifying Antirheumatic Drug to Combine With Different Advanced Therapies in Rheumatoid Arthritis: A Systematic Literature Review With Meta-Analysis. Arthritis Care Res (Hoboken) 2021; 73:873-884. [PMID: 32216091 DOI: 10.1002/acr.24195] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 03/17/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE In rheumatoid arthritis, the association between advanced therapies (including biologic disease-modifying antirheumatic drugs [DMARDs] and targeted synthetic DMARDs) and methotrexate (MTX) is recommended by international societies. When MTX cannot be used, other conventional synthetic DMARDs (csDMARDs) may be proposed. We aimed to compare the safety and efficacy of MTX and non-MTX csDMARDs in combination with advanced therapies. METHODS We systematically searched the literature for studies comparing the effectiveness, retention rate, and safety of MTX versus non-MTX csDMARDs (leflunomide or others) in combination with tumor necrosis factor inhibitors (TNFi), abatacept, rituximab, tocilizumab, and JAK inhibitors. Meta-analysis was performed with RevMan, using an inverse variance approach with fixed or random-effects models. Risk ratios (RRs) and 95% confidence intervals (95% CIs) were estimated. RESULTS The literature search revealed 3,842 articles; 41 studies were included for the systematic literature review and 21 for the meta-analysis: 13 with TNFi, 3 with abatacept, and 5 with rituximab. For TNFi, the European Alliance of Associations for Rheumatology (EULAR) response at 6 months was lower for patients receiving non-MTX csDMARDs than for those using MTX (RR 0.93 [95% CI 0.87, 1.0], P = 0.04; n = 3,843; I2 = 28%), with a lower retention rate at 12 months. For abatacept, effectiveness and safety were similar between the 2 groups. For rituximab, a good EULAR response was higher with leflunomide than MTX (RR 1.38 [95% CI 1.13, 1.68], P = 0.001; n = 2,078; I2 = 0%), with similar adverse event rates. Meta-analysis for tocilizumab or JAK inhibitors could not be performed. CONCLUSION The different csDMARDs seem safe and efficient to combine with advanced therapies in RA patients. Although MTX seems slightly superior to other csDMARDs in combination with TNFi, leflunomide might be superior to MTX in combination with rituximab.
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Affiliation(s)
| | | | - Bernard Combe
- CHU Montpellier and Montpellier University, Montpellier, France
| | | | - Cédric Lukas
- CHU Montpellier and Montpellier University, Montpellier, France
| | - Jacques Morel
- CHU Montpellier and Montpellier University, Montpellier, France
| | - Claire Daien
- CHU Montpellier and Montpellier University, Montpellier, France
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Sánchez-Piedra C, Sueiro-Delgado D, García-González J, Ros-Vilamajo I, Prior-Español A, Moreno-Ramos MJ, Garcia-Magallon B, Calvo-Gutiérrez J, Perez-Vera Y, Martín-Domenech R, Ruiz-Montesino D, Vela-Casasempere P, Expósito L, Sánchez-Alonso F, González-Davila E, Díaz-González F. Changes in the use patterns of bDMARDs in patients with rheumatic diseases over the past 13 years. Sci Rep 2021; 11:15051. [PMID: 34302036 PMCID: PMC8302725 DOI: 10.1038/s41598-021-94504-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 07/12/2021] [Indexed: 02/07/2023] Open
Abstract
The better understanding of the safety of biologic DMARDs (bDMARDs), as well as the emergence of new bDMARDs against different therapeutic targets and biosimilars have likely influenced the use patterns of these compounds over time. The aim of this study is to assess changes in demographic characteristics, disease activity and treatment patterns in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), or ankylosing spondylitis (AS) who started a first- or second-line biologic between 2007 and mid-2020. Patients diagnosed with RA, PsA or AS included in the BIOBADASER registry from January 2007 to July 2020 were included. According to the start date of a first- or second-line biologic therapy, patients were stratified into four time periods: 2007-2009; 2010-2013; 2014-2017; 2018-2020 and analyzed cross-sectionally in each period. Demographic and clinical variables, as well as the type of biologic used, were assessed. Generalized linear models were applied to study the evolution of the variables of interest over time periods, the diagnosis, and the interactions between them. A total of 4543 patients initiated a first biologic during the entire time frame of the study. Over the four time periods, disease evolution at the time of biologic initiation (p < 0.001), disease activity (p < 0.001), retention rate (p < 0.001) and the use of tumor necrosis factor inhibitors as a first-line treatment (p < 0.001) showed a significant tendency to decrease. Conversely, comorbidities, as assessed by the Charlson index (p < 0.001), and the percentage of patients using bDMARDs in monotherapy (p < 0.001), and corticosteroids (p < 0.001) tended to increase over time. Over the entire period of the study's analysis, 3289 patients started a second biologic. The following trends were observed: decreased DAS28 at switching (p < 0.001), lower retention rates (p = 0.004), and incremental changes to the therapeutic target between the first and second biologic (p < 0.001). From 2007 until now rheumatic patients who started a biologic were older, exhibited less clinical activity, presented more comorbidities, and switched to a different biologic more frequently and earlier.
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Affiliation(s)
| | | | | | | | - Agueda Prior-Español
- Servicio de Reumatología, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | | | | | | | - Yanira Perez-Vera
- Servicio de Reumatología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas, Spain
| | | | | | | | - Lorena Expósito
- Servicio de Reumatología, Hospital Universitario de Canarias, Calle Ofra s/n 38320, La Laguna, Santa Cruz de Tenerife, Spain
| | | | - Enrique González-Davila
- Departamento de Matemáticas, Estadística e Investigación Operativa, Universidad de La Laguna, Tenerife, Spain
| | - Federico Díaz-González
- Servicio de Reumatología, Hospital Universitario de Canarias, Calle Ofra s/n 38320, La Laguna, Santa Cruz de Tenerife, Spain.
- Departamento de Medicina Interna, Dermatología y Cirugía, Dermatología y Psiquiatría, Universidad de La Laguna, Tenerife, Spain.
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Predictive factors for switching in patients with psoriatic arthritis undergoing anti-TNFα, anti-IL12/23, or anti-IL17 drugs: a 15-year monocentric real-life study. Clin Rheumatol 2021; 40:4569-4580. [PMID: 34136971 PMCID: PMC8519923 DOI: 10.1007/s10067-021-05799-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/13/2021] [Accepted: 05/26/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVES We aimed to evaluate the (a) potential predictors of first biological disease-modifying anti-rheumatic drug (bDMARD) failure and (b) factors associated with failure of multiple therapies in psoriatic arthritis (PsA). MATERIALS AND METHODS We enrolled consecutive PsA patients attending our unit and undergoing bDMARDs during 2004-2020. Disease characteristics, previous/ongoing treatments, comorbidities, and follow-up duration were recorded. Disease activity and functional and clinimetric scores were recorded at baseline and yearly and were compared between switchers and non-switchers, and within switchers according to the reasons for switching. Effectiveness was evaluated over time with descriptive statistics; multivariate Cox and logistic regression models were used to evaluate predictors of response and failure of multiple bDMARDs. Kaplan-Meier curves were used to assess differences in time-to-first bDMARD discontinuation. Infections and adverse events were recorded. RESULTS Two hundred sixty-four patients were included (117 (44.32%) females, mean age 56 years, mean PsA duration 15 years); 117 (44.32%) switched bDMARDs at least once. Switchers were mostly females, with higher Psoriasis Area and Severity Index and worse Health Assessment Questionnaire at baseline. Mean time-to-first bDMARD discontinuation was 72 months; 2-year and 5-year retention rates were 75% and 60%, respectively. Survival curves for anti-TNFα/anti-IL12/23/anti-IL17 were similar (p = 0.66). Main reasons for switching were inefficacy (67.52%) and adverse events (25.7%). Female sex was associated with a higher risk of first bDMARD discontinuation (HR = 2.39; 95% CI: 1.50-3.81) and failure of multiple bDMARDs (OR = 1.99; 95% CI: 1.07-3.69); initiating therapy before 2015 was protective (HR = 0.40; 95% CI: 0.22-0.73). CONCLUSIONS Survival rate was good for anti-TNFα and other bDMARDs. Female sex was a predictor of first bDMARD discontinuation, unlike mechanism of action, comorbidities, and BMI. Key Points • Drug survival in PsA patients was confirmed be greater for the first bDMARD administered. • In case of failure of the first bDMARD, switching/swapping proved a good treatment option, as reflected by a persistent satisfactory effectiveness with second-line bDMARDs and so subsequent switches. • Female sex may constitute a predisposing risk factor for flare and therapeutic switches. • Discontinuation or switching of biologics due to mechanism of action, comorbidities tolerability and BMI did not seem to impact first bDMARD withdrawal.
