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Butink M, Boonen A, Boymans T, Baadjou V, Hazelzet E, de Rijk A. A Mixed-Methods Process Evaluation of the Maastricht Work-Related Support Intervention for Healthcare Professionals in Clinical Care. JOURNAL OF OCCUPATIONAL REHABILITATION 2024:10.1007/s10926-024-10211-0. [PMID: 38856951 DOI: 10.1007/s10926-024-10211-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/08/2024] [Indexed: 06/11/2024]
Abstract
PURPOSE To perform the process evaluation of an intervention that aims to facilitate clinical healthcare professionals (HCP) to provide Maastricht Work-Related Support (WRS) to working patients with a chronic disease. METHODS A mixed-methods approach was applied to address reach, efficacy, adoption, implementation, and maintenance (RE-AIM framework) as well as context of the Maastricht WRS intervention. Qualitative data included interviews with HCPs (N = 10), patients at two time points (N = 10 and N = 9), and field notes. Quantitative data included screening logbooks of HCPs, patient screening forms, and a questionnaire for patients. Content analysis or computation of frequencies was applied where applicable. RESULTS Twenty-eight HCPs participated in the intervention (reach). They had a low attitude toward providing Maastricht WRS themselves (adoption). During clinical consultations, they addressed work for 770 of 1,624 (47%) persons of working age. Only 57% (437/770) had paid work, of which 10% (44/437) acknowledged a current need for support. Discussing work during clinical consultations by HCPs was hindered by other medical priorities and patients not disclosing problems (implementation). Over time, Maastricht WRS was less consistently provided (maintenance). Patients reported a positive impact of the intervention, such as fitness for work (efficacy). Context (e.g., lack of urgency, priority, time, and management support) played a pivotal role in the implementation. CONCLUSION This evaluation showed that HCPs had a positive attitude toward WRS in general, but their attitude toward provide Maastricht WRS themselves in daily clinical care was low. Recommendations include improving HCPs' attitude, addressing WRS as a key policy point, and facilitating time.
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Affiliation(s)
- Maarten Butink
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229HX, Maastricht, The Netherlands.
- Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, Duboisdomein 30, 6200 MD, Maastricht, The Netherlands.
- Research School Care and Public Health Research Institute (CAPHRI), Universiteitssingel 40, 6200 MD, Maastricht, The Netherlands.
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229HX, Maastricht, The Netherlands
- Research School Care and Public Health Research Institute (CAPHRI), Universiteitssingel 40, 6200 MD, Maastricht, The Netherlands
| | - Tim Boymans
- Research School Care and Public Health Research Institute (CAPHRI), Universiteitssingel 40, 6200 MD, Maastricht, The Netherlands
- Department Orthopedic Surgery, Maastricht University Medical Centre+ (MUMC+), P. Debyelaan 25, 6229HX, Maastricht, The Netherlands
| | - Vera Baadjou
- Research School Care and Public Health Research Institute (CAPHRI), Universiteitssingel 40, 6200 MD, Maastricht, The Netherlands
- Department of Rehabilitation Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 40, 6200 MD, Maastricht, The Netherlands
| | - Emmelie Hazelzet
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229HX, Maastricht, The Netherlands
| | - Angelique de Rijk
- Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, Duboisdomein 30, 6200 MD, Maastricht, The Netherlands
- Research School Care and Public Health Research Institute (CAPHRI), Universiteitssingel 40, 6200 MD, Maastricht, The Netherlands
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Alotaibi A, Albarrak D, Alammari Y. The Efficacy and Safety of Biologics in Treating Ankylosing Spondylitis and Their Impact on Quality of Life and Comorbidities: A Literature Review. Cureus 2024; 16:e55459. [PMID: 38571822 PMCID: PMC10988185 DOI: 10.7759/cureus.55459] [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: 02/22/2024] [Indexed: 04/05/2024] Open
Abstract
Ankylosing spondylitis (AS) is a chronic inflammatory arthritis that affects the axial skeleton, causing intense pain, progressive joint destruction, and a gradual reduction in physical function. Additionally, AS can result in extra-musculoskeletal manifestations including inflammatory bowel disease (IBD), psoriasis, and acute anterior uveitis (AAU) affecting patients' quality of life (QoL). Furthermore, AS association with neurological and cardiovascular events has been documented. With the advent of biologics, treating AS has dramatically changed due to their high efficacy and tolerable safety. Nevertheless, there are differences in traits, including rapidity of onset, long-term efficacy, safety profile, and influence on comorbidities. A better understanding of such traits enables clinicians to make the best decision for each patient, increasing persistence, extending medication survival, enhancing patient satisfaction, and reducing the disease effect of AS. A review of the literature published in English in PubMed and Google Scholar databases from 2010 to 2023 was conducted. All relevant results fitting the scope of the topic were included. In this article, we emphasize biologics' efficacy and safety profile in patients with AS. In addition, we discuss the impact of biologics on comorbidities and health-related quality of life (HRQoL).
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Affiliation(s)
| | - Danah Albarrak
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Yousef Alammari
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
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Kiltz U, Hoeper K, Hammel L, Lieb S, Hähle A, Meyer-Olson D. Work participation in patients with axial spondyloarthritis: high prevalence of negative workplace experiences and long-term work impairment. RMD Open 2023; 9:rmdopen-2022-002663. [PMID: 36927848 PMCID: PMC10030742 DOI: 10.1136/rmdopen-2022-002663] [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: 08/11/2022] [Accepted: 02/15/2023] [Indexed: 03/18/2023] Open
Abstract
INTRODUCTION Axial spondyloarthritis (axSpA) is a chronic inflammatory disease that typically affects people in their second and third decades of life, which are important years for establishing a professional career. We aim to study outcomes of work participation (WP) and their associations with demographic and clinical confounders, in addition to prevalence of negative workplace experiences in axSpA. METHODS In total, 770 patients with axSpA participated in the multicentre, observational ATTENTUS-axSpA survey in Germany. Demographic information, clinical parameters and patient-related outcomes (including disease activity and function) with a focus on WP were prospectively recorded. RESULTS A high prevalence of negative workplace experiences was reported among the 770 patients analysed. Overall, 23.4% of patients were not employed and 6.5% received disability pensions. Current work cessation was prevalent in 120 patients, and 28 of those were out of work for 10 years or longer. Of the 590 currently employed patients, 31.9% reported absenteeism and 35.9% reported presenteeism for >1 month within the past year. Multivariate logistic regression identified low disease activity (Bath Ankylosing Spondylitis Disease Activity Index), better physical function (Bath Ankylosing Spondylitis Functional Index) and better global functioning (Assessment of SpondylAarthritis International Society-Health Index) as the main predictors for unimpaired WP (n=242). Importantly, biological treatment, disease duration, age, sex, education level and body mass index were not reliable predictors. DISCUSSION Despite improvements in pharmacological treatment options, we still observed substantially impaired WP in patients with axSpA. These data emphasise the high unmet need for targeted strategies to provide improved medical and social care.
