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Linde A, Gerdts E, Fevang BT, Eilertsen RK, Kringeland E, Alsing CL, Midtbø H. Factors associated with change in arterial stiffness in patients with rheumatoid arthritis: the JointHeart study. Blood Press 2024; 33:2353167. [PMID: 38824646 DOI: 10.1080/08037051.2024.2353167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 05/03/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND Rheumatoid arthritis (RA) predominantly affects women and is associated with hypertension and arterial stiffness. We explored factors associated with change in arterial stiffness in patients with RA treated with disease-modifying antirheumatic drug (DMARD) therapy. METHODS Seventy-seven outpatients with RA (age 55 ± 11, 69% women), with indication for treatment with biological or targeted synthetic DMARDs, were included. Pulse wave velocity (PWV), augmentation pressure (AP), augmentation index (AIx) and Disease Activity Score in 28 joints (DAS28) were measured at baseline and after a mean of 22 months of follow-up. RESULTS At follow-up, 83% used DMARDs and 73% had achieved remission or low disease activity. DAS28 decreased from 3.8 ± 1.3 to 2.8 ± 1.2 (p < 0.001). Mean PWV increased from 7.8 ± 1.6 m/s at baseline to 8.5 ± 1.8 m/s at follow-up (p < 0.001), while AP and AIx were stable. Increase in PWV during follow-up was associated with increase in systolic blood pressure (BP), diabetes, higher DAS28 and body mass index (BMI) at baseline, independent of achieved remission/low disease activity and use of DMARDs at follow-up. In multivariable analyses at follow-up, female sex was associated with higher AP and AIx, but with lower PWV, after adjusting for possible confounders. CONCLUSION In patients with RA, higher disease activity, BMI and diabetes at baseline, together with increase in office systolic BP were associated with an increase in arterial stiffness during follow-up, despite DMARD therapy. This highlights the need for management of cardiovascular risk factors in addition to reducing the inflammatory load in patients with RA to preserve arterial function.
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Affiliation(s)
- Anja Linde
- Department of Clinical Science, Centre for Research on Cardiac Disease in Women, University of Bergen, Bergen, Norway
- Norwegian Research Centre for Women's Health, Oslo University Hospital, Oslo, Norway
| | - Eva Gerdts
- Department of Clinical Science, Centre for Research on Cardiac Disease in Women, University of Bergen, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Bjørg T Fevang
- Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
| | - Rune K Eilertsen
- Department of Clinical Science, Centre for Research on Cardiac Disease in Women, University of Bergen, Bergen, Norway
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
| | - Ester Kringeland
- Department of Clinical Science, Centre for Research on Cardiac Disease in Women, University of Bergen, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Christian L Alsing
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Helga Midtbø
- Department of Clinical Science, Centre for Research on Cardiac Disease in Women, University of Bergen, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
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Slouma M, Lahmar W, Mohamed G, Dhrif O, Dhahri R, Bellali H, Gharsallah I, Ebdelli N. Associated factors with liver fibrosis in rheumatoid arthritis patients treated with methotrexate. Clin Rheumatol 2024; 43:929-938. [PMID: 38159207 DOI: 10.1007/s10067-023-06847-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 12/08/2023] [Accepted: 12/14/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION There are conflicting findings on the link between liver fibrosis and cumulative methotrexate dosages. We aimed to determine the frequency of liver fibrosis in rheumatoid arthritis patients treated with methotrexate and to identify its associated factors. METHODS We conducted a cross-sectional study over 9 months (April-December 2021), including rheumatoid arthritis patients treated with methotrexate. Demographic and clinical data were collected. Liver stiffness was assessed by FibroScan. Fibrosis and significant liver fibrosis were defined as liver stiffness higher than 6 and 7.2 kPa, respectively. Liver tests, albuminemia, lipid profile, and blood glycemia were measured. Metabolic syndrome was also evaluated. Statistical analyses were performed using SPSS. RESULTS We included 21 men and 47 women. The mean age was 51.60 ± 1.82 years. The mean disease duration was 8.29 ± 6.48 years. The mean weekly intake of methotrexate was 13.76 ± 3.91 mg. The mean methotrexate duration was 4.67 ± 4.24 years. The mean cumulative dose was 3508.87 ± 3390.48 mg. Hypoalbuminemia and metabolic syndrome were found in 34% and 25% of cases. We noted increased alkaline phosphatase levels in four cases. The mean liver stiffness was 4.50 ± 1.53 kPa. Nine patients had liver fibrosis, and four had significant fibrosis. Associated factors with liver fibrosis were as follows: age ≥ 60 years (OR:22.703; 95%CI [1.238-416.487]; p = 0.035), cumulated dose of methotrexate ≥ 3 g (OR: 76.501; 95%CI [2.383-2456.070]; p = 0.014), metabolic syndrome (OR: 42.743; 95%CI [1.728-1057.273]; p = 0.022), elevated alkaline phosphatase levels (OR: 28.252; 95%CI [1.306-611.007]; p = 0.033), and hypoalbuminemia (OR: 59.302; 95%CI [2.361-1489.718]; p = 0.013). CONCLUSION Cumulating more than 3 g of methotrexate was associated with liver fibrosis in rheumatoid arthritis patients. Having a metabolic syndrome, higher age, hypoalbuminemia, and elevated alkaline phosphatase levels were also likely to be independently associated with liver fibrosis. Key points • Rheumatoid arthritis patients require monitoring hepatic fibrosis when the cumulated dose of methotrexate is above 3 g. • Metabolic syndrome is a risk factor for liver fibrosis, suggesting that its management is necessary to prevent this complication. • Hypoalbuminemia and elevated alkaline phosphatase levels (twice the upper limit) in rheumatoid arthritis patients treated with methotrexate were associated with liver fibrosis.
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Affiliation(s)
- Maroua Slouma
- Department of Rheumatology, Military Hospital, 1008, Tunis, Tunisia.
- Department of Rheumatology, Military Hospital, 1008, Tunis, Tunisia.
- University of Tunis El Manar, 1068, Tunis, Tunisia.
| | - Wided Lahmar
- Department of Rheumatology, Military Hospital, 1008, Tunis, Tunisia
- University of Tunis El Manar, 1068, Tunis, Tunisia
| | - Ghanem Mohamed
- University of Tunis El Manar, 1068, Tunis, Tunisia
- Department of Gastrology, Military Hospital, 1008, Tunis, Tunisia
| | - Omar Dhrif
- University of Tunis El Manar, 1068, Tunis, Tunisia
- Department of Internal Medicine, Military Hospital of Bizerta, 7000, Bizerta, Tunisia
| | - Rim Dhahri
- Department of Rheumatology, Military Hospital, 1008, Tunis, Tunisia
- University of Tunis El Manar, 1068, Tunis, Tunisia
| | - Hedia Bellali
- University of Tunis El Manar, 1068, Tunis, Tunisia
- Department of Epidemiology, Hbib Thameur Hospital, 1008, Tunis, Tunisia
| | - Imen Gharsallah
- Department of Rheumatology, Military Hospital, 1008, Tunis, Tunisia
- University of Tunis El Manar, 1068, Tunis, Tunisia
| | - Nabil Ebdelli
- University of Tunis El Manar, 1068, Tunis, Tunisia
- Department of Gastrology, Military Hospital, 1008, Tunis, Tunisia
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Snoeck Henkemans SVJ, Vis M, Looijen AEM, van der Helm-van Mil AHM, de Jong PHP. Patient-reported outcomes and radiographic progression in patients with rheumatoid arthritis in sustained remission versus low disease activity. RMD Open 2024; 10:e003860. [PMID: 38382943 PMCID: PMC10882354 DOI: 10.1136/rmdopen-2023-003860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/06/2024] [Indexed: 02/23/2024] Open
Abstract
OBJECTIVE To compare clinical and patient-reported outcomes (PROs) over 5 years between patients with rheumatoid arthritis (RA) in sustained remission (sREM), sustained low disease activity (sLDA) or active disease (AD) in the first year after diagnosis. METHODS All patients with RA from the treatment in the Rotterdam Early Arthritis CoHort trial, a multicentre, stratified, single-blinded trial with a treat-to-target approach, aiming for LDA (Disease Activity Score (DAS) ≤2.4), were studied. Patients were categorised into: (1) sREM (mean DAS from 6 to 12 months <1.6) (n=173); (2) sLDA (mean DAS from 6 to 12 months 1.6-2.4) (n=142); and (3) AD (mean DAS from 6 to 12 months >2.4) (n=59). Pain, fatigue, functional impairment, health-related quality of life (HRQoL), health status and productivity loss during 5 years were compared between groups. Radiographic progression (modified Total Sharp Score (mTSS)) was compared over 2 years. RESULTS Patients in sLDA in the first year had worse PROs during follow-up, compared with patients in sREM: pain (0-10 Likert) was 0.90 units higher (95% CI 0.52 to 1.27), fatigue (Visual Analogue Scale) was 12.10 units higher (95% CI 7.27 to 16.92), functional impairment (Health Assessment Questionnaire-Disability Index) was 0.28 units higher (95% CI 0.17 to 0.39), physical HRQoL (36-item Short Form Health Survey (SF-36) Physical Component Summary score) was 4.42 units lower (95% CI -6.39 to -2.45), mental HRQoL (SF-36 Mental Component Summary score (MCS)) was 2.95 units lower (95% CI -4.83 to -1.07), health status (European Quality of life 5-Dimensions 3-Levels (EQ-5D-3L)) was 0.06 units lower (95% CI -0.09 to -0.03) and productivity loss (0%-100%) was 7.76% higher (95% CI 2.76 to 12.75). Differences between the AD and sREM group were even larger, except for the SF-36 MCS and EQ-5D-3L. No differences in mTSS were found between groups. CONCLUSION Patients with RA who reach sREM in the first year have better HRQoL and function, and less pain, fatigue and productivity loss in the years thereafter, compared with patients with RA who are in sLDA or AD in the first year.
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Affiliation(s)
| | - Marijn Vis
- Department of Rheumatology, Erasmus MC, Rotterdam, The Netherlands
| | | | - Annette H M van der Helm-van Mil
- Department of Rheumatology, Erasmus MC, Rotterdam, The Netherlands
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
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Ruyssen-Witrand A, Guernec G, Dupont J, Lapuyade D, Lioté F, Vittecoq O, Degboé Y, Constantin A. Ten-year radiographic and functional outcomes in rheumatoid arthritis patients in remission compared to patients in low disease activity. Arthritis Res Ther 2023; 25:207. [PMID: 37864239 PMCID: PMC10588022 DOI: 10.1186/s13075-023-03176-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/19/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND To compare the 10-year structural and functional prognosis between patients in sustained remission versus patients in sustained low disease activity (LDA) in early rheumatoid arthritis (RA). METHODS We included 256 patients from the ESPOIR cohort who fulfilled the 2010 ACR/EULAR criteria for RA and who were in sustained remission using the Simple Disease Activity Index (SDAI) score (n = 48), in sustained LDA (n = 139) or in sustained moderate to high disease activity (MDA or HDA, n = 69) over 10 years. The mTSSs progression over 10 years and the 10-year HAQ-DI scores were compared between the 3 groups. A longitudinal latent process mixed model was used to assess the independent effect of SDAI status over time on 10-year mTSS progression and HAQ-DI at 10 years. RESULTS Patients in sustained remission group were younger, had lower baseline HAQ-DI and mTSS scores and were less exposed to glucocorticoids, methotrexate or biologic disease-modifying anti-rheumatic drugs over 10 years. Patients in sustained remission had lower 10-year structural progression (variation of mTSS in the remission group: 4.06 (± 4.75) versus 14.59 (± 19.76) in the LDA group and 21.04 (± 24.08), p < 0.001 in the MDA or HDA groups) and lower 10-year HAQ-DI scores (10-year HAQ-DI in the remission group: 0.14 (± 0.33) versus 0.53 (± 0.49) in the LDA group and 1.20 (± 0.62) in the MDA or HDA groups, p < 0.001). The incidence of serious adverse events over 10 years was low, about 3.34/100 patient years, without any difference between the three groups. CONCLUSION RA patients in sustained SDAI remission have better long-term structural and functional outcomes in comparison to patients in sustained LDA.
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Affiliation(s)
- Adeline Ruyssen-Witrand
- Rheumatology Centre, Toulouse University Hospital, Centre d'Investigation Clinique de Toulouse CIC1436, Inserm, Team PEPSS "Pharmacologie En Population cohorteS Et biobanqueS, Purpan Teaching Hospital, University of Toulouse 3, 1 Place du Dr Baylac, 31059, Toulouse, Cedex 9, France.
| | - Gregory Guernec
- Inserm, Centre d'Epidémiologie Et de Recherche en Santé Des Populations, UMR1295, Inserm, Toulouse, France
| | - Julia Dupont
- Rheumatology Centre, Toulouse University Hospital, Toulouse, France
| | - Diane Lapuyade
- Rheumatology Centre, Toulouse University Hospital, Toulouse, France
| | - Frédéric Lioté
- Université Paris Cité and Inserm UMR1132 Bioscar Hôpital Lariboisière and Service de Rhumatologie, Hôpital Saint-Joseph, Paris, France
| | - Olivier Vittecoq
- Department of Rheumatology and CIC-CRB1404, Normandie Univ, UNIROUEN, Rouen University Hospital, 76000, Rouen, France
| | - Yannick Degboé
- Rheumatology Center, Toulouse University Hospital, INFINITY, Toulouse Institute for Infectious and Inflammatory Diseases, INSERM U1291, CNRS U5051, University Toulouse 3, Toulouse, France
| | - Arnaud Constantin
- Rheumatology Center, Toulouse University Hospital, INFINITY, Toulouse Institute for Infectious and Inflammatory Diseases, INSERM U1291, CNRS U5051, University Toulouse 3, Toulouse, France
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Fleischmann R, Haraoui B, Buch MH, Gold D, Sawyerr G, Shi H, Diehl A, Lee K. Analysis of Disease Activity Metrics in a Methotrexate Withdrawal Study among Patients with Rheumatoid Arthritis Treated with Tofacitinib plus Methotrexate. Rheumatol Ther 2023; 10:375-386. [PMID: 36534208 PMCID: PMC10011257 DOI: 10.1007/s40744-022-00511-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/04/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION The objective of this analysis was to assess disease activity metrics using a variety of disease outcome measures following methotrexate (MTX) withdrawal in ORAL Shift, a phase 3b/4 study of tofacitinib with/without MTX, in patients with rheumatoid arthritis (RA) achieving Clinical Disease Activity Index (CDAI)-defined low disease activity (LDA). METHODS Patients aged ≥ 18 years with active RA and an inadequate response to MTX received open-label tofacitinib modified-release 11 mg once daily plus MTX for 24 weeks. In the double-blind MTX withdrawal phase, those who had achieved CDAI LDA (≤ 10) at week 24 were randomised 1:1 to receive tofacitinib monotherapy or continued tofacitinib plus MTX. Efficacy analyses were performed in subgroups defined by whether remission and/or LDA had been achieved at week 24 with: Disease Activity Score in 28 joints, erythrocyte sedimentation rate [DAS28-4(ESR)], Routine Assessment of Patient Index Data 3 (RAPID3), CDAI and Simplified Disease Activity Index (SDAI); or DAS28-4[C-reactive protein(CRP)] < 2.4/ < 2.6/ < 2.9/ ≤ 3.2. RESULTS Five hundred and thirty patients received treatment in the double-blind MTX withdrawal phase. Proportions of patients achieving each disease activity criterion at week 24 varied by metric. Across disease activity metrics [excluding DAS28-4(ESR) remission], 58-89% of patients per group, and numerically more patients receiving tofacitinib plus MTX, achieved the same criterion at week 48 as at week 24. Differences between groups in least squares mean change from baseline (Δ) DAS28-4(ESR) from week 24-48 favoured tofacitinib plus MTX (nominal p values < 0.05). RAPID3 and DAS28-4(CRP) estimated a higher proportion of patients with acceptable disease state versus DAS28-4(ESR), CDAI remission and SDAI remission. CONCLUSION Response rates at the beginning of the double-blind phase varied across metrics. A consistent trend towards higher response rates with tofacitinib plus MTX was observed across metrics after randomisation, with nominal differences in DAS28-4(ESR) responses. Compared with continued combination therapy, MTX withdrawal did not lead to a clinically meaningful reduction in the response to tofacitinib. DAS28-4(CRP) and RAPID3 were the least stringent metrics. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02831855.