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Migliore A, Pompilio G, Integlia D, Zhuo J, Alemao E. Cycling of tumor necrosis factor inhibitors versus switching to different mechanism of action therapy in rheumatoid arthritis patients with inadequate response to tumor necrosis factor inhibitors: a Bayesian network meta-analysis. Ther Adv Musculoskelet Dis 2021; 13:1759720X211002682. [PMID: 33854570 PMCID: PMC8010806 DOI: 10.1177/1759720x211002682] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 02/15/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction: For patients with rheumatoid arthritis (RA) with an inadequate response to tumor necrosis factor inhibitors (TNFi), main options include cycling onto a different TNFi or switching to a biologic/targeted synthetic disease-modifying antirheumatic drug with a different mechanism of action (MOA). This network meta-analysis (NMA) assessed comparative clinical efficacy of cycling versus switching. Methods: We conducted a literature search in MEDLINE, Embase, and Cochrane Library. Outcomes included proportion of patients with 20%, 50%, or 70% response to American College of Rheumatology criteria (ACR20/ACR50/ACR70 response), Disease Activity Score in 28 joints (DAS28) score below 2.6 or between 2.6 and 3.2, mean change in DAS28 score, mean reduction in and proportion of patients achieving a clinically meaningful reduction (⩾0.22) in Health Assessment Questionnaire score, number of serious adverse events (AEs), and withdrawals for any reason/due to AEs/lack of treatment efficacy. To account for the wide range of study populations and designs, we developed three models to conduct the NMA: fixed-effect, random-effects, and hierarchical Bayesian. PROSPERO ID: CRD42019122993. Results: We identified nine randomized controlled trials and 16 observational studies. The fixed-effect model suggested a 0.99 probability that switch was the better strategy for increasing odds of a clinically meaningful improvement in ACR50 [odds ratio (OR): 1.35 (95% credible interval (CI): 0.96–1.81)]. The fixed-effect model also suggested that switch was associated with lower rates of withdrawal for any reasons [OR: 0.53 (95% CI: 0.40–0.68)]. The random-effects and hierarchical Bayesian models suggested additional uncertainty as they considered more variability than the fixed-effect model. Discussion: Results suggest that switching to a drug with a different MOA is more effective and associated with lower rates of withdrawal than cycling to a different TNFi after failure of first-line TNFi. Further trials that directly compare cycling with switching are warranted to better assess comparative efficacy. Plain language summary Assessment of the effectiveness of different drug treatment strategies in patients with rheumatoid arthritis: an analysis of the published literature
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Affiliation(s)
- Alberto Migliore
- Unit of Rheumatology, Ospedale S. Pietro Fatebenefratelli ISPOR Italy, Via Cassia 600, Rome, 00189, Italy
| | | | | | - Joe Zhuo
- Worldwide Health Economics & Outcomes Research, Bristol Myers Squibb, Princeton, NJ, USA
| | - Evo Alemao
- Worldwide Health Economics & Outcomes Research, Bristol Myers Squibb, Princeton, NJ, USA
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Zhao J, Zhou W, Wu Y, Ji P, Yang L, Yan X, Zhang Z. The efficacy, safety and cost-effectiveness of hydroxychloroquine, sulfasalazine, methotrexate triple therapy in preventing relapse among patients with rheumatoid arthritis achieving clinical remission or low disease activity: the study protocol of a randomized controlled clinical Trial (ESCoRT study). BMC Med Inform Decis Mak 2021; 21:83. [PMID: 33663487 PMCID: PMC7934358 DOI: 10.1186/s12911-021-01449-2] [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: 07/01/2020] [Accepted: 02/18/2021] [Indexed: 11/25/2022] Open
Abstract
Background Tumor necrosis factor α inhibitors (TNFi) is effective for rheumatoid arthritis (RA) patients who fail to conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs). Because of high cost, the discontinuation is common but often lead to disease relapse. The study aims to investigate, if the combination therapy of csDMARDs is more effective in reducing disease relapse than methotrexate (MTX) monotherapy, and more cost-effective than continuing TNFi and MTX. Methods It will be a two-stage trial. In the first stage, all RA patients who failed to csDMARDs treatment [disease activity score 28 (DAS28)-CRP > 3.2] will receive MTX plus TNFi for no more than 12 weeks. Patients achieving DAS28-CRP < 3.2 during the first stage will be randomized into three groups at 1:1:1 ratio: (A) add hydroxychloroquine (HCQ) and sulfasalazine (SSZ) for the first 12 weeks and then remove TNFi but continue other treatments for the next 48 weeks; (B) maintain TNFi + MTX for 60 weeks; and (C) maintain TNFi + MTX for the first 12 weeks and then remove TNFi but continue MTX monotherapy for the next 48 weeks. The primary outcome will be disease relapse (DAS28-CRP increases by at least 0.6 and > 3.2). Secondary outcomes will include the incremental cost per reducing 1 case of relapse; patient reported intolerance to the treatment; adverse events; change of mean disease activity measured by DAS28, clinical disease activity index (CDAI) and simplified disease activity index (SDAI); the proportion of modified Sharp score increase < 0.3; ultrasound-detected remission in hands; Health Assessment Questionnaire Disability Index (HAQ-DI) and health related quality of life [the five-level EuroQol-5D (EQ-5D-5L) and short form-6D (SF-6D)]. Discussion The aim of this trail will be to seek effective treatment options of preventing relapse of RA. The results of the current study may provide an instructive recommendation for more economical application of TNFi treatment in RA. Trial registration NCT, NCT02320630. Registered on 16 December 2014. https://register.clinicaltrials.gov/prs/app/action/LoginUser?ts=3&cx=-jg9qo2.
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Affiliation(s)
- Juan Zhao
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, 100034, China
| | - Wei Zhou
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, 100034, China
| | - Yangfeng Wu
- Peking University Clinical Research Institute (PUCRI), Beijing, 100083, China
| | - Ping Ji
- Peking University Clinical Research Institute (PUCRI), Beijing, 100083, China
| | - Li Yang
- Peking University School of Public Health, Beijing, 100083, China
| | - Xiaoyan Yan
- Peking University Clinical Research Institute (PUCRI), Beijing, 100083, China
| | - Zhuoli Zhang
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, 100034, China.
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Choi SJ. Biologic therapies for the treatment of rheumatoid arthritis. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2021. [DOI: 10.5124/jkma.2021.64.2.95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Rheumatoid arthritis (RA) is a chronic autoimmune disease that primarily affects the synovial joints. If left untreated, persistent synovial inflammation can lead to cartilage and bone destruction, ultimately causing significant longterm disability and mortality. However, since the late 1990s, the combined use of methotrexate, a synthetic diseasemodifying antirheumatic drug (DMARD), and a biological DMARD has revolutionized the treatment of RA. As of 2021, the Korea Food and Drug Administration has approved seven biological DMARDs for RA treatment: four tumor necrosis factor-alpha inhibitors (infliximab, etanercept, adalimumab, and golimumab) and three non-tumor necrosis factor biological products (abatacept, rituximab, and tocilizumab). Although the use of biological products has allowed significant advances in the treatment of RA, there are certain drawbacks, such as high cost, increased infection risk, and the necessity for parenteral route product administration. Therefore, discontinuation of biological DMARD use without a resulting disease flare is the next treatment goal and a desirable result from the standpoint of risk reduction and cost-effectiveness, especially for patients with clinical remission. It is still unclear which biological product is the best. Clinicians must, therefore, personalize the sequence and strategy of treatment by considering patient characteristics, disease activity, comorbidity, and economic condition
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27
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Safy-Khan M, de Hair MJH, Welsing PMJ, van Laar JM, Jacobs JWG. Current Smoking Negatively Affects the Response to Methotrexate in Rheumatoid Arthritis in a Dose-responsive Way, Independently of Concomitant Prednisone Use. J Rheumatol 2021; 48:1504-1507. [PMID: 33526623 DOI: 10.3899/jrheum.200213] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Current smoking reduces clinical response to several disease-modifying antirheumatic drugs. It is unknown if this is also the case for prednisone. We aimed to determine whether current smoking affects the clinical response to concomitant prednisone in a methotrexate (MTX)-based treatment strategy. METHODS In the CAMERA-II trial (isrctn.com identifier: 70365169), patients with early rheumatoid arthritis (RA) initiated an MTX-based strategy and were randomized to concomitant prednisone (MTX + pred) or placebo (MTX + PBO) for 24 months. Linear mixed modeling was performed with Disease Activity Score assessing 28 joints (DAS28) as the dependent variable, and strategy group and current smoking status as independent variables, correcting for relevant covariates. The interaction between current smoking and strategy was tested to find out whether the effect of current smoking on clinical response was different between the strategy groups with prednisone or PBO. RESULTS Current smoking was significantly associated with higher DAS28 over time (mean difference with nonsmokers 0.57 [95% CI 0.22-0.92, P < 0.01]). This association was not different between the strategy groups with prednisone or PBO (P = 0.73). The negative effect of current smoking on DAS28 was dose dependent. CONCLUSION Current smoking in patients with early RA significantly reduces the clinical effect of an MTX-based strategy, independent of whether concomitant prednisone is used. This effect is dose dependent.
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Affiliation(s)
- Mary Safy-Khan
- M. Safy-Khan, MD, P.M. Welsing, PhD, J.M. van Laar, MD, PhD, Professor, J.W. Jacobs, MD, PhD, Associate Professor, Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University
| | | | - Paco M J Welsing
- M. Safy-Khan, MD, P.M. Welsing, PhD, J.M. van Laar, MD, PhD, Professor, J.W. Jacobs, MD, PhD, Associate Professor, Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University
| | - Jacob M van Laar
- M. Safy-Khan, MD, P.M. Welsing, PhD, J.M. van Laar, MD, PhD, Professor, J.W. Jacobs, MD, PhD, Associate Professor, Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University
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Bechman K, Oke A, Yates M, Norton S, Dennison E, Cope AP, Galloway JB. Is background methotrexate advantageous in extending TNF inhibitor drug survival in elderly patients with rheumatoid arthritis? An analysis of the British Society for Rheumatology Biologics Register. Rheumatology (Oxford) 2021; 59:2563-2571. [PMID: 31998962 PMCID: PMC7449803 DOI: 10.1093/rheumatology/kez671] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 12/09/2019] [Indexed: 12/16/2022] Open
Abstract
Objective To evaluate drug survival with monotherapy compared with combination therapy with MTX in RA older adults. Methods Patients from the British Society for Rheumatology Biologics Register, a prospective observational cohort, who were biologic naïve and commencing their first TNF inhibitors (TNFi) were included. The cohort was stratified according to age: <75 and ≥75. Cox-proportional hazards models compared the risk of TNFi discontinuation from (i) any-cause, (ii) inefficacy and (iii) adverse events, between patients prescribed TNFi-monotherapy compared with TNFi MTX combination. Results The analysis included 15 700 patients. Ninety-five percent were <75 years old. Comorbidity burden and disease activity were higher in the ≥75 cohort. Fifty-two percent of patients discontinued TNFi therapy during the follow-up period. Persistence with therapy was higher in the <75 cohort. Patients receiving TNFi monotherapy were more likely to discontinue compared with patients receiving concomitant MTX [hazard rate 1.12 (1.06–1.18) P <0.001]. This finding only held true in patients <75 [hazard rate (HR) 1.11 (1.05–1.17) vs ≥75 [HR 1.13 (0.90–1.41)]. Examining TNFi discontinuation by cause revealed patients ≥75 receiving TNFi monotherapy were less likely to discontinue TNFi due to inefficacy [HR 0.66 (0.43–0.99) P=0.04] and more likely to discontinue therapy from adverse events [HR 1.41(1.02–1.96) P =0.04]. These results were supported by the multivariate adjustment in complete case and imputed analyses. Conclusion TNFi monotherapy is associated with increased treatment failure. In older adults, the disadvantage of TNFi monotherapy on drug survival is no longer seen. Patients ≥75 have fewer discontinuations due to inefficacy than adverse events compared with younger patients. This likely reflects greater disposition to toxicity but perhaps also a decline in immunogenicity associated with immunosenescence.