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Affiliation(s)
- Uta Kiltz
- Ruhr-Universität Bochum, Bochum, Germany
- Rheumatology, Rheumazentrum Ruhrgebiet, Herne, Germany
| | - Kirsten Hoeper
- Rheumatologie and Immunologie, Regionales Kooperatives Rheumazentrum Niedersachsen eV, Hannover, Germany
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Ludwig Hammel
- Deutsche Vereinigung Morbus Bechterew e.V, Schweinfurt, Germany
| | | | | | - Dirk Meyer-Olson
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Hannover, Germany
- Rheumatologie, m&i Fachklinik Bad Pyrmont, Bad Pyrmont, Germany
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Tian C, Shu J, Shao W, Zhou Z, Guo H, Wang J. Efficacy and safety of IL inhibitors, TNF-α inhibitors, and JAK inhibitors in patients with ankylosing spondylitis: a systematic review and Bayesian network meta-analysis. ANNALS OF TRANSLATIONAL MEDICINE 2023; 11:178. [PMID: 36923085 PMCID: PMC10009571 DOI: 10.21037/atm-23-195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 02/10/2023] [Indexed: 03/05/2023]
Abstract
Background Biologics and Janus kinase (JAK) inhibitors are commonly used to improve ankylosing spondylitis (AS) symptoms if conventional treatments are ineffective or unsuitable. This systematic review aimed to compare the therapeutic effects and safety of JAK inhibitors, tumor necrosis factor-alpha (TNF-α) inhibitors, and interleukin (IL) inhibitors in patients with AS. Methods We retrieved literature from various databases including Web of Science, Cochrane, Embase, PubMed, China National Knowledge Infrastructure, Weipu Journal Database, SinoMed, and WanFang Data up to February 1, 2023, and evaluated the quality of the included RCTs using the Cochrane risk-of-bias tool. R 4.1.3, STATA 15.1 were employed for network meta-analyses. Results We identified 48 eligible articles including 8,937 patients. Ten articles were rated as "low risk", 5 as "high risk", and the others as "some concerns". In terms of efficacy, IL-17, IL-6, and JAK inhibitors were compared with TNF-α inhibitors in ASAS20 (RR =0.81, 95% CI: 0.66-0.98; RR =0.57, 95% CI: 0.35-0.95; RR =0.77, 95% CI: 0.60-0.99). IL-6 inhibitors were compared with TNF-α inhibitors in ASAS5/6 (RR =0.39, 95% CI: 0.16-0.98). IL-23, JAK inhibitors were compared with TNF-α inhibitors in BASDAI50 (RR =0.35, 95% CI: 0.20-0.60; RR =0.70, 95% CI: 0.49-0.98). IL-17 inhibitors were compared with IL-23 and IL-6 inhibitors in BASFI (MD =-1.05, 95% CI: -1.65--0.51; MD =-1.46, 95% CI: -2.02--0.97). In terms of safety, IL-6 inhibitors were compared with JAK, TNF-α inhibitors in AEs (RR =1.38, 95% CI: 1.06-1.88; RR =1.30, 95% CI: 1.01-1.70). Conclusions TNF-α inhibitors are significantly superior to both IL and JAK inhibitors, and may be the preferable option to deal with the rapid progression of AS and severe functional limitations. IL-17 inhibitors may better improve the BASDAI50 response compared with JAK, IL-23, and TNF-α inhibitors. The efficacy and safety of IL-6 inhibitors are inferior to other types of drugs, indicating the low efficacy and high risk of IL-6 inhibitors.
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Affiliation(s)
- Cong Tian
- Department of Traditional Chinese Medicine (TCM) Orthopedics & Traumatology, Funan Hospital of Traditional Chinese Medicine, Fuyang, China
| | - Jianlong Shu
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Wenhui Shao
- Department of TCM Internal Medicine, Funan Hospital of Traditional Chinese Medicine, Fuyang, China
| | - Zhengxin Zhou
- Department of TCM Orthopedics & Traumatology, The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, China
| | - Huayang Guo
- Department of Traditional Chinese Medicine (TCM) Orthopedics & Traumatology, Funan Hospital of Traditional Chinese Medicine, Fuyang, China
| | - Jingang Wang
- Department of Traditional Chinese Medicine (TCM) Orthopedics & Traumatology, Funan Hospital of Traditional Chinese Medicine, Fuyang, China
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Ogdie A, Hwang M, Veeranki P, Portelli A, Sison S, Shafrin J, Pedro S, Kim N, Yi E, Michaud K. Association of health care utilization and costs with patient-reported outcomes in patients with ankylosing spondylitis. J Manag Care Spec Pharm 2022; 28:1008-1020. [PMID: 36001102 PMCID: PMC10373008 DOI: 10.18553/jmcp.2022.28.9.1008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND: Interventions for ankylosing spondylitis (AS) have improved patient-reported outcomes (PROs) in clinical studies. However, limited data exist associating these improvements with health care resource utilization (HCRU) or cost savings. Few studies have evaluated the economic impact of patient-reported physical status and related disease burden in patients with AS in the United States. OBJECTIVE: To assess the association of PRO measures with HCRU and health care costs in patients with AS from a national US registry. METHODS: This cohort study included adults with a diagnosis of AS enrolled in the FORWARD registry from July 2009 to June 2019 who completed at least 1 questionnaire from January 2010 to December 2019 and completed the Health Assessment Questionnaire Disability Index (HAQ-DI) (0-3) and/or Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) (0-10). Patient-reported data for demographics, clinical characteristics, and PROs were collected through questionnaires administered biannually and reported from the most recent questionnaire. Patient-reported HCRU and total health care costs (2019 US dollars) for hospitalizations, emergency department (ED) visits, outpatient visits, diagnostic tests, and procedures were captured during the 6 months prior to the most recent survey completion. The relationship between HAQ-DI or BASDAI and HCRU outcomes was assessed using negative binomial regression models, and the relationship between HAQ-DI or BASDAI and the cost outcomes was evaluated using generalized linear models with γ distribution and log-link function. RESULTS: Overall, 334 patients with AS who completed the HAQ-DI (n = 253) or BASDAI (n = 81) were included. The mean (SD) HAQ-DI and BASDAI scores at the time of patients' most recent surveys were 0.9 (0.7) and 3.7 (2.3), respectively. HAQ-DI score was positively associated with number of hospitalizations, ED visits, outpatient visits, and diagnostic tests, whereas BASDAI was not associated with HCRU outcomes. Overall annualized mean (SD) total health care, medical, and pharmacy costs for patients with AS were $44,783 ($40,595); $6,521 ($12,733); and $38,263 ($40,595), respectively. Annualized total health care, medical, and pharmacy costs adjusted for confounders increased by 35%, 76%, and 26%, respectively, for each 1.0-unit increase in HAQ-DI score (coefficient [95% CI]: 1.35 [1.15-1.58], 1.76 [1.22-2.55]; both P < 0.01 and 1.26 [1.04-1.52]; P < 0.05, respectively); BASDAI score was not significantly associated with cost outcomes. CONCLUSIONS: Higher HAQ-DI scores were associated with higher HCRU and total health care costs among patients with AS in FORWARD, but BASDAI scores were not. These findings indicate that greater functional impairment may impose an increased economic burden compared with other patient-reported measures of AS. DISCLOSURES: A. Ogdie has received consulting fees from Amgen, AbbVie, Bristol Myers Squibb, Celgene, CorEvitas (formerly Corrona), Gilead, Janssen, Lilly, Novartis, Pfizer, and UCB and has received grant support from the National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases, Rheumatology Research Foundation, National Psoriasis Foundation, Pfizer (University of Pennsylvania), Amgen (FORWARD), and Novartis (FORWARD). M. Hwang has received consulting fees from Novartis and UCB and has received grant support (5KL2TR003168-03) from the University of Texas Health Science Center at Houston Center of Clinical and Translational Sciences KL2 program. P. Veeranki and J. Shafrin were employees of PRECISION-heor at the time of this analysis. A. Portelli and S. Sison are employees of PRECISION-heor. S. Pedro does not have anything to disclose. N. Kim was a postdoctoral fellow at the University of Texas at Austin and Baylor Scott and White Health, providing services to Novartis at the time of this study. E. Yi is an employee of Novartis. K. Michaud received grant funding from the Rheumatology Research Foundation at the time of this analysis. This study was funded by Novartis Pharmaceuticals Corporation, East Hanover, NJ.
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Affiliation(s)
- Alexis Ogdie
- Division of Rheumatology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Mark Hwang
- Division of Rheumatology, McGovern Medical School, University of Texas Health Science Center, Houston
| | - Phani Veeranki
- PRECISIONheor, Los Angeles, CA
- Optum LifeSciences, Eden Prairie, MN
| | | | | | - Jason Shafrin
- PRECISIONheor, Los Angeles, CA
- Center for Healthcare Economics and Policy, FTI Consulting, Los Angeles, CA
| | - Sofia Pedro
- FORWARD—The National Data Bank for Rheumatic Diseases, Wichita, KS
| | - Nina Kim
- Baylor Scott and White Health, Temple, TX, now with Janssen Pharmaceutical Companies of Johnson & Johnson, Horsham, PA
| | - Esther Yi
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Kaleb Michaud
- FORWARD—The National Data Bank for Rheumatic Diseases, Wichita, KS
- University of Nebraska Medical Center, Omaha
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Rusman T, Nurmohamed MT, Hoekstra S, van Denderen CJ, van Vollenhoven RF, Boers M, Ter Wee MM, van der Horst-Bruinsma IE. Disease activity in women with ankylosing spondylitis remains higher under Tumour Necrosis Factor inhibitor treatment than in men: a five-year observational study. Scand J Rheumatol 2021; 51:506-512. [PMID: 34726125 DOI: 10.1080/03009742.2021.1967046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To assess sex differences in response, level of disease activity, and drug survival in tumour necrosis factor inhibitor (TNFi)-naïve ankylosing spondylitis (AS) patients. METHOD Consecutive AS patients, fulfilling the modified New York criteria, were included in a prospective cohort study at initiation of the first TNFi and followed until this medication was stopped (drug survival). Disease activity scores [AS Disease Activity Score using C-reactive protein (ASDAS-CRP), Bath AS Disease Activity Index (BASDAI), and CRP] were measured at 3, 6, and 12 months, and every subsequent year, up to 5 years. The response was defined by the ASDAS-CRP response criteria (clinically important improvement: ASDAS-CRP decrease ≥ 1.1). Analyses included regression methods for repeated measurements and survival analyses. RESULTS Overall, 356 patients were included (34% women, mean ± sd age 46 ± 12 years), with a median disease duration of 12 (interquartile range 6;20) years. Women were less likely than men to achieve a clinically important response after 6 months of TNFi treatment (47% vs 64%; relative risk 1.4, 95% confidence interval (CI) 1.1;1.9, p = 0.02], despite a lack of sex differences in mean ASDAS-CRP levels over 5 year follow-up. Adjusted models for BASDAI over 5 years showed that women had a 0.6 point higher BASDAI score than men (β = 0.6 0.1;1.1 <0.02). Numerically, more women than men discontinued treatment over a period of 5 years (hazard ratio = 1.5, 95% CI 0.9;2.5, p = 0.15). CONCLUSION Female AS patients show a lower response to TNFi and a higher disease activity compared to men.