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Affiliation(s)
- Roy Fleischmann
- Metroplex Clinical Research Center and University of Texas Southwestern Medical Center, Dallas, TX USA
| | - Boulos Haraoui
- Institut de Rhumatologie de Montréal, Montreal, QC Canada
| | - Maya H. Buch
- Centre for Musculoskeletal Research, University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester, UK
| | | | | | - Harry Shi
- Pfizer Inc, 500 Arcola Rd, Collegeville, PA 19426 USA
| | - Annette Diehl
- Pfizer Inc, 500 Arcola Rd, Collegeville, PA 19426 USA
| | - Kristen Lee
- Pfizer Inc, 500 Arcola Rd, Collegeville, PA 19426 USA
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Value of Remission in Patients with Rheumatoid Arthritis: A Targeted Review. Adv Ther 2022; 39:75-93. [PMID: 34787822 PMCID: PMC8799574 DOI: 10.1007/s12325-021-01946-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/01/2021] [Indexed: 11/03/2022]
Abstract
The treat-to-target strategy, which defines clinical remission as the primary therapeutic goal for rheumatoid arthritis (RA), is a widely recommended treatment approach in clinical guidelines. Achieving remission has been associated with improved clinical outcomes, quality of life, and productivity. These benefits are likely to translate to reduced economic burden in terms of lower healthcare costs and resource utilization. As such, a literature review was conducted to better understand the economic value of remission. Despite the large heterogeneity found in RA-related economic outcomes across studies, patients in remission consistently had lower direct medical and indirect costs, less healthcare resource utilization, and greater productivity compared to those without remission. Remission was associated with 19–52% savings in direct medical costs and 37–75% savings in indirect costs. The economic value of remission should thus be considered in economic analyses of RA therapies to inform treatment and reimbursement decisions.
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Busby AD, Wason J, Pratt AG, Young A, Isaacs JD, Nikiphorou E. OUP accepted manuscript. Rheumatology (Oxford) 2022; 61:4297-4304. [PMID: 35258566 PMCID: PMC9629371 DOI: 10.1093/rheumatology/keac139] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 02/26/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Control of disease activity in RA is a crucial part of its management to prevent long-term joint damage and disability. This study aimed to identify early predictors of poor disease activity at 5 and 10 years, focusing on comorbidities and clinical/sociodemographic factors at first presentation. METHODS Patients from two UK-based RA cohorts were classified into two groups; low (<3.2) and moderate/high (≥3.2) DAS using 28 joint counts (DAS28) at 5/10 years. Clinical variables (e.g. rheumatoid nodules, erosions), sociodemographic factors (e.g. ethnicity, deprivation) and comorbidities were recorded at baseline and yearly thereafter. The Rheumatic Diseases Comorbidity Index quantified patient comorbidity burden. Binary logistic regression models (outcome low vs moderate/high DAS28) were fitted using multiple imputation. RESULTS A total of 2701 patients living with RA were recruited (mean age 56.1 years, 66.9% female); 5-year data were available for 1718 (63.4%) patients and 10-year data for 820 (30.4%). Baseline Rheumatic Diseases Comorbidity Index was not associated with DAS28 at 5 [odds ratio (OR) 1.05, 95% CI 0.91, 1.22] or 10 years (OR 0.99, 95% CI 0.75, 1.31) in multivariable analyses. Sociodemographic factors (female gender, worse deprivation) and poorer baseline HAQ-Disability Index were associated with DAS28 ≥3.2 at both timepoints. Being seropositive was associated with 5-year DAS28 ≥3.2. CONCLUSION This study demonstrates an association between sociodemographic and clinical factors and long-term RA disease activity, in models adjusting for comorbidity burden. The findings call for more holistic and targeted patient management in patients with RA and provide insights for more individualized management plans even on first presentation to rheumatology.
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Affiliation(s)
- Amanda D Busby
- Correspondence to: Amanda D. Busby, Centre for Health Services and Clinical Research, Life and Medical Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK. E-mail:
| | - James Wason
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne
| | - Arthur G Pratt
- Faculty of Medical Sciences, Newcastle University Translational and Clinical Research Institute, Newcastle upon Tyne
- Musculoskeletal Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne
| | - Adam Young
- Centre for Health Services and Clinical Research, Life and Medical Sciences, University of Hertfordshire, Hatfield
| | - John D Isaacs
- Faculty of Medical Sciences, Newcastle University Translational and Clinical Research Institute, Newcastle upon Tyne
- Musculoskeletal Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases, King’s College London
- Rheumatology Department, King’s College Hospital, London, UK
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Defining the Optimal Strategies for Achieving Drug-Free Remission in Rheumatoid Arthritis: A Narrative Review. Healthcare (Basel) 2021; 9:healthcare9121726. [PMID: 34946453 PMCID: PMC8701994 DOI: 10.3390/healthcare9121726] [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: 10/05/2021] [Revised: 11/24/2021] [Accepted: 11/30/2021] [Indexed: 12/14/2022] Open
Abstract
Background: It is now accepted that the optimum treatment goal for rheumatoid arthritis (RA) is sustained remission, as this has been shown to be associated with the best patient outcomes. There is little guidance on how to manage patients once remission is achieved; however, it is recommended that patients can taper therapy, with a view to discontinuing and achieving drug-free remission if treatment goals are maintained. This narrative review aims to present the current literature on drug-free remission in rheumatoid arthritis, with a view to identifying which strategies are best for disease-modifying anti-rheumatic drug (DMARD) tapering and to highlight areas of unmet clinical need. Methods: We performed a narrative review of the literature, which included research articles, meta-analyses and review papers. The key search terms included were rheumatoid arthritis, remission, drug-free remission, b-DMARDS/biologics, cs-DMARDS and tapering. The databases that were searched included PubMed and Google Scholar. For each article, the reference section of the paper was reviewed to find additional relevant articles. Results: It has been demonstrated that DFR is possible in a proportion of RA patients achieving clinically defined remission (both on cs and b-DMARDS). Immunological, imaging and clinical associations with/predictors of DFR have all been identified, including the presence of autoantibodies, absence of Power Doppler (PD) signal on ultrasound (US), lower disease activity according to composite scores of disease activity and lower patient-reported outcome scores (PROs) at treatment cessation. Conclusions: DFR in RA may be an achievable goal in certain patients. This carries importance in reducing medication-induced side-effects and potential toxicity, the burden of taking treatment if not required and cost effectiveness, specifically for biologic therapy. Prospective studies of objective biomarkers will help facilitate the prediction of successful treatment discontinuation.
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Predictive clinical factors in rheumatoid arthritis using disease activity and functional score. Reumatologia 2021; 59:309-312. [PMID: 34819705 PMCID: PMC8609377 DOI: 10.5114/reum.2021.110611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 10/01/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives Rheumatoid arthritis (RA) is a chronic inflammatory arthritis that may lead to severe joint pain. There are several scores to evaluate the disease activity of RA. This study aimed to evaluate if clinical factors which representing activity scores and health assessment score. Material and methods This study was conducted prospectively by including adult patients with RA. Clinical factors and 5 RA disease activity and health assessment scores were evaluated. Each activity score was executed for clinical predictors by using multivariate linear regression analysis. Results There were 33 female adult patients in the study. The average (SD) age was 52.33 (11.11) years, while the duration of RA was 7.65 years. The DAS28 ESR had 1 predictor: RA duration with a coefficient of –0.04. For DAS28 CRP, CDAI, and SDAI scores, body mass index (BMI) and RA duration were independent factors for the scores with negative coefficient values. For the HAQ score, both age and rheumatoid duration were positively associated with the score. The coefficients of both factors were 0.02 and 0.03, respectively. Conclusions Age, RA duration, and BMI were associated with RA activity and functional score. Body mass index is a potential modifiable factor that may be associated with RA activities.
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Liu F, Li W, Zhu J, Liu F, Fan W, Chen Z. Predictive role of ultrasound remission for progressive ultrasonography-detected structural damage in patients with rheumatoid arthritis. J Investig Med 2021; 70:391-395. [PMID: 34518320 DOI: 10.1136/jim-2021-001885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 11/03/2022]
Abstract
Regarding the persistence of subclinical synovitis, the concept of ultrasound remission has been proposed in addition to clinical remission. However, there have been no studies that explored the different time points of ultrasound remission to predict non-progressive structural damage. Given this, the aim of our study is to explore whether early ultrasound remission in patients with rheumatoid arthritis (RA) has predictive value for non-progressive structural damage in the subsequent 12 months. Sixty-one patients with RA were prospectively studied. Synovial hypertrophy, power Doppler (PD) signal, and bone erosions of bilateral wrists, metacarpophalangeal joints I-V, and proximal interphalangeal joints II-III were assessed by ultrasonography at baseline and at 3, 6, and 12 months. Ultrasound remission was defined as no PD signal. Clinical remission was defined as Disease Activity Score in 28 Joints <2.6. Ultrasonography-detected joint damage progression was defined as increase in bone erosion score of ≥1 in the subsequent 12 months. Baseline ultrasonographic factors were not significantly correlated with progressive ultrasonography-detected joint damage in patients with RA at 12 months (all p>0.05). Ultrasound remission at 3 and 6 months was significantly correlated with non-progressive ultrasonography-detected structural damage at 12 months (p=0.006 and p=0.004), with relatively low sensitivity and high specificity. Clinical remission at 3 months was significantly correlated with non-progression of ultrasonography-detected structural damage at 12 months (p=0.029), with relatively low sensitivity and moderate specificity. Ultrasound remission at 3 and 6 months has high specificity in predicting non-progressive structural damage in patients with RA at 12 months; however, the sensitivity is limited.
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Affiliation(s)
- Feifei Liu
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
| | - Wenxue Li
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
| | - Jiaan Zhu
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
| | - Fang Liu
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
| | - Wenting Fan
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
| | - Zheng Chen
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
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Scott DL, Ibrahim F, Hill H, Tom B, Prothero L, Baggott RR, Bosworth A, Galloway JB, Georgopoulou S, Martin N, Neatrour I, Nikiphorou E, Sturt J, Wailoo A, Williams FMK, Williams R, Lempp H. Intensive therapy for moderate established rheumatoid arthritis: the TITRATE research programme. PROGRAMME GRANTS FOR APPLIED RESEARCH 2021. [DOI: 10.3310/pgfar09080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
Rheumatoid arthritis is a major inflammatory disorder and causes substantial disability. Treatment goals span minimising disease activity, achieving remission and decreasing disability. In active rheumatoid arthritis, intensive management achieves these goals. As many patients with established rheumatoid arthritis have moderate disease activity, the TITRATE (Treatment Intensities and Targets in Rheumatoid Arthritis ThErapy) programme assessed the benefits of intensive management.
Objectives
To (1) define how to deliver intensive therapy in moderate established rheumatoid arthritis; (2) establish its clinical effectiveness and cost-effectiveness in a trial; and (3) evaluate evidence supporting intensive management in observational studies and completed trials.
Design
Observational studies, secondary analyses of completed trials and systematic reviews assessed existing evidence about intensive management. Qualitative research, patient workshops and systematic reviews defined how to deliver it. The trial assessed its clinical effectiveness and cost-effectiveness in moderate established rheumatoid arthritis.
Setting
Observational studies (in three London centres) involved 3167 patients. These were supplemented by secondary analyses of three previously completed trials (in centres across all English regions), involving 668 patients. Qualitative studies assessed expectations (nine patients in four London centres) and experiences of intensive management (15 patients in 10 centres across England). The main clinical trial enrolled 335 patients with diverse socioeconomic deprivation and ethnicity (in 39 centres across all English regions).
Participants
Patients with established moderately active rheumatoid arthritis receiving conventional disease-modifying drugs.
Interventions
Intensive management used combinations of conventional disease-modifying drugs, biologics (particularly tumour necrosis factor inhibitors) and depot steroid injections; nurses saw patients monthly, adjusted treatment and provided supportive person-centred psychoeducation. Control patients received standard care.
Main outcome measures
Disease Activity Score for 28 joints based on the erythrocyte sedimentation rate (DAS28-ESR)-categorised patients (active to remission). Remission (DAS28-ESR < 2.60) was the treatment target. Other outcomes included fatigue (measured on a 100-mm visual analogue scale), disability (as measured on the Health Assessment Questionnaire), harms and resource use for economic assessments.
Results
Evaluation of existing evidence for intensive rheumatoid arthritis management showed the following. First, in observational studies, DAS28-ESR scores decreased over 10–20 years, whereas remissions and treatment intensities increased. Second, in systematic reviews of published trials, all intensive management strategies increased remissions. Finally, patients with high disability scores had fewer remissions. Qualitative studies of rheumatoid arthritis patients, workshops and systematic reviews helped develop an intensive management pathway. A 2-day training session for rheumatology practitioners explained its use, including motivational interviewing techniques and patient handbooks. The trial screened 459 patients and randomised 335 patients (168 patients received intensive management and 167 patients received standard care). A total of 303 patients provided 12-month outcome data. Intention-to-treat analysis showed intensive management increased DAS28-ESR 12-month remissions, compared with standard care (32% vs. 18%, odds ratio 2.17, 95% confidence interval 1.28 to 3.68; p = 0.004), and reduced fatigue [mean difference –18, 95% confidence interval –24 to –11 (scale 0–100); p < 0.001]. Disability (as measured on the Health Assessment Questionnaire) decreased when intensive management patients achieved remission (difference –0.40, 95% confidence interval –0.57 to –0.22) and these differences were considered clinically relevant. However, in all intensive management patients reductions in the Health Assessment Questionnaire scores were less marked (difference –0.1, 95% confidence interval –0.2 to 0.0). The numbers of serious adverse events (intensive management n = 15 vs. standard care n = 11) and other adverse events (intensive management n = 114 vs. standard care n = 151) were similar. Economic analysis showed that the base-case incremental cost-effectiveness ratio was £43,972 from NHS and Personal Social Services cost perspectives. The probability of meeting a willingness-to-pay threshold of £30,000 was 17%. The incremental cost-effectiveness ratio decreased to £29,363 after including patients’ personal costs and lost working time, corresponding to a 50% probability that intensive management is cost-effective at English willingness-to-pay thresholds. Analysing trial baseline predictors showed that remission predictors comprised baseline DAS28-ESR, disability scores and body mass index. A 6-month extension study (involving 95 intensive management patients) showed fewer remissions by 18 months, although more sustained remissions were more likley to persist. Qualitative research in trial completers showed that intensive management was acceptable and treatment support from specialist nurses was beneficial.
Limitations
The main limitations comprised (1) using single time point remissions rather than sustained responses, (2) uncertainty about benefits of different aspects of intensive management and differences in its delivery across centres, (3) doubts about optimal treatment of patients unresponsive to intensive management and (4) the lack of formal international definitions of ‘intensive management’.
Conclusion
The benefits of intensive management need to be set against its additional costs. These were relatively high. Not all patients benefited. Patients with high pretreatment physical disability or who were substantially overweight usually did not achieve remission.
Future work
Further research should (1) identify the most effective components of the intervention, (2) consider its most cost-effective delivery and (3) identify alternative strategies for patients not responding to intensive management.