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Affiliation(s)
- Katie Bechman
- Centre for Rheumatic Diseases, Kings College London, LondonUK
| | - Anuoluwapo Oke
- Centre for Rheumatic Diseases, Kings College London, LondonUK.,MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Mark Yates
- Centre for Rheumatic Diseases, Kings College London, LondonUK
| | - Sam Norton
- Psychology Department, Institute of Psychiatry, Kings College London, London, UK
| | - Elaine Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Andrew P Cope
- Centre for Rheumatic Diseases, Kings College London, LondonUK
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29
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Guo Z, Qiu C, Mecca C, Zhang Y, Bian J, Wang Y, Wu X, Wang T, Su W, Li X, Zhang W, Chen B, Xiang H. Elevated lymphotoxin-α (TNFβ) is associated with intervertebral disc degeneration. BMC Musculoskelet Disord 2021; 22:77. [PMID: 33441130 PMCID: PMC7807514 DOI: 10.1186/s12891-020-03934-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 12/28/2020] [Indexed: 11/25/2022] Open
Abstract
Background Intervertebral disc degeneration (IVDD) is a primary cause of degenerative disc diseases; however, the mechanisms underlying the degeneration remain unclear. The immunoinflammatory response plays an important role in IVDD progression. The inflammatory cytokine lymphotoxin-α (LTα), formerly known as TNFβ, is associated with various pathological conditions, while its role in the pathogenesis of IVDD remains elusive. Methods Real-time quantitative polymerase chain reaction (RT-qPCR), Western blotting (WB), and enzyme-linked immunosorbent assays were used to assess the levels of LTα in human nucleus pulposus (NP) tissues between degeneration and control groups. The plasma concentrations of LTα and C-reactive protein (CRP) were compared between healthy and IVDD patients. Rat primary NP cells were cultured and identified via immunofluorescence. Methyl-thiazolyl-tetrazolium assays and flow cytometry were used to evaluate the effects of LTα on rat NP cell viability. After NP cells were treated with LTα, degeneration-related molecules (Caspase-3, Caspase-1, matrix metalloproteinase (MMP) -3, aggrecan and type II collagen) were measured via RT-qPCR and WB. Results The levels of both the mRNA and protein of LTα in human degenerated NP tissue significantly increased. Plasma LTα and CRP did not differ between healthy controls and IVDD patients. Rat primary NP cells were cultured, and the purity of primary NP cells was > 90%. Cell experiments showed inversely proportional relationships among the LTα dose, treatment time, and cell viability. The optimal conditions (dose and time) for LTα treatment to induce rat NP cell degeneration were 5 μg/ml and 48 ~ 72 h. The apoptosis rate and the levels of Caspase-3, Caspase-1, and MMP-3 significantly increased after LTα treatment, while the levels of type II collagen and aggrecan were decreased, and the protein expression levels were consistent with their mRNA expression levels. Conclusions This study demonstrated that elevated LTα is closely associated with IVDD and that LTα may induce NP cell apoptosis and reduce important extracellular matrix (ECM) proteins, which cause adverse effects on IVDD progress. Moreover, the optimal conditions for LTα treatment to induce NP cell degeneration were determined. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-020-03934-7.
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Affiliation(s)
- Zhu Guo
- Department of Orthopedic Surgery, the Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Chensheng Qiu
- Department of Orthopedic Surgery, the Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China.,Department of Orthopedic Surgery, Qingdao Municipal Hospital (Group), Qingdao, 266011, Shandong, China
| | - Christina Mecca
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Yang Zhang
- Department of Spine Surgery, Weifang People's Hospital, Weifang, 261041, Shandong, China
| | - Jiang Bian
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, 266000, Shandong, China
| | - Yan Wang
- Department of Orthopedic Surgery, the Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Xiaolin Wu
- Department of Orthopedic Surgery, the Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Tianrui Wang
- Department of Orthopedic Surgery, the Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Weiliang Su
- Department of Orthopedic Surgery, the Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Xianglin Li
- School of Medical Imaging, Bin Zhou Medical University, Yantai, 264003, China
| | - Wei Zhang
- School of Medical Imaging, Bin Zhou Medical University, Yantai, 264003, China
| | - Bohua Chen
- Department of Orthopedic Surgery, the Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China.
| | - Hongfei Xiang
- Department of Orthopedic Surgery, the Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China.
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van Mulligen E, Ahmed S, Weel AEAM, Hazes JMW, van der Helm-van Mil AHM, de Jong PHP. Factors that influence biological survival in rheumatoid arthritis: results of a real-world academic cohort from the Netherlands. Clin Rheumatol 2021; 40:2177-2183. [PMID: 33415451 PMCID: PMC8121743 DOI: 10.1007/s10067-020-05567-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/18/2020] [Accepted: 12/22/2020] [Indexed: 11/28/2022]
Abstract
We aim to explore real-world biological survival stratified for discontinuation reason and determine its influenceability in rheumatoid arthritis (RA) patients. Data from the local pharmacy database and patient records of a university hospital in the Netherlands were used. RA patients who started a biological between 2000 and 2020 were included. Data on age, anti-citrullinated protein antibody (ACPA) and rheumatoid factor (RF) status, presence of erosions, gender, body mass index, time to first biological, biological survival time, use of csDMARDs, and discontinuation reasons were collected. Of the included 318 patients, 12% started their first biological within 6 months after diagnosis. The median time to first biological was 3.6 years (95% CI, 1.0–7.2). The median survival of the first- and second-line biological was respectively 1.7 years (95% CI, 1.3–2.2) and 0.8 years (95% CI, 0.5–1.0) (p = 0.0001). Discontinuation reasons for the first-line biological were ineffectiveness (47%), adverse events (17%), remission (16%), pregnancy (30%), or patient preference (10%). Multivariable Cox regression analyses for discontinuation due to inefficacy or adverse events showed that concomitant use of csDMARDs (HR = 1.32, p < 0.001) positively while RF positivity negatively (HR = 0.82, p = 0.03) influenced biological survival. ACPA positivity was associated with the inability to discontinue biologicals after achieving remission (HR = 1.43, p = 0.023). Second-line TNF inhibitor survival was similar between patients with a primary and secondary non-response on the first-line TNF inhibitor (HR = 1.28, p = 0.34). Biological survival diminishes with the number of biologicals used. Biological survival is prolonged if patients use csDMARDs. RF was negatively associated with biological survival. ACPA was negatively associated with the inability to discontinue biologicals after achieving remission. Therefore, tailoring treatment based upon autoantibody status might be the first step towards personalized medicine in RA.Key Points • Prolonged biological survival is a surrogate for treatment effectiveness; however, an increasing amount of patients will taper treatment due to remission, and factors influencing biological survival based on separate reasons for discontinuation have not been explored. • We found that combining a biological DMARD with a conventional synthetic DMARD increases biological DMARD survival. Rheumatoid factor is negatively associated with biological survival. Anti-citrullinated protein antibody is negatively associated with the inability to discontinue the biological when remission was reached. • The first step towards personalized medicine might be tailoring of treatment based upon autoantibody status. |
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Affiliation(s)
- Elise van Mulligen
- Department of Rheumatology, Erasmus MC, Room Na-523, Postbus 2040, 3000 CA, Rotterdam, the Netherlands.
| | - Saad Ahmed
- Department of Rheumatology, Erasmus MC, Room Na-523, Postbus 2040, 3000 CA, Rotterdam, the Netherlands
| | - Angelique E A M Weel
- Department of Rheumatology, Erasmus MC, Room Na-523, Postbus 2040, 3000 CA, Rotterdam, the Netherlands.,Department of Rheumatology, Maasstad Hospital, Rotterdam, the Netherlands.,Erasmus School of Health Policy & Management, Rotterdam, the Netherlands
| | - Johanna M W Hazes
- Department of Rheumatology, Erasmus MC, Room Na-523, Postbus 2040, 3000 CA, Rotterdam, the Netherlands
| | - Annette H M van der Helm-van Mil
- Department of Rheumatology, Erasmus MC, Room Na-523, Postbus 2040, 3000 CA, Rotterdam, the Netherlands.,Department of Rheumatology, LUMC, Leiden, the Netherlands
| | - Pascal H P de Jong
- Department of Rheumatology, Erasmus MC, Room Na-523, Postbus 2040, 3000 CA, Rotterdam, the Netherlands
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Hilliquin P, Barnetche T, Baillet A, Flipo RM, Lespessailles E, Roux C, Fardellone P, Gilbert-Marceau A, Idier I, Constantin A, Shipley E, Baudens G, Saraux A. Real-World 1-Year Retention Rate of Subcutaneous Tocilizumab Treatment in Patients with Moderate to Severe Active Rheumatoid Arthritis: TANDEM Study. Rheumatol Ther 2020; 8:95-108. [PMID: 33216287 PMCID: PMC7991027 DOI: 10.1007/s40744-020-00253-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/03/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction Drug retention is particularly relevant to assess long-term treatments. This real-world study mainly aimed to describe 1-year retention rate (RR) of subcutaneously administered tocilizumab (TCZ-SC) in patients with moderate to severe active rheumatoid arthritis (RA). Methods This non-interventional, prospective, multicenter study (NCT02608112) was conducted in patients with RA initiating TCZ-SC treatment, with an 18-month follow-up. RR was estimated at month 12 in the overall population and baseline subgroups (combination with a conventional synthetic disease-modifying antirheumatic drug (csDMARD) or not, age, body mass index, methotrexate dose), using the Kaplan–Meier method. Patient compliance to TCZ-SC was described using the 5-item Compliance Questionnaire for Rheumatology (CQR5). Results At inclusion 75% of the 285 analyzed patients were women, mean RA duration was 9 ± 9 years, previous RA treatments included biological agents (63%) and/or csDMARDs (94%), mean Disease Activity Score 28 joints-Erythrocyte Sedimentation Rate (DAS28-ESR) was 4.8 ± 1.2. TCZ-SC RR at month 12 was estimated to be 64% (95% CI 58%–69%) with no statistical differences between subgroups. Clinical results improved with TCZ-SC; the proportion of patients treated with combined glucocorticoids decreased from 49% to 22% at month 12. At each follow-up time, at least 80% of patients were high adherers to TCZ-SC (at least 80% of theoretical injections). Among the 286 patients with at least one TCZ-SC injection, 25 patients (9%) experienced serious adverse events related to TCZ-SC with no differences according to patient age. Conclusions This real-world study corroborates the RR at month 12 previously shown in interventional studies on TCZ-SC. Our data suggest there are no differences according to patient’s profile (age, BMI), methotrexate doses, and TCZ-SC use. Trial Registration NCT02608112.