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Affiliation(s)
- T Rusman
- Department of Rheumatology, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - M T Nurmohamed
- Department of Rheumatology, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands.,Reade, Rheumatology, Amsterdam, The Netherlands
| | - S Hoekstra
- Department of Rheumatology, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | | | - R F van Vollenhoven
- Department of Rheumatology, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - M Boers
- Department of Rheumatology, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands.,Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - M M Ter Wee
- Department of Rheumatology, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands.,Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Su J, Li M, He L, Zhao D, Wan W, Liu Y, Xu J, Xu J, Liu H, Jiang L, Wu H, Zuo X, Huang C, Liu X, Li F, Zhang Z, Liu X, Dong L, Li T, Chen H, Li J, He D, Lu X, Huang A, Tao Y, Wang Y, Zhang Z, Wei W, Li X, Zeng X. Evaluation of adalimumab biosimilar candidate (HS016) in Chinese patients with active ankylosing spondylitis based on a health survey: sub-analysis of a phase 3 study. Clin Rheumatol 2021; 41:731-739. [PMID: 34709497 PMCID: PMC8873115 DOI: 10.1007/s10067-021-05943-w] [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: 02/10/2021] [Revised: 09/16/2021] [Accepted: 09/24/2021] [Indexed: 02/05/2023]
Abstract
Objective The equivalence of the biosimilar HS016 to adalimumab (Humira) for the treatment of active ankylosing spondylitis (AS) patients has been previously validated. The aim was to compare the efficacy of HS016 and adalimumab in stratified subgroups at different time points using Health Assessment Questionnaire for Spondyloarthropathies (HAQ-S) and short form 36 (SF-36) questionnaires. Methods We carried out a multicenter, randomized, double-blind, parallel, positive control, phase 3 trial of patients with active AS. They were selected randomly to be subcutaneously administered 40 mg HS016 or adalimumab every 2 weeks for a total treatment period of 24 weeks in a 2:1 ratio. A health surveys were used to assess mental and physical improvements of patients as well as other factors. Results HAQ-S revealed that changes in scores from baseline in both groups were time dependent until 14 weeks and that during the first 4 weeks of treatment the changes declined rapidly. The SF-36 health survey revealed that both HS016 and adalimumab produced rapid beneficial effects against AS during the first 2 weeks of therapy, which gradually declined between 2 and 12 weeks and flattened out after 12 weeks until 24 weeks. Conclusion This trial demonstrated that both HS016 and adalimumab produced rapid improvements in symptoms during the first 2 weeks of treatment. These findings suggest that HS016 is an alternative economical treatment for Chinese AS patients producing a rapid amelioration of symptoms, aiding them to recover their lifestyle satisfaction. Trial registration http://www.chictr.org.cn/enindex.aspx, ChiCTR1900022520, retrospectively registered.
Key points | • HS016 and adalimumab produced rapid AS symptom improvements during the first 2 weeks followed by a slowdown of improvements until week 4 with afterwards few improvements evaluated by HAQ-S | • The improvements according to the short form of the 36 (SF-36) questionnaires revealed similar trends as for HAQ-S | • There was no significant difference in HAQ-S and SF-36 scores between HS016 and adalimumab |
Supplementary Information The online version contains supplementary material available at 10.1007/s10067-021-05943-w.
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Affiliation(s)
- Jinmei Su
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, National Clinical Research Center for Immunologic Diseases, Ministry of Science and Technology, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Mengtao Li
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, National Clinical Research Center for Immunologic Diseases, Ministry of Science and Technology, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Lan He
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Dongbao Zhao
- Department of Rheumatology, Changhai Hospital, Shanghai, China
| | - Weiguo Wan
- Department of Rheumatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yi Liu
- Department of Rheumatology, West China Hospital, Sichuan University, Chengdu, China
| | - Jianhua Xu
- Department of Rheumatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jian Xu
- Department of Rheumatology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Huaxiang Liu
- Department of Rheumatology, Qilu Hospital of Shandong University, Jinan, China
| | - Lindi Jiang
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Huaxiang Wu
- Department of Rheumatology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaoxia Zuo
- Department of Rheumatology, Xiangya Hospital, Central South University, Changsha, China
| | - Cibo Huang
- Department of Rheumatology, Beijing Hospital, Beijing, China
| | - Xiumei Liu
- Department of Rheumatology, The First Affiliated Hospital of Shanxi Medical University, Taiyuan, China
| | - Fen Li
- Department of Rheumatology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Zhiyi Zhang
- Department of Rheumatology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xiangyuan Liu
- Department of Rheumatology, Peking University Third Hospital, Beijing, China
| | - Lingli Dong
- Department of Rheumatology, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Tianwang Li
- Department of Rheumatology, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Haiying Chen
- Department of Rheumatology, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jingyang Li
- Department of Rheumatology, Zhuzhou Central Hospital, Zhuzhou, China
| | - Dongyi He
- Department of Rheumatology, Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, China
| | - Xin Lu
- Department of Rheumatology, China-Japan Friendship Hospital, Beijing, China
| | - Anbin Huang
- Department of Rheumatology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Yi Tao
- Department of Rheumatology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yanyan Wang
- Department of Rheumatology, Jiangsu Province Hospital, Nanjing, China
| | - Zhuoli Zhang
- Department of Rheumatology, Peking University First Hospital, Beijing, China
| | - Wei Wei
- Department of Rheumatology, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiaofeng Li
- Department of Rheumatology, The Second Affiliated Hospital of Shanxi Medical University, Taiyuan, China
| | - Xiaofeng Zeng
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, National Clinical Research Center for Immunologic Diseases, Ministry of Science and Technology, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
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Kiefer D, Baraliakos X, Adolf D, Chatzistefanidi V, Schwarze I, Lange U, Brandt-Jürgens J, Stemmler E, Sartingen S, Braun J. Successful evaluation of spinal mobility measurements with the Epionics SPINE device in patients with axial spondyloarthritis compared to controls. J Rheumatol 2021; 49:44-52. [PMID: 34393107 DOI: 10.3899/jrheum.201470] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate ES for quantification of spinal mobility in patients with axSpA. METHODS A total of 153 individuals, 39 females and 114 males, were examined:134 axSpA patients, 40 non-(nr-) and 94 radiographic (r)-axSpA, and 19 healthy controls (HC), respectively. The results were compared using mean ES scores and modeling was performed using multivariable logistic regression models resulting in good validity and high discriminative power. RESULTS ES measurements showed meaningful differences between axSpA patients and HC (all p<0.001) as well as between r- and nr-axSpA (p<0.01). In axSpA patients a negative correlation between ES and BASMI values was found: -0.76≤r≤-0.52 (p<0.05). BASFI scores showed a similar trend (r > -0.39). Patients with r-axSpA had a more limited and slower spinal mobility than those with nr-axSpA. Other patient reported outcomes did almost not correlate. CONCLUSION This study shows that the ES is an objective performance measure and a valid tool to assess spinal mobility in axSpA, also based on OMERACT criteria. RoK and RoM scores provide additional information on physical function of axSpA patients.