Trial registration
Current Controlled Trials ISRCTN70160382.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 9, No. 8. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- David L Scott
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, King’s College London, London, UK
| | - Fowzia Ibrahim
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, King’s College London, London, UK
| | - Harry Hill
- ScHARR Health Economics and Decision Science, The University of Sheffield, Sheffield, UK
| | - Brian Tom
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - Louise Prothero
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, King’s College London, London, UK
| | - Rhiannon R Baggott
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, King’s College London, London, UK
| | | | - James B Galloway
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, King’s College London, London, UK
| | - Sofia Georgopoulou
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, King’s College London, London, UK
| | - Naomi Martin
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, King’s College London, London, UK
| | - Isabel Neatrour
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, King’s College London, London, UK
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, King’s College London, London, UK
| | - Jackie Sturt
- Department of Adult Nursing, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, London, UK
| | - Allan Wailoo
- ScHARR Health Economics and Decision Science, The University of Sheffield, Sheffield, UK
| | - Frances MK Williams
- Twin Research and Genetic Epidemiology, School of Life Course Sciences, King’s College London, St Thomas’ Hospital, London, UK
| | - Ruth Williams
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, King’s College London, London, UK
| | - Heidi Lempp
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, King’s College London, London, UK
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12
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Rodriguez-García SC, Montes N, Ivorra-Cortes J, Triguero-Martinez A, Rodriguez-Rodriguez L, Castrejón I, Carmona L, González-Álvaro I. Disease Activity Indices in Rheumatoid Arthritis: Comparative Performance to Detect Changes in Function, IL-6 Levels, and Radiographic Progression. Front Med (Lausanne) 2021; 8:669688. [PMID: 34136506 PMCID: PMC8200542 DOI: 10.3389/fmed.2021.669688] [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: 02/19/2021] [Accepted: 04/30/2021] [Indexed: 01/10/2023] Open
Abstract
Objective: To compare the capacity of various disease activity indices to evaluate changes in function, IL-6 levels, and radiographic progression in early and established rheumatoid arthritis (RA). Methods: Secondary data analysis of a clinical trial assessing the efficacy of tocilizumab in patients with established RA (ACT-RAY) and a longitudinal prospective register of early arthritis (PEARL). Targeted outcomes were changes in physical function, measured with the health assessment questionnaire (HAQ), IL-6 serum levels, and radiographic progression. The "Hospital Universitario La Princesa Index" (HUPI), DAS28 using erythrocyte sedimentation rate and SDAI were the disease activity indices compared. Models adjusted for age and sex were fitted for each outcome and index and ranked based on the R 2 parameter and the quasi-likelihood under the independence model criterion. Results: Data from 8,090 visits (550 patients) from ACT-RAY and 775 visits (534 patients) from PEARL were analyzed. The best performing models for HAQ were the HUPI (R 2 = 0.351) and SDAI ones (R 2 = 0.329). For serum IL-6 levels, the SDAI (R 2 = 0.208) followed by the HUPI model (R 2 = 0.205). For radiographic progression in ACT-RAY, the HUPI (R 2 = 0.034) and the DAS28 models (R 2 = 0.026) performed best whereas the DAS28 (R 2 = 0.030) and HUPI models (R 2 = 0.023) did so in PEARL. Conclusions: HUPI outperformed other indices identifying changes in HAQ and radiographic progression and performed similarly to SDAI for IL-6 serum levels.
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Affiliation(s)
- Sebastián C Rodriguez-García
- Rheumatology Department, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria - Instituto Princesa (IIS-IP), Madrid, Spain
| | - Nuria Montes
- Rheumatology Department, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria - Instituto Princesa (IIS-IP), Madrid, Spain
| | - José Ivorra-Cortes
- Rheumatology Department, Hospital Universitario y Politécnico La Fé, Valencia, Spain
| | - Ana Triguero-Martinez
- Rheumatology Department, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria - Instituto Princesa (IIS-IP), Madrid, Spain
| | - Luis Rodriguez-Rodriguez
- Rheumatology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdiSSC), Madrid, Spain
| | - Isabel Castrejón
- Rheumatology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Loreto Carmona
- Instituto de Investigación Músculo-Esquelética (InMusc), Madrid, Spain
| | - Isidoro González-Álvaro
- Rheumatology Department, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria - Instituto Princesa (IIS-IP), Madrid, Spain
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13
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Os HA, Rollefstad S, Gerdts E, Kringeland E, Ikdahl E, Semb AG, Midtbø H. Preclinical cardiac organ damage during statin treatment in patients with inflammatory joint diseases: the RORA-AS statin intervention study. Rheumatology (Oxford) 2020; 59:3700-3708. [PMID: 32386421 PMCID: PMC7946801 DOI: 10.1093/rheumatology/keaa190] [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: 12/27/2019] [Revised: 03/20/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Statin treatment has been associated with reduction in blood pressure and arterial stiffness in patients with inflammatory joint diseases (IJD). We tested whether statin treatment also was associated with regression of preclinical cardiac organ damage in IJD patients. METHODS Echocardiography was performed in 84 IJD patients (52 RA, 20 ankylosing spondylitis, 12 psoriatric arthritis, mean age 61 (9) years, 63% women) without known cardiovascular disease before and after 18 months of rosuvastatin treatment. Preclinical cardiac organ damage was identified by echocardiography as presence of left ventricular (LV) hypertrophy, LV concentric geometry, increased LV chamber size and/or dilated left atrium. RESULTS At baseline, hypertension was present in 63%, and 36% used biologic DMARDs (bDMARDs). Preclinical cardiac organ damage was not influenced by rosuvastatin treatment (44% at baseline vs 50% at follow-up, P = 0.42). In uni- and multivariable logistic regression analyses, risk of preclinical cardiac organ damage at follow-up was increased by higher baseline body mass index [odds ratio (OR) 1.3, 95% CI: 1.1, 1.5, P = 0.01] and presence of preclinical cardiac organ damage at baseline (OR 6.4, 95% CI: 2.2, 18.5, P = 0.001) and reduced by use of bDMARDs at follow-up (OR 0.3, 95% CI: 0.1, 0.9, P = 0.03). CONCLUSION Rosuvastatin treatment was not associated with a reduction in preclinical cardiac organ damage in IJD patients after 18 months of treatment. However, use of bDMARDS at follow-up was associated with lower risk of preclinical cardiac organ damage at study end, pointing to a possible protective cardiac effect of bDMARDs in IJD patients. CLINICALTRIALS.GOV https://clinicaltrials.gov/NCT01389388.
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Affiliation(s)
- Hanna A Os
- Department of Clinical Science, University of Bergen, Bergen
| | - Silvia Rollefstad
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo
| | - Eva Gerdts
- Department of Clinical Science, University of Bergen, Bergen
| | | | - Eirik Ikdahl
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo
| | - Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo
| | - Helga Midtbø
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
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14
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Dos Santos JBR, da Silva MRR, Kakehasi AM, Acurcio FA, Almeida AM, Alves de Oliveira Junior H, Pimenta PRK, Alvares-Teodoro J. FIRST LINE OF SUBCUTANEOUS ANTI-TNF THERAPY FOR RHEUMATOID ARTHRITIS: A PROSPECTIVE COHORT STUDY. Expert Rev Clin Immunol 2020; 16:1217-1225. [PMID: 33203248 DOI: 10.1080/1744666x.2021.1850271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Objectives: This study aims to evaluate and compare the use of subcutaneous anti-TNF for RA in a Brazilian real-life setting. Methods: A prospective cohort of biological disease-modifying antirheumatic drug (bDMARD)-naïve patients treated with adalimumab, etanercept, golimumab, and certolizumab was developed. Medication persistence, disease activity by the Clinical Disease Activity Index (CDAI), functionality by the Health Assessment Questionnaire (HAQ), quality of life by the European Quality of Life 5 Dimensions (EQ-5D), and safety were evaluated at 6 and 12 months. Results: In a total of 327 individuals, 211 (64.5%) were persistent at 12 months. Patients improved after the use of anti-TNF, with a reduction in the mean of CDAI and HAQ, in addition to an increase in the mean of EQ-5D (p < 0.05). The number of patients who achieved the clinical response was 114 (34.86%) by CDAI, 212 (64.83%) by HAQ, and 215 (65.75%) by EQ-5D at 12 months. There were no statistically significant differences among the drugs (p > 0.05). The anti-TNF was well tolerated. Conclusion: Anti-TNF reduced disease activity, in addition to improving patients' functionality and quality of life. Additional pharmacotherapeutic monitoring can be essential to achieve better results.
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Affiliation(s)
- Jéssica Barreto Ribeiro Dos Santos
- Health Assessment, Technology, and Economy Group, Center for Exact, Natural and Health Sciences, Federal University of Espírito Santo , Alegre, Brazil.,Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais , President Antônio Carlos Avenue, 6627, Campus Pampulha, Belo Horizonte, Brazil
| | - Michael Ruberson Ribeiro da Silva
- Health Assessment, Technology, and Economy Group, Center for Exact, Natural and Health Sciences, Federal University of Espírito Santo , Alegre, Brazil.,Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais , President Antônio Carlos Avenue, 6627, Campus Pampulha, Belo Horizonte, Brazil
| | | | - Franciscode Assis Acurcio
- Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais , President Antônio Carlos Avenue, 6627, Campus Pampulha, Belo Horizonte, Brazil.,Medicine School, Federal University of Minas Gerais , Belo Horizonte, Brazil
| | - Alessandra Maciel Almeida
- Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais , President Antônio Carlos Avenue, 6627, Campus Pampulha, Belo Horizonte, Brazil.,Faculty of Medical Sciences of Minas Gerais, Belo Horizonte, Brasil
| | | | - Pedro Ricardo Kömel Pimenta
- Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais , President Antônio Carlos Avenue, 6627, Campus Pampulha, Belo Horizonte, Brazil
| | - Juliana Alvares-Teodoro
- Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais , President Antônio Carlos Avenue, 6627, Campus Pampulha, Belo Horizonte, Brazil
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15
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Dos Santos JBR, da Silva MRR, Almeida AM, Acurcio FDA, Alvares-Teodoro J. Cost-utility analysis of the anti-TNF therapy for rheumatoid arthritis in a real-world based model. Expert Rev Pharmacoecon Outcomes Res 2020; 21:1011-1016. [DOI: 10.1080/14737167.2021.1840980] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Jéssica Barreto Ribeiro Dos Santos
- Health Assessment, Technology, and Economy Group, Center for Exact, Natural and Health Sciences, Federal University of Espírito Santo, Alegre, Espírito Santo, Brazil
- Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Michael Ruberson Ribeiro da Silva
- Health Assessment, Technology, and Economy Group, Center for Exact, Natural and Health Sciences, Federal University of Espírito Santo, Alegre, Espírito Santo, Brazil
- Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Alessandra Maciel Almeida
- Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Faculty of Medical Sciences of Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
| | - Francisco De Assis Acurcio
- Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Department of Social and Preventive Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Juliana Alvares-Teodoro
- Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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16
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Gul HL, Eugenio G, Rabin T, Burska A, Parmar R, Wu J, Ponchel F, Emery P. Defining remission in rheumatoid arthritis: does it matter to the patient? A comparison of multi-dimensional remission criteria and patient reported outcomes. Rheumatology (Oxford) 2020; 59:613-621. [PMID: 31424522 DOI: 10.1093/rheumatology/kez330] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 06/28/2019] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES In a cross-sectional study, we evaluated the prevalence of 'multi-dimensional remission' (MDR) and its component parameters, assessed using objective measures in a cohort of RA patients in treatment-induced DAS28-remission, and their relationship with patient-reported outcome measures. We sought to confirm the feasibility and face validity of the MDR construct, providing a platform for future longitudinal studies in which its clinical utility might be further established. METHODS 605 patients were selected from an inflammatory arthritis register using DAS28(CRP)<2.6. Demographic, clinical and patients reported outcomes (PRO) data were collected. Ultrasound power doppler synovitis (n = 364) and T-cell subsets (n = 297) were also measured. Remission using clinical parameters was defined as: tender and swollen joint count (TJC/SJC) and CRP all ⩽1; ultrasound remission: total power doppler = 0 and T cell remission: positive normalized naïve T-cell frequency. MDR was defined as the achievement of all three dimensions. RESULTS Overall, only 53% (321/605) of the patients achieved clinical parameters, failures being mainly due to raised CRP (52%), TJC (28)>1 (37%) or SJC (28)>1 (16%). 211/364 (58%) of patients achieved ultrasound remission and 193/297 (65%) patients showed T-cell remission. Complete data were available for 231 patients. MDR was observed in only 35% and was associated with the best (lower) PRO scores (all P ⩽ 0.05 vs non-MDR) when compared with the other definitions of remission assessed. The MDR rate was similar in early and established RA patients on b-DMARDs; however, it was lower in established RA patients who received multiple cs-DMARDs (P = 0.011). CONCLUSIONS In this study, MDR, which may represent a state closer to normality, was found to occur in about a third of DAS28-remission patients and was associated with better patient-reported outcome measures. MDR could be a novel optimal treatment target, notably from a patient's perspective. The relevance of these findings needs further assessment.
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Affiliation(s)
- Hanna L Gul
- NIHR Leeds Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, UK
| | - Gisella Eugenio
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, UK
| | - Thibault Rabin
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, UK
| | - Agata Burska
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, UK
| | - Rekha Parmar
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, UK
| | - Jianhua Wu
- Leeds Institute of Data Analytics, University of Leeds, Leeds, UK
| | - Frederique Ponchel
- NIHR Leeds Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, UK
| | - Paul Emery
- NIHR Leeds Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, UK
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17
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Norvang V, Brinkmann GH, Yoshida K, Lillegraven S, Aga AB, Sexton J, Tedeschi SK, Lyu H, Norli ES, Uhlig T, Kvien TK, Mjaavatten MD, Solomon DH, Haavardsholm EA. Achievement of remission in two early rheumatoid arthritis cohorts implementing different treat-to-target strategies. Arthritis Rheumatol 2020; 72:1072-1081. [PMID: 32090491 DOI: 10.1002/art.41232] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 02/06/2020] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To compare achievement of remission in two early rheumatoid arthritis (RA) treat-to-target (TTT) cohorts, one tight control cohort targeting stringent remission in a randomized controlled strategy trial and one observational cohort targeting a looser definition of remission in clinical practice. METHODS We analyzed data from the ARCTIC trial and the NOR-VEAC observational study. Both were Norwegian multicenter studies including disease modifying anti-rheumatic drug (DMARD)-naïve RA-patients and implementing TTT. The target in ARCTIC was remission defined as a Disease Activity Score (DAS44) <1.6 plus 0 of 44 swollen joint count, while the target in NOR-VEAC was the less stringent remission of DAS28<2.6. We assessed achievement of the study-specific targets and compared achievement of the ACR/ EULAR Boolean remission during two years of follow-up. RESULTS We included 189 patients from ARCTIC and 330 patients from NOR-VEAC. More than half in each cohort had reached the study-specific target at 6 months, increasing to more than 60% at 12 and 24 months. The odds of reaching ACR/EULAR Boolean remission during follow-up were higher in ARCTIC than in NOR-VEAC, with statistically significant differences at 3 months (OR 1.73; 95% CI 1.03-2.89), 12 months (OR 1.97; 95% CI 1.21-3.20) and 24 months (OR 1.82; 95% CI 1.05 - 3.16). CONCLUSION A majority of patients in both cohorts reached the study-specific treatment targets. More patients in ARCTIC than in NOR-VEAC achieved ACR/EULAR Boolean remission during follow-up, suggesting that targeting a more stringent definition of remission provide further potential for favorable outcomes of a TTT strategy.
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Affiliation(s)
- Vibeke Norvang
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Kazuki Yoshida
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women´s Hospital, Boston, USA
- Harvard Medical School, Boston, USA
| | - Siri Lillegraven
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | | | - Joseph Sexton
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Sara K Tedeschi
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women´s Hospital, Boston, USA
- Harvard Medical School, Boston, USA
| | - Houchen Lyu
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ellen S Norli
- Department of Rheumatology, Martina Hansens Hospital, Sandvika, Norway
| | - Till Uhlig
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Daniel H Solomon
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women´s Hospital, Boston, USA
- Harvard Medical School, Boston, USA
| | - Espen A Haavardsholm
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
- Department of Rheumatology, Østfold Hospital, Grålum, Norway
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18
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Einarsson JT, Willim M, Ernestam S, Saxne T, Geborek P, Kapetanovic MC. Prevalence of sustained remission in rheumatoid arthritis: impact of criteria sets and disease duration, a Nationwide Study in Sweden. Rheumatology (Oxford) 2019. [PMID: 29538755 DOI: 10.1093/rheumatology/key054] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Objectives The aims of this national study in Sweden of patients with RA were to: examine the prevalence of sustained remission (SR), that is, remission lasting for at least 6 months; compare the prevalence of SR in patients with early RA and established RA; study the timing of onset of and time spent in SR; and study possible predictors of SR. Methods Adult patients with RA included in the Swedish Rheumatology Quality registry were studied. The registry was searched for patients fulfilling remission criteria: DAS28-ESR, Clinical Disease Activity Index (CDAI), Simplified Disease Activity Index (SDAI) and ACR/EULAR remission for at least 6 months. Early RA was defined as symptom duration ⩽6 months at inclusion in the Swedish Rheumatology Quality. Results Of 29 084 patients, 12 193 (41.9%) reached DAS28 SR at some time point during follow-up compared with 6445 (22.2%), 6199 (21.3%) and 5087 (17.5%) for CDAI, SDAI and ACR/EULAR SR, respectively. SR was more common in early RA (P < 0.001). The median time from symptom onset to SR was 1.9, 2.4, 2.4 and 2.5 years according to DAS28, CDAI, SDAI and ACR/EULAR criteria, respectively. Lower age, male sex and milder disease characteristics were associated with SR. Conclusion The majority of patients in this nationwide study never reached SR. Patients with early RA are more likely to reach SR than patients with established RA.