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Affiliation(s)
- Pascal Hilliquin
- Rheumatology Department, C.H. Sud Francilien, Corbeil-Essonnes, France.
| | - Thomas Barnetche
- Rheumatology Department, University Hospital of Bordeaux, FHU ACRONIM, Bordeaux, France
| | - Athan Baillet
- Rheumatology Department, University Hospital of Grenoble, Grenoble, France
| | - René-Marc Flipo
- Rheumatology Department, University Hospital of Lille, Lille, France
| | | | - Christian Roux
- Rheumatology Department, University Hospital of Nice, Nice, France
| | | | | | - Isabelle Idier
- Medical Affairs, Chugai Pharma France, Paris La Défense, Puteaux, France
| | - Arnaud Constantin
- Rheumatology Department, University Hospital of Toulouse, Toulouse, France
| | - Emilie Shipley
- Rheumatology Department, General Hospital of Dax, Dax, France
| | - Guy Baudens
- Rheumatology, Private Practice, Valenciennes, France
| | - Alain Saraux
- Rheumatology Department, CHU de Brest, Univ Brest, Inserm UMR1227, Lymphocytes B et Autoimmunité, Brest, France
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Sebastiani M, Manfredi A, Iannone F, Gremese E, Bortoluzzi A, Favalli E, Bazzani C, Salaffi F, Fusaro E, Foti R, Giannitti C, Caporali R, Cauli A, Cassone G, Lopalco G, Petricca L, Ferraccioli G, Lapadula G. Factors Predicting Early Failure of Etanercept in Rheumatoid Arthritis: An Analysis From the Gruppo Italiano di Studio sulla Early Arthritis (Italian Group for the Study of Early Arthritis) Registry. Arch Rheumatol 2020; 35:163-169. [PMID: 32851364 DOI: 10.46497/archrheumatol.2020.7499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 06/21/2019] [Indexed: 11/03/2022] Open
Abstract
Objectives This study aims to investigate the factors associated with early discontinuation (within one year) of etanercept (ETA) in rheumatoid arthritis (RA) patients who began ETA as first biologic disease-modifying antirheumatic drug (bDMARD) and who were entered into the Gruppo Italiano di Studio sulla Early Arthritis (Italian Group for the Study of Early Arthritis; GISEA) registry. Patients and methods This registry-based cohort study included 477 RA patients (95 males, 382 females; median age 53 years; range 18 to 83 years) who began ETA as first bDMARD. Patient demographics, disease features and drugs were re-evaluated after 12 months. Baseline predictors of ETA discontinuation were estimated by univariate and multivariate analyses using Cox regression model. Results Seventy patients (14.7%) discontinued ETA during the first year (for inefficacy in 55.8%, adverse events in 28.6%, and other reasons in 6.5%). Concurrent conventional synthetic DMARDs (csDMARDs) were reported in 54.3% of patients, mainly methotrexate (MTX), while 52.4% of subjects took low doses of glucocorticoids. Patients stopping ETA more frequently showed one or more comorbidities, mainly cardiovascular diseases (28.6% vs. 15.7% in patients stopping and continuing ETA, respectively, p=0.009). The presence of comorbidities and a combination therapy with csDMARDs other than MTX were independent factors associated with early discontinuation of ETA at multivariate Cox analysis. Conclusion Although ETA demonstrated a high persistence in biologic-naïve RA patients, about 15% of patients discontinued the treatment within 12 months. The presence of comorbidities and a combination therapy with csDMARDs other than MTX were the main factors for an early withdrawal of the drug.
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Affiliation(s)
- Marco Sebastiani
- Azienda Ospedaliera Policlinico Di Modena, University of Modena and Reggio Emilia, Rheumatology Unit, Modena, Italy
| | - Andreina Manfredi
- Azienda Ospedaliera Policlinico Di Modena, University of Modena and Reggio Emilia, Rheumatology Unit, Modena, Italy
| | - Florenzo Iannone
- Department of Medicine, Rheumatology Unit, University of Bari, Interdisciplinary Bari, Italy
| | - Elisa Gremese
- Policlinico Gemelli Foundation, Catholic University of the Sacred Heart, Rheumatology Unit, Rome, Italy
| | - Alessandra Bortoluzzi
- Department of Clinical and Experimental Medicine, Rheumatology Unit, Sant'anna Hospital, University of Ferrara, Ferrara, Italy
| | - Ennio Favalli
- Department of Rheumatology, Gaetano Pini Institute, Milan, Italy
| | - Chiara Bazzani
- Spedali Civili Di Brescia, Rheumatology and Clinical Immunology Unit, Brescia, Italy
| | - Fausto Salaffi
- Università Politecnica Delle Marche, Rheumatology Unit, Jesi, Italy
| | - Enrico Fusaro
- Città Della Salute E Della Scienza Hospital, Rheumatology Unit, Turin, Italy
| | - Rosario Foti
- A.o.u. Policlinico Vittorio Emanuele, Rheumatology Unit, Catania, Italy
| | | | - Roberto Caporali
- Irccs Policlinico San Matteo Foundation, University of Pavia, Rheumatology Unit, Pavia, Italy
| | - Alberto Cauli
- Department of Medical Sciences, Rheumatology Unit, Policlinico of the University of Cagliari, Cagliari, Italy
| | - Giulia Cassone
- Department of Clinical and Experimental Medicine, University of Modena and Raggio Emilia, Modena, Italy
| | - Giuseppe Lopalco
- Department of Medicine, Rheumatology Unit, University of Bari, Interdisciplinary Bari, Italy
| | - Luca Petricca
- Policlinico Gemelli Foundation, Catholic University of the Sacred Heart, Rheumatology Unit, Rome, Italy
| | - Gianfranco Ferraccioli
- Policlinico Gemelli Foundation, Catholic University of the Sacred Heart, Rheumatology Unit, Rome, Italy
| | - Giovanni Lapadula
- Department of Medicine, Rheumatology Unit, University of Bari, Interdisciplinary Bari, Italy
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Lin CM, Cooles FA, Isaacs JD. Basic Mechanisms of JAK Inhibition. Mediterr J Rheumatol 2020; 31:100-104. [PMID: 32676567 PMCID: PMC7361186 DOI: 10.31138/mjr.31.1.100] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/20/2020] [Indexed: 12/13/2022] Open
Affiliation(s)
- Chung Ma Lin
- Translational and Clinical Research Institute, Newcastle University and Musculoskeletal Unit, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, United Kingdom
| | - Faye Ah Cooles
- Translational and Clinical Research Institute, Newcastle University and Musculoskeletal Unit, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, United Kingdom
| | - John D Isaacs
- Translational and Clinical Research Institute, Newcastle University and Musculoskeletal Unit, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, United Kingdom
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Hernández-Muñoz JJ, Wei W, Sierra-Zorita R. Prevalence of Rheumatoid Arthritis and Drug Dispensing Patterns Among Medicaid and Medicaid-Medicare Dually Eligible Beneficiaries in Puerto Rico. Arthritis Care Res (Hoboken) 2020; 73:199-206. [PMID: 32475025 DOI: 10.1002/acr.24330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 05/19/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To estimate the prevalence of rheumatoid arthritis (RA) in Puerto Rico, to describe disease-modifying antirheumatic drug (DMARD) dispensing patterns by prescriber specialty, and to illustrate the impact of RA case definition on the estimated prevalence. METHODS This study estimated the prevalence of RA in Puerto Rico during 2016 among Medicaid and Medicaid-Medicare dually eligible beneficiaries of the Mi Salud health care plan, a federally funded health insurance program. DMARD dispensing and cost patterns were described and stratified by provider specialty. A sensitivity analysis was conducted to evaluate the effect of RA case definition on estimated prevalence. RESULTS The prevalence of RA in 2016 was estimated to be 2 cases per 1,000 beneficiaries, with 3 per 1,000 beneficiaries among females, 4.5 times that of males. In total, 44% of beneficiaries received conventional synthetic DMARDs (csDMARDs) only, 32% received biologic or targeted synthetic DMARDs (b/tsDMARDs) only, and 24% received a combination of csDMARDs and b/tsDMARDs. Rheumatologists and a combination of specialties accounted for the highest median number of dispensed DMARDs, with 14 each. A sensitivity analysis revealed that when RA cases with ≥3 medical claims were restricted to having ≥1 DMARD claim, the estimated prevalence changed from 6 to 3 cases per 1,000 beneficiaries. CONCLUSION The prevalence of RA in Puerto Rico in this study is lower than reported in the mainland US, possibly due to more stringent criteria to define RA. DMARD dispensing and cost patterns are similar to those found in other studies. Claims algorithms that identify RA have higher validity when pharmacy data is included.
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Tkacz J, Gharaibeh M, DeYoung KH, Wilson K, Collier D, Oko-osi H. Treatment Patterns and Costs in Biologic DMARD-Naive Patients with Rheumatoid Arthritis Initiating Etanercept or Adalimumab with or Without Methotrexate. J Manag Care Spec Pharm 2020; 26:285-294. [PMID: 32105179 PMCID: PMC10391042 DOI: 10.18553/jmcp.2020.26.3.285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Etanercept (ETN) and adalimumab (ADA) are tumor necrosis factor inhibitors indicated for treatment of moderate to severe rheumatoid arthritis (RA) and are used as monotherapy or in combination with conventional disease-modifying antirheumatic drugs (DMARDs) such as methotrexate (MTX). Data on treatment patterns and costs of ETN and ADA as monotherapies or in combination therapy with MTX are lacking in biologic DMARD (bDMARD)-naive patients with RA. OBJECTIVE To evaluate treatment patterns and costs of ETN and ADA monotherapy and combination therapy in bDMARD-naive patients with RA. METHODS Data from adult bDMARD-naive patients with RA were evaluated according to index therapy (ADA or ETN as monotherapy or combination therapy with MTX) in a retrospective cohort study using the IBM MarketScan Commercial Claims and Encounters and Medicare Supplemental Databases from January 1, 2010, to June 30, 2017. Participants were bDMARD-naive for ≥ 12 months before initial ETN or ADA pharmacy claim (index date) and had continuous enrollment for ≥ 12 months pre-index and 24 months post-index. Combination therapy cohorts had an MTX claim within 30 days of the index date. Outcomes included persistence (no treatment changes or gap [≥ 60 days]); modifications to index therapy (discontinuation or switching without prior gap, restarting as switch or restart after gap, or MTX initiation/discontinuation); and mean total bDMARD costs for 2 years post-index. RESULTS Patients on ETN monotherapy (n = 2,064) had higher persistence (26.8% vs. 21.1%, respectively; P < 0.001) on index treatment and received treatment for a longer duration (mean 375.9 days vs. 339.7 days, respectively; P < 0.001) than those on ADA monotherapy (n = 1,528). Regimen changes were more common in patients on ADA monotherapy than patients on ETN monotherapy (38.0% vs. 33.4%, respectively; P = 0.004). More patients on ADA monotherapy added MTX than those on ETN (17.5% vs. 12.6%, respectively; P < 0.001). Overall, 790 patients receiving index monotherapy had a regimen change following a gap (≥ 60 days), with a similar proportion between cohorts. Among these patients, 13.8% restarted index therapy, and 7.9% switched from index therapy. Significantly more patients receiving ETN monotherapy restarted their index regimen after a gap than those receiving ADA monotherapy (14.9% vs. 12.2%, respectively; P = 0.023). The proportion of patients persistent on combination therapy was similar between the ETN and ADA combination therapy cohorts (21.9% vs. 22.2%, respectively; P = 0.818). Treatment pattern rates were similar regardless of index combination therapy. Overall, costs for ADA were consistently higher within the index regimen throughout the follow-up period irrespective of MTX. CONCLUSIONS ETN monotherapy as first-line treatment was associated with higher persistence, lower rate of MTX supplementation, and lower bDMARD costs than ADA monotherapy. ETN monotherapy may represent a less costly option for achieving treatment targets in bDMARD-naive patients with RA. DISCLOSURES This study was sponsored by Amgen. Tkacz, Henderson DeYoung, and Wilson are employees of IBM Watson Health, which received funding from Amgen for this study. Collier and Oko-osi are employees and shareholders of Amgen. Gharaibeh was an employee of Amgen at the time of study execution and manuscript drafting. Data pertaining to this study were presented in a poster at AMCP Nexus 2018; October 25-28, 2018; Orlando, FL.