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Affiliation(s)
- David Kiefer
- Rheumazentrum Ruhrgebiet, Ruhr-University Bochum; StatConsult, Gesellschaft für klinische und Versorgungsforschung mbH Magdeburg, Germany; Praxis für Rheumatologie, Leipzig; Rheumatologie und klinische Immunologie Campus Kerckhoff, Bad Nauheim, Universität Gießen; Rheumatologische Schwerpunktpraxis, Berlin; Medical Immunology, AbbVie Deutschland GmbH & Co. KG, Germany. AbbVie sponsored this study and contributed to the design, study conduct, and analysis. AbbVie participated in the interpretation of data, review, and approval of the Manuscript. D. Kiefer, X. Baraliakos, D. Adolf, V. Chatzistefanidi, I. Schwarze, U. Lange, J. Brandt-Jürgens, and J. Braun received speaker or consulting fees from AbbVie. E. Stemmler, and S. Sartingen are employees of AbbVie and may own AbbVie stock. AbbVie sponsored this study and contributed to the design, study conduct, and analysis. AbbVie participated in the interpretation of data, review, and approval of the Manuscript. Corresponding author: David Kiefer, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Claudiusstrasse 45, 44649 Herne, Germany.
| | - Xenofon Baraliakos
- Rheumazentrum Ruhrgebiet, Ruhr-University Bochum; StatConsult, Gesellschaft für klinische und Versorgungsforschung mbH Magdeburg, Germany; Praxis für Rheumatologie, Leipzig; Rheumatologie und klinische Immunologie Campus Kerckhoff, Bad Nauheim, Universität Gießen; Rheumatologische Schwerpunktpraxis, Berlin; Medical Immunology, AbbVie Deutschland GmbH & Co. KG, Germany. AbbVie sponsored this study and contributed to the design, study conduct, and analysis. AbbVie participated in the interpretation of data, review, and approval of the Manuscript. D. Kiefer, X. Baraliakos, D. Adolf, V. Chatzistefanidi, I. Schwarze, U. Lange, J. Brandt-Jürgens, and J. Braun received speaker or consulting fees from AbbVie. E. Stemmler, and S. Sartingen are employees of AbbVie and may own AbbVie stock. AbbVie sponsored this study and contributed to the design, study conduct, and analysis. AbbVie participated in the interpretation of data, review, and approval of the Manuscript. Corresponding author: David Kiefer, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Claudiusstrasse 45, 44649 Herne, Germany.
| | - Daniela Adolf
- Rheumazentrum Ruhrgebiet, Ruhr-University Bochum; StatConsult, Gesellschaft für klinische und Versorgungsforschung mbH Magdeburg, Germany; Praxis für Rheumatologie, Leipzig; Rheumatologie und klinische Immunologie Campus Kerckhoff, Bad Nauheim, Universität Gießen; Rheumatologische Schwerpunktpraxis, Berlin; Medical Immunology, AbbVie Deutschland GmbH & Co. KG, Germany. AbbVie sponsored this study and contributed to the design, study conduct, and analysis. AbbVie participated in the interpretation of data, review, and approval of the Manuscript. D. Kiefer, X. Baraliakos, D. Adolf, V. Chatzistefanidi, I. Schwarze, U. Lange, J. Brandt-Jürgens, and J. Braun received speaker or consulting fees from AbbVie. E. Stemmler, and S. Sartingen are employees of AbbVie and may own AbbVie stock. AbbVie sponsored this study and contributed to the design, study conduct, and analysis. AbbVie participated in the interpretation of data, review, and approval of the Manuscript. Corresponding author: David Kiefer, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Claudiusstrasse 45, 44649 Herne, Germany.
| | - Varvara Chatzistefanidi
- Rheumazentrum Ruhrgebiet, Ruhr-University Bochum; StatConsult, Gesellschaft für klinische und Versorgungsforschung mbH Magdeburg, Germany; Praxis für Rheumatologie, Leipzig; Rheumatologie und klinische Immunologie Campus Kerckhoff, Bad Nauheim, Universität Gießen; Rheumatologische Schwerpunktpraxis, Berlin; Medical Immunology, AbbVie Deutschland GmbH & Co. KG, Germany. AbbVie sponsored this study and contributed to the design, study conduct, and analysis. AbbVie participated in the interpretation of data, review, and approval of the Manuscript. D. Kiefer, X. Baraliakos, D. Adolf, V. Chatzistefanidi, I. Schwarze, U. Lange, J. Brandt-Jürgens, and J. Braun received speaker or consulting fees from AbbVie. E. Stemmler, and S. Sartingen are employees of AbbVie and may own AbbVie stock. AbbVie sponsored this study and contributed to the design, study conduct, and analysis. AbbVie participated in the interpretation of data, review, and approval of the Manuscript. Corresponding author: David Kiefer, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Claudiusstrasse 45, 44649 Herne, Germany.
| | - Ilka Schwarze
- Rheumazentrum Ruhrgebiet, Ruhr-University Bochum; StatConsult, Gesellschaft für klinische und Versorgungsforschung mbH Magdeburg, Germany; Praxis für Rheumatologie, Leipzig; Rheumatologie und klinische Immunologie Campus Kerckhoff, Bad Nauheim, Universität Gießen; Rheumatologische Schwerpunktpraxis, Berlin; Medical Immunology, AbbVie Deutschland GmbH & Co. KG, Germany. AbbVie sponsored this study and contributed to the design, study conduct, and analysis. AbbVie participated in the interpretation of data, review, and approval of the Manuscript. D. Kiefer, X. Baraliakos, D. Adolf, V. Chatzistefanidi, I. Schwarze, U. Lange, J. Brandt-Jürgens, and J. Braun received speaker or consulting fees from AbbVie. E. Stemmler, and S. Sartingen are employees of AbbVie and may own AbbVie stock. AbbVie sponsored this study and contributed to the design, study conduct, and analysis. AbbVie participated in the interpretation of data, review, and approval of the Manuscript. Corresponding author: David Kiefer, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Claudiusstrasse 45, 44649 Herne, Germany.
| | - Uwe Lange
- Rheumazentrum Ruhrgebiet, Ruhr-University Bochum; StatConsult, Gesellschaft für klinische und Versorgungsforschung mbH Magdeburg, Germany; Praxis für Rheumatologie, Leipzig; Rheumatologie und klinische Immunologie Campus Kerckhoff, Bad Nauheim, Universität Gießen; Rheumatologische Schwerpunktpraxis, Berlin; Medical Immunology, AbbVie Deutschland GmbH & Co. KG, Germany. AbbVie sponsored this study and contributed to the design, study conduct, and analysis. AbbVie participated in the interpretation of data, review, and approval of the Manuscript. D. Kiefer, X. Baraliakos, D. Adolf, V. Chatzistefanidi, I. Schwarze, U. Lange, J. Brandt-Jürgens, and J. Braun received speaker or consulting fees from AbbVie. E. Stemmler, and S. Sartingen are employees of AbbVie and may own AbbVie stock. AbbVie sponsored this study and contributed to the design, study conduct, and analysis. AbbVie participated in the interpretation of data, review, and approval of the Manuscript. Corresponding author: David Kiefer, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Claudiusstrasse 45, 44649 Herne, Germany.
| | - Jan Brandt-Jürgens
- Rheumazentrum Ruhrgebiet, Ruhr-University Bochum; StatConsult, Gesellschaft für klinische und Versorgungsforschung mbH Magdeburg, Germany; Praxis für Rheumatologie, Leipzig; Rheumatologie und klinische Immunologie Campus Kerckhoff, Bad Nauheim, Universität Gießen; Rheumatologische Schwerpunktpraxis, Berlin; Medical Immunology, AbbVie Deutschland GmbH & Co. KG, Germany. AbbVie sponsored this study and contributed to the design, study conduct, and analysis. AbbVie participated in the interpretation of data, review, and approval of the Manuscript. D. Kiefer, X. Baraliakos, D. Adolf, V. Chatzistefanidi, I. Schwarze, U. Lange, J. Brandt-Jürgens, and J. Braun received speaker or consulting fees from AbbVie. E. Stemmler, and S. Sartingen are employees of AbbVie and may own AbbVie stock. AbbVie sponsored this study and contributed to the design, study conduct, and analysis. AbbVie participated in the interpretation of data, review, and approval of the Manuscript. Corresponding author: David Kiefer, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Claudiusstrasse 45, 44649 Herne, Germany.
