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Neve M, Diderichsen PM, Helmer E, de Vries D, Taneja A. Prediction of Disease Progression and Clinical Response in Systemic Sclerosis: Experience From a Proof-of-Concept Trial. ACR Open Rheumatol 2024; 6:511-518. [PMID: 38923416 PMCID: PMC11319916 DOI: 10.1002/acr2.11678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 03/03/2024] [Indexed: 06/28/2024] Open
Abstract
OBJECTIVE Using the modified Rodnan skin score (mRSS) as a surrogate for disease activity, a phase 2a study in patients with systemic sclerosis (SSc) measured efficacy of the autotaxin inhibitor ziritaxestat. Mathematical modeling of mRSS was used to predict disease progression, examine candidate trial designs, and predict the probability of successfully discriminating treatment effect. METHODS Patients with SSc receiving 600 mg of ziritaxestat or placebo for 24 weeks were included, in addition to data up to week 52 of the open-label extension (OLE). Longitudinal mRSS data were described using a disease progression model; drug effect was a binary variable. Parameters used to predict the OLE mRSS outcome were estimated using data from the 24-week double-blind phase and validated with observed data. Three trial designs were simulated to identify which had the highest probability of detecting a treatment effect. Power to detect a treatment effect was quantified using the simulations. RESULTS Maximum decreases from baseline in mRSS were 50.4% (ziritaxestat) and 34.7% (placebo). Study designs based on 300 patients randomized 2:1 or 1:1 to 600 mg of ziritaxestat or placebo had similar probabilities of detecting a significant treatment effect. Power to detect a treatment effect was >80% for all simulations. CONCLUSION Disease progression and drug effect could be predicted beyond the range of observed data. This modeling and simulation approach may inform future trial design, including study duration, and predict the probability of success.
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Affiliation(s)
- Marta Neve
- Certara USA, IncPrincetonNew Jersey
- Present address:
GlaxoSmithKline Research CentreVeronaItaly
| | | | - Eric Helmer
- Galapagos Biotech LtdCambridgeUnited Kingdom
- Present address:
ExscientiaOxfordUnited Kingdom
| | | | - Amit Taneja
- Galapagos SASU, Romainville, France, and Simulations Plus, IncLancasterCalifornia
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Ross L, Hansen D, Proudman S, Khanna D, Herrick AL, Stevens W, Baron M, Nikpour M. Development and Initial Validation of the Novel Scleroderma Clinical Trials Consortium Activity Index. Arthritis Rheumatol 2024. [PMID: 38937146 DOI: 10.1002/art.42939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 05/10/2024] [Accepted: 06/20/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVE Accurate measurement of disease activity in systemic sclerosis (SSc) remains a significant clinical challenge. The Scleroderma Clinical Trials Consortium (SCTC) convened an Activity Index (AI) Working Group (WG) to develop a novel measure of disease activity (SCTC-AI). METHODS Using consensus methodology, we developed a conceptual definition of disease activity. Literature review and expert consensus generated provisional SCTC-AI items, which were reduced by Delphi survey. Provisional items were weighted against a combined endpoint of morbidity and mortality, using time-dependent Cox proportional hazards regression analysis of the Australian Scleroderma Cohort Study (ASCS) (n = 1,254). External validation of the SCTC-AI was performed using data collected from 1,103 Canadian Scleroderma Research Group Study participants. RESULTS Disease activity in SSc was defined using consensus methodology as "aspects of disease that are reversible, or can be arrested, with time and, or effective therapy." One-hundred and forty-one provisional SCTC-AI items were generated and reduced using three rounds of Delphi survey and statistical reduction and weighting, against mortality and quality of life measures, yielding a final 24-item index with a maximum possible score of 140. Survival analysis in an external cohort showed a graded relationship between disease activity scores and survival (P < 0.01). CONCLUSION We present a novel instrument to quantify the burden of disease activity in SSc. We have employed a rigorous consensus-based process in combination with data-driven methods to develop an instrument that has face, content, and criterion validity. Further work is required to fully validate and confirm the construct and discriminative validity of the SCTC-AI.