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Efficacy and retention rate of adalimumab in rheumatoid arthritis and psoriatic arthritis patients after first-line etanercept failure: the FEARLESS cohort. Rheumatol Int 2020; 40:263-272. [DOI: 10.1007/s00296-019-04416-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 08/08/2019] [Indexed: 10/26/2022]
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Lauper K, Mongin D, Iannone F, Kristianslund EK, Kvien TK, Nordström DC, Pavelka K, Pombo-Suarez M, Rotar Z, Santos MJ, Codreanu C, Lukina G, Gale SL, John M, Luder Y, Courvoisier DS, Gabay C. Comparative effectiveness of TNF inhibitors and tocilizumab with and without conventional synthetic disease-modifying antirheumatic drugs in a pan-European observational cohort of bio-naïve patients with rheumatoid arthritis. Semin Arthritis Rheum 2020; 50:17-24. [DOI: 10.1016/j.semarthrit.2019.06.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 06/07/2019] [Accepted: 06/24/2019] [Indexed: 01/31/2023]
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Taylor PC, Law ST. When the first visit to the rheumatologist is established rheumatoid arthritis. Best Pract Res Clin Rheumatol 2020; 33:101479. [PMID: 32001168 DOI: 10.1016/j.berh.2019.101479] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The outlook for people living with rheumatoid arthritis (RA) has improved tremendously in a generation. Major contributions to this include recognition of the importance of early treatment initiation, improved understanding of the pathobiology, the identification of therapeutic targets and their subsequent validation in clinic trials and the realisation of the importance of 'tight control' of inflammatory responses. Despite these advances, many patients meeting classification criteria present for the first time to a rheumatologist with longstanding symptoms. There is no definition as to when RA becomes 'established'. But there is evidence that a 'window of opportunity' exists over about 12-16 weeks symptom duration, during which treatment intervention gives rise to the most optimal outcomes. This review addresses issues regarding the management of patients presenting outside the window of opportunity in terms of heterogeneity of presentation, assessment, therapeutic goals and treatment options as well as the importance of a multidisciplinary approach to holistic care.
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Olsen IC, Lie E, Vasilescu R, Wallenstein G, Strengholt S, Kvien TK. Assessments of the unmet need in the management of patients with rheumatoid arthritis: analyses from the NOR-DMARD registry. Rheumatology (Oxford) 2020; 58:481-491. [PMID: 30508189 PMCID: PMC6381770 DOI: 10.1093/rheumatology/key338] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 10/15/2018] [Indexed: 01/19/2023] Open
Abstract
Objective To describe the outcomes of MTX and biologic DMARD (bDMARD) treatment in patients with RA and assess unmet needs in patients who fail treatment, using real-world data from the Norwegian DMARD (NOR-DMARD) registry. Methods Data included RA treatment courses from January 2007 until July 2016. Patients received MTX monotherapy (in MTX-naïve patients), bDMARD monotherapy, bDMARDs + MTX, or bDMARDs + other conventional synthetic DMARDs (csDMARDs). DAS28-4(ESR) was used to measure remission (<2.6) and inadequate response (>3.2) across all groups at Months 6 and 12. Estimated ACR20/50/70 and EULAR good and good/moderate response rates (based on DAS28-4[ESR] score) for bDMARDs were modelled at Months 6 and 12 using logistic mixed regression. DAS28-4(ESR) scores and changes from baseline, and rates and reasons for discontinuation, were evaluated for all groups over 24 months. Results The 2778 treatment courses in this analysis included 714 MTX monotherapy, 396 bDMARD monotherapy, 1460 bDMARDs + MTX and 208 bDMARDs + other csDMARDs. Of patients with DAS28-4(ESR) data at Months 6 and 12 (25.0–34.1%), 33.9–47.2% did not switch treatment and were inadequate-responders at Month 12. There were no significant differences in efficacy between bDMARD groups (bDMARD monotherapy, or bDMARDs + MTX or other csDMARDs). Lack of efficacy was the most common reason for stopping treatment across all groups (13.7–22.1% over 24 months). Conclusion An unmet treatment need exists for patients still experiencing inadequate response to MTX monotherapy and bDMARDs as monotherapy or in combination with MTX/other csDMARDs after 12 months. Trial registration ClinicalTrials.gov, https://clinicaltrials.gov/ct2/show/NCT01581294.
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Affiliation(s)
- Inge C Olsen
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Elisabeth Lie
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | | | | | | | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
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Wehler E, Boytsov N, Nicolay C, Herrera-Restrepo O, Kowal S. A Budget Impact and Cost Per Additional Responder Analysis for Baricitinib for the Treatment of Moderate-to-Severe Rheumatoid Arthritis in Patients with an Inadequate Response to Tumor Necrosis Factor Inhibitors in the USA. PHARMACOECONOMICS 2020; 38:39-56. [PMID: 31452079 PMCID: PMC7081656 DOI: 10.1007/s40273-019-00829-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
BACKGROUND/OBJECTIVE Baricitinib is a selective and reversible Janus kinase (JAK) inhibitor indicated for the treatment of adult patients with moderately to severely active rheumatoid arthritis (RA) who have had an inadequate response to one or more tumor necrosis factor inhibitors (TNFis) and has been shown to improve multiple clinical and patient-reported outcomes. However, it is unclear what the budgetary impact would be for US commercial payers to add baricitinib to their formulary and how the efficacy of baricitinib compares to other disease-modifying antirheumatic drugs (DMARDs) with a similar indication. METHODS A budget impact model (BIM) was developed for a hypothetical population of 1 million plan members that compared a world without and with baricitinib. A retrospective observational study was carried out to estimate market utilization of advanced therapies. Number needed to treat (NNT) and cost per additional responder were calculated for American College of Rheumatology (ACR) 20%/50%/70% improvement criteria (ACR20/50/70) response outcomes combining cost estimates from the BIM and efficacy values from a network meta-analysis (NMA). The model included costs related to drug acquisition and monitoring costs. RESULTS Adding baricitinib would save a commercial payer $US169,742 for second-line therapy and $US135,471 for third-line therapy over a 2-year time horizon (all costs correspond to 2019 US dollars). Cost savings were driven by baricitinib drawing market share away from more expensive comparators. The NMA, based on nine studies, found no statistically significant differences in the median treatment difference between baricitinib and comparators except for versus a conventional synthetic DMARD (csDMARD), and thus NNT versus a csDMARD was similar. The cost per additional responder for baricitinib in patients with inadequate response to a TNFi was substantially lower than all other treatments for all three ACR response criteria at 12 weeks (ACR20: $US129,672; ACR50: $US237,732; ACR70: $US475,464), and among the lowest at 24 weeks (ACR20: $US167,811; ACR50: $US259,344; ACR70: $US570,557). CONCLUSIONS Baricitinib, compared to other DMARDs, was a less expensive option (- $US0.01 incremental cost per member per month in second- and third-line therapy over a 2-year time horizon) with comparable efficacy in patients with inadequate response to TNFi. Adding baricitinib to formulary would likely be cost saving for US payers and expands treatment options for these patients.
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Affiliation(s)
| | - Natalie Boytsov
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA
| | | | | | - Stacey Kowal
- IQVIA, 3110 Fairview Park Drive, Falls Church, VA, 22042, USA
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Leong JWY, Cheung PP, Dissanayake S, Fong WWS, Leong KH, Leung YY, Lim AYN, Lui NL, Manghani M, Santosa A, Sriranganathan MK, Suresh E, Tan TC, Teng GG, Lahiri M. Singapore Chapter of Rheumatologists updated consensus statement on the eligibility for government subsidization of biologic and targeted-synthetic therapy for the treatment of rheumatoid arthritis. Int J Rheum Dis 2019; 23:140-152. [PMID: 31859424 DOI: 10.1111/1756-185x.13762] [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: 07/10/2019] [Revised: 10/29/2019] [Accepted: 11/03/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Approximately 30% of patients with rheumatoid arthritis (RA) respond inadequately to conventional-synthetic disease-modifying anti-rheumatic drugs (csDMARDs). However, widespread use of biologic DMARDs (bDMARDs) and targeted-synthetic (tsDMARDs) is limited by cost. We formulated updated recommendations for eligibility criteria for government-assisted funding of bDMARDs/tsDMARDs for RA patients in Singapore. MATERIALS AND METHODS Published guidelines regarding use of bDMARD and tsDMARDs were reviewed. We excluded those without a systematic literature review, formal consensus process or evidence grading. Separately, unpublished national reimbursement guidelines were included. RESULTS Eleven recommendations regarding choice of disease activity measure, initiation, order of selection and continuation of bDMARD/tsDMARDs were formulated. A bDMARD/tsDMARD is indicated if a patient has: (a) at least moderately active RA with a Disease Activity Score in 28 joints/erythrocyte sedimentation rate (DAS28-ESR) score of ≥3.2; (b) failed ≥2 csDMARD strategies, 1 of which must be a combination; (c) received an adequate dose regimen of ≥3 months for each strategy. For the first-line bDMARD/tsDMARD, either tumor necrosis factor inhibitors (TNFi), non-TNFi (abatacept, tocilizumab, rituximab), or tsDMARDs, may be considered. If a first-line TNFi fails, options include another TNFi, non-TNFi biologic or tsDMARDs. If a first-line non-TNFi biologic or tsDMARD fails, options include TNFi or another non-TNF biologic or tsDMARD. For continued bDMARD/tsDMARD subsidization, a patient must have a documented DAS28-ESR every 3 months and at least a moderate European League Against Rheumatism response by 6 months. CONCLUSION These recommendations are useful for guiding funding decisions, making bDMARD/tsDMARDs usage accessible and equitable in RA patients who fail csDMARDs.