| | - Edgar Stemmler
- Rheumazentrum Ruhrgebiet, Ruhr-University Bochum; StatConsult, Gesellschaft für klinische und Versorgungsforschung mbH Magdeburg, Germany; Praxis für Rheumatologie, Leipzig; Rheumatologie und klinische Immunologie Campus Kerckhoff, Bad Nauheim, Universität Gießen; Rheumatologische Schwerpunktpraxis, Berlin; Medical Immunology, AbbVie Deutschland GmbH & Co. KG, Germany. AbbVie sponsored this study and contributed to the design, study conduct, and analysis. AbbVie participated in the interpretation of data, review, and approval of the Manuscript. D. Kiefer, X. Baraliakos, D. Adolf, V. Chatzistefanidi, I. Schwarze, U. Lange, J. Brandt-Jürgens, and J. Braun received speaker or consulting fees from AbbVie. E. Stemmler, and S. Sartingen are employees of AbbVie and may own AbbVie stock. AbbVie sponsored this study and contributed to the design, study conduct, and analysis. AbbVie participated in the interpretation of data, review, and approval of the Manuscript. Corresponding author: David Kiefer, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Claudiusstrasse 45, 44649 Herne, Germany.
| | - Sabine Sartingen
- Rheumazentrum Ruhrgebiet, Ruhr-University Bochum; StatConsult, Gesellschaft für klinische und Versorgungsforschung mbH Magdeburg, Germany; Praxis für Rheumatologie, Leipzig; Rheumatologie und klinische Immunologie Campus Kerckhoff, Bad Nauheim, Universität Gießen; Rheumatologische Schwerpunktpraxis, Berlin; Medical Immunology, AbbVie Deutschland GmbH & Co. KG, Germany. AbbVie sponsored this study and contributed to the design, study conduct, and analysis. AbbVie participated in the interpretation of data, review, and approval of the Manuscript. D. Kiefer, X. Baraliakos, D. Adolf, V. Chatzistefanidi, I. Schwarze, U. Lange, J. Brandt-Jürgens, and J. Braun received speaker or consulting fees from AbbVie. E. Stemmler, and S. Sartingen are employees of AbbVie and may own AbbVie stock. AbbVie sponsored this study and contributed to the design, study conduct, and analysis. AbbVie participated in the interpretation of data, review, and approval of the Manuscript. Corresponding author: David Kiefer, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Claudiusstrasse 45, 44649 Herne, Germany.
| | - Jürgen Braun
- Rheumazentrum Ruhrgebiet, Ruhr-University Bochum; StatConsult, Gesellschaft für klinische und Versorgungsforschung mbH Magdeburg, Germany; Praxis für Rheumatologie, Leipzig; Rheumatologie und klinische Immunologie Campus Kerckhoff, Bad Nauheim, Universität Gießen; Rheumatologische Schwerpunktpraxis, Berlin; Medical Immunology, AbbVie Deutschland GmbH & Co. KG, Germany. AbbVie sponsored this study and contributed to the design, study conduct, and analysis. AbbVie participated in the interpretation of data, review, and approval of the Manuscript. D. Kiefer, X. Baraliakos, D. Adolf, V. Chatzistefanidi, I. Schwarze, U. Lange, J. Brandt-Jürgens, and J. Braun received speaker or consulting fees from AbbVie. E. Stemmler, and S. Sartingen are employees of AbbVie and may own AbbVie stock. AbbVie sponsored this study and contributed to the design, study conduct, and analysis. AbbVie participated in the interpretation of data, review, and approval of the Manuscript. Corresponding author: David Kiefer, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Claudiusstrasse 45, 44649 Herne, Germany.
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9
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Lee YJ, Kim MJ, Jo S, Jin SH, Park PR, Park K, Song HC, Kim J, Kim JY, Shim SC, Kim TH, Hong SJ, Kang H, Kim TJ, Won EJ. Clonorchis sinensis-Derived Protein Attenuates Inflammation and New Bone Formation in Ankylosing Spondylitis. Front Immunol 2021; 12:615369. [PMID: 33717104 PMCID: PMC7947613 DOI: 10.3389/fimmu.2021.615369] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 01/18/2021] [Indexed: 12/17/2022] Open
Abstract
Helminth infections and their components have been shown to have the potential to modulate and attenuate immune responses. The objective of this study was to evaluate the potential protective effects of Clonorchis sinensis-derived protein (CSp) on ankylosing spondylitis (AS). Cytotoxicity of CSp at different doses was assessed by MTS and flow cytometry before performing experiments. Peripheral blood mononuclear cells (PBMCs) and synovial fluid mononuclear cells (SFMCs) were obtained from AS patients. Inflammatory cytokine-producing cells were analyzed using flow cytometry. The levels of INF- γ , IL-17A, TNF-α, and IL-6 were measured by enzyme-linked immunosorbent assay (ELISA). SKG mice were treated with CSp or vehicles. Inflammation and new bone formation were evaluated using immunohistochemistry, positron emission tomography (PET), and micro-computed tomography (CT). Treatment with CSp resulted in no reduced cell viability of PBMCs or SFMCs until 24 h. In experiments culturing PBMCs and SFMCs, the frequencies of IFN- γ and IL-17A producing cells were significantly reduced after CSp treatment. In the SKG mouse model, CSp treatment significantly suppressed arthritis, enthesitis, and enteritis. Micro-CT analysis of hind paw revealed reduced new bone formation in CSp-treated mice than in vehicle-treated mice. We provide the first evidence demonstrating that CSp can ameliorate clinical signs and cytokine derangements in AS. In addition, such CSp treatment could reduce the new bone formation of AS.
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Affiliation(s)
- Yu Jeong Lee
- Department of Parasitology and Tropical Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Moon-Ju Kim
- Department of Parasitology and Tropical Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Sungsin Jo
- Department of Rheumatology, Hanyang University Institute for Rheumatology Research, Seoul, South Korea
| | - So-Hee Jin
- Department of Rheumatology, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Pu-Reum Park
- Department of Rheumatology, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Kijeong Park
- Department of Rheumatology, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Ho-Chun Song
- Department of Nuclear Medicine, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Jahae Kim
- Department of Nuclear Medicine, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Ji-Young Kim
- Division of Rheumatology, Daejeon Rheumatoid & Degenerative Arthritis Center, Chungnam National University Hospital, Daejeon, South Korea
| | - Seung Cheol Shim
- Division of Rheumatology, Daejeon Rheumatoid & Degenerative Arthritis Center, Chungnam National University Hospital, Daejeon, South Korea
| | - Tae-Hwan Kim
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea
| | - Sung-Jong Hong
- Department of Medical Environmental Biology, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Hyundeok Kang
- Department of Biomedical Systems Informatics, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Tae-Jong Kim
- Department of Rheumatology, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Eun Jeong Won
- Department of Parasitology and Tropical Medicine, Chonnam National University Medical School, Gwangju, South Korea
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10
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Tu L, Xie Y, Liao Z, Jiang Y, Lv Q, Cao S, Wei Q, Gu J. Cost of Illness, Quality of Life, and Work Outcomes in Active Ankylosing Spondylitis Patients Treated With Adalimumab in China. Front Public Health 2020; 8:602334. [PMID: 33330342 PMCID: PMC7732412 DOI: 10.3389/fpubh.2020.602334] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/26/2020] [Indexed: 01/31/2023] Open
Abstract
Objectives: To access the cost of illness, quality of life and work limitation in active ankylosing spondylitis (AS) patients using adalimumab in China. Methods: A prospective study was performed in 91 patients with active AS in China. Adult patients (aged ≥ 18 years) fulfilled the 1984 New York modified criteria of AS with the Bath Ankylosing Spondylitis Disease Activity Index ≥ 4 were enrolled. All participants received adalimumab (40 mg per 2 weeks) therapy and completed questionnaires about disease characteristics, quality of life and cost. Only patients with pay-work completed the Work Limitation Questionnaire and Work productivity and activity impairment questionnaire in AS. Factors associated with work outcomes were evaluated. Results: A total of 91 patients with mean age of 30 years old (87.8% males) and mean disease duration of 10 years received adalimumab treatment for 24 weeks. The annual estimated cost of each patient was $37581.41 while the direct cost accounted for 84.6%. Seventy-eight percent of patients have a paid job with average work productivity loss of 0.28 measured by work limitation questionnaire, absenteeism and presenteeism were 10.22 and 43.86%, respectively, with a mean work productivity loss of 47.92% measured by Work productivity and activity impairment questionnaire in AS. Patients experienced significantly greater improvements after adalimumab treatment in presenteeism, absenteeism, work productivity, and quality of life. Conclusions: The cost of AS patients with adalimumab therapy was high in China. Disease activity, physical function, quality of life, and work outcomes improved significantly after therapy.