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Affiliation(s)
- Laura Ross
- University of Melbourne and St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Dylan Hansen
- St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Susanna Proudman
- Royal Adelaide Hospital and University of Adelaide, South Australia, Australia
| | | | - Ariane L Herrick
- The University of Manchester, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Wendy Stevens
- St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Murray Baron
- Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Mandana Nikpour
- University of Melbourne and St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Sydney Musculoskeletal Research Flagship Centre (University of Sydney), University of Sydney School of Public Health, Sydney, New South Wales, and Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
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Zinellu A, Mangoni AA. The association between the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and monocyte-to-lymphocyte ratio and systemic sclerosis and its complications: a systematic review and meta-analysis. Front Immunol 2024; 15:1395993. [PMID: 38799443 PMCID: PMC11116674 DOI: 10.3389/fimmu.2024.1395993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 04/26/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction The identification of new, easily measurable biomarkers might assist clinicians in diagnosing and managing systemic sclerosis (SSc). Although the full blood count is routinely assessed in the evaluation of SSc, the diagnostic utility of specific cell-derived inflammatory indices, i.e., neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR), has not been critically appraised in this patient group. Methods We conducted a systematic review and meta-analysis of studies investigating the NLR, PLR, and MLR, in SSc patients and healthy controls and in SSc patients with and without relevant complications. PubMed, Scopus, and Web of Science were searched from inception to 23 February 2024. Risk of bias and certainty of evidence were assessed using validated tools. Results In 10 eligible studies, compared to controls, patients with SSc had significantly higher NLR (standard mean difference, SMD=0.68, 95% CI 0.46 to 0.91, p<0.001; I2 = 74.5%, p<0.001), and PLR values (SMD=0.52, 95% CI 0.21 to 0.83, p=0.001; I2 = 77.0%, p=0.005), and a trend towards higher MLR values (SMD=0.60, 95% CI -0.04 to 1.23, p=0.066; I2 = 94.1%, p<0.001). When compared to SSc patients without complications, the NLR was significantly higher in SSc with interstitial lung disease (ILD, SMD=0.31, 95% CI 0.15 to 0.46, p<0.001; I2 = 43.9%, p=0.11), pulmonary arterial hypertension (PAH, SMD=1.59, 95% CI 0.04 to 3.1, p=0.045; I2 = 87.6%, p<0.001), and digital ulcers (DU, SMD=0.43, 95% CI 0.13 to 0.74, p=0.006; I2 = 0.0%, p=0.49). The PLR was significantly higher in SSc patients with ILD (SMD=0.42, 95% CI 0.25 to 0.59, p<0.001; I2 = 24.8%, p=0.26). The MLR was significantly higher in SSc patients with PAH (SMD=0.63, 95% CI 0.17 to 1.08, p=0.007; I2 = 66.0%, p=0.086), and there was a trend towards a higher MLR in SSc patients with ILD (SMD=0.60, 95% CI -0.04 to 1.23, p=0.066; I2 = 94.1%, p<0.001). Discussion Pending the results of appropriately designed prospective studies, the results of this systematic review and meta-analysis suggest that blood cell-derived indices of inflammation, particularly the NLR and PLR, may be useful in the diagnosis of SSc and specific complications. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024520040.
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Affiliation(s)
- Angelo Zinellu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Arduino A. Mangoni
- Discipline of Clinical Pharmacology, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
- Department of Clinical Pharmacology, Flinders Medical Centre, Southern Adelaide Local Health Network, Bedford Park, SA, Australia
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4
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Ross L, Nikpour M. Composite measures to assess disease damage, disease severity and treatment response in systemic sclerosis clinical trials. Curr Opin Rheumatol 2023; 35:334-340. [PMID: 37650689 DOI: 10.1097/bor.0000000000000971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
PURPOSE OF REVIEW The aim of this study was to summarize the composite outcome measures available to assess disease damage, severity and treatment response in systemic sclerosis (SSc). RECENT FINDINGS There have been many recent efforts to rigorously develop and validate composite outcome measures to assess the totality of the impact of SSc on patients. All initiatives have used both consensus and data-driven methods. Recently developed are a SSc-specific damage index, a patient-reported disease impact questionnaire (ScleroID) and a treatment response index (ACR-CRISS). SUMMARY Multiorgan, composite measures are being increasingly applied to assess treatment efficacy in clinical trials. Although a fully validated, disease-specific composite measure is not yet available, there has been significant recent progress towards developing measures of treatment response, damage and overall impact of SSc for application in randomized controlled trials.