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Affiliation(s)
- Jon T Einarsson
- Lund University, Department of Clinical Sciences, Section of Rheumatology, Lund, Skåne University Hospital, Lund, Sweden
| | - Minna Willim
- Lund University, Department of Clinical Sciences, Section of Rheumatology, Lund, Skåne University Hospital, Lund, Sweden
| | - Sofia Ernestam
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Centre of Rheumatology, Stockholm County Council, Stockholm, Sweden
| | - Tore Saxne
- Lund University, Department of Clinical Sciences, Section of Rheumatology, Lund, Skåne University Hospital, Lund, Sweden
| | - Pierre Geborek
- Lund University, Department of Clinical Sciences, Section of Rheumatology, Lund, Skåne University Hospital, Lund, Sweden
| | - Meliha C Kapetanovic
- Lund University, Department of Clinical Sciences, Section of Rheumatology, Lund, Skåne University Hospital, Lund, Sweden
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Aletaha D, Wang X, Zhong S, Florentinus S, Monastiriakos K, Smolen JS. Differences in disease activity measures in patients with rheumatoid arthritis who achieved DAS, SDAI, or CDAI remission but not Boolean remission. Semin Arthritis Rheum 2019; 50:276-284. [PMID: 31590930 DOI: 10.1016/j.semarthrit.2019.09.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 08/14/2019] [Accepted: 09/09/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVES In patients with rheumatoid arthritis (RA), remission may be assessed by various composite measures. We assessed achievement of remission as defined by Boolean criteria, Simplified Disease Activity Index (SDAI), Clinical Disease Activity Index (CDAI), and 28-joint Disease Activity Score using C-reactive protein (DAS28[CRP]) and determined the components that limit patients in SDAI, CDAI, or DAS28(CRP) remission from achieving Boolean remission. METHODS The proportions of patients achieving Boolean, SDAI, CDAI, or DAS28(CRP) remission were calculated for 3 trials: PREMIER and OPTIMA in patients with early RA and DE019 in patients with established RA. At the first visit that remission was recorded during the first 52 weeks of the trial, the following were assessed: swollen/tender joint count at 28 and 66/68 joints, CRP, Patient's/Physician's Global Assessment (PGA/PhGA), SDAI, DAS28(CRP), and Health Assessment Questionnaire-Disability Index. RESULTS The majority of patients (61-66%) who achieved SDAI or CDAI remission also attained Boolean remission. Although DAS28(CRP) remission was most frequently attained, 74-77% of patients in DAS28(CRP) remission did not achieve Boolean remission. Compared with patients in Boolean remission, patients in SDAI or CDAI remission but not Boolean remission had higher PGA scores, while patients with DAS28(CRP) remission but not Boolean remission had higher joint counts, and PGA and PhGA scores. CONCLUSIONS Differences in PGA limit patients in SDAI/CDAI remission from meeting the Boolean remission criteria, suggesting that these criteria otherwise can be used interchangeably. In contrast, patients in DAS28(CRP) remission are limited by differences in multiple disease activity measures from achieving Boolean remission.
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Affiliation(s)
- Daniel Aletaha
- Medical University of Vienna, Waehringer, Guertel 18-20, A-1090, Vienna, Austria.
| | - Xin Wang
- AbbVie Inc., 1 North Waukegan Road, North Chicago, IL, 60064, USA.
| | - Sheng Zhong
- AbbVie Inc., 1 North Waukegan Road, North Chicago, IL, 60064, USA.
| | | | | | - Josef S Smolen
- Medical University of Vienna, Waehringer, Guertel 18-20, A-1090, Vienna, Austria.
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20
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Ultrasound remission can predict future good structural outcome in collagen-induced arthritis rats. Sci Rep 2019; 9:13294. [PMID: 31527701 PMCID: PMC6746853 DOI: 10.1038/s41598-019-49948-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 09/03/2019] [Indexed: 11/08/2022] Open
Abstract
Regarding the persistence of subclinical synovitis, the concept of ultrasound remission has been proposed in addition to clinical remission. The present study aims to explore whether ultrasound remission has predictive value and ultrasound remission at which time point has predictive value for good structural outcome. Collagen-induced arthritis (CIA) was induced in 32 rats by immunizing with bovine type II collagen. Twenty-four CIA rats were treated with rhTNFR:Fc, and 8 rats were left untreated. Ultrasonography was performed to assess synovial hypertrophy, power Doppler (PD) signal, and bone erosion of the ankle joints of both hindpaws every week following the booster immunization. In the treated group, the scores for synovial hypertrophy, PD signal and bone erosions decreased from baseline to the end. Synovial hypertrophy, PD signal, and bone erosion at baseline were not significantly associated with good structural outcome. Ultrasound remission from 4 to 6 weeks after treatment was significantly associated with good outcome and had the highest area under the curve, sensitivity, specificity, and positive and negative predictive values. Therefore, we conclude that ultrasound remission from 4 to 6 weeks after treatment has a high value for predicting good structural outcome in CIA rats.
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21
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Carvalho PD, Ferreira RJ, Landewé R, Vega-Morales D, Salomon-Escoto K, Veale DJ, Chopra A, da Silva JA, Machado PM. Association of 17 Definitions of Remission with Functional Status in a Large Clinical Practice Cohort of Patients with Rheumatoid Arthritis. J Rheumatol 2019; 47:20-27. [DOI: 10.3899/jrheum.181286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2019] [Indexed: 12/30/2022]
Abstract
Objective.To compare the association between different remission criteria and physical function in patients with rheumatoid arthritis followed in clinical practice.Methods.Longitudinal data from the METEOR database were used. Seventeen definitions of remission were tested: American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) Boolean-based; Simplified/Clinical Disease Activity Index (SDAI/CDAI); and 14 Disease Activity Score (DAS)-based definitions. Health Assessment Questionnaire (HAQ) ≤ 0.5 was defined as good functional status. Associations were investigated using generalized estimating equations. Potential confounders were tested and sensitivity analyses performed.Results.Data from 32,915 patients (157,899 visits) were available. The most stringent definition of remission was the ACR/EULAR Boolean-based definition (1.9%). The proportion of patients with HAQ ≤ 0.5 was higher for the most stringent definitions, although it never reached 100%. However, this also meant that, for the most stringent criteria, many patients in nonremission had HAQ ≤ 0.5. All remission definitions were associated with better function, with the strongest degree of association observed for the SDAI (adjusted OR 3.36, 95% CI 3.01–3.74).Conclusion.The 17 definitions of remission confirmed their validity against physical function in a large international clinical practice setting. Achievement of remission according to any of the indices may be more important than the use of a specific index. A multidimensional approach, targeted at wider goals than disease control, is necessary to help all patients achieve the best possible functional status.
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Novel benzoxanthene lignans that favorably modulate lipid mediator biosynthesis: A promising pharmacological strategy for anti-inflammatory therapy. Biochem Pharmacol 2019; 165:263-274. [PMID: 30836057 DOI: 10.1016/j.bcp.2019.03.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 03/01/2019] [Indexed: 02/08/2023]
Abstract
Lipid mediators (LM) encompass pro-inflammatory prostaglandins (PG) and leukotrienes (LT) but also specialized pro-resolving mediators (SPM) which display pivotal bioactivities in health and disease. Pharmacological intervention with inflammatory disorders such as osteoarthritis and rheumatoid arthritis commonly employs anti-inflammatory drugs that can suppress PG and LT formation, which however, possess limited effectiveness and side effects. Here, we report on the discovery and characterization of the two novel benzoxanthene lignans 1 and 2 that modulate select LM biosynthetic enzymes enabling the switch from pro-inflammatory LT to SPM biosynthesis as potential pharmacological strategy to intervene with inflammation. In cell-free assays, compound 1 and 2 inhibit microsomal prostaglandin E2 synthase-1 and leukotriene C4 synthase (IC50 ∼ 0.6-3.4 µM) and potently interfere with 5-lipoxygenase (5-LOX), the key enzyme in LT biosynthesis (IC50 = 0.04 and 0.09 µM). In human neutrophils, monocytes and M1 and M2 macrophages, compound 1 and 2 efficiently suppress LT biosynthesis (IC50 < 1 µM), accompanied by elevation of 15-LOX-derived LM including SPM. In zymosan-induced murine peritonitis, compound 1 and 2 ameliorated self-limited inflammation along with suppression of early LT formation and elevation of subsequent SPM biosynthesis in vivo. Together, these novel benzoxanthene lignans promote the LM class switch from pro-inflammatory towards pro-resolving LM to terminate inflammation, suggesting their suitability as novel leads for pharmacotherapy of arthritis and related inflammatory disorders.
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23
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Scott IC, Ibrahim F, Panayi G, Cope AP, Garrood T, Vincent A, Scott DL, Kirkham B. The frequency of remission and low disease activity in patients with rheumatoid arthritis, and their ability to identify people with low disability and normal quality of life. Semin Arthritis Rheum 2018; 49:20-26. [PMID: 30685064 DOI: 10.1016/j.semarthrit.2018.12.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 11/29/2018] [Accepted: 12/21/2018] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Treat-to-target in rheumatoid arthritis (RA) recommends targeting remission, with low disease activity (LDA) being an alternative goal. When deciding to target remission or LDA, important considerations are the likelihood of attaining them, and their impacts on function and health-related quality of life (HRQoL). We have addressed this by studying: (a) the frequency of remission and LDA/remission; (b) DAS28-ESR trends after remission; (c) ability of remission vs. LDA to identify patients with normal function (HAQ ≤ 0.5) and HRQoL (EQ-5D ≥ the normal population). METHODS We studied 571 patients in two clinical trials, and 1693 patients in a 10-year routine care cohort. We assessed the frequency and sustainability of remission and LDA/remission, variability in DAS28-ESR after remission, and sensitivity/specificity of remission and LDA/remission at identifying patients with low disability levels and normal HRQoL using Receiver Operator Characteristic (ROC) curves. RESULTS Point remission and remission/LDA were common (achieved by 35-58% and 49-74% of patients, respectively), but were rarely sustained (sustained remission and remission/LDA achieved by 5-9% and 9-16% of patients, respectively). Following attaining remission, DAS28-ESR levels varied substantially. Despite this, of those patients attaining point remission, the majority (53-61%) were in remission at study end-points. Whilst remission was highly specific at identifying patients with low disability (85-91%) it lacked sensitivity (51-57%); similar findings were seen for normal HRQoL (specificity 78-86%; sensitivity 52-59%). The optimal DAS28-cut-off to identify individuals with low disability and normal HRQoL was around the LDA threshold. CONCLUSIONS Our findings support both the treat-to-target goals. Attaining remission is highly specific for attaining low disability and normal HRQoL, although many patients with more active disease also have good function and HRQoL. Attaining a DAS28-ESR ≤ 3.2 has a better balance of specificity and sensitivity for attaining these outcomes, with the benefit of being more readily achievable. Although sustaining these targets over time is rare, even attaining them on a one-off basis leads to better function and HRQoL outcomes for patients.
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Affiliation(s)
- I C Scott
- Research Institute for Primary Care & Health Sciences, Primary Care Sciences, Keele University, Staffordshire, UK; Department of Rheumatology, Haywood Hospital, Midlands Partnership NHS Foundation Trust, High Lane, Burslem, Staffordshire, UK.
| | - F Ibrahim
- Department of Rheumatology, 3rd Floor, Weston Education Centre, King's College Hospital, Cutcombe Road, London, UK
| | - G Panayi
- Department of Rheumatology, Guy's and St Thomas' NHS Trust, 4th Floor, Tower Wing, Guy's Hospital, Great Maze Pond, London, UK
| | - A P Cope
- Department of Rheumatology, Guy's and St Thomas' NHS Trust, 4th Floor, Tower Wing, Guy's Hospital, Great Maze Pond, London, UK; Academic Department of Rheumatology, Centre for Molecular and Cellular Biology of Inflammation, 1st Floor, New Hunt's House, Guy's Campus, King's College London, Great Maze Pond, London, UK
| | - T Garrood
- Department of Rheumatology, Guy's and St Thomas' NHS Trust, 4th Floor, Tower Wing, Guy's Hospital, Great Maze Pond, London, UK
| | - A Vincent
- Department of Rheumatology, Guy's and St Thomas' NHS Trust, 4th Floor, Tower Wing, Guy's Hospital, Great Maze Pond, London, UK
| | - D L Scott
- Department of Rheumatology, 3rd Floor, Weston Education Centre, King's College Hospital, Cutcombe Road, London, UK
| | - B Kirkham
- Department of Rheumatology, Guy's and St Thomas' NHS Trust, 4th Floor, Tower Wing, Guy's Hospital, Great Maze Pond, London, UK; Academic Department of Rheumatology, Centre for Molecular and Cellular Biology of Inflammation, 1st Floor, New Hunt's House, Guy's Campus, King's College London, Great Maze Pond, London, UK
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Naseem M, Samir S, Ibrahim IK, Khedr L, Shahba AAE. 2-D speckle-tracking assessment of left and right ventricular function in rheumatoid arthritis patients with and without disease activity. J Saudi Heart Assoc 2018; 31:41-49. [PMID: 30559579 PMCID: PMC6289904 DOI: 10.1016/j.jsha.2018.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 10/09/2018] [Accepted: 10/18/2018] [Indexed: 11/19/2022] Open
Abstract
Objectives Disease activity has been considered as independent cardiovascular risk factor in rheumatoid arthritis (RA) patients. We aimed to evaluate the effect of RA disease activity on left ventricular (LV) and right ventricular (RV) functions by speckle tracking echocardiography (STE). Methods 120 patients with RA without evidence of cardiovascular disease and 40 healthy control subjects were included. Disease activity was evaluated according to Simplified Disease Activity Index (SDAI) score and Disease Activity Score 28 (DAS28). LV and RV functions were assessed using conventional echocardiography and global longitudinal strain (GLS) technique measured by STE. Results 81 patients had active disease while 39 patients were in remission. The LV and RV GLS value for active RA patients was reduced compared to RA patients in remission and control group (p = <0.001). There was a significant correlation between RA disease activity scores level and LV GLS value, increasing levels of disease activity was associated with worse LV GLS (r = −0.802, p value = <0.001) and r = −0.824, p value = <0.001) for SDAI and DAS28 scores respectively. Also, there were significant correlations between RA disease activity scores level and RV GLS value as the disease activity level increases the RV GLS value become worse (r = −0.682, p value = <0.001) and r = −0.731, p value = <0.001) for SDAI and DAS28 scores respectively Receiver operating characteristic (ROC) curve analysis showed that SDAI score and DAS28 were predictive for reduced LV GLS with a cut off value of >7 and >2.8 respectively with sensitivity of 77.6%, specificity of 85.0% and area under ROC curve = 90.4 for SDAI score and with sensitivity of 89.7%, specificity of 71.7% and area under ROC curve = 89.4 for DAS28 score. Also, SDAI score and DAS28 were predictive for reduced RV GLS with a cut off value of >11 and >3 respectively with sensitivity of 73.1%, specificity of 93.5% and area under ROC curve = 91.6 for SDAI score and with sensitivity of 84.6%, specificity of 80.4% and area under ROC curve = 90.8 for DAS28 score. Conclusion Disease activity in patients with rheumatoid arthritis is associated with lower left and right ventricular function. Disease activity scores can predict subclinical left and right ventricular dysfunction.