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Affiliation(s)
- Liudan Tu
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ya Xie
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zetao Liao
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yutong Jiang
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qing Lv
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shuangyan Cao
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qiujing Wei
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jieruo Gu
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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11
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Kiltz U, Wei JCC, van der Heijde D, van den Bosch F, Walsh JA, Boonen A, Gensler LS, Hunter T, Carlier H, Dong Y, Li X, Bolce R, Strand V, Braun J. Ixekizumab Improves Functioning and Health in the Treatment of Radiographic Axial Spondyloarthritis: Week 52 Results from 2 Pivotal Studies. J Rheumatol 2020; 48:188-197. [DOI: 10.3899/jrheum.200093] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2020] [Indexed: 12/20/2022]
Abstract
Objective.This study evaluated the effect of ixekizumab (IXE) on self-reported functioning and health in patients with radiographic axial spondyloarthritis (r-axSpA) who were either biological disease-modifying antirheumatic drug (bDMARD)–naïve or failed at least 1 tumor necrosis factor inhibitor (TNFi).Methods.In 2 multicenter, randomized, double-blind, placebo-controlled, and active-controlled (bDMARD-naïve only) trials, patients with r-axSpA were randomly assigned to receive 80 mg of IXE [every 2 weeks (Q2W) or every 4 weeks (Q4W)], placebo (PBO), or adalimumab (ADA; bDMARD-naïve only). After 16 weeks, patients who received PBO or ADA were rerandomized to receive IXE (Q2W or Q4W) up to Week 52. Functioning and health were measured by the generic 36-item Short Form Health Survey (SF-36) and the disease-specific Assessment of Spondyloarthritis international Society Health Index (ASAS HI). Societal health utility was assessed by the 5-level EuroQol-5 Dimension (EQ-5D-5L).Results.At Week 16, both doses of IXE in bDMARD-naïve and TNFi-experienced patients resulted in larger improvement in SF-36, ASAS HI, and EQ-5D-5L versus placebo. For SF-36, the largest improvements were seen for the domains of bodily pain, physical function, and role physical. A larger proportion of patients reaching improvement in ASAS HI ≥ 3 as well as an achievement of ASAS HI good health status was reported in patients treated with IXE. Improvements were maintained through Week 52.Conclusion.IXE significantly improved functioning and health as assessed by both generic and disease-specific measures, as well as societal health utility values in patients with r-axSpA, as measured by SF-36, ASAS HI, and EQ-5D-5L at Week 16, and improvements were sustained through 52 weeks.
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12
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Rodrigues-Manica S, Silva J, Cruz-Machado R, Coelho C, Duarte J, Vieira-Sousa E, Tavares-Costa J, Pimentel-Santos FM. Biologic disease-modifying anti-rheumatic drugs and patient-reported outcomes in axial SpA: a systematic review and a call for action. Clin Rheumatol 2020; 40:33-41. [PMID: 32533340 DOI: 10.1007/s10067-020-05209-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/26/2020] [Accepted: 05/28/2020] [Indexed: 12/17/2022]
Abstract
This paper is to assess the efficacy of different biologic DMARDs (bDMARDs) on several patient-reported outcomes (PROs) in randomized controlled trials (RCT) in axial spondyloarthritis (axSpA). A systematic literature review (SLR) was performed. MEDLINE (May 1, 2018) was used with the filters "published in the last 10 years" and "humans." The PICO criteria used were Patients: adults with radiographic axSpA (r-axSpA) or non-radiographic axSpA (nr-axSpA); Intervention: any bDMARD; Compararator: placebo (PBO)/any different drug; Outcome: the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Functional Index (BASFI), the Ankylosing Spondylitis Quality of Life (ASQoL), the EuroQol-5D (EQ-5D), the Short Form 36 Health Survey physical component summary (SF36-PCS), the Short Form 36 Health Survey mental component summary (SF36-MCS), and the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F). After screening 84 initial references and manually selecting other 9, 24 publications, assessing TNF inhibitors (TNFi) or IL17A inhibitors (IL17Ai) were selected. Four RCTs quantified the minimal clinical important difference (MCID) between treatment arms. Most of the RCTs compared the mean difference of PROs between different timepoints. Overall, the treatment arm was superior to the comparator. PROs were often underreported or highly heterogeneously presented. MCID was seldom mentioned. There is a need to raise the standard of care on SpA by aiming at remission and PRO associated improvements. In order to achieve this goal, the target must be clearly defined, reported, and tested.
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Affiliation(s)
- Santiago Rodrigues-Manica
- CEDOC, NOVA Medical School, Lisbon, Portugal. .,Rheumatology Department, Centro Hospitalar de Lisboa Ocidental, Hospital Egas Moniz EPE, R. da Junqueira 126, 1349-019, Lisbon, Portugal.
| | - Joana Silva
- Rheumatology Department, Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal
| | - Rita Cruz-Machado
- Rheumatology Department, Centro Hospitalar de Lisboa Norte EPE, Hospital de Santa Maria, R. da Junqueira 126, 1349-019, Lisbon, Portugal.,Rheumatology Research Unit, Instituto de Medicina Molecular, Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Constança Coelho
- Genetics Laboratory, Environmental Health Institute, Lisbon Medical School, University of Lisbon, Lisbon, Portugal
| | - Joana Duarte
- Medical Department, Novartis Pharma, Oeiras, Portugal
| | - Elsa Vieira-Sousa
- Rheumatology Department, Centro Hospitalar de Lisboa Norte EPE, Hospital de Santa Maria, R. da Junqueira 126, 1349-019, Lisbon, Portugal.,Rheumatology Research Unit, Instituto de Medicina Molecular, Lisbon Academic Medical Centre, Lisbon, Portugal
| | - José Tavares-Costa
- Rheumatology Department, Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal
| | - Fernando M Pimentel-Santos
- CEDOC, NOVA Medical School, Lisbon, Portugal.,Rheumatology Department, Centro Hospitalar de Lisboa Ocidental, Hospital Egas Moniz EPE, R. da Junqueira 126, 1349-019, Lisbon, Portugal
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13
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[Cost of illness in axial spondylarthritis for patients with and without tumor necrosis factor inhibitor treatment: results of a routine data analysis]. Z Rheumatol 2020; 79:85-94. [PMID: 31359143 DOI: 10.1007/s00393-019-0678-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Tumour necrosis factor-alpha inhibitors (TNFi) are an effective but expensive treatment option in axial spondylarthritis (axSpA) patients who fail to achieve disease control under conventional treatment. OBJECTIVE The aim of this study was to assess the cost of illness in axSpA patients treated with and without TNFi. METHODS Using German health insurance data, patients with axSpA who newly received TNFi between 2011 and 2015 were identified and matched by age and sex to a reference group of patients with axSpA without TNFi treatment. Costs for services performed in an outpatient setting, inpatient care, pharmacotherapy and for productivity loss due to absence from paid work were analyzed over a 2-year period. In patients treated with TNFi , the 2‑year period included 1 year before and 1 year after the initiation of TNFi. RESULTS Data from 1455 axSpA patients who received TNFi treatment were included in the analyses. Costs for services performed in an outpatient setting, inpatient care, pharmacotherapy (excluding TNFi) as well as productivity loss significantly decreased after initiation of TNFi. Mean total costs increased from € 6075 in the year prior to TNFi initiation to € 27,871 in the year after TNFi initiation. Excluding costs for TNFi, total costs decreased by 22% to € 4761. Mean total costs among the reference group of 1455 age and sex-matched axSpA patients who did not receive TNFi remained stable over 2 years: € 3939 in the first year vs. € 3832 in the second year. CONCLUSION Initiation of TNFi treatment led to a sharp increase in the total costs of axSpA patients. Part of this increase was offset by a decrease of costs for services performed in an outpatient setting, inpatient care, pharmacotherapy (excluding TNFi) as well as productivity loss. In patients who did not receive TNFi, the costs remained stable over 2 years.