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Affiliation(s)
- Laura Ross
- Department of Medicine at St Vincent's Hospital, University of Melbourne
- Department of Rheumatology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Mandana Nikpour
- Department of Medicine at St Vincent's Hospital, University of Melbourne
- Department of Rheumatology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
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Rodríguez-Silverio J, Ocampo-Torres MC, Fajardo-Hermosillo LD. [Characteristics of patients with systemic sclerosis who develop interstitial lung disease]. REVISTA MEDICA DEL INSTITUTO MEXICANO DEL SEGURO SOCIAL 2023; 61:S363-S371. [PMID: 37934671 PMCID: PMC10730132 DOI: 10.5281/zenodo.8383951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 01/07/2023] [Indexed: 11/09/2023]
Abstract
Background Systemic sclerosis associated-interstitial lung disease (SSc-ILD) show a high mortality. The factors associated SSc-ILD have shown variability in different populations. There are few studies in Mexican mestizos. Objective To analyze the epidemiological, clinical and paraclinical factors associated with SSc-ILD. Material and methods Cross-sectional study, where patients > 18 years of age with a diagnosis of SSc according to EULAR/ACR 2013 criteria and diagnosis of ILD by forced vital capacity (FVC) < 70% and > 5% of affected lung area on tomography were included. The strength of association of the factors for ILD was measured by odds ratio (OR) with 95% confidence intervals (95% CI). The significant variables were analyzed by multiple logistic regression with adjustment. Results Of the 80 patients with SSc, 38 (47.5%) had ILD. Risk factors such as smoking, higher activity index, lower FVC, anti-topoisomerase I antibodies, and protective factors such as a limited SSc, early capillaroscopic pattern, and anti-centromere antibodies (ACA) were associated with ILD. In the multivariate analysis, a higher activity index with OR 4.17, (95% CI 2.01-8.65) persisted as a risk factor, while ACA with OR 0.17, (95% CI 0.03-0.85) persisted as a protective factor associated with SSc-ILD. Conclusions A higher index of activity and ACA persisted as factors associated with SSc-ILD.
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Affiliation(s)
- Juan Rodríguez-Silverio
- Instituto Mexicano del Seguro Social, Centro Médico Nacional de Occidente, Hospital de Especialidades, Servicio de Reumatología. Guadalajara, Jalisco, México. Instituto Mexicano del Seguro SocialMéxico
| | - Mario César Ocampo-Torres
- Instituto Mexicano del Seguro Social, Centro Médico Nacional Siglo XXI, Hospital de Especialidades, Servicio de Reumatología. Ciudad de México, México.Instituto Mexicano del Seguro SocialMéxico
| | - Luis Daniel Fajardo-Hermosillo
- Instituto Politécnico Nacional, Escuela Superior de Medicina. Ciudad de México, MéxicoInstituto Politécnico NacionalMéxico
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Klotsche J, Torok KS, Kasapcopur O, Adrovic A, Terreri MT, Sakamoto AP, Katsicas M, Sztajnbok F, Marrani E, Sifuentes-Giraldo A, Stanevicha V, Anton J, Feldmann B, Kostik M, Nemcova D, Santos MJ, Appenzeller S, Avcin T, Battagliotti C, Berntson L, Bica B, Brunner J, Eleftheriou D, Harel L, Horneff G, Kallinich T, Minden K, Nielsen S, Patwardhan A, Helmus N, Foeldvari I. Application and performance of disease activity indices proposed for patients with systemic sclerosis in an international cohort of patients with juvenile systemic sclerosis. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2023; 8:183-191. [PMID: 37744052 PMCID: PMC10515993 DOI: 10.1177/23971983231164700] [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: 11/22/2022] [Accepted: 02/25/2023] [Indexed: 09/26/2023]
Abstract
Objectives Juvenile systemic sclerosis is a rare childhood disease. Three disease activity indices have been published for adult patients with systemic sclerosis: the European Scleroderma Study Group Index, a modified version of the European Scleroderma Study Group Index and the revised European Scleroderma Trials and Research index. The objective of this study was to determine the feasibility and performance of the three disease activity indices in a prospectively followed cohort of patients with juvenile systemic sclerosis. Methods The analysis cohort was selected from the prospective international inception cohort enrolling juvenile systemic sclerosis patients. The correlation of the disease activity indices with the physicians' and the patients' global assessment of disease activity was determined. The disease activity indices were compared between patients with active and inactive disease. Sensitivity to change between 6- and 12-month follow-up was investigated by mixed models. Results Eighty percent of the 70 patients had a diffuse cutaneous subtype. The revised European Scleroderma Trials and Research index was highly correlated with the physician-reported global disease activity/parents-reported global disease activity (r = 0.74/0.64), followed by the European Scleroderma Study Group activity index (r = 0.61/0.55) and the modified version of the European Scleroderma Study Group activity index (r = 0.51/0.43). The disease activity indices significantly differed between active and inactive patients. The disease activity indices showed sensitivity to change between 6- and 12-month follow-up among patients who improved or worsened according to the physician-reported global disease activity and the parents-reported global disease activity. Conclusion Overall, no disease activity score is superior to the other, and all three scores have limitations in the application in juvenile systemic sclerosis patients. Furthermore, research on the concept of disease activity and suitable scores to measure disease activity in patients with juvenile systemic sclerosis is necessary in future.