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Affiliation(s)
- Mohamed Naseem
- Cardiovascular Medicine Department, Tanta Faculty of Medicine, Tanta University, Elgeish Street, Tanta, EgyptEgypt
- Corresponding author.
| | - Sameh Samir
- Cardiovascular Medicine Department, Tanta Faculty of Medicine, Tanta University, Elgeish Street, Tanta, EgyptEgypt
| | - Ibtsam Khairat Ibrahim
- Cardiovascular Medicine Department, Tanta Faculty of Medicine, Tanta University, Elgeish Street, Tanta, EgyptEgypt
| | - Lamiaa Khedr
- Cardiovascular Medicine Department, Tanta Faculty of Medicine, Tanta University, Elgeish Street, Tanta, EgyptEgypt
| | - Abeer Abd Elmonem Shahba
- Internal Medicine Department, Tanta Faculty of Medicine, Tanta University, Elgeish Street, Tanta, EgyptEgypt
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The extra-articular impacts of rheumatoid arthritis: moving towards holistic care. BMC Rheumatol 2018; 2:32. [PMID: 30886982 PMCID: PMC6390577 DOI: 10.1186/s41927-018-0039-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 10/04/2018] [Indexed: 12/16/2022] Open
Abstract
Although treat-to-target has revolutionised the outcomes of patients with rheumatoid arthritis (RA) there is emerging evidence that attaining the target of remission is insufficient to normalise patients’ quality of life, and ameliorate the extra-articular impacts of RA. RA has a broad range of effects on patient’s lives, with four key “extra-articular” impacts being pain, depression and anxiety, fatigue and rheumatoid cachexia. All of these are seen frequently; for example, studies have reported that 1 in 4 patients with RA have high-levels of fatigue. Commonly used drug treatments (including simple analgesics, non-steroidal anti-inflammatory drugs and anti-depressants) have, at most, only modest benefits and often cause adverse events. Psychological strategies and dynamic and aerobic exercise all reduce issues like pain and fatigue, although their effects are also only modest. The aetiologies of these extra-articular impacts are multifactorial, but share overlapping components. Consequently, patients are likely to benefit from management strategies that extend beyond the assessment and treatment of synovitis, and incorporate more broad-based, or “holistic”, assessments of the extra-articular impacts of RA and their management, including non-pharmacological approaches. Innovative digital technologies (including tablet and smartphone “apps” that directly interface with hospital systems) are increasingly available that can directly capture patient-reported outcomes during and between clinic visits, and include them within electronic patient records. These are likely to play an important future role in delivering such approaches.
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26
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Alemao E, Al MJ, Boonen AA, Stevenson MD, Verstappen SMM, Michaud K, Weinblatt ME, Rutten-van Mölken MPMH. Conceptual model for the health technology assessment of current and novel interventions in rheumatoid arthritis. PLoS One 2018; 13:e0205013. [PMID: 30289926 PMCID: PMC6173427 DOI: 10.1371/journal.pone.0205013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 09/18/2018] [Indexed: 11/25/2022] Open
Abstract
The objective of this study was to evaluate current approaches to economic modeling in rheumatoid arthritis (RA) and propose a new conceptual model for evaluation of the cost-effectiveness of RA interventions. We followed recommendations from the International Society of Pharmacoeconomics and Outcomes Research-Society of Medical Decision Making (ISPOR-SMDM) Modeling Good Research Practices Task Force-2. The process involved scoping the decision problem by a working group and drafting a preliminary cost-effectiveness model framework. A systematic literature review (SLR) of existing decision-analytic models was performed and analysis of an RA registry was conducted to inform the structure of the draft conceptual model. Finally, an expert panel was convened to seek input on the draft conceptual model. The proposed conceptual model consists of three separate modules: 1) patient characteristic module, 2) treatment module, and 3) outcome module. Consistent with the scope, the conceptual model proposed six changes to current economic models in RA. These changes proposed are to: 1) use composite measures of disease activity to evaluate treatment response as well as disease progression (at least two measures should be considered, one as the base case and one as a sensitivity analysis); 2) conduct utility mapping based on disease activity measures; 3) incorporate subgroups based on guideline-recommended prognostic factors; 4) integrate realistic treatment patterns based on clinical practice/registry datasets; 5) assimilate outcomes that are not joint related (extra-articular outcomes); and 6) assess mortality based on disease activity. We proposed a conceptual model that incorporates the current understanding of clinical and real-world evidence in RA, as well as of existing modeling assumptions. The proposed model framework was reviewed with experts and could serve as a foundation for developing future cost-effectiveness models in RA.
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Affiliation(s)
- Evo Alemao
- Worldwide Health Economics and Outcomes Research, Bristol-Myers Squibb (BMS), Lawrence, New Jersey, United States of America
- Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Maiwenn J. Al
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Annelies A. Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
| | - Matthew D. Stevenson
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Suzanne M. M. Verstappen
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Kaleb Michaud
- Department of Rheumatology and Immunology, University of Nebraska Medical Center, Omaha, New England, United States of America
| | - Michael E. Weinblatt
- Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard University, Boston, Massachusetts, United States of America
| | - Maureen P. M. H. Rutten-van Mölken
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Institute for Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam, The Netherlands
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Kaeley GS, Ranganath VK. Chasing the Ghost of Imaging Remission in Rheumatoid Arthritis. J Rheumatol 2018; 45:881-883. [PMID: 29961675 DOI: 10.3899/jrheum.180035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Gurjit S Kaeley
- University of Florida College of Medicine, Jacksonville, Florida;
| | - Veena K Ranganath
- University of California at Los Angeles, Los Angeles, California, USA
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28
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Karpouzas GA, Strand V, Ormseth SR. Latent profile analysis approach to the relationship between patient and physician global assessments of rheumatoid arthritis activity. RMD Open 2018; 4:e000695. [PMID: 30018802 PMCID: PMC6045765 DOI: 10.1136/rmdopen-2018-000695] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 06/06/2018] [Accepted: 06/11/2018] [Indexed: 12/24/2022] Open
Abstract
Objective Patients and physicians commonly differ in their assessments of rheumatoid arthritis (RA) activity. Clinically meaningful discordance thresholds or validation of their ability to predict functional outcomes are lacking. We explored whether an unbiased, person-centred latent profile analysis (LPA) approach could classify cases based on patient global assessment (PtGA) and physician global assessment (MDGA) assessments of RA activity. We further examined whether the LPA groups displayed greater differences in clinical outcomes compared with traditional threshold-based groups. Finally, we evaluated whether LPA yielded higher explanatory power for clinical outcomes. Methods LPA was performed in 618 patients with established RA from a single centre. A threshold-based discordance definition was used as a comparator, with patients classified into concordant (PtGA–MDGA within ± 3 cm), positively discordant (PtGA–MDGA ≥3 cm) and negatively discordant groups (PtGA–MDGA ≤−3 cm). Results LPA yielded five distinct groups: low PtGA/low MDGA (35.9%), moderate PtGA/moderate MDGA (18.6%), high PtGA/high MDGA (14.7%), high PtGA/low MDGA (23.3%) and low PtGA/high MDGA (7.4%). Groups differed across clinical, physical function, pain, fatigue, health-related quality of life, work productivity and activity impairment outcomes (p<0.001). Concordance groups, in particular, displayed marked heterogeneity in outcomes depending on the magnitude of disease activity reported, with the low/low group faring the best (p<0.001). The LPA solution demonstrated superior explanatory power for all outcomes (p<0.001). Conclusions We confirmed the validity and advantages of LPA in characterising the relationship between PtGA and MDGA over a conventional threshold-based definition. LPA yielded optimally distinct, clinically meaningful and cohesive groupings, demonstrating superior explanatory power for disease-related outcomes of interest.
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Affiliation(s)
- George A Karpouzas
- Division of Rheumatology, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Torrance, California, USA
| | - Vibeke Strand
- Division of Immunology/Rheumatology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Sarah R Ormseth
- Division of Rheumatology, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Torrance, California, USA
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Paulshus Sundlisæter N, Aga AB, Olsen IC, Hammer HB, Uhlig T, van der Heijde D, Kvien TK, Lillegraven S, Haavardsholm EA. Clinical and ultrasound remission after 6 months of treat-to-target therapy in early rheumatoid arthritis: associations to future good radiographic and physical outcomes. Ann Rheum Dis 2018; 77:1421-1425. [PMID: 29934373 DOI: 10.1136/annrheumdis-2017-212830] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 06/05/2018] [Accepted: 06/08/2018] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To explore associations between remission, based on clinical and ultrasound definitions, and future good radiographic and physical outcome in early rheumatoid arthritis (RA). METHODS Newly diagnosed patients with RA followed a treat-to-target strategy incorporating ultrasound information in the Aiming for Remission in rheumatoid arthritis: a randomised trial examining the benefit of ultrasound in a Clinical TIght Control regimen (ARCTIC) trial. We defined 6-month remission according to Disease Activity Score, Disease Activity Score in 28 joints-erythrocyte sedimentation rate, American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) Boolean criteria, Simplified Disease Activity Index, Clinical Disease Activity Index and two ultrasound definitions (no power Doppler signal, grey scale score ≤2). Two outcomes were defined: no radiographic progression and good outcome (no radiographic progression+physical function≥general population median), both sustained 12-24 months. We calculated the ORs of these outcomes for the remission definitions. RESULTS Of 103 patients, 42%-82% reached remission at 6 months, dependent on definition. Seventy-one per cent of patients had no radiographic progression and 37% had good outcome. An association between 6-month remission and no radiographic progression was observed for ACR/EULAR Boolean remission (44 joints, OR 3.2, 95% CI 1.2 to 8.4), ultrasound power Doppler (OR 3.6, 95% CI 1.3 to 10.0) and grey scale remission (OR 3.2, 95% CI 1.2 to 8.0). All clinical, but not ultrasound remission criteria were associated with achievement of a good outcome. CONCLUSIONS Our data support ACR/EULAR Boolean remission based on 44 joints as the preferred treatment target in early RA. Absence of ultrasound inflammation was associated with no radiographic progression. TRIAL REGISTRATION NUMBER NCT01205854; Post-results.
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Affiliation(s)
- Nina Paulshus Sundlisæter
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | | | | | - Till Uhlig
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Désirée van der Heijde
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,Medical Department, Leiden University, Leiden, The Netherlands
| | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Siri Lillegraven
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Espen A Haavardsholm
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
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What is the optimal target for treat-to-target strategies in rheumatoid arthritis? Curr Opin Rheumatol 2018; 30:282-287. [DOI: 10.1097/bor.0000000000000484] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Martin NH, Ibrahim F, Tom B, Galloway J, Wailoo A, Tosh J, Lempp H, Prothero L, Georgopoulou S, Sturt J, Scott DL. Does intensive management improve remission rates in patients with intermediate rheumatoid arthritis? (the TITRATE trial): study protocol for a randomised controlled trial. Trials 2017; 18:591. [PMID: 29221496 PMCID: PMC5723045 DOI: 10.1186/s13063-017-2330-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 11/16/2017] [Indexed: 01/26/2023] Open
Abstract
Background Uncontrolled active rheumatoid arthritis can lead to increasing disability and reduced quality of life over time. ‘Treating to target’ has been shown to be effective in active established disease and also in early disease. However, there is a lack of nationally agreed treatment protocols for patients with established rheumatoid arthritis who have intermediate disease activity. This trial is designed to investigate whether intensive management of disease leads to a greater number of remissions at 12 months. Levels of disability and quality of life, and acceptability and cost-effectiveness of the intervention will also be examined. Methods The trial is a 12-month, pragmatic, randomised, open-label, two-arm, parallel-group, multicentre trial undertaken at specialist rheumatology centres across England. Three hundred and ninety-eight patients with established rheumatoid arthritis will be recruited. They will currently have intermediate disease activity (disease activity score for 28 joints assessed using an erythrocyte sedimentation rate of 3.2 to 5.1 with at least three active joints) and will be taking at least one disease-modifying anti-rheumatic drug. Participants will be randomly selected to receive intensive management or standard care. Intensive management will involve monthly clinical reviews with a specialist health practitioner, where drug treatment will be optimised and an individualised treatment support programme delivered based on several principles of motivational interviewing to address identified problem areas, such as pain, fatigue and adherence. Standard care will follow standard local pathways and will be in line with current English guidelines from the National Institute for Health and Clinical Excellence. Patients will be assessed initially and at 6 and 12 months through self-completed questionnaires and clinical evaluation. Discussion The trial will establish whether the known benefits of intensive treatment strategies in active rheumatoid arthritis are also seen in patients with established rheumatoid arthritis who have moderately active disease. It will evaluate both the clinical and cost-effectiveness of intensive treatment. Trial registration Current Controlled Trials, ID: ISRCTN70160382. Registered on 16 January 2014. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2330-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Naomi H Martin
- Academic Department of Rheumatology, King's College London, Weston Education Centre, Cutcombe Road, Denmark Hill, London, SE5 9RJ, UK.
| | - Fowzia Ibrahim
- Academic Department of Rheumatology, King's College London, Weston Education Centre, Cutcombe Road, Denmark Hill, London, SE5 9RJ, UK
| | - Brian Tom
- MRC Biostatistics Unit, Institute of Public Health, University Forvie Site, Robinson Way, Cambridge, CB2 0SR, UK
| | - James Galloway
- Academic Department of Rheumatology, King's College London, Weston Education Centre, Cutcombe Road, Denmark Hill, London, SE5 9RJ, UK
| | - Allan Wailoo
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Jonathan Tosh
- DRG Abacus, Manchester One, 53 Portland Street, Manchester, M1 3LF, UK
| | - Heidi Lempp
- Academic Department of Rheumatology, King's College London, Weston Education Centre, Cutcombe Road, Denmark Hill, London, SE5 9RJ, UK
| | - Louise Prothero
- Academic Department of Rheumatology, King's College London, Weston Education Centre, Cutcombe Road, Denmark Hill, London, SE5 9RJ, UK
| | - Sofia Georgopoulou
- Department of Physiotherapy, King's College London, 5th Floor, Addison House, Guy's Campus, London, SE1 1UL, UK
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA, UK
| | - David L Scott
- Academic Department of Rheumatology, King's College London, Weston Education Centre, Cutcombe Road, Denmark Hill, London, SE5 9RJ, UK
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Restrepo‐Correa R, Rodríguez‐Padilla LM, Zapata‐Castellanos AL, Ocampo A, García JJ, Muñoz‐Grajales C, Pinto‐Peñaranda LF, Márquez‐Hernández JD, Mesa‐Navas MA, Velásquez‐Franco CJ. Concordance and correlation of activity indices in patients with rheumatoid arthritis in northwestern Colombia: A cross‐sectional study. Int J Rheum Dis 2017; 21:1946-1954. [DOI: 10.1111/1756-185x.13227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Ricardo Restrepo‐Correa
- Internal Medicine Universidad Pontificia Bolivariana Hospital Pablo Tobón UribeMedellínColombia
- Immunology and Clinical Rheumatology Unit (UNIR) Group School of Health Sciences, Clínica Universitaria Bolivariana Universidad Pontificia BolivarianaMedellínColombia
- School of Medicine Universidad Pontificia Bolivariana Medellín Colombia
| | - Libia M. Rodríguez‐Padilla
- Immunology and Clinical Rheumatology Unit (UNIR) Group School of Health Sciences, Clínica Universitaria Bolivariana Universidad Pontificia BolivarianaMedellínColombia
- School of Medicine Universidad Pontificia Bolivariana Medellín Colombia
| | - Aura L. Zapata‐Castellanos
- Immunology and Clinical Rheumatology Unit (UNIR) Group School of Health Sciences, Clínica Universitaria Bolivariana Universidad Pontificia BolivarianaMedellínColombia
- School of Medicine Universidad Pontificia Bolivariana Medellín Colombia
| | - Andrea Ocampo
- Immunology and Clinical Rheumatology Unit (UNIR) Group School of Health Sciences, Clínica Universitaria Bolivariana Universidad Pontificia BolivarianaMedellínColombia
| | - Juan J. García
- Immunology and Clinical Rheumatology Unit (UNIR) Group School of Health Sciences, Clínica Universitaria Bolivariana Universidad Pontificia BolivarianaMedellínColombia
| | | | | | | | - Miguel A. Mesa‐Navas
- Immunology and Clinical Rheumatology Unit (UNIR) Group School of Health Sciences, Clínica Universitaria Bolivariana Universidad Pontificia BolivarianaMedellínColombia
- School of Medicine Universidad Pontificia Bolivariana Medellín Colombia
| | - Carlos J. Velásquez‐Franco
- Immunology and Clinical Rheumatology Unit (UNIR) Group School of Health Sciences, Clínica Universitaria Bolivariana Universidad Pontificia BolivarianaMedellínColombia
- School of Medicine Universidad Pontificia Bolivariana Medellín Colombia
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Keystone EC, Breedveld FC, van der Heijde D, van Vollenhoven RF, Emery P, Smolen JS, Sainsbury I, Florentinus S, Kupper H, Chen K, Kavanaugh A. Achieving comprehensive disease control in patients with early and established rheumatoid arthritis treated with adalimumab plus methotrexate versus methotrexate alone. RMD Open 2017; 3:e000445. [PMID: 29018564 PMCID: PMC5623327 DOI: 10.1136/rmdopen-2017-000445] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 08/22/2017] [Accepted: 08/23/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To evaluate the achievement of comprehensive disease control (CDC) following 1 year of treatment with adalimumab+methotrexate versus methotrexate alone and whether early achievement of remission (at week 24 or 26) is associated with CDC at week 52 in patients with either early or established rheumatoid arthritis (RA). METHODS Post hoc analyses were conducted in three clinical studies assessing treatment with adalimumab+methotrexate: DE019 (NCT00195702) enrolled patients with established RA who were methotrexate inadequate responders; OPTIMA (NCT00420927) and PREMIER (NCT00195663) enrolled methotrexate-naive patients with early RA. In OPTIMA, patients not achieving stable low disease activity at weeks 22 and 26 in the placebo+methotrexate group could receive open-label adalimumab+methotrexate for 52 weeks (Rescue ADA arm). CDC was defined as the simultaneous achievement of clinical remission (DAS28(CRP)<2.6), normal function (HAQ-DI<0.5) and absence of radiographic progression (ΔmTSS≤0.5). RESULTS Regardless of disease duration, significantly more patients receiving adalimumab+methotrexate achieved CDC compared with methotrexate alone. In the adalimumab+methotrexate group, a numerically greater proportion of patients with early RA (~25%) versus established RA (14%) achieved CDC at 1 year; achievement of CDC was notably greater among patients who met criteria for remission at week 24 or 26 (~50% of patients with early RA and 39% with established RA). CONCLUSION Treatment with adalimumab+methotrexate increases the likelihood of achieving CDC in patients with either early or established RA. Clinical remission at week 24 or 26 is associated with achievement of CDC at week 52. TRIAL REGISTRATION NUMBER DE019 (NCT00195702), OPTIMA (NCT00420927), PREMIER (NCT00195663); Post-results.