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14
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Resende GG, Meirelles EDS, Marques CDL, Chiereghin A, Lyrio AM, Ximenes AC, Saad CG, Gonçalves CR, Kohem CL, Schainberg CG, Campanholo CB, Bueno Filho JSDS, Pieruccetti LB, Keiserman MW, Yazbek MA, Palominos PE, Goncalves RSG, Lage RDC, Assad RL, Bonfiglioli R, Anti SMA, Carneiro S, Oliveira TL, Azevedo VF, Bianchi WA, Bernardo WM, Pinheiro MDM, Sampaio-Barros PD. The Brazilian Society of Rheumatology guidelines for axial spondyloarthritis - 2019. Adv Rheumatol 2020; 60:19. [PMID: 32171329 DOI: 10.1186/s42358-020-0116-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 01/22/2020] [Indexed: 12/13/2022] Open
Abstract
Spondyloarthritis is a group of chronic inflammatory systemic diseases characterized by axial and/or peripheral joints inflammation, as well as extra-articular manifestations. The classification axial spondyloarthritis is adopted when the spine and/or the sacroiliac joints are predominantly involved. This version of recommendations replaces the previous guidelines published in May 2013.A systematic literature review was performed, and two hundred thirty-seven studies were selected and used to formulate 29 recommendations answering 15 clinical questions, which were divided into four sections: diagnosis, non-pharmacological therapy, conventional drug therapy and biological therapy. For each recommendation the level of evidence supporting (highest available), the strength grade according to Oxford, and the degree of expert agreement (inter-rater reliability) is informed.These guidelines bring evidence-based information on clinical management of axial SpA patients, including, diagnosis, treatment, and prognosis.
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Affiliation(s)
- Gustavo Gomes Resende
- Universidade Federal de Minas Gerais (UFMG), Alameda Álvaro Celso, 175 / 2° Andar. Santa Efigênia. CEP 30.150-260, Belo Horizonte, MG, Brazil.
| | | | | | | | - Andre Marun Lyrio
- Pontifície Universidade Católica (PUC) de Campinas, Campinas, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | - Ricardo da Cruz Lage
- Universidade Federal de Minas Gerais (UFMG), Alameda Álvaro Celso, 175 / 2° Andar. Santa Efigênia. CEP 30.150-260, Belo Horizonte, MG, Brazil
| | | | | | | | - Sueli Carneiro
- Universidade Federal do Rio De Janeiro (UFRJ), Rio de Janeiro, Brazil
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Kiltz U, Braun J, Becker A, Chenot JF, Dreimann M, Hammel L, Heiligenhaus A, Hermann KG, Klett R, Krause D, Kreitner KF, Lange U, Lauterbach A, Mau W, Mössner R, Oberschelp U, Philipp S, Pleyer U, Rudwaleit M, Schneider E, Schulte TL, Sieper J, Stallmach A, Swoboda B, Winking M. [Long version on the S3 guidelines for axial spondyloarthritis including Bechterew's disease and early forms, Update 2019 : Evidence-based guidelines of the German Society for Rheumatology (DGRh) and participating medical scientific specialist societies and other organizations]. Z Rheumatol 2020; 78:3-64. [PMID: 31784900 DOI: 10.1007/s00393-019-0670-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- U Kiltz
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Claudiusstr. 45, 44649, Herne, Deutschland.
| | - J Braun
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Claudiusstr. 45, 44649, Herne, Deutschland
| | | | - A Becker
- Allgemeinmedizin, präventive und rehabilitative Medizin, Universität Marburg, Karl-von-Frisch-Str. 4, 35032, Marburg, Deutschland
| | | | - J-F Chenot
- Universitätsmedizin Greifswald, Fleischmann Str. 6, 17485, Greifswald, Deutschland
| | - M Dreimann
- Zentrum für Operative Medizin, Klinik und Poliklinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistraße 52, 20251, Hamburg, Deutschland
| | | | - L Hammel
- Geschäftsstelle des Bundesverbandes der DVMB, Metzgergasse 16, 97421, Schweinfurt, Deutschland
| | | | - A Heiligenhaus
- Augenzentrum und Uveitis-Zentrum, St. Franziskus Hospital, Hohenzollernring 74, 48145, Münster, Deutschland
| | | | - K-G Hermann
- Institut für Radiologie, Charité Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | | | - R Klett
- Praxis Manuelle & Osteopathische Medizin, Fichtenweg 17, 35428, Langgöns, Deutschland
| | | | - D Krause
- , Friedrich-Ebert-Str. 2, 45964, Gladbeck, Deutschland
| | - K-F Kreitner
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - U Lange
- Kerckhoff-Klinik, Rheumazentrum, Osteologie & Physikalische Medizin, Benekestr. 2-8, 61231, Bad Nauheim, Deutschland
| | | | - A Lauterbach
- Schule für Physiotherapie, Orthopädische Universitätsklinik Friedrichsheim, Marienburgstraße 2, 60528, Frankfurt, Deutschland
| | | | - W Mau
- Institut für Rehabilitationsmedizin, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, 06097, Halle (Saale), Deutschland
| | - R Mössner
- Klinik für Dermatologie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland
| | | | - U Oberschelp
- , Barlachstr. 6, 59368, Werne a.d. L., Deutschland
| | | | - S Philipp
- Praxis für Dermatologie, Bernauer Str. 66, 16515, Oranienburg, Deutschland
| | - U Pleyer
- Campus Virchow-Klinikum, Charité Centrum 16, Klinik f. Augenheilkunde, Charité, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - M Rudwaleit
- Klinikum Bielefeld, An der Rosenhöhe 27, 33647, Bielefeld, Deutschland
| | - E Schneider
- Abt. Fachübergreifende Frührehabilitation und Sportmedizin, St. Antonius Hospital, Dechant-Deckersstr. 8, 52249, Eschweiler, Deutschland
| | - T L Schulte
- Klinik für Orthopädie und Unfallchirurgie, Orthopädische Universitätsklinik, Ruhr-Universität Bochum, Gudrunstr. 65, 44791, Bochum, Deutschland
| | - J Sieper
- Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Deutschland
| | - A Stallmach
- Klinik für Innere Medizin IV, Universitätsklinikum Jena, Am Klinikum 1, 07743, Jena, Deutschland
| | | | - B Swoboda
- Abteilung für Orthopädie und Rheumatologie, Orthopädische Universitätsklinik, Malteser Waldkrankenhaus St. Marien, 91054, Erlangen, Deutschland
| | | | - M Winking
- Zentrum für Wirbelsäulenchirurgie, Klinikum Osnabrück, Am Finkenhügel 3, 49076, Osnabrück, Deutschland
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Maksymowych WP, Strand V, Nash P, Yazici Y, Thom H, Hunger M, Kalyvas C, Gandhi KK, Porter B, Jugl SM. Comparative effectiveness of secukinumab and adalimumab in ankylosing spondylitis as assessed by matching-adjusted indirect comparison. Eur J Rheumatol 2018; 5:216-223. [PMID: 30388073 PMCID: PMC6267743 DOI: 10.5152/eurjrheum.2018.18162] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 10/05/2018] [Indexed: 12/17/2022] Open
Abstract
Objective Matching-adjusted indirect comparison was used to assess the comparative effectiveness of secukinumab 150 mg and adalimumab 40 mg in biologic-naïve patients with ankylosing spondylitis (AS) for up to 1 year. Methods Pooled individual patient data from the secukinumab arms of MEASURE 1 (NCT01358175) and MEASURE 2 (NCT01649375) trials (n=197) were matched against the ATLAS (NCT00085644) adalimumab population (n=208). Logistic regression analysis was used to determined weights to match for age, sex, Bath AS Functional Index, C-reactive protein levels, and previous tumor necrosis factor inhibitor therapy. Recalculated Assessment of SpondyloArthritis International Society (ASAS) 20 and 40 responses at weeks 8, 12, 16, 24, and 52 from MEASURE 1/2 (effective sample size=120) were compared with those of ATLAS. Anchored (placebo-adjusted) comparisons were possible until week 12, and unanchored (non-placebo-adjusted) comparisons were necessary thereafter. Results For placebo-anchored ASAS 20 and 40 comparisons up to week 12, there were no differences between secukinumab and adalimumab. For unanchored comparisons at week 16, ASAS 20 was higher for secukinumab [odds ratio 1.60 (95% confidence interval, 1.01–2.54); p=0.047]; at week 24, ASAS 20 and 40 were higher for secukinumab [1.76 (1.11–2.79); p=0.017 and 1.79 (1.14–2.82); p=0.012, respectively]; and at week 52, ASAS 40 was higher for secukinumab [1.54 (1.06–2.23); p=0.023] than for adalimumab. Conclusion There were no differences observed in placebo-adjusted ASAS 20 and 40 responses up to 12 weeks between secukinumab- and adalimumab-treated patients with ankylosing spondylitis. After week 12, secukinumab demonstrated signs of greater improvement in non-placebo-adjusted ASAS 20 and 40 responses than adalimumab.