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Affiliation(s)
- Jens Klotsche
- German Rheumatism Research Center, A Leibniz Institute, Berlin, Germany
| | - Kathryn S Torok
- University of Pittsburgh, Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Ozgur Kasapcopur
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Amra Adrovic
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | | | | | - Maria Katsicas
- Hospital de Pediatria J.P. Garrahan, Buenos Aires, Argentine
| | | | | | | | - Valda Stanevicha
- Department of Pediatrics, Riga Stradins University, University Children Hospital, Riga, Latvia
| | - Jordi Anton
- Pediatric Rheumatology, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Brian Feldmann
- SickKids, The Hospital for Sick Children, Toronto, ON, Canada
| | - Mikhail Kostik
- Saint-Petersburg State Pediatric Medical University, Saint Petersburg, Russia
| | | | | | - Simone Appenzeller
- School of Medical Science, State University of Campinas, Campinas, Brazil
| | - Tadej Avcin
- University Children’s Hospital, University Medical Center Ljubljana, Ljubljana, Slovenia
| | | | - Lillemor Berntson
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Blanca Bica
- Hospital Universitário Clementino Fraga Filho (HUCFF), Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jürgen Brunner
- Department of Pediatrics, Pediatric Rheumatology, Medical University Innsbruck, Innsbruck, Austria
| | | | - Liora Harel
- Schneider Children’s Medical Center, Tel Aviv University, Petah Tikva, Israel
| | - Gerd Horneff
- Asklepios Klinik Sankt Augustin, Sankt Augustin, Germany
| | - Tilmann Kallinich
- Charité University Medicine and German Rheumatism Research Center Berlin, Berlin, Germany
| | - Kirsten Minden
- German Rheumatism Research Center, A Leibniz Institute, Berlin, Germany
- Charité University Medicine and German Rheumatism Research Center Berlin, Berlin, Germany
| | | | | | - Nicola Helmus
- Hamburg Centre for Pediatric and Adolescent Rheumatology, Schön Klinik Hamburg Eilbek, Hamburg, Germany
| | - Ivan Foeldvari
- Hamburg Centre for Pediatric and Adolescent Rheumatology, Schön Klinik Hamburg Eilbek, Hamburg, Germany
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7
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Groseanu L, Petrescu S, Balanescu A, Bojinca V, Opris-Belinski D, Berghea F, Mazilu D, Saulescu I, Borangiu A, Daia-Iliescu S, Constantinescu C, Cobilinschi C, Abobului M, Negru MM, Ionescu R. Do we have good activity indices in systemic sclerosis? Curr Rheumatol Rev 2021; 18:39-47. [PMID: 34517805 DOI: 10.2174/1573397117666210913102759] [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] [Received: 10/19/2020] [Revised: 02/12/2021] [Accepted: 06/07/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND No fully validated index is available for assessing overall disease activity in systemic sclerosis (SSc). OBJECTIVES To estimate the effect of disease activity as measured by different disease activity indices on the risk of subsequent organ damage. METHODS The European Systemic sclerosis study group activity index (EScSG AI), the European Scleroderma Trials and Research Group Activity Index (r-EUSTAR AI), 12 point activity index proposed by Minier (12point AI) were calculated for 91 patients; the CRISS (The Composite Response Index for Systemic Sclerosis) for patients included after 2016. Data were analysed by parametric and non-parametric tests and logistic regression. RESULTS EscSG AI, r-EUSTAR AI and 12point AI correlated with lung involvement. EScSG AI and r-EUSTAR AI correlated with diffuse skin involvement. EscSG AI correlated with digital ulcers and diffuse cutaneous involvement and r-EUSTAR AI with renal crisis. Bivariate analysis showed an inverse correlation between the three disease activity scores and forced vital capacity (FVC) (p<0.001) and diffusing capacity for carbon monoxide (DLCO) (p<0.001) and positive correlation with pulmonary fibrosis (p<0.001), modified Rodnan skin score (mRSS) (p<0.001), health assessment questionnaire (HAQ) (p<0.001), systolic pulmonary pressure (sPAP) (p<0.001), C-reactive protein (CRP) (p<0.001) and capillaroscopy scoring (p<0.001) at both baseline visit and at the 3-year follow-up visit. Logistic regression revealed that baseline EScSG AI adjusted for gender and age and that baseline 12-point AI both adjusted and unadjusted predicted worse skin involvement at 3-year follow-up; while adjusted EScSG AI predicted decreasing of DLCO. Also, 12-point AI predicted decline of FVC and higher HAQ scores at 3-year follow up; while baseline r-EUSTAR AI was able to predict muscular deterioration, decline of FVC and the increase of HAQ score during 3 years of following. An active disease according to EScSG AI at first visit predicted progression of joint involvement while an active disease at baseline showed by r-EUSTAR AI predicted muscular deterioration, FVC and DLCO worsening, as well as an increasing in HAQ score during the follow-up period. r-EUSTAR AI was the only score to predict the decrease of FVC in a multiple regression prediction model [OR= 1.306 (1.025, 1.665), p=0.31] while baseline EScSG AI best predicted worsening of DLCO [OR=1.749 (1.104, 2.772), p=0.017]. CONCLUSION Our study could not establish a gold standard to assess disease activity in SSc; especially EscSG AI and r-EUSTAR AI could quantify and predict major organ involvement in daily practice. CRISS can be useful as an outcome measure for patients with short disease duration included in clinical studies.