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Affiliation(s)
| | - Peter P Cheung
- Division of Rheumatology, University Medicine Cluster, National University Hospital, National University Health System, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University Health System, Singapore, Singapore
| | - Sajeewani Dissanayake
- Division of Rheumatology, University Medicine Cluster, National University Hospital, National University Health System, Singapore, Singapore
| | | | - Keng Hong Leong
- Leong Keng Hong Arthritis and Medical Clinic, Singapore, Singapore
| | - Ying Ying Leung
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
| | - Anita Yee Nah Lim
- Division of Rheumatology, University Medicine Cluster, National University Hospital, National University Health System, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University Health System, Singapore, Singapore
| | - Nai Lee Lui
- Lui Centre for Arthritis & Rheumatology, Gleneagles Medical Centre, Singapore, Singapore
| | - Mona Manghani
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Amelia Santosa
- Division of Rheumatology, University Medicine Cluster, National University Hospital, National University Health System, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University Health System, Singapore, Singapore
| | | | - Ernest Suresh
- Department of Medicine, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Teck Choon Tan
- Department of Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Gim Gee Teng
- Division of Rheumatology, University Medicine Cluster, National University Hospital, National University Health System, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University Health System, Singapore, Singapore
| | - Manjari Lahiri
- Division of Rheumatology, University Medicine Cluster, National University Hospital, National University Health System, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University Health System, Singapore, Singapore
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Pettipher C, Benitha R. Tuberculosis in biologic users for rheumatic diseases: results from the South African Biologics Registry (SABIO). Ann Rheum Dis 2019; 79:292-299. [DOI: 10.1136/annrheumdis-2019-216128] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 11/12/2019] [Accepted: 11/13/2019] [Indexed: 02/04/2023]
Abstract
ObjectivesTo evaluate the rate of tuberculosis (TB) in biologic users for rheumatic diseases in South Africa, the effectiveness of our latent TB infection (LTBI) programme, risk factors and outcome.MethodsTB cases were collected from the South African Biologics Registry (SABIO), rheumatologists and pharmaceutical companies. Demographics, LTBI screening and treatment, biological and disease modifying antirheumatic drug (DMARD) therapies, TB diagnosis and outcomes were recorded.Results96 TB cases were collected from 1999 to June 2017: rheumatoid arthritis 55, ankylosing spondylitis 27, psoriatic arthritis 4, and juvenile inflammatory arthritis 10. The TB rate was 1240/100 000 person years for biologic users (n=96) versus the biologic naive cohort of 0/100 000 years with an incidence rate difference of 0.0124 (p<0.0001). 60/96 had pulmonary and 36/96 had extra-pulmonary TB. Reactivation TB occurred in 45/96 cases. TB occurred in all biologics licenced in South Africa, the majority in monoclonal inhibitors (1683/100 000 person years) compared with etanercept (861/100 000 person years) and non-tumour necrosis factor (TNF) inhibitors (681/100 000 person years). The incidence rate ratio for monoclonal inhibitors compared with etanercept was 1.96 (p=0.005) and 2.47 (p=0.002) compared with non-TNF inhibitors with no significant difference between non-TNF inhibitors and etanercept (p=0.336). From those (12.9%) who screened LTBI positive, 14 developed TB, while the majority (77) screened LTBI negative. Black race, male sex, younger age and residence in the Western Cape were statistical risk factors. Two drug resistant TB cases and six deaths occurred.ConclusionReactivation and new onset TB is a significant risk for all biologics users in SA. Screening for LTBI is an imperative preventative strategy.
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Burmester GR, Strand V, Rubbert-Roth A, Amital H, Raskina T, Gómez-Centeno A, Pena-Rossi C, Gervitz L, Thangavelu K, St John G, Boklage S, Genovese MC. Safety and efficacy of switching from adalimumab to sarilumab in patients with rheumatoid arthritis in the ongoing MONARCH open-label extension. RMD Open 2019; 5:e001017. [PMID: 31673415 PMCID: PMC6802992 DOI: 10.1136/rmdopen-2019-001017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 09/04/2019] [Accepted: 09/08/2019] [Indexed: 11/19/2022] Open
Abstract
Objective Evaluate open-label sarilumab monotherapy in patients with rheumatoid arthritis switching from adalimumab monotherapy in MONARCH (NCT02332590); assess long-term safety and efficacy in patients continuing sarilumab during open-label extension (OLE). Methods During the 48-week OLE, patients received sarilumab 200 mg subcutaneously once every 2 weeks. Safety (March 2017 cut-off) and efficacy, including patient-reported outcomes, were evaluated. Results In the double-blind phase, patients receiving sarilumab or adalimumab monotherapy showed meaningful improvements in disease activity; sarilumab was superior to adalimumab for improving signs, symptoms and physical function. Overall, 320/369 patients completing the 24-week double-blind phase entered OLE (155 switched from adalimumab; 165 continued sarilumab). Sarilumab safety profile was consistent with previous reports. Treatment-emergent adverse events were similar between groups; no unexpected safety signals emerged in the first 10 weeks postswitch. Among switch patients, improvement in disease activity was evident at OLE week 12: 47.1%/34.8% had changes ≥1.2 in Disease Activity Score (28 joints) (DAS28)-erythrocyte sedimentation rate/DAS28-C-reactive protein. In switch patients achieving low disease activity (LDA: Clinical Disease Activity Index (CDAI) ≤10; Simplified Disease Activity Index (SDAI) ≤11) by OLE week 24, 70.7%/69.5% sustained CDAI/SDAI LDA at both OLE weeks 36 and 48. Proportions of switch patients achieving CDAI ≤2.8 and SDAI ≤3.3 by OLE week 24 increased through OLE week 48. Improvements postswitch approached continuation-group values, including scores ≥normative values. Conclusions During this OLE, there were no unexpected safety issues in patients switching from adalimumab to sarilumab monotherapy, and disease activity improved in many patients. Patients continuing sarilumab reported safety consistent with prolonged use and had sustained benefit.
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Affiliation(s)
- Gerd R Burmester
- Department of Rheumatology and Clinical Immunology, Charité – Medical University Berlin, Free University, and Humboldt University Berlin, Berlin, Germany
| | - Vibeke Strand
- Department of Immunology and Rheumatology, Stanford University, Palo Alto, California, USA
| | | | - Howard Amital
- Department of Medicine ‘B’ and Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
| | - Tatiana Raskina
- Faculty of Therapeutics, Kemerovo State Medical Academy of Roszdrav, Kemerovo, Russian Federation
| | | | | | - Leon Gervitz
- Medical Operations and Effectiveness, Sanofi Genzyme, Cambridge, Massachusetts, USA
| | | | - Gregory St John
- Medical Affairs, Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Susan Boklage
- Medical Affairs, Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Mark C Genovese
- Immunology and Rheumatology, Stanford University Medical Center, Palo Alto, California, USA
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Law ST, Taylor PC. Role of biological agents in treatment of rheumatoid arthritis. Pharmacol Res 2019; 150:104497. [PMID: 31629903 DOI: 10.1016/j.phrs.2019.104497] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 09/26/2019] [Accepted: 10/14/2019] [Indexed: 12/20/2022]
Abstract
Advances in understanding of the pathophysiology of rheumatoid arthritis with concurrent advances in protein engineering led to the development of biological disease-modifying antirheumatic drugs which have dramatically revolutionized the treatment of this condition. This review article focuses on the role of biological agents currently employed in the treatment of rheumatoid arthritis, as well as novel biological agents in development.
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Affiliation(s)
- Shing T Law
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, OX3 7LD, UK
| | - Peter C Taylor
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, OX3 7LD, UK.
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Wells AF, Parrino J, Mangan EK, Paccaly A, Lin Y, Xu C, Fan C, Graham NMH, van Hoogstraten H, Torri A. Immunogenicity of Sarilumab Monotherapy in Patients with Rheumatoid Arthritis Who Were Inadequate Responders or Intolerant to Disease-Modifying Antirheumatic Drugs. Rheumatol Ther 2019; 6:339-352. [PMID: 31090044 PMCID: PMC6702535 DOI: 10.1007/s40744-019-0157-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION This open-label study evaluated the immunogenicity, safety, and efficacy of sarilumab monotherapy in patients with active, moderate-to-severe rheumatoid arthritis (RA) and inadequate response or intolerance to prior conventional synthetic disease-modifying antirheumatic drugs. METHODS Adults with RA (n = 132) were randomized to receive subcutaneous sarilumab (150 [n = 65] or 200 mg [n = 67]) every 2 weeks (q2w) for 24 weeks. Endpoints included incidence of antidrug antibodies (ADAs) at week 24, safety, and efficacy. RESULTS Persistent ADAs occurred in eight patients (12.3%) receiving sarilumab 150 mg q2w, seven of whom (10.8%) had neutralizing antibodies (NAbs), and in four patients (6.1%) receiving sarilumab 200 mg q2w, two of whom (3.0%) had NAbs; all exhibited low antibody titers. Infections and neutropenia were the most common adverse events (AEs). There were three serious AEs, no reports of anaphylaxis, and few hypersensitivity reactions (e.g., rash) with no notable differences in hypersensitivity reactions in ADA-positive patients relative to ADA-negative patients. Changes in absolute neutrophil count, alanine aminotransferase level, and platelet count were consistent with interleukin-6 signaling blockade and in agreement with previous observations. At week 24, overall American College of Rheumatology 20%/50%/70% improvement criteria responses were 73.8%/53.8%/29.2%, respectively, with sarilumab 150 mg q2w and 71.6%/50.7%/29.9% with sarilumab 200 mg q2w. No patients with an ADA-positive response showed loss of efficacy. CONCLUSIONS ADA titers were low and persistent ADAs and NAbs occurred relatively infrequently in both sarilumab dose groups. ADA did not meaningfully impact the safety or efficacy of either dose of sarilumab over 24 weeks. TRIAL REGISTRATION ClinicalTrials.gov, identifier NCT02121210. FUNDING Sanofi Genzyme and Regeneron Pharmaceuticals, Inc. Plain language summary available for this article.