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Affiliation(s)
- Edward C Keystone
- Department of Rheumatology, University of Toronto, Toronto, Ontario, Canada
| | - Ferdinand C Breedveld
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Ronald F van Vollenhoven
- Department of Clinical Immunology and Rheumatology, Academic Medical Center, Amsterdam, The Netherlands.,Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands
| | - Paul Emery
- University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, UK
| | - Josef S Smolen
- Division of Rheumatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria.,Second Department of Medicine, Hietzing Hospital, Vienna, Austria
| | | | | | - Hartmut Kupper
- Pharmaceutical Development, AbbVie Deutschland GmbH & Co. KG, Ludwigshafen, Germany
| | - Kun Chen
- Data and Statistical Sciences, AbbVie Inc, North Chicago, Illinois, USA
| | - Arthur Kavanaugh
- Department of Rheumatology, University of California San Diego, La Jolla, California, USA
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Louthrenoo W, Kasitanon N, Katchamart W, Aiewruengsurat D, Chevaisrakul P, Chiowchanwisawakit P, Dechanuwong P, Hanvivadhanakul P, Mahakkanukrauh A, Manavathongchai S, Muangchan C, Narongroeknawin P, Phumethum V, Siripaitoon B, Suesuwan A, Suwannaroj S, Uea-Areewongsa P, Ukritchon S, Asavatanabodee P, Koolvisoot A, Nanagara R, Totemchokchyakarn K, Nuntirooj K, Kitumnuaypong T. 2016 updated Thai Rheumatism Association Recommendations for the use of biologic and targeted synthetic disease-modifying anti-rheumatic drugs in patients with rheumatoid arthritis. Int J Rheum Dis 2017; 20:1166-1184. [DOI: 10.1111/1756-185x.13130] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Worawit Louthrenoo
- Division of Rheumatology; Department of Internal Medicine; Faculty of Medicine; Chiang Mai University; Chiang Mai Thailand
| | - Nuntana Kasitanon
- Division of Rheumatology; Department of Internal Medicine; Faculty of Medicine; Chiang Mai University; Chiang Mai Thailand
| | - Wanruchada Katchamart
- Division of Rheumatology; Department of Medicine; Faculty of Medicine; Siriraj Hospital, Mahidol University; Bangkok Thailand
| | - Duangkamol Aiewruengsurat
- Division of Rheumatology; Department of Internal Medicine; Faculty of Medicine; Prince of Songkla University; Songkla Thailand
| | - Parawee Chevaisrakul
- Division of Allergy Immunology and Rheumatology; Department of Internal Medicine; Faculty of Medicine; Ramathibodi Hospital, Mahidol University; Bangkok Thailand
| | - Praveena Chiowchanwisawakit
- Division of Rheumatology; Department of Medicine; Faculty of Medicine; Siriraj Hospital, Mahidol University; Bangkok Thailand
| | - Pornchai Dechanuwong
- Department of Internal Medicine; Faculty of Medicine; Vajira Hospital, Navamindradhiraj University; Bangkok Thailand
| | - Punchong Hanvivadhanakul
- Division of Rheumatology; Department of Internal Medicine; Faculty of Medicine; Thammasat University; Pathum Thani Thailand
| | - Ajanee Mahakkanukrauh
- Division of Allergy Immunology and Rheumatology; Department of Medicine, Faculty of Medicine; Khon Kaen University; Khon Kaen Thailand
| | - Siriporn Manavathongchai
- Department of Internal Medicine; Faculty of Medicine; Vajira Hospital, Navamindradhiraj University; Bangkok Thailand
| | - Chayawee Muangchan
- Division of Rheumatology; Department of Medicine; Faculty of Medicine; Siriraj Hospital, Mahidol University; Bangkok Thailand
| | - Pongthorn Narongroeknawin
- Division of Rheumatology, Department of Internal Medicine; Phramongkutklao Hospital and College of Medicine; Bangkok Thailand
| | - Veerapong Phumethum
- Division of Rheumatology, Department of Internal Medicine; Pha Pok Klao Hospital; Chanthaburi Thailand
| | - Boonjing Siripaitoon
- Division of Rheumatology; Department of Internal Medicine; Faculty of Medicine; Prince of Songkla University; Songkla Thailand
| | | | - Siraphop Suwannaroj
- Division of Allergy Immunology and Rheumatology; Department of Medicine, Faculty of Medicine; Khon Kaen University; Khon Kaen Thailand
| | - Parichat Uea-Areewongsa
- Division of Rheumatology; Department of Internal Medicine; Faculty of Medicine; Prince of Songkla University; Songkla Thailand
| | - Sittichai Ukritchon
- Division of Rheumatology, Department of Medicine; Faculty of Medicine; Chulalongkorn University; Bangkok Thailand
| | - Paijit Asavatanabodee
- Rheumatic Disease Unit; Department of Medicine; Phramongkutklao Hospital; Bangkok Thailand
| | - Ajchara Koolvisoot
- Division of Rheumatology; Department of Medicine; Faculty of Medicine; Siriraj Hospital, Mahidol University; Bangkok Thailand
| | - Ratanavadee Nanagara
- Division of Allergy Immunology and Rheumatology; Department of Medicine, Faculty of Medicine; Khon Kaen University; Khon Kaen Thailand
| | - Kitti Totemchokchyakarn
- Division of Allergy Immunology and Rheumatology; Department of Internal Medicine; Faculty of Medicine; Ramathibodi Hospital, Mahidol University; Bangkok Thailand
| | - Kanokrut Nuntirooj
- Division of Allergy Immunology and Rheumatology; Department of Internal Medicine; Faculty of Medicine; Ramathibodi Hospital, Mahidol University; Bangkok Thailand
| | - Tasanee Kitumnuaypong
- Rheumatology Unit; Department of Medicine; Rajavithi Hospital, Ministry of Public Health; Bangkok Thailand
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Hambardzumyan K, Saevarsdottir S, Forslind K, Petersson IF, Wallman JK, Ernestam S, Bolce RJ, van Vollenhoven RF. A Multi-Biomarker Disease Activity Score and the Choice of Second-Line Therapy in Early Rheumatoid Arthritis After Methotrexate Failure. Arthritis Rheumatol 2017; 69:953-963. [PMID: 27992691 PMCID: PMC5516230 DOI: 10.1002/art.40019] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 12/06/2016] [Indexed: 12/20/2022]
Abstract
Objective To investigate whether the Multi‐Biomarker Disease Activity (MBDA) score predicts optimal add‐on treatment in patients with early rheumatoid arthritis (RA) who were inadequate responders to MTX (MTX‐IRs). Methods We analyzed data from 157 MTX‐IRs (with a Disease Activity Score using the erythrocyte sedimentation rate [DAS28‐ESR] >3.2) from the Swedish Pharmacotherapy (SWEFOT) trial who were randomized to receive triple therapy (MTX plus sulfasalazine plus hydroxychloroquine) versus MTX plus infliximab. The MBDA score as a predictor of the subsequent DAS28‐based response to each second‐line treatment was analyzed at randomization with the Breslow‐Day test for 2 × 2 groups, using both validated categories (low [<30], moderate [30–44], and high [>44]) and dichotomized categories (lower [≤38] versus higher [>38]). Results Among the 157 patients, 12% had a low MBDA score, 32% moderate, and 56% high. Of those with a low MBDA score, 88% responded to subsequent triple therapy, and 18% responded to MTX plus infliximab (P = 0.006); for those with a high MBDA score, the response rates were 35% and 58%, respectively (P = 0.040). When using 38 as a cutoff for the MBDA score (29% patients with lower scores versus 71% with higher scores), the differential associations with response to triple therapy versus MTX plus infliximab were 79% versus 44% and 36% versus 58%, respectively (P = 0.001). Clinical and inflammatory markers had poorer predictive capacity for response to triple therapy or MTX plus infliximab. Conclusion In patients with RA who had an inadequate response to MTX, the MBDA score categories were differentially associated with response to subsequent therapies. Thus, patients with post‐MTX biochemical improvements (lower MBDA scores) were more likely to respond to triple therapy than to MTX plus infliximab. If confirmed, these results may help to improve treatment in RA.
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Affiliation(s)
| | | | | | | | | | - Sofia Ernestam
- Institution LIME Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
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Koyama K, Ohba T, Ishii K, Jung G, Haro H, Matsuda K. Development of a quick serum IL-6 measuring system in rheumatoid arthritis. Cytokine 2017; 95:22-26. [PMID: 28214674 DOI: 10.1016/j.cyto.2017.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 01/26/2017] [Accepted: 02/03/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Interleukin-6 (IL-6) plays a crucial role in the pathogenesis of rheumatoid arthritis (RA). Both fulfillment of remission criteria and assessment of other methods of evaluation of RA are important for preventing joint damage progression. Measurement of serum IL-6 concentrations has been reported to be useful for monitoring RA disease activity. However, it takes at least 4-5h to measure serum IL-6 concentrations using traditional methods, which limits its utility during routine assessment in daily clinical practice settings. We established a novel method that enables measurement of serum IL-6 within 24min and requires a very small blood volume. We investigated the accuracy and efficacy of this system in RA patients. METHODS One hundred fifty blood samples collected from 76 patients were measured using the two systems. We first developed the prototype of the Human IL-6 RAYFAST. Then, we examined the correlation between the prototype RAYFAST and chemiluminescent enzyme immunoassay (CLEIA) methods. Finally, we compared IL-6 concentrations and clinical parameters using both systems. RESULTS The correlation between RAYFAST (x) and CLEIA (y) for IL-6 was y=0.895x-5.94, r=0.941 (p<0.0001). Serum IL-6 concentrations in RAYFAST correlated with DAS28-CRP (r=0.372, p<0.05) and DAS28-ESR (r=0.397, p<0.01). Serum IL-6 concentrations in CLEIA correlated with DAS28-CRP (r=0.313, p<0.001) and DAS28-ESR (r=0.353, p<0.001). CONCLUSION This new cytokine quick measure system is as accurate as CLEIA methods. Serum IL-6 concentrations can be measured in 24min using the prototype RAYFAST. It might be usable in the daily clinical practice setting, thereby contributing to improved RA management.
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Affiliation(s)
- Kensuke Koyama
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi 409-3898, Japan.
| | - Tetsuro Ohba
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi 409-3898, Japan
| | - Kentaro Ishii
- New Frontiers Research Labs, Toray Industries, Inc., Kamakura, Kanagawa, Japan
| | - Giman Jung
- New Frontiers Research Labs, Toray Industries, Inc., Kamakura, Kanagawa, Japan
| | - Hirotaka Haro
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi 409-3898, Japan
| | - Kenichi Matsuda
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi 409-3898, Japan
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Sung YK, Cho SK, Kim D, Yoon BY, Choi CB, Cha HS, Choe JY, Chung WT, Hong SJ, Jun JB, Kang YM, Kim J, Kim TH, Kim TJ, Koh E, Lee CK, Lee J, Lee SS, Lee SW, Lee HS, Lee YA, Park SH, Yoo DH, Yoo WH, Bae SC. Factors Contributing to Discordance between the 2011 ACR/EULAR Criteria and Physician Clinical Judgment for the Identification of Remission in Patients with Rheumatoid Arthritis. J Korean Med Sci 2016; 31:1907-1913. [PMID: 27822928 PMCID: PMC5102853 DOI: 10.3346/jkms.2016.31.12.1907] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 08/22/2016] [Indexed: 12/26/2022] Open
Abstract
Remission is a primary end point of in clinical practice and trials of treatments for rheumatoid arthritis (RA). The 2011 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) remission criteria were developed to provide a consensus definition of remission. This study aimed to assess the concordance between the new remission criteria and the physician's clinical judgment of remission and also to identify factors that affect the discordance between these two approaches. A total of 3,209 patients with RA were included from the KORean Observational Study Network for Arthritis (KORONA) database. The frequency of remission was evaluated based on each approach. The agreement between the results was estimated by Cohen's kappa (κ). Patients with remission according to the 2011 ACR/EULAR criteria (i.e. the Boolean criteria) and/or physician judgment (n = 855) were divided into three groups: concordant remission, the Boolean criteria only, and physician judgment only. Multinomial logistic regression analysis was used to identify factors responsible for the assignment of patients with remission to one of the discordant groups rather than the concordant group. The remission rates using the Boolean criteria and physician judgment were 10.5% and 19.9%, respectively. The agreement between two approaches for remission was low (κ = 0.226) and the concordant remission rate was only 5.5% (n = 177). Pain affected classification in both discordant groups, whereas fatigue was associated with remission only by physician clinical judgment. The Boolean criteria were more stringent than clinical judgment. Patient subjective symptoms such as pain and fatigue were associated with discordance between the two approaches.
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Affiliation(s)
- Yoon Kyoung Sung
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Soo Kyung Cho
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Dam Kim
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Bo Young Yoon
- Department of Rheumatology, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Chan Bum Choi
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Hoon Suk Cha
- Department of Rheumatology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
| | - Jung Yoon Choe
- Department of Rheumatology, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Won Tae Chung
- Department of Rheumatology, Dong-A University Hospital, Busan, Korea
| | - Seung Jae Hong
- Department of Rheumatology, Kyung Hee University Hospital, Seoul, Korea
| | - Jae Bum Jun
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Young Mo Kang
- Department of Rheumatology, Kyungpook National University Hospital, Daegu, Korea
| | - Jinseok Kim
- Department of Rheumatology, Jeju National University Hospital, Jeju, Korea
| | - Tae Hwan Kim
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Tae Jong Kim
- Department of Rheumatology, Chonnam National University Hospital, Gwangju, Korea
| | - Eunmi Koh
- Department of Rheumatology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
| | - Choong Ki Lee
- Department of Rheumatology, Yeungnam University Hospital, Daegu, Korea
| | - Jisoo Lee
- Department of Rheumatology, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Shin Seok Lee
- Department of Rheumatology, Chonnam National University Hospital, Gwangju, Korea
| | - Sung Won Lee
- Department of Rheumatology, Dong-A University Hospital, Busan, Korea
| | - Hye Soon Lee
- Department of Rheumatology, Hanyang University Guri Hospital, Guri, Korea
| | - Yeon Ah Lee
- Department of Rheumatology, Kyung Hee University Hospital, Seoul, Korea
| | - Sung Hoon Park
- Department of Rheumatology, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Dae Hyun Yoo
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Wan Hee Yoo
- Department of Rheumatology, Chonbuk National University Hospital, Jeonju, Korea
| | - Sang Cheol Bae
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea.