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Affiliation(s)
- Laura Groseanu
- Carol Davila University of Medicine and Pharmacy, Bucharest. Romania
| | - Sorana Petrescu
- Carol Davila University of Medicine and Pharmacy, Bucharest. Romania
| | - Andra Balanescu
- Carol Davila University of Medicine and Pharmacy, Bucharest. Romania
| | - Violeta Bojinca
- Carol Davila University of Medicine and Pharmacy, Bucharest. Romania
| | | | - Florian Berghea
- Carol Davila University of Medicine and Pharmacy, Bucharest. Romania
| | - Diana Mazilu
- Carol Davila University of Medicine and Pharmacy, Bucharest. Romania
| | - Ioana Saulescu
- Carol Davila University of Medicine and Pharmacy, Bucharest. Romania
| | - Andreea Borangiu
- Carol Davila University of Medicine and Pharmacy, Bucharest. Romania
| | | | | | | | - Mihai Abobului
- Carol Davila University of Medicine and Pharmacy, Bucharest. Romania
| | | | - Ruxandra Ionescu
- Carol Davila University of Medicine and Pharmacy, Bucharest. Romania
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Simon D, Balogh P, Erdő-Bonyár S, Böröcz K, Minier T, Czirják L, Berki T. Increased Frequency of Activated Switched Memory B Cells and Its Association With the Presence of Pulmonary Fibrosis in Diffuse Cutaneous Systemic Sclerosis Patients. Front Immunol 2021; 12:686483. [PMID: 34276673 PMCID: PMC8278062 DOI: 10.3389/fimmu.2021.686483] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/11/2021] [Indexed: 11/22/2022] Open
Abstract
Disease-associated, high-affinity pathological autoantibody production is a well-described consequence of immune dysregulation affecting B cells in systemic sclerosis (SSc), including the distribution of B-cell subsets. We have previously shown that the increased relative frequency of CD19+CD27+IgD- switched memory B cells is associated with the severe form of SSc. This study sought to analyze memory B cell subsets using an extended range of markers for further subdivision based on CD19, IgD, CD27, CD38 and CD95 phenotype, to define relationship between the alterations of memory B cell subsets and the clinical features of SSc. Peripheral blood samples were obtained from 21 SSc patients, including 14 diffuse (dcSSc) and 7 limited (lcSSc) cutaneous SSc patients, with disease duration of 2.7 ( ± 1.6) years. After purification of CD19+ B cells, multiparametric flow cytometry was performed and the frequencies of CD19+IgD-CD27-CD38+ double negative (DN) 1, CD19+IgDloCD27+CD38+ unswitched, CD19+IgD-CD27+CD38+CD95- resting switched and CD19+IgD-CD27+CD38-CD95+ activated switched memory (ASM) B cells were determined, and correlated with clinical features of SSc. The dcSSc patients had a higher frequency of ASM B cells (p = 0.028) compared to lcSSc patients. The percentage of ASM B cells was elevated in anti-Scl-70 (anti-topoisomerase I) antibody positive patients compared to negative patients (p = 0.016). Additionally, the frequency of ASM B cells was also increased in patients with pulmonary fibrosis (p = 0.003) suggesting that patients with severe form of SSc have higher ASM B cell ratios. Furthermore, the ratio of DN1 B cells was decreased (p = 0.029), while the level of anti-citrate synthase IgG natural autoantibody was elevated (p = 0.028) in patients with active disease. Our observations on the increase of ASM B cells in dcSSc and in patients with pulmonary fibrosis may point to the association of this alteration with the severe form of the disease. Functionally the correlation of ASM B cells as effector memory-plasma cell precursors with anti-topoisomerase I antibody positivity could reflect their contribution to pathological autoantibody production, whereas the decrease of memory precursor DN B cells and the increase of anti-citrate synthase IgG autoantibody may have potential significance in the assessment of disease activity.