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Affiliation(s)
- Alvin F Wells
- Rheumatology and Immunology Center, Franklin, WI, USA.
| | | | | | - Anne Paccaly
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | - Yong Lin
- Sanofi Genzyme, Bridgewater, NJ, USA
| | | | | | | | | | - Albert Torri
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
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46
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Asai S, Hayashi M, Hanabayashi M, Kanayama Y, Takemoto T, Yabe Y, Shioura T, Ishikawa H, Yoshioka Y, Kato T, Hirano Y, Fujibayashi T, Hattori Y, Kobayakawa T, Ando M, Kuwatsuka Y, Takahashi N, Matsumoto T, Asai N, Sobue Y, Nishiume T, Suzuki M, Ishiguro N, Kojima T. Discontinuation of concomitant methotrexate in Japanese patients with rheumatoid arthritis treated with tocilizumab: An interventional study. Mod Rheumatol 2019; 30:434-441. [PMID: 31390271 DOI: 10.1080/14397595.2019.1641934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Objectives: To evaluate the efficacy and safety of methotrexate (MTX) discontinuation in Japanese rheumatoid arthritis (RA) patients with sustained low disease activity undergoing combination therapy with tocilizumab (TCZ) plus MTX.Methods: This multicenter, open-label, uncontrolled, prospective study included RA patients maintaining low disease activity (Clinical Disease Activity Index (CDAI) ≤10) for ≥12 weeks with TCZ plus MTX. Methotrexate was discontinued following 12 weeks of biweekly administration while continuing TCZ therapy. The primary endpoint was the proportion of patients maintaining low disease activity with no flare at week 36.Results: A total of 49 patients completed 36 weeks of therapy. The proportion of patients maintaining low disease activity at week 36 was 75.5%. The lower limit of the 95% confidence interval exceeded the assumed threshold response rate of 60%, demonstrating the clinical feasibility of MTX discontinuation. The prevalence of gastroesophageal reflux disease, defined as a Frequency Scale for Symptoms of Gastroesophageal reflux disease score ≥8, significantly decreased from week 0 to 12 (27.1-18.4%; p= .025).Conclusion: Discontinuation of concomitant MTX is clinically feasible for maintaining low disease activity, and may be beneficial from the perspective of reducing gastrointestinal symptoms in Japanese RA patients treated with TCZ. Trial registration number: UMIN000021247.
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Affiliation(s)
- Shuji Asai
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masatoshi Hayashi
- Department of Rheumatology, Nagano Red Cross Hospital, Nagano, Japan
| | | | | | - Toki Takemoto
- Department of Orthopedic Surgery, Anjo Kosei Hospital, Anjo, Japan
| | - Yuichiro Yabe
- Department of Rheumatology, Tokyo Shinjuku Medical Center, Tokyo, Japan
| | - Tomone Shioura
- Department of Rheumatology, Shizuoka Kosei Hospital, Shizuoka, Japan
| | - Hisato Ishikawa
- Department of Rheumatology, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan
| | - Yutaka Yoshioka
- Department of Rheumatology, Handa Municipal Hospital, Handa, Japan
| | | | - Yuji Hirano
- Department of Rheumatology, Toyohashi Municipal Hospital, Toyohashi, Japan
| | | | - Yosuke Hattori
- Department of Orthopedic Surgery and Rheumatology, Nagoya Medical Center, Nagoya, Japan
| | | | - Masahiko Ando
- Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Yachiyo Kuwatsuka
- Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Nobunori Takahashi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takuya Matsumoto
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nobuyuki Asai
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasumori Sobue
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tsuyoshi Nishiume
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mochihito Suzuki
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Ishiguro
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toshihisa Kojima
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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47
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Chen C, Hartzema AG, Xiao H, Wei YJ, Chaudhry N, Ewelukwa O, Glover SC, Zimmermann EM. Real-world Pattern of Biologic Use in Patients With Inflammatory Bowel Disease: Treatment Persistence, Switching, and Importance of Concurrent Immunosuppressive Therapy. Inflamm Bowel Dis 2019; 25:1417-1427. [PMID: 30839057 DOI: 10.1093/ibd/izz001] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Medication persistence, defined as the time from drug initiation to discontinuation of therapy, has been suggested as a proxy for real-world therapeutic benefit and safety. This study seeks to compare the persistence of biologic drugs among patients with inflammatory bowel disease (IBD). METHODS Patients with newly diagnosed IBD were included in a retrospective study using Truven MarketScan database. Treatment persistence and switching was compared among biologic medications including infliximab, adalimumab, certolizumab, golimumab, and vedolizumab. Predictors for discontinuation and switching were evaluated using time-dependent proportional hazard regression. RESULTS In total, 5612 patients with Crohn's disease (CD) and 3533 patients with ulcerative colitis (UC) were included in this analysis. Less than half of the patients continued using their initial biologic treatment after 1 year (48.48% in CD cohort; 44.78% in UC cohort). In the first year, adalimumab had the highest persistence and lowest switching rates for both CD (median survival time: 1.04 years) and UC (median survival time: 0.84 years). In subsequent years, infliximab users were more likely to persist in the use of biologic. Combination therapy with immunomodulators significantly decreased the risk of discontinuation, especially when immunomodulator therapy was started more than 30 days before the biologic (hazard ratio [HR], 0.22; CI, 0.16, 0.32). The major predictors for noncompliance included infection and hospitalization. CONCLUSION Overall, the persistence profiles of biologics suggest a high rate of dissatisfaction or adverse disease outcomes resulting in discontinuation and switching to a different agent. Early initiation of immunomodulators will substantially increase the persistence of biologic treatment.
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Affiliation(s)
- Chao Chen
- Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - Abraham G Hartzema
- Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - Hong Xiao
- Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - Yu-Jung Wei
- Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - Naueen Chaudhry
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, USA
| | - Ofor Ewelukwa
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, USA
| | - Sarah C Glover
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, USA
| | - Ellen M Zimmermann
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, USA
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48
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Mousavi M, Karimzadeh H, Pakzad B, Mirrokni F. Comparison of the Effect of Disease: Modifying Antirheumatic Drugs Alone or in Combination with Biologic Drugs in the Outcome of Patients with Rheumatoid Arthritis. Adv Biomed Res 2019; 8:32. [PMID: 31214550 PMCID: PMC6521615 DOI: 10.4103/abr.abr_247_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Rheumatoid arthritis (RA) is a rheumatic disease that could be disabling if not treated. The aim of RA therapy is to resolve tenderness and swelling in the joints. The present study was conducted to compare two methods of RA treatment with disease-modifying anti-rheumatic drugs (DMARDs) and DMARDs with biologic drugs in two groups of patients. Materials and Methods The present study was a nonrandomized clinical trial which was conducted from July to September 2017 on 110 patients who were selected based on the American College of Rheumatology (2010) criteria for RA. Patients were divided into two groups of 55: Groups A and B. For the treatment of Group A, prednisolone along with one or two drugs from the DMARDs combinations was used. Group B received one biologic drug besides with the drugs of the group A. T-test and covariance analysis was used to compare the outcomes of both groups. Results Disease activity score (DAS-28) at the beginning of the study was 4.23 (0.81) in Group A and 4.51 (0.7) in Group B (P = 0.05). At the end of the study, DAS-28 was 3.52 (0.79) in Group A and 3.75 (0.85) in Group B (P = 0.1). DAS-28 activity index had a significant difference between both two groups at the beginning of the study (P = 0.05), but at the end of the study, the difference was not statistically significant (P = 0.1). Conclusions Simultaneous use of DMARDs and biologic drugs in RA patients could lead to improvement the disease symptoms and decrease the severity and activity of the disease.
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Affiliation(s)
- Maryam Mousavi
- Isfahan Metabolic Bone Disorders Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hadi Karimzadeh
- Isfahan Metabolic Bone Disorders Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Bahram Pakzad
- Isfahan Metabolic Bone Disorders Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Farzaneh Mirrokni
- Isfahan Metabolic Bone Disorders Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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49
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Smolen JS, Pangan AL, Emery P, Rigby W, Tanaka Y, Vargas JI, Zhang Y, Damjanov N, Friedman A, Othman AA, Camp HS, Cohen S. Upadacitinib as monotherapy in patients with active rheumatoid arthritis and inadequate response to methotrexate (SELECT-MONOTHERAPY): a randomised, placebo-controlled, double-blind phase 3 study. Lancet 2019; 393:2303-2311. [PMID: 31130260 DOI: 10.1016/s0140-6736(19)30419-2] [Citation(s) in RCA: 217] [Impact Index Per Article: 43.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 02/12/2019] [Accepted: 02/19/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Upadacitinib, an oral Janus kinase (JAK)1-selective inhibitor, showed efficacy in combination with stable background conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) in patients with rheumatoid arthritis who had an inadequate response to DMARDs. We aimed to evaluate the safety and efficacy of upadacitinib monotherapy after switching from methotrexate versus continuing methotrexate in patients with inadequate response to methotrexate. METHODS SELECT-MONOTHERAPY was conducted at 138 sites in 24 countries. The study enrolled adults (≥18 years) who fulfilled the 2010 American College of Rheumatology (ACR)-European League Against Rheumatism (EULAR) classification criteria for rheumatoid arthritis. Patients with active rheumatoid arthritis despite stable methotrexate were randomly assigned 2:2:1:1 to switch to once-daily monotherapy of of upadacitinib or to continue methotrexate at their existing dose as blinded study drug; starting from week 14, patients assigned to continue methotrexate were switched to 15 mg or 30 mg once-daily upadacitinib per prespecified random assignment at baseline. The primary endpoints in this report are proportion of patients achieving 20% improvement in the ACR criteria (ACR20) at week 14, and proportion achieving low disease activity defined as 28-joint Disease Activity Score using C-reactive protein (DAS28[CRP]) of 3·2 or lower, both with non-responder imputation at week 14. Outcomes were assessed in patients who received at least one dose of study drug. This study is active but not recruiting and is registered with ClinicalTrials.gov, number NCT02706951. FINDINGS Patients were screened between Feb 23, 2016, and May 19, 2017 and 648 were randomly assigned to treatment. 598 (92%) completed week 14. At week 14, an ACR20 response was achieved by 89 (41%) of 216 patients (95% CI 35-48) in the continued methotrexate group, 147 (68%) of 217 patients (62-74) receiving upadacitinib 15 mg, and 153 (71%) of 215 patients (65-77) receiving upadacitinib 30 mg (p<0·0001 for both doses vs continued methotrexate). DAS28(CRP) 3·2 or lower was met by 42 (19%) of 216 (95% CI 14-25) in the continued methotrexate group, 97 (45%) of 217 (38-51) receiving upadacitinib 15 mg, and 114 (53%) of 215 (46-60) receiving upadacitinib 30 mg (p<0·0001 for both doses vs continued methotrexate). Adverse events were reported in 102 patients (47%) on continued methotrexate, 103 (47%) on upadacitinib 15 mg, and 105 (49%) on upadacitinib 30 mg. Herpes zoster was reported by one (<1%) patient on continued methotrexate, three (1%) on upadacitinib 15 mg, and six (3%) on upadacitinib 30 mg. Three malignancies (one [<1%] on continued methotrexate, two [1%] on upadacitinib 15 mg), three adjudicated major adverse cardiovascular events (one [<1%] on upadacitinib 15 mg, two [<1%] on upadacitinib 30 mg), one adjudicated pulmonary embolism (<1%; upadacitinib 15 mg), and one death (<1%; upadacitinib 15 mg, haemorrhagic stroke [ruptured aneurysm]) were reported in the study. INTERPRETATION Upadacitinib monotherapy showed statistically significant improvements in clinical and functional outcomes versus continuing methotrexate in this methotrexate inadequate-responder population. Safety observations were similar to those in previous upadacitinib rheumatoid arthritis studies. FUNDING AbbVie Inc, USA.