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Faccin F, Tebbey P, Alexander E, Wang X, Cui L, Albuquerque T. The design of clinical trials to support the switching and alternation of biosimilars. Expert Opin Biol Ther 2016; 16:1445-1453. [PMID: 27666115 DOI: 10.1080/14712598.2017.1238454] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Loss of exclusivity for biological therapeutics opens the door for biosimilar development. Biosimilars must demonstrate structural, functional, and clinical similarity with a currently approved biological originator product. A therapeutic alternative for biologic-naive patients, a single switch from an originator to biosimilar has also been studied in clinically stable patients; further, switching therapy multiple times (alternating) between an originator and a biosimilar has been investigated. Because biosimilars are not identical to originators and no robust clinical data have convincingly demonstrated that switching or alternating therapy of stable patients is safe and efficacious, there is an imperative need to understand the characteristics of well-designed clinical trials to support these practices. Areas covered: Clinical trials of biosimilars are reviewed, with an emphasis on trial designs that incorporate therapy switching, including the NOR-SWITCH study as an example. Expert opinion: As currently designed, biosimilar clinical trials provide insufficient information to support switching or alternating between originator products and their biosimilars. Lack of regulatory guidance contributes to this void. More robust data are required to inform the safety and efficacy of switching or alternating therapies, particularly regarding immunogenicity risks. Studies that also include alternations of therapy are needed to address these knowledge gaps.
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Affiliation(s)
- Freddy Faccin
- a Biotherapeutics, Global Medical Affairs , AbbVie Inc ., San Juan , PR , USA
| | - Paul Tebbey
- b Gastroenterology & Biotherapeutics, US Medical Affairs , AbbVie Inc ., North Chicago , IL , USA
| | - Emily Alexander
- c Biologics Strategic Development , AbbVie Inc ., North Chicago , IL , USA
| | - Xin Wang
- d Data and Statistical Science , AbbVie Inc ., North Chicago , IL , USA
| | - Lu Cui
- d Data and Statistical Science , AbbVie Inc ., North Chicago , IL , USA
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Dos Santos JBR, Almeida AM, Acurcio FDA, de Oliveira Junior HA, Kakehasi AM, Guerra Junior AA, Bennie M, Godman B, Alvares J. Comparative effectiveness of adalimumab and etanercept for rheumatoid arthritis in the Brazilian Public Health System. J Comp Eff Res 2016; 5:539-549. [PMID: 27641309 DOI: 10.2217/cer-2016-0027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
AIM Biological disease-modifying antirheumatic drugs (bDMARDs) are used to treat rheumatoid arthritis (RA) with adalimumab and etanercept the most used bDMARDs in Brazil. This open prospective cohort study evaluated their effectiveness and safety among RA patients in the Brazilian Public Health System given their costs. METHODS The Clinical Disease Activity Index was primarily used to assess their effectiveness after 6 and 12 months of follow-up. The Health Assessment Questionnaire and EuroQol-5D were also used. RESULTS A total of 266 RA patients started treatment with adalimumab or etanercept. Adalimumab was the most widely used bDMARD (70%). In total, 46% achieved remission or low-disease activity at 12 months with no difference in effectiveness between them (p = 0.306). bDMARDs were more effective in patients who had better functionality at treatment onset and had spent longer in education. CONCLUSION This real-world study demonstrated that adalimumab and etanercept are equal alternatives for RA treatment and both were well tolerated.
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Affiliation(s)
- Jéssica Barreto Ribeiro Dos Santos
- Postgraduate Program in Medicines & Pharmaceutical Assistance, College of Pharmacy, Federal University of Minas Gerais, Av. Presidente Antônio Carlos, 6627 Campus Pampulha, Belo Horizonte, Minas Gerais 31270-901, Brazil
| | - Alessandra Maciel Almeida
- College of Pharmacy, Federal University of Minas Gerais, Av. Presidente Antônio Carlos, 6627 Campus Pampulha, Belo Horizonte, Minas Gerais 31270-901, Brazil
| | - Francisco de Assis Acurcio
- College of Pharmacy, Federal University of Minas Gerais, Av. Presidente Antônio Carlos, 6627 Campus Pampulha, Belo Horizonte, Minas Gerais 31270-901, Brazil
| | - Haliton Alves de Oliveira Junior
- Postgraduate Program in Medicines & Pharmaceutical Assistance, College of Pharmacy, Federal University of Minas Gerais, Av. Presidente Antônio Carlos, 6627 Campus Pampulha, Belo Horizonte, Minas Gerais 31270-901, Brazil
| | - Adriana Maria Kakehasi
- Medicine School, Federal University of Minas Gerais, Av. Prof. Alfredo Balena, 190, Belo Horizonte, Minas Gerais 30130-100, Brazil
| | - Augusto Afonso Guerra Junior
- College of Pharmacy, Federal University of Minas Gerais, Av. Presidente Antônio Carlos, 6627 Campus Pampulha, Belo Horizonte, Minas Gerais 31270-901, Brazil
| | - Marion Bennie
- Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Brian Godman
- Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, Glasgow, UK.,Division of Clinical Pharmacology, Karolinska Institute, Stockholm, Sweden
| | - Juliana Alvares
- College of Pharmacy, Federal University of Minas Gerais, Av. Presidente Antônio Carlos, 6627 Campus Pampulha, Belo Horizonte, Minas Gerais 31270-901, Brazil
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Lóránd V, Bálint Z, Komjáti D, Németh B, Minier T, Kumánovics G, Farkas N, Czirják L, Varjú C. Validation of disease activity indices using the 28 joint counts in systemic sclerosis. Rheumatology (Oxford) 2016; 55:1849-58. [DOI: 10.1093/rheumatology/kew246] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Indexed: 01/23/2023] Open
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Lisbona MP, Solano A, Ares J, Almirall M, Salman-Monte TC, Maymó J. ACR/EULAR Definitions of Remission Are Associated with Lower Residual Inflammatory Activity Compared with DAS28 Remission on Hand MRI in Rheumatoid Arthritis. J Rheumatol 2016; 43:1631-6. [DOI: 10.3899/jrheum.150849] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2016] [Indexed: 12/15/2022]
Abstract
Objective.To determine the level of residual inflammation [synovitis, bone marrow edema (BME), tenosynovitis, and total inflammation] quantified by hand magnetic resonance imaging (h-MRI) in patients with rheumatoid arthritis (RA) in remission according to 3 different definitions of clinical remission, and to compare these remission definitions.Methods.A cross-sectional study. To assess the level of residual MRI inflammation in remission, cutoff levels associated to remission and median scores of MRI residual inflammatory lesions were calculated. Data from an MRI register of patients with RA who have various levels of disease activity were used. These were used for the analyses: synovitis, BME according to the Rheumatoid Arthritis Magnetic Resonance Imaging Scoring system, tenosynovitis, total inflammation, and disease activity composite measures recorded at the time of MRI. Receiver-operating characteristic analysis was used to identify the best cutoffs associated with remission for each inflammatory lesion on h-MRI. Median values of each inflammatory lesion for each definition of remission were also calculated.Results.A total of 388 h-MRI sets of patients with RA with different levels of disease activity, 130 in remission, were included. Cutoff values associated with remission according to the Simplified Disease Activity Index (SDAI) ≤ 3.3 and the Boolean American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) definitions for BME and tenosynovitis (1 and 3, respectively) were lower than BME and tenosynovitis (2 and 5, respectively) for the Disease Activity Score on 28 joints (DAS28) ≤ 2.6. Median scores for synovitis, BME, and total inflammation were also lower for the SDAI and Boolean ACR/EULAR remission criteria compared with DAS28.Conclusion.Patients with RA in remission according to the SDAI and Boolean ACR/EULAR definitions showed lower levels of MRI-detected residual inflammation compared with DAS28.
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Mian AN, Ibrahim F, Scott DL, Galloway J. Optimal responses in disease activity scores to treatment in rheumatoid arthritis: Is a DAS28 reduction of >1.2 sufficient? Arthritis Res Ther 2016; 18:142. [PMID: 27312203 PMCID: PMC4910246 DOI: 10.1186/s13075-016-1028-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 05/19/2016] [Indexed: 02/07/2023] Open
Abstract
Background The overall benefit of intensive treatment strategies in rheumatoid arthritis (RA) remains uncertain. We explored how reductions in disability and improvements in quality of life scores are affected by alternative assessments of reductions in disease activity scores for 28 joints (DAS28) in two trials of intensive treatment strategies in active RA. Methods One trial (CARDERA) studied 467 patients with early active RA receiving 24 months of methotrexate monotherapy or steroid and disease-modifying anti-rheumatic drug (DMARD) combinations. The other trial (TACIT) studied 205 patients with established active RA; they received 12 months of treatment with DMARD combinations or biologic agents. We compared changes in the health assessment questionnaire (HAQ) and Euroqol-5D (EQ5D) at trial endpoints in European League Against Rheumatism (EULAR) good and moderate EULAR responders in patients in whom complete endpoint data were available. Results In the CARDERA trial 98 patients (26 %) were good EULAR responders and 160 (32 %) were EULAR moderate responders; comparable data in TACIT were 66 (35 %) and 86 (46 %) patients. The magnitude of change in the HAQ and EQ5D was greater in both trials in EULAR good responders than in EULAR moderate responders. HAQ scores had a difference in of –0.49 (95 % CI –0.66, –0.32) in the CARDERA and –0.31 (95 % CI –0.47, –0.13) in the TACIT trial. With the EQ5D comparable differences were 0.12 (95 % CI 0.04, 0.19) and 0.15 (95 % CI 0.05, 0.25). Both exceeded minimum clinically important differences in HAQ and EQ5D scores. Conclusions We conclude that achieving a good EULAR response with DMARDs and biologic agents in active RA results in substantially improved mean HAQ and EQ5D scores. Patients who achieve such responses should continue on treatment. However, continuing such treatment strategies is more challenging when only a moderate EULAR response is achieved. In these patients evidence of additional clinically important benefits in measures such as the HAQ should also be sought.
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Affiliation(s)
- Aneela N Mian
- Department of Rheumatology, King's College Hospital, Denmark Hill, London, SE5 9RS, UK. .,Department of Rheumatology, King's College School of Medicine, King's College London, Weston Education Centre, Denmark Hill, London, SE5 9RT, UK.
| | - Fowzia Ibrahim
- Department of Rheumatology, King's College Hospital, Denmark Hill, London, SE5 9RS, UK.,Department of Rheumatology, King's College School of Medicine, King's College London, Weston Education Centre, Denmark Hill, London, SE5 9RT, UK
| | - David L Scott
- Department of Rheumatology, King's College Hospital, Denmark Hill, London, SE5 9RS, UK.,Department of Rheumatology, King's College School of Medicine, King's College London, Weston Education Centre, Denmark Hill, London, SE5 9RT, UK
| | - James Galloway
- Department of Rheumatology, King's College Hospital, Denmark Hill, London, SE5 9RS, UK.,Department of Rheumatology, King's College School of Medicine, King's College London, Weston Education Centre, Denmark Hill, London, SE5 9RT, UK
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Midtbø H, Semb AG, Matre K, Kvien TK, Gerdts E. Disease activity is associated with reduced left ventricular systolic myocardial function in patients with rheumatoid arthritis. Ann Rheum Dis 2016; 76:371-376. [PMID: 27269296 DOI: 10.1136/annrheumdis-2016-209223] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 04/14/2016] [Accepted: 05/17/2016] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Disease activity has emerged as a new, independent risk factor for cardiovascular disease in patients with rheumatoid arthritis (RA). We tested if disease activity in RA was associated with lower left ventricular (LV) systolic function independent of traditional cardiovascular risk factors. METHODS Echocardiographic assessment was performed in 78 patients with RA having low, moderate or high disease activity (Simplified Disease Activity Index (SDAI) >3.3), 41 patients in remission (SDAI ≤3.3) and 46 controls, all without known cardiac disease. LV systolic function was assessed by biplane Simpson ejection fraction, stress-corrected midwall shortening (scMWS) and global longitudinal strain (GLS). RESULTS Patients with active RA had higher prevalence of hypertension and diabetes compared with patients in remission and controls (both p<0.05). LV ejection fraction (endocardial function) was normal in all three groups, while mean scMWS and GLS (myocardial function) were reduced in patients with RA with active disease compared with patients with RA in remission (95±18% vs 105±17% and -18.9±3.1% vs -20.6±3.5%, respectively, both p<0.01). Patients with RA in remission had similar scMWS and GLS as the controls. In multivariable analyses, having active RA was associated with lower GLS (β=0.21) and scMWS (β=-0.22, both p<0.05), both reflecting lower LV systolic myocardial function, independent of cardiovascular risk factors and LV ejection fraction. Classification of RA disease activity by other disease activity composite scores yielded similar results. CONCLUSIONS Active RA is associated with lower LV systolic myocardial function despite normal ejection fraction and independent of traditional cardiovascular risk factors.
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Affiliation(s)
- Helga Midtbø
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Knut Matre
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Tore K Kvien
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Eva Gerdts
- Department of Clinical Science, University of Bergen, Bergen, Norway
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Does a Simplified 6-Joint Ultrasound Index Correlate Well Enough With the 28-Joint Disease Activity Score to Be Used in Clinical Practice? J Clin Rheumatol 2016; 22:179-83. [DOI: 10.1097/rhu.0000000000000415] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ciftci GG, Ciftci IH, Karakece E, Harman H, Kamanlı A, Tekeoglu I. Identification of ESM-1 as a new endothelial biomarker in the pathogenesis of rheumatoid arthritis. BIOTECHNOL BIOTEC EQ 2016. [DOI: 10.1080/13102818.2016.1148635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Gönül Gürol Ciftci
- Faculty of Medicine, Department of Physiology, Sakarya University, Sakarya, Turkey
| | - Ihsan Hakkı Ciftci
- Faculty of Medicine, Department of Microbiology, Sakarya University, Sakarya, Turkey
| | - Engin Karakece
- Faculty of Medicine, Department of Microbiology, Sakarya University, Sakarya, Turkey
| | - Halil Harman
- Department of Rheumatology/Rehabilitation, School of Medicine, Sakarya University, Sakarya, Turkey
| | - Ayhan Kamanlı
- Department of Rheumatology/Rehabilitation, School of Medicine, Sakarya University, Sakarya, Turkey
| | - Ibrahim Tekeoglu
- Department of Rheumatology/Rehabilitation, School of Medicine, Sakarya University, Sakarya, Turkey
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Midtbø H, Gerdts E, Kvien TK, Olsen IC, Lønnebakken MT, Davidsen ES, Rollefstad S, Semb AG. The association of hypertension with asymptomatic cardiovascular organ damage in rheumatoid arthritis. Blood Press 2016; 25:298-304. [PMID: 27123584 DOI: 10.3109/08037051.2016.1172867] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The association of hypertension with asymptomatic cardiovascular organ damage in patients with rheumatoid arthritis (RA) has been little studied by echocardiography. METHODS Echocardiography was done in 134 RA patients and 102 healthy controls. Left ventricular (LV) geometry was considered abnormal if LV mass index or relative wall thickness was increased. LV diastolic dysfunction was considered present if septal early diastolic tissue velocity <8 cm/s. Systemic arterial compliance (SAC) was assessed from stroke volume index/pulse pressure ratio. RESULTS The hypertensive RA patients (n = 72) had higher inflammatory activity, older age and more diabetes than the normotensive RA patients (n = 62) (all p < 0.05). Rates of abnormal LV geometry, LV diastolic dysfunction and lower SAC were higher among the hypertensive RA patients (p < 0.05), but similar between normotensive RA patients and controls. Hypertension was associated with a 3-fold higher prevalence both for abnormal LV geometry (odds ratio 2.89 [95% confidence interval 1.09-7.63], p = 0.03) and for diastolic LV dysfunction (odds ratio 2.92 [95% confidence interval 1.14-7.46], p = 0.03) as well as lower SAC (β = 0.31, p = 0.001) independent of age, gender, diabetes and inflammatory activity measured by erythrocyte sedimentation rate. CONCLUSION The presence of asymptomatic cardiovascular organ damage in RA patients is closely associated with hypertension independent of inflammatory activity.