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Affiliation(s)
- Diána Simon
- Department of Immunology and Biotechnology, Clinical Center, University of Pécs Medical School, Pécs, Hungary
| | - Péter Balogh
- Department of Immunology and Biotechnology, Clinical Center, University of Pécs Medical School, Pécs, Hungary
| | - Szabina Erdő-Bonyár
- Department of Immunology and Biotechnology, Clinical Center, University of Pécs Medical School, Pécs, Hungary
| | - Katalin Böröcz
- Department of Immunology and Biotechnology, Clinical Center, University of Pécs Medical School, Pécs, Hungary
| | - Tünde Minier
- Department of Rheumatology and Immunology, Clinical Center, University of Pécs Medical School, Pécs, Hungary
| | - László Czirják
- Department of Rheumatology and Immunology, Clinical Center, University of Pécs Medical School, Pécs, Hungary
| | - Tímea Berki
- Department of Immunology and Biotechnology, Clinical Center, University of Pécs Medical School, Pécs, Hungary
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9
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Furst D, Varga J, Roofeh D, Pauling JD, Hughes M, Sandler R, Zimmermann F, Wessel R, Townsend W, Chung L, Denton CP, Merkel PA, Steen V, Allanore Y, Del Galdo F, Godard D, Cella D, Farrington S, Buch MH, Khanna D. Considerations for a combined index for limited cutaneous systemic sclerosis to support drug development and improve outcomes. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2021; 6:66-76. [PMID: 34316516 PMCID: PMC8313014 DOI: 10.1177/2397198320961967] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Systemic sclerosis (SSc; systemic scleroderma) is characterized by a heterogeneous range of clinical manifestations. SSc is classified into limited cutaneous SSc (lcSSc) and diffuse cutaneous subgroups (dcSSc) based on the extent of skin involvement. Randomized controlled trials in scleroderma have mainly focused on dcSSc partly because the measurement of skin involvement, critical for evaluating a therapeutic intervention is more dynamic in this subset. Nonetheless, lcSSc, the most common cutaneous subset (about 2/3), is also associated with significant morbidity and detrimental impact on health-related quality of life. The lack of interventional studies in lcSSc is partly due to a lack of relevant outcome measures to evaluate this subgroup. Combining several clinically meaningful outcomes selected specifically for lcSSc may improve representativeness in clinical trials and responsiveness of outcomes measured in randomized controlled trials. A composite index dedicated to lcSSc combining such relevant outcomes could advance clinical trial development for lcSSc by providing the opportunity to test and select among candidate drugs that could act as disease-modifying treatments for this neglected subgroup of SSc. This proposed index would include items selected by expert physicians and patients with lcSSc across domains grounded in the lived experience of lcSSc. This article reviews the reasons behind the relative neglect of lcSSc, discusses the current state of outcome measures for lcSSc, identifies challenges, and proposes a roadmap for a combined lcSSc-specific treatment response index.
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Affiliation(s)
| | | | - David Roofeh
- Department of Internal Medicine, Division of Rheumatology, Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA
| | - John D Pauling
- Royal National Hospital for Rheumatic Diseases (at Royal United Hospitals), Bath, UK
| | - Michael Hughes
- Department of Rheumatology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Robert Sandler
- Department of Rheumatology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - François Zimmermann
- Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, Rennes, France
| | - Rachel Wessel
- Department of Internal Medicine, Division of Rheumatology, Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA
| | - Whitney Townsend
- Taubman Health Sciences Library, University of Michigan. Ann Arbor, Michigan, USA
| | - Lorinda Chung
- Division of Immunology and Rheumatology, Stanford University School of Medicine, Palo Alto, CA, USA.,Division of Immunology and Rheumatology, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Christopher P Denton
- Centre for Rheumatology and Connective Tissue Diseases, Royal Free Hospital Campus, University College London Medical School, London, UK
| | - Peter A Merkel
- Division of Rheumatology, Department of Medicine, Division of Clinical Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Virginia Steen
- Division of Rheumatology, Georgetown University Medical Center, Washington, DC, USA
| | - Yannick Allanore
- Rheumatology A department, Cochin Hospital, APHP, Paris Descartes University, Paris, France
| | - Francesco Del Galdo
- Institute of Rheumatic and Musculoskeletal Medicine and NIHR Biomedical Research Centre, University of Leeds, Leeds LS7 4SA, UK
| | | | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 Michigan Ave, 21st Floor, Chicago, IL, 60611, USA
| | - Sue Farrington
- Federation of European Scleroderma Associations (FESCA), Tournai, Belgium
| | - Maya H Buch
- Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK.,NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester University Foundation Trust, Manchester, UK
| | - Dinesh Khanna
- Department of Internal Medicine, Division of Rheumatology, Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA
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10