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Affiliation(s)
| | | | - Paul Emery
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds NIHR BRC, Leeds, UK
| | | | - Yoshiya Tanaka
- University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | | | | | - Nemanja Damjanov
- University of Belgrade School of Medicine, Institute of Rheumatology, Belgrade, Serbia
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50
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Peterfy C, Kremer J, Rigby W, Singer N, Birchwood C, Gill D, Reiss W, Pei J, Michalska M. Magnetic Resonance Imaging (MRI) Results Following Discontinuation of Methotrexate in Rheumatoid Arthritis Treated with Subcutaneous Tocilizumab: The COMP-ACT MRI Substudy. J Rheumatol 2019; 47:325-332. [PMID: 31154414 DOI: 10.3899/jrheum.180953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess differences in joint damage and inflammation using magnetic resonance imaging (MRI) between patients with rheumatoid arthritis (RA) who achieved low disease activity with tocilizumab (TCZ) + methotrexate (MTX) and subsequently continued or discontinued MTX. METHODS In the COMP-ACT trial, US patients with RA received subcutaneous TCZ 162 mg + MTX. Those who achieved 28-joint count Disease Activity Score calculated with erythrocyte sedimentation rate (DAS28-ESR) ≤ 3.2 at Week 24 were randomized 1:1 (double-blind) to discontinue MTX (TCZ monotherapy; mono) or continue TCZ + MTX until Week 52. In a subset of patients, 1.5-Tesla MRI was used to obtain images of bilateral hands and wrists at weeks 24 and 40. Outcomes included changes in MRI-assessed synovitis, osteitis, erosion, and cartilage loss from Week 24 to Week 40, and in the proportion of patients with progression of each score. RESULTS Of 296 patients who achieved DAS28-ESR ≤ 3.2 at Week 24, 79 were enrolled in the pilot MRI substudy and randomized to TCZ mono (n = 38) or TCZ + MTX (n = 41). Treatment with either TCZ mono or TCZ + MTX suppressed erosion progression, synovitis, osteitis, and cartilage loss. The proportion of patients with no progression in each outcome measure was similar between groups (range, TCZ mono: 84.8-97.0%; TCZ + MTX: 92.3-100%). CONCLUSION In a subset of patients who achieved low disease activity with TCZ + MTX, MRI changes were minimal in intraarticular inflammation and damage measures in patients who discontinued MTX versus those who continued TCZ + MTX.
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Affiliation(s)
- Charles Peterfy
- From Spire Sciences Inc., Boca Raton, Florida; Albany Medical College and The Center for Rheumatology, Albany, New York; Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire; Case Western Reserve University and MetroHealth System, Cleveland, Ohio; Genentech Inc., South San Francisco, California, USA. .,C. Peterfy, MD, Spire Sciences Inc.; J. Kremer, MD, Albany Medical College and The Center for Rheumatology; W. Rigby, MD, Geisel School of Medicine, Dartmouth College; N. Singer, MD, Case Western Reserve University and MetroHealth System; C. Birchwood, PhD, Genentech Inc.; D. Gill, BS, Genentech Inc.; W. Reiss, PharmD, Genentech Inc.; J. Pei, BS, Genentech Inc.; M. Michalska, MD, Genentech Inc.
| | - Joel Kremer
- From Spire Sciences Inc., Boca Raton, Florida; Albany Medical College and The Center for Rheumatology, Albany, New York; Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire; Case Western Reserve University and MetroHealth System, Cleveland, Ohio; Genentech Inc., South San Francisco, California, USA.,C. Peterfy, MD, Spire Sciences Inc.; J. Kremer, MD, Albany Medical College and The Center for Rheumatology; W. Rigby, MD, Geisel School of Medicine, Dartmouth College; N. Singer, MD, Case Western Reserve University and MetroHealth System; C. Birchwood, PhD, Genentech Inc.; D. Gill, BS, Genentech Inc.; W. Reiss, PharmD, Genentech Inc.; J. Pei, BS, Genentech Inc.; M. Michalska, MD, Genentech Inc
| | - William Rigby
- From Spire Sciences Inc., Boca Raton, Florida; Albany Medical College and The Center for Rheumatology, Albany, New York; Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire; Case Western Reserve University and MetroHealth System, Cleveland, Ohio; Genentech Inc., South San Francisco, California, USA.,C. Peterfy, MD, Spire Sciences Inc.; J. Kremer, MD, Albany Medical College and The Center for Rheumatology; W. Rigby, MD, Geisel School of Medicine, Dartmouth College; N. Singer, MD, Case Western Reserve University and MetroHealth System; C. Birchwood, PhD, Genentech Inc.; D. Gill, BS, Genentech Inc.; W. Reiss, PharmD, Genentech Inc.; J. Pei, BS, Genentech Inc.; M. Michalska, MD, Genentech Inc
| | - Nora Singer
- From Spire Sciences Inc., Boca Raton, Florida; Albany Medical College and The Center for Rheumatology, Albany, New York; Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire; Case Western Reserve University and MetroHealth System, Cleveland, Ohio; Genentech Inc., South San Francisco, California, USA.,C. Peterfy, MD, Spire Sciences Inc.; J. Kremer, MD, Albany Medical College and The Center for Rheumatology; W. Rigby, MD, Geisel School of Medicine, Dartmouth College; N. Singer, MD, Case Western Reserve University and MetroHealth System; C. Birchwood, PhD, Genentech Inc.; D. Gill, BS, Genentech Inc.; W. Reiss, PharmD, Genentech Inc.; J. Pei, BS, Genentech Inc.; M. Michalska, MD, Genentech Inc
| | - Christine Birchwood
- From Spire Sciences Inc., Boca Raton, Florida; Albany Medical College and The Center for Rheumatology, Albany, New York; Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire; Case Western Reserve University and MetroHealth System, Cleveland, Ohio; Genentech Inc., South San Francisco, California, USA.,C. Peterfy, MD, Spire Sciences Inc.; J. Kremer, MD, Albany Medical College and The Center for Rheumatology; W. Rigby, MD, Geisel School of Medicine, Dartmouth College; N. Singer, MD, Case Western Reserve University and MetroHealth System; C. Birchwood, PhD, Genentech Inc.; D. Gill, BS, Genentech Inc.; W. Reiss, PharmD, Genentech Inc.; J. Pei, BS, Genentech Inc.; M. Michalska, MD, Genentech Inc
| | - Darcy Gill
- From Spire Sciences Inc., Boca Raton, Florida; Albany Medical College and The Center for Rheumatology, Albany, New York; Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire; Case Western Reserve University and MetroHealth System, Cleveland, Ohio; Genentech Inc., South San Francisco, California, USA.,C. Peterfy, MD, Spire Sciences Inc.; J. Kremer, MD, Albany Medical College and The Center for Rheumatology; W. Rigby, MD, Geisel School of Medicine, Dartmouth College; N. Singer, MD, Case Western Reserve University and MetroHealth System; C. Birchwood, PhD, Genentech Inc.; D. Gill, BS, Genentech Inc.; W. Reiss, PharmD, Genentech Inc.; J. Pei, BS, Genentech Inc.; M. Michalska, MD, Genentech Inc
| | - William Reiss
- From Spire Sciences Inc., Boca Raton, Florida; Albany Medical College and The Center for Rheumatology, Albany, New York; Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire; Case Western Reserve University and MetroHealth System, Cleveland, Ohio; Genentech Inc., South San Francisco, California, USA.,C. Peterfy, MD, Spire Sciences Inc.; J. Kremer, MD, Albany Medical College and The Center for Rheumatology; W. Rigby, MD, Geisel School of Medicine, Dartmouth College; N. Singer, MD, Case Western Reserve University and MetroHealth System; C. Birchwood, PhD, Genentech Inc.; D. Gill, BS, Genentech Inc.; W. Reiss, PharmD, Genentech Inc.; J. Pei, BS, Genentech Inc.; M. Michalska, MD, Genentech Inc
| | - Jinglan Pei
- From Spire Sciences Inc., Boca Raton, Florida; Albany Medical College and The Center for Rheumatology, Albany, New York; Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire; Case Western Reserve University and MetroHealth System, Cleveland, Ohio; Genentech Inc., South San Francisco, California, USA.,C. Peterfy, MD, Spire Sciences Inc.; J. Kremer, MD, Albany Medical College and The Center for Rheumatology; W. Rigby, MD, Geisel School of Medicine, Dartmouth College; N. Singer, MD, Case Western Reserve University and MetroHealth System; C. Birchwood, PhD, Genentech Inc.; D. Gill, BS, Genentech Inc.; W. Reiss, PharmD, Genentech Inc.; J. Pei, BS, Genentech Inc.; M. Michalska, MD, Genentech Inc
| | - Margaret Michalska
- From Spire Sciences Inc., Boca Raton, Florida; Albany Medical College and The Center for Rheumatology, Albany, New York; Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire; Case Western Reserve University and MetroHealth System, Cleveland, Ohio; Genentech Inc., South San Francisco, California, USA.,C. Peterfy, MD, Spire Sciences Inc.; J. Kremer, MD, Albany Medical College and The Center for Rheumatology; W. Rigby, MD, Geisel School of Medicine, Dartmouth College; N. Singer, MD, Case Western Reserve University and MetroHealth System; C. Birchwood, PhD, Genentech Inc.; D. Gill, BS, Genentech Inc.; W. Reiss, PharmD, Genentech Inc.; J. Pei, BS, Genentech Inc.; M. Michalska, MD, Genentech Inc
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