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Affiliation(s)
- Helga Midtbø
- a Department of Heart Disease , Haukeland University Hospital , Bergen , Norway ;,b Department of Clinical Science , University of Bergen , Bergen , Norway
| | - Eva Gerdts
- b Department of Clinical Science , University of Bergen , Bergen , Norway
| | - Tore K Kvien
- c Department of Rheumatology , Diakonhjemmet Hospital , Oslo , Norway
| | - Inge C Olsen
- c Department of Rheumatology , Diakonhjemmet Hospital , Oslo , Norway
| | | | | | - Silvia Rollefstad
- c Department of Rheumatology , Diakonhjemmet Hospital , Oslo , Norway
| | - Anne Grete Semb
- c Department of Rheumatology , Diakonhjemmet Hospital , Oslo , Norway
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Einarsson JT, Geborek P, Saxne T, Kristensen LE, Kapetanovic MC. Sustained Remission Improves Physical Function in Patients with Established Rheumatoid Arthritis, and Should Be a Treatment Goal: A Prospective Observational Cohort Study from Southern Sweden. J Rheumatol 2016; 43:1017-23. [PMID: 27036384 DOI: 10.3899/jrheum.150995] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2016] [Indexed: 01/18/2023]
Abstract
OBJECTIVE It has been proposed that remission should be maintained throughout the course of rheumatoid arthritis (RA); however, the evidence supporting this is limited. Physical function measured by the Health Assessment Questionnaire (HAQ) is a major outcome in RA, and HAQ is shown to be one of the strongest predictors of longterm outcomes. The purpose of this study was to investigate the physical function over a long time in patients with RA who achieved sustained remission (SR) compared with that of patients occasionally achieving remission [non-sustained remission (NSR)]. METHODS Patients with RA treated with antitumor necrosis factor and included in the South Swedish Arthritis Treatment Group register were eligible for this study. We identified patients with a Disease Activity Score at 28 joints (DAS28) < 2.6 or Simplified Disease Activity Index (SDAI) ≤ 3.3 at some point and those who achieved SR, i.e., remission during consecutive visits for at least 6 months. The course of functional status was assessed using the HAQ at each visit. RESULTS Of the 2416 patients, 1177 (48.7%) reached DAS28 remission at some point. SR was achieved by 382 (15.8%) for the DAS28 and 186 (7.7%) for the SDAI criteria. Comparing the SR and NSR groups, HAQ improved during the first 12 months in the DAS28 remission. HAQ continued to improve relatively as long as SR was maintained. A higher proportion of patients in SR reached full physical function. CONCLUSION In patients with established RA, physical function measured by the HAQ improves in patients reaching SR compared with patients who only occasionally reach remission. The improvement continues while in remission, which supports that maintaining remission should be a treatment goal.
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Affiliation(s)
- Jon Thorkell Einarsson
- From the Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Skåne University Hospital, Lund, Sweden; The Parker Institute, Department of Rheumatology, Bispebjerg and Frederiksberg Hospital, the Capital Region of Copenhagen, Copenhagen, Denmark.J.T. Einarsson, MD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Skåne University Hospital; P. Geborek, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Skåne University Hospital; T. Saxne, MD, PhD, Professor, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Skåne University Hospital; L.E. Kristensen, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Skåne University Hospital, and The Parker Institute, Department of Rheumatology, Bispebjerg and Frederiksberg Hospital, the Capital Region of Copenhagen; M.C. Kapetanovic, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Skåne University Hospital.
| | - Pierre Geborek
- From the Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Skåne University Hospital, Lund, Sweden; The Parker Institute, Department of Rheumatology, Bispebjerg and Frederiksberg Hospital, the Capital Region of Copenhagen, Copenhagen, Denmark.J.T. Einarsson, MD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Skåne University Hospital; P. Geborek, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Skåne University Hospital; T. Saxne, MD, PhD, Professor, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Skåne University Hospital; L.E. Kristensen, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Skåne University Hospital, and The Parker Institute, Department of Rheumatology, Bispebjerg and Frederiksberg Hospital, the Capital Region of Copenhagen; M.C. Kapetanovic, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Skåne University Hospital
| | - Tore Saxne
- From the Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Skåne University Hospital, Lund, Sweden; The Parker Institute, Department of Rheumatology, Bispebjerg and Frederiksberg Hospital, the Capital Region of Copenhagen, Copenhagen, Denmark.J.T. Einarsson, MD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Skåne University Hospital; P. Geborek, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Skåne University Hospital; T. Saxne, MD, PhD, Professor, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Skåne University Hospital; L.E. Kristensen, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Skåne University Hospital, and The Parker Institute, Department of Rheumatology, Bispebjerg and Frederiksberg Hospital, the Capital Region of Copenhagen; M.C. Kapetanovic, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Skåne University Hospital
| | - Lars Erik Kristensen
- From the Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Skåne University Hospital, Lund, Sweden; The Parker Institute, Department of Rheumatology, Bispebjerg and Frederiksberg Hospital, the Capital Region of Copenhagen, Copenhagen, Denmark.J.T. Einarsson, MD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Skåne University Hospital; P. Geborek, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Skåne University Hospital; T. Saxne, MD, PhD, Professor, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Skåne University Hospital; L.E. Kristensen, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Skåne University Hospital, and The Parker Institute, Department of Rheumatology, Bispebjerg and Frederiksberg Hospital, the Capital Region of Copenhagen; M.C. Kapetanovic, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Skåne University Hospital
| | - Meliha C Kapetanovic
- From the Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Skåne University Hospital, Lund, Sweden; The Parker Institute, Department of Rheumatology, Bispebjerg and Frederiksberg Hospital, the Capital Region of Copenhagen, Copenhagen, Denmark.J.T. Einarsson, MD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Skåne University Hospital; P. Geborek, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Skåne University Hospital; T. Saxne, MD, PhD, Professor, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Skåne University Hospital; L.E. Kristensen, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Skåne University Hospital, and The Parker Institute, Department of Rheumatology, Bispebjerg and Frederiksberg Hospital, the Capital Region of Copenhagen; M.C. Kapetanovic, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Skåne University Hospital
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Hambardzumyan K, Bolce RJ, Saevarsdottir S, Forslind K, Wallman JK, Cruickshank SE, Sasso EH, Chernoff D, van Vollenhoven RF. Association of a multibiomarker disease activity score at multiple time-points with radiographic progression in rheumatoid arthritis: results from the SWEFOT trial. RMD Open 2016; 2:e000197. [PMID: 26958364 PMCID: PMC4780313 DOI: 10.1136/rmdopen-2015-000197] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 01/18/2016] [Accepted: 01/31/2016] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES In rheumatoid arthritis (RA), predictive biomarkers for subsequent radiographic progression (RP) could improve therapeutic choices for individual patients. We previously showed that the multibiomarker disease activity (MBDA) score in patients with newly diagnosed RA identified patients at risk for RP. We evaluated the MBDA score at multiple time-points as a predictor of RP during 2 years of follow-up. METHODS A subset of patients with RA (N=220) from the Swedish Farmacotherapy (SWEFOT) trial were analysed for MBDA score, disease activity score of 28 joints (DAS28), C reactive protein (CRP) and erythrocyte sedimentation rate (ESR) at baseline (BL), month 3 and year 1, for predicting RP based on modified Sharp/van der Heijde scores at BL, year 1 and year 2. RESULTS Patients with persistently low MBDA (<30) scores or those with a decrease from moderate (30-44) to low MBDA scores, did not develop RP during 2 years of follow-up. The highest risk for RP during 2 years of follow-up (42%) was observed among patients with persistently high (>44) MBDA scores. Among methotrexate non-responders with a high MBDA score at BL or month 3, significantly more of those who received triple therapy had RP at year 2 compared with those who received antitumour necrosis factor therapy. CONCLUSIONS Measuring the MBDA score both before and during treatment in RA was useful for the assessment of individual patient risk for RP during 2 years of follow-up. In comparison with low CRP, ESR or DAS28, a low MBDA score at any time-point was associated with numerically lower proportions of RP. TRIAL REGISTRATION NUMBER NCT00764725.
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Affiliation(s)
- Karen Hambardzumyan
- Unit of Clinical Therapy Research, Inflammatory Diseases (ClinTRID), Department of Medicine , Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden
| | - Rebecca J Bolce
- Crescendo Bioscience Inc , South San Francisco, California , USA
| | - Saedis Saevarsdottir
- Unit of Clinical Therapy Research, Inflammatory Diseases (ClinTRID), Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Rheumatology Unit, Department of Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Kristina Forslind
- Section of Rheumatology, Department of Clinical Sciences, Lund University, Helsingborg, Sweden; Section of Rheumatology, Department of Medicine, Helsingborg's Lasarett, Helsingborg, Sweden
| | - Johan K Wallman
- Section of Rheumatology, Department of Clinical Sciences , Lund University , Lund , Sweden
| | | | - Eric H Sasso
- Crescendo Bioscience Inc , South San Francisco, California , USA
| | - David Chernoff
- Crescendo Bioscience Inc , South San Francisco, California , USA
| | - Ronald F van Vollenhoven
- Unit of Clinical Therapy Research, Inflammatory Diseases (ClinTRID), Department of Medicine , Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden
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Smolen JS, Breedveld FC, Burmester GR, Bykerk V, Dougados M, Emery P, Kvien TK, Navarro-Compán MV, Oliver S, Schoels M, Scholte-Voshaar M, Stamm T, Stoffer M, Takeuchi T, Aletaha D, Andreu JL, Aringer M, Bergman M, Betteridge N, Bijlsma H, Burkhardt H, Cardiel M, Combe B, Durez P, Fonseca JE, Gibofsky A, Gomez-Reino JJ, Graninger W, Hannonen P, Haraoui B, Kouloumas M, Landewe R, Martin-Mola E, Nash P, Ostergaard M, Östör A, Richards P, Sokka-Isler T, Thorne C, Tzioufas AG, van Vollenhoven R, de Wit M, van der Heijde D. Treating rheumatoid arthritis to target: 2014 update of the recommendations of an international task force. Ann Rheum Dis 2016; 75:3-15. [PMID: 25969430 PMCID: PMC4717393 DOI: 10.1136/annrheumdis-2015-207524] [Citation(s) in RCA: 953] [Impact Index Per Article: 119.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 04/10/2015] [Accepted: 04/13/2015] [Indexed: 01/23/2023]
Abstract
BACKGROUND Reaching the therapeutic target of remission or low-disease activity has improved outcomes in patients with rheumatoid arthritis (RA) significantly. The treat-to-target recommendations, formulated in 2010, have provided a basis for implementation of a strategic approach towards this therapeutic goal in routine clinical practice, but these recommendations need to be re-evaluated for appropriateness and practicability in the light of new insights. OBJECTIVE To update the 2010 treat-to-target recommendations based on systematic literature reviews (SLR) and expert opinion. METHODS A task force of rheumatologists, patients and a nurse specialist assessed the SLR results and evaluated the individual items of the 2010 recommendations accordingly, reformulating many of the items. These were subsequently discussed, amended and voted upon by >40 experts, including 5 patients, from various regions of the world. Levels of evidence, strengths of recommendations and levels of agreement were derived. RESULTS The update resulted in 4 overarching principles and 10 recommendations. The previous recommendations were partly adapted and their order changed as deemed appropriate in terms of importance in the view of the experts. The SLR had now provided also data for the effectiveness of targeting low-disease activity or remission in established rather than only early disease. The role of comorbidities, including their potential to preclude treatment intensification, was highlighted more strongly than before. The treatment aim was again defined as remission with low-disease activity being an alternative goal especially in patients with long-standing disease. Regular follow-up (every 1-3 months during active disease) with according therapeutic adaptations to reach the desired state was recommended. Follow-up examinations ought to employ composite measures of disease activity that include joint counts. Additional items provide further details for particular aspects of the disease, especially comorbidity and shared decision-making with the patient. Levels of evidence had increased for many items compared with the 2010 recommendations, and levels of agreement were very high for most of the individual recommendations (≥9/10). CONCLUSIONS The 4 overarching principles and 10 recommendations are based on stronger evidence than before and are supposed to inform patients, rheumatologists and other stakeholders about strategies to reach optimal outcomes of RA.
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Affiliation(s)
- Josef S Smolen
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
- 2nd Department of Medicine, Hietzing Hospital, Vienna, Austria
| | - Ferdinand C Breedveld
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Gerd R Burmester
- Department of Rheumatology, Clinical Immunology Free University and Humboldt University, Charité-University Medicine, Berlin, Germany
| | - Vivian Bykerk
- Division of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College, Cornell University, New York, USA
| | - Maxime Dougados
- Department of Rheumatology B, Cochin Hospital, René Descartes University, Paris, France
| | - Paul Emery
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital,Leeds, UK
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | | | | | - Monika Schoels
- 2nd Department of Medicine, Hietzing Hospital, Vienna, Austria
| | - Marieke Scholte-Voshaar
- EULAR Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), Zurich, Switzerland
| | - Tanja Stamm
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Michaela Stoffer
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Tsutomu Takeuchi
- Division of Rheumatology, Department of internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Daniel Aletaha
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Jose Louis Andreu
- Rheumatology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Spain
| | - Martin Aringer
- Department of Medicine III, University Medical Center TU Dresden, Dresden, Germany
| | - Martin Bergman
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Neil Betteridge
- EULAR Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), Zurich, Switzerland
| | - Hans Bijlsma
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, and VU University Medical Center, Amsterdam, The Netherlands
| | - Harald Burkhardt
- Division of Rheumatology, Department of Medicine, Johann-Wolfgang-Goethe University Frankfurt, German
| | - Mario Cardiel
- Centro de Investigación Clínica de Morelia, Morelia, Michoacán, Mexico
| | - Bernard Combe
- Service d'Immuno-Rhumatologie, Montpellier University, Lapeyronie Hospital, Montpellier, France
| | - Patrick Durez
- Pôle de Recherche en Rhumatologie, Institut de Recherche Experimentale et Clinique, Université Catholique de Louvain and Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Joao Eurico Fonseca
- Rheumatology Research Unit, Instituto de de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
- Rheumatology Department, Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Alan Gibofsky
- Weill Medical College, Cornell University Hospital for Special Surgery, New York, USA
| | - Juan J Gomez-Reino
- Rheumatology Unit, Santiago University Clinical Hospital, Santiago de Compostela, Spain
| | | | - Pekka Hannonen
- Department of Medicine, Central Hospital, Jyväskylä, Finland
| | | | - Marios Kouloumas
- EULAR Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), Zurich, Switzerland
| | - Robert Landewe
- Academic Medical Center, University of Amsterdam, Amsterdam, and Atrium Medical Center, Heerlen, The Netherlands
| | | | - Peter Nash
- University of Queensland, Brisbane, Queensland, Australia
| | - Mikkel Ostergaard
- Department of Clinical Medicine, Faculty of Health Sciences, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet and Glostrup Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Andrew Östör
- Rheumatology Clinical Research Unit, School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge University Hospitals, NHS Foundation Trust, Cambridge, UK
| | - Pam Richards
- EULAR Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), Zurich, Switzerland
| | | | - Carter Thorne
- Division of Rheumatology, Southlake Regional Health Centre, Newarket, Ontario, Canada
| | | | | | - Martinus de Wit
- EULAR Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), Zurich, Switzerland
| | - Desirée van der Heijde
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Li W, Sasso EH, van der Helm-van Mil AHM, Huizinga TWJ. Relationship of multi-biomarker disease activity score and other risk factors with radiographic progression in an observational study of patients with rheumatoid arthritis. Rheumatology (Oxford) 2015; 55:357-66. [PMID: 26385370 PMCID: PMC4710803 DOI: 10.1093/rheumatology/kev341] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Indexed: 12/12/2022] Open
Abstract
Objectives. To evaluate the multi-biomarker disease activity (MBDA) score as a predictor of radiographic progression and compare it with other risk factors among patients with established RA receiving non-biologic DMARDs. Methods. For 163 patients with RA, we assessed 271 visits for MBDA score (scale of 1−100), clinical data and subsequent 1-year radiographic progression (change in Sharp−van der Heijde score [SHS]). Scatter plot and non-parametric quantile regression curves evaluated the relationship between the MBDA score and change in SHS. Changes in joint space narrowing and erosions were compared among MBDA categories with Wilcoxon rank-sum tests. The ability of the MBDA score to independently predict progression was determined by multivariate models and cross-classification of MBDA score with other risk factors. Generalized estimating equation methodology was used in model estimations to adjust for same-patient visits, always ≥1 year apart. Results. Patient characteristics included 67% female, 66%/67% RF+/anti-CCP+; mean age 55 years, MBDA score 43 (moderate = 30−44); median disease duration 4.6 years, SHS 23. Radiographic progression was infrequent for low MBDA scores. Relative risk for progression increased continuously as the MBDA score increased, reaching 17.4 for change in SHS >5 with MBDA scores ≥60. Joint space narrowing and erosion progression were associated with MBDA score. MBDA score was associated with radiographic progression after adjustments for other risk factors. MBDA score significantly differentiated risk for progression when swollen joint count, CRP or DAS28–CRP was low, and among seropositive patients. Conclusion. MBDA score enhanced the ability of conventional risk factors to predict radiographic progression in patients with established RA receiving non-biologic DMARDs.
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Affiliation(s)
| | - Eric H Sasso
- Medical and Scientific Affairs, Crescendo Bioscience, South San Francisco, USA and
| | | | - Tom W J Huizinga
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
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