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Ross L, Stevens W, Wilson M, Strickland G, Walker J, Sahhar J, Ngian GS, Roddy J, Major G, Proudman S, Baron M, Nikpour M. Can Patient-Reported Symptoms Be Used to Measure Disease Activity in Systemic Sclerosis? Arthritis Care Res (Hoboken) 2020; 72:1459-1465. [PMID: 31421031 DOI: 10.1002/acr.24053] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 08/13/2019] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To evaluate the association between patient-reported symptoms and changes in disease activity over time in systemic sclerosis (SSc). METHODS Using data from 1,636 patients enrolled in the Australian Scleroderma Cohort Study, we used generalized estimating equations to determine the relationship between patient-reported worsening of Raynaud's phenomenon (RP), skin involvement, and breathlessness in the month preceding each study visit and features of disease activity in the corresponding organ systems. The associations between the following parameters were analyzed: patient-reported worsening RP and the presence of new-onset digital pitting and digital ulcers; patient-reported worsening skin involvement and increasing modified Rodnan skin thickness score (MRSS); new areas of skin involvement and new-onset joint contractures; patient-reported worsening breathlessness and deteriorating respiratory functions test (RFT) results, indicated by a 10% decrease in forced vital capacity (FVC) and a 15% decrease in diffusing capacity for carbon monoxide (DLco), new-onset interstitial lung disease (ILD), and new-onset pulmonary arterial hypertension (PAH). RESULTS We found a significant association between patient-reported worsening RP and the presence of digital ulcers (odds ratio [OR] 1.53 [95% confidence interval (95% CI) 0.60-0.93]), patient-reported worsening skin involvement and increasing MRSS (OR 2.10 [95% CI 1.54-2.86]), and worsening patient breathlessness and deteriorating RFTs (FVC OR 2.12 [95% CI 1.70-2.65]; DLco OR 1.97 [95% CI 1.34-2.02]), new-onset ILD (OR 1.91 [95% CI 1.40-2.61]), and new-onset PAH (OR 5.08 [95% CI 3.59-7.19]). CONCLUSION These results demonstrate that patient-reported symptoms are associated with clinically meaningful changes in disease activity in patients with SSc. This suggests that when objective measures of change in disease status are unavailable, patient-reported symptoms could be used to indicate a change in SSc disease activity.
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Affiliation(s)
- Laura Ross
- St. Vincent's Hospital Melbourne and the University of Melbourne, Fitzroy, Victoria, Australia
| | - Wendy Stevens
- St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Michelle Wilson
- St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | | | - Jennifer Walker
- Flinders Medical Centre, Bedford Park, South Australia, Australia, and Royal Adelaide Hospital and Flinders University, Adelaide, South Australia, Australia
| | - Joanne Sahhar
- Monash Health and Monash University, Clayton, Victoria, Australia
| | - Gene-Siew Ngian
- Monash Health and Monash University, Clayton, Victoria, Australia
| | - Janet Roddy
- Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Gabor Major
- Royal Newcastle Centre, New Lambton Heights, New South Wales, Australia
| | - Susanna Proudman
- Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia
| | - Murray Baron
- Sir Mortimer B. Davis Jewish General Hospital, Montreal, Quebec, Canada
| | - Mandana Nikpour
- St. Vincent's Hospital Melbourne and the University of Melbourne, Fitzroy, Victoria, Australia
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11
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Ross L, Stevens W, Wilson M, Huq M, Strickland G, Walker J, Sahhar J, Ngian GS, Roddy J, Youssef P, Proudman S, Nikpour M. Performance of the 2017 EUSTAR activity index in an scleroderma cohort. Clin Rheumatol 2020; 39:3701-3705. [PMID: 32696281 DOI: 10.1007/s10067-020-05126-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/14/2020] [Accepted: 04/21/2020] [Indexed: 11/28/2022]
Abstract
Assessment of disease activity in systemic sclerosis (SSc) is limited by the absence of a fully validated, multisystem measure of disease activity. The European Scleroderma Trials and Research Group (EUSTAR) SSc activity index (EScSG-AI) was recently revised, and a validation study within the EUSTAR cohort was performed. In this study, we evaluated the performance of the revised EScSG-AI in an external Australian cohort. The association between the EScSG-AI and the physician global assessment of disease activity (PhGA), both collected prospectively at each annual visit over up to 12 years follow-up, was evaluated using Pearson's correlation coefficient and Cohen's kappa coefficient. Generalized linear modelling and time-dependent Cox regression analysis were performed to determine the association of disease activity measured by the EScSG-AI and the summed Medsger Severity Scale (MSS) and death, respectively. There was a moderate correlation between EScSG-AI and PhGA scores (r 0.42, p < 0.001) and moderate association between rising EScSG-AI and summed MSS (r 0.60, p < 0.001). High disease activity, measured by the EScSG-AI at any time during follow-up, was associated with a hazard ratio of 2.07 (95% CI 1.51-2.79) for mortality. The EScSG-AI has a moderate correlation with physician-assessed SSc disease activity. This suggests that the criterion and construct validity of the EScSG-AI are yet to be demonstrated in an external cohort of SSc patients. Key Points •There remains no gold standard measure of SSc disease activity. •The revised 2017 EUSTAR SSc disease activity index shows moderate correlation with physician-rated global disease activity. •Significant work remains to develop a validated multisystem measure of disease activity in SSc.
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Affiliation(s)
- Laura Ross
- Department of Medicine, The University of Melbourne at St Vincent's Hospital, Melbourne, Australia.,Department of Rheumatology, St Vincent's Hospital, Melbourne, Australia
| | - Wendy Stevens
- Department of Rheumatology, St Vincent's Hospital, Melbourne, Australia
| | - Michelle Wilson
- Department of Rheumatology, St Vincent's Hospital, Melbourne, Australia
| | - Molla Huq
- Department of Medicine, The University of Melbourne at St Vincent's Hospital, Melbourne, Australia
| | - Gemma Strickland
- Department of Rheumatology, St Vincent's Hospital, Melbourne, Australia
| | - Jennifer Walker
- Rheumatology Unit, Flinders Medical Centre, Adelaide, Australia
| | - Joanne Sahhar
- Department of Rheumatology, Monash Health & Monash University, Melbourne, Australia.,Department of Medicine, Monash Health & Monash University, Melbourne, Australia
| | - Gene-Siew Ngian
- Department of Rheumatology, Monash Health & Monash University, Melbourne, Australia.,Department of Medicine, Monash Health & Monash University, Melbourne, Australia
| | - Janet Roddy
- Department of Rheumatology, Fiona Stanley Hospital, Perth, Australia
| | - Peter Youssef
- Department of Rheumatology, Royal Prince Alfred Hospital, Sydney, Australia.,Department of Medicine, University of Sydney, Sydney, Australia
| | - Susanna Proudman
- Rheumatology Unit, Royal Adelaide Hospital, Adelaide, Australia.,Discipline of Medicine, University of Adelaide, Adelaide, Australia
| | - Mandana Nikpour
- Department of Medicine, The University of Melbourne at St Vincent's Hospital, Melbourne, Australia. .,Department of Rheumatology, St Vincent's Hospital, Melbourne, Australia.
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12
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Iordache C, Antohe ME, Chirieac R, Ancuța E, Țănculescu O, Ancuța C. Volumetric Cone Beam Computed Tomography for the Assessment of Oral Manifestations in Systemic Sclerosis: Data from an EUSTAR Cohort. J Clin Med 2019; 8:E1620. [PMID: 31590232 PMCID: PMC6832751 DOI: 10.3390/jcm8101620] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 09/19/2019] [Accepted: 09/29/2019] [Indexed: 12/28/2022] Open
Abstract
Background: Oral health issues are commonly reported in systemic sclerosis (SSc), comprising a broad spectrum of manifestations, e.g., reduced mouth opening, periodontal disease, increased periodontal ligament (PDL) space width, and mandibular resorption. We aimed to assess oral radiographic abnormalities, particularly PDL space widening and erosions, and to identify potential relations with disease measures. Methods: cross-sectional study in 43 SSc and matching controls receiving systematic oral assessments (full mouth dental/periodontal) and imaging (radiographs and cone beam computed tomography (CBCT)). Associations between disease variables and radiologic findings were investigated by univariate and multivariate analysis (SPSS-v.20, p < 0.05). Results: CBCT demonstrated generalized PDL space widening in up to half SSc, with at least one tooth involved, essentially in the posterior region (p < 0.05). Significant correlations between number of teeth with PDL space widening and disease severity, skin score, disease subset, topoisomerase I specificity, age, and disease duration were reported (p < 0.05). Additionally, mandibular erosions were described in one out of four patients, commonly condylar erosions. Conclusions: Tridimensional CBCT approach confirmed widening of PDL and mandibular erosions as common dental findings in scleroderma. Furthermore, widened PDL spaces correlated with several disease characteristics including severity, skin extent, and antibody profile.
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Affiliation(s)
- Cristina Iordache
- Grigore T. Popa University of Medicine and Pharmacy, School of Dental Medicine, Department of Implantology, Removable Dentures, Technology, Iasi 700115, Romania.
| | - Magda-Ecaterina Antohe
- Grigore T. Popa University of Medicine and Pharmacy, School of Dental Medicine, Department of Implantology, Removable Dentures, Technology, Iasi 700115, Romania.
| | | | - Eugen Ancuța
- Elena Doamna Clinical Hospital, Research Department, Iasi 700398, Romania.
| | - Oana Țănculescu
- Grigore T. Popa University of Medicine and Pharmacy, School of Dental Medicine, Department of Odontology-Periodontology. Fixed Prosthodontics, Iasi 700115, Romania.
| | - Codrina Ancuța
- Grigore T. Popa University of Medicine and Pharmacy, School of Medicine, Department of Rheumatology, Iasi 700115, Romania.
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13
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Ingegnoli F, Ughi N, Mihai C. Update on the epidemiology, risk factors, and disease outcomes of systemic sclerosis. Best Pract Res Clin Rheumatol 2018; 32:223-240. [DOI: 10.1016/j.berh.2018.08.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 07/22/2018] [Accepted: 07/26/2018] [Indexed: 12/12/2022]
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