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Affiliation(s)
- Walter P Maksymowych
- Division of Rheumatology, University of Alberta School of Medicine and Dentistry, Edmonton, Canada
| | - Vibeke Strand
- Division Immunology-Rheumatology, Stanford University, Palo Alto, California, USA
| | - Peter Nash
- Department of Medicine, University of Queensland, Brisbane, Australia
| | - Yusuf Yazici
- New York University School of Medicine, New York, USA
| | | | | | | | - Kunal K Gandhi
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | - Brian Porter
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
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17
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Packham J. Optimizing outcomes for ankylosing spondylitis and axial spondyloarthritis patients: a holistic approach to care. Rheumatology (Oxford) 2018; 57:vi29-vi34. [PMID: 30445484 PMCID: PMC6238224 DOI: 10.1093/rheumatology/key200] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/05/2018] [Indexed: 01/20/2023] Open
Abstract
Axial SpA (axSpA) can affect diverse elements of an individual's life. The areas affected can be much more wide-ranging than the historical medical model of SpA, causing increased disease activity (pain and stiffness) and disability (reduced range of movement and physical function). A more holistic view of the individual results in the realization that many other areas of life can be adversely affected by axSpA, from the ability to work effectively and function socially, to effects on quality of life and the onset of worsening fatigue or mood disturbance. A good understanding of these areas outside the medical model allows for an improved understanding of the overall life impact of axSpA. This highlights the importance of understanding how to measure these elements of life using patient-reported outcome measures that can truly reflect an individual's experience of axSpA. These measures can then provide a better insight into the risks and benefits of interventions and medications used to treat axSpA.
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Affiliation(s)
- Jonathan Packham
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
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18
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Jo S, Wang SE, Lee YL, Kang S, Lee B, Han J, Sung IH, Park YS, Bae SC, Kim TH. IL-17A induces osteoblast differentiation by activating JAK2/STAT3 in ankylosing spondylitis. Arthritis Res Ther 2018; 20:115. [PMID: 29880011 PMCID: PMC5992730 DOI: 10.1186/s13075-018-1582-3] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 03/27/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND IL-17A has recently emerged as a potential target that regulates the extensive inflammation and abnormal bone formation observed in ankylosing spondylitis (AS). Blocking IL-17A is expected to inhibit bony ankylosis. Here, we investigated the effects of anti IL-17A agents in AS. METHODS TNFα, IL-17A, and IL-12/23 p40 levels in serum and synovial fluid from patients with ankylosing spondylitis (AS), rheumatoid arthritis (RA), osteoarthritis (OA), or healthy controls (HC) were measured by ELISA. Bone tissue samples were obtained at surgery from the facet joints of ten patients with AS and ten control (Ct) patients with noninflammatory spinal disease. The functional relevance of IL-17A, biological blockades, Janus kinase 2 (JAK2), and non-receptor tyrosine kinase was assessed in vitro with primary bone-derived cells (BdCs) and serum from patients with AS. RESULTS Basal levels of IL-17A and IL-12/23 p40 in body fluids were elevated in patients with AS. JAK2 was also highly expressed in bone tissue and primary BdCs from patients with AS. Furthermore, addition of exogenous IL-17A to primary Ct-BdCs promoted the osteogenic stimulus-induced increase in ALP activity and mineralization. Intriguingly, blocking IL-17A with serum from patients with AS attenuated ALP activity and mineralization in both Ct and AS-BdCs by inhibiting JAK2 phosphorylation and downregulating osteoblast-involved genes. Moreover, JAK2 inhibitors effectively reduced JAK2-driven ALP activity and JAK2-mediated events. CONCLUSIONS Our findings indicate that IL-17A regulates osteoblast activity and differentiation via JAK2/STAT3 signaling. They shed light on AS pathogenesis and suggest new rational therapies for clinical AS ankylosis.
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Affiliation(s)
- Sungsin Jo
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, 222-1, Wangsimni-ro, Seongdong-gu, Seoul, 04763 Republic of Korea
| | - Sung Eun Wang
- Hanyang Biomedical Research Institute, Hanyang University, Seoul, Republic of Korea
| | - Young Lim Lee
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, 222-1, Wangsimni-ro, Seongdong-gu, Seoul, 04763 Republic of Korea
| | - Suman Kang
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, 222-1, Wangsimni-ro, Seongdong-gu, Seoul, 04763 Republic of Korea
| | - Bitnara Lee
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, 222-1, Wangsimni-ro, Seongdong-gu, Seoul, 04763 Republic of Korea
| | - Jinil Han
- Gencurix, Inc, Hanhwan Bizmetro 1, Guro 3-dong, Guro-gu, Seoul, Republic of Korea
| | - Il-Hoon Sung
- Department of Orthopedic Surgery, Hanyang University Hospital, Seoul, Republic of Korea
| | - Ye-Soo Park
- Department of Orthopedic Surgery, Hanyang University Hospital, Guri, Republic of Korea
| | - Sang-Cheol Bae
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, 222-1, Wangsimni-ro, Seongdong-gu, Seoul, 04763 Republic of Korea
- Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, Republic of Korea
| | - Tae-Hwan Kim
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, 222-1, Wangsimni-ro, Seongdong-gu, Seoul, 04763 Republic of Korea
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Schofield D, Shrestha R, Cunich M. The economic impacts of using adalimumab (Humira ® ) for reducing pain in people with ankylosing spondylitis: A microsimulation study for Australia. Int J Rheum Dis 2018; 21:1106-1113. [PMID: 29611342 DOI: 10.1111/1756-185x.13277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AIM The onset and progression of ankylosing spondylitis (AS) usually occurs during the life stage when individuals are more likely to be working and receiving an income, but little is known about the effects of interventions that reduce pain and improve the economic circumstances of patients out of the labour force due to AS. This study evaluates the economic benefits of pain reduction among people aged 19-64 with AS using adalimumab (Humira® ) from the patient and governmental perspectives. METHODS We estimated the benefits of adalimumab for reducing pain in people aged 19-64 with AS in terms of labor force participation and earnings, and to the Australian Government in terms of income tax revenue and welfare payments using economic simulation. The simulation model integrated data from the Adalimumab Trial Evaluating Long-Term Safety and Efficacy for Ankylosing Spondylitis (ATLAS), the Household Income and Labour Dynamics in Australia (HILDA) Survey - Wave 10, and Static Incomes Model (STINMOD). All benefits are expressed in 2014 real Australian dollars. RESULTS We estimated an additional 131 people aged 19-64 with AS (111 males, 20 females) would be in the labour force after using adalimumab for 24 weeks. National benefits consisted of an increase in annual earnings of AU$7.4 million for patients through increased labour force participation, savings of $2 million in annual welfare payments, and an increase of $1.3 million in income tax revenue in 2014 (after 24 weeks). CONCLUSION Adalimumab therapy generates substantial economic benefits in addition to health benefits for individuals, and savings for government.
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Affiliation(s)
- Deborah Schofield
- Faculty of Pharmacy, Charles Perkins Centre, The University of Sydney, New South Wales, Australia.,Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia.,Garvan Institute of Medical Research, Sydney, New South Wales, Australia
| | - Rupendra Shrestha
- Faculty of Pharmacy, Charles Perkins Centre, The University of Sydney, New South Wales, Australia
| | - Michelle Cunich
- Faculty of Pharmacy, Charles Perkins Centre, The University of Sydney, New South Wales, Australia
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20
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Chen MH, Lee MH, Liao HT, Chen WS, Lai CC, Tsai CY. Health-related quality of life outcomes in patients with rheumatoid arthritis and ankylosing spondylitis after tapering biologic treatment. Clin Rheumatol 2018; 37:429-438. [DOI: 10.1007/s10067-017-3965-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 12/01/2017] [Accepted: 12/18/2017] [Indexed: 12/19/2022]
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21
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Marzo-Ortega H, Sieper J, Kivitz A, Blanco R, Cohen M, Delicha EM, Rohrer S, Richards H. Secukinumab provides sustained improvements in the signs and symptoms of active ankylosing spondylitis with high retention rate: 3-year results from the phase III trial, MEASURE 2. RMD Open 2017; 3:e000592. [PMID: 29435364 PMCID: PMC5761290 DOI: 10.1136/rmdopen-2017-000592] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 11/22/2017] [Accepted: 11/24/2017] [Indexed: 12/14/2022] Open
Abstract
Background Secukinumab treatment has previously been shown to significantly improve the signs and symptoms of active ankylosing spondylitis (AS), with responses sustained through 2 years. Here, we report the long-term (3 years) efficacy and safety of secukinumab in the MEASURE 2 study. Methods MEASURE 2 (NCT01649375) is a 5-year phase III, randomised, double-blind, double-dummy, parallel-group, placebo-controlled study to evaluate the efficacy, safety and tolerability of subcutaneous loading and maintenance dosing of secukinumab in adult subjects with active AS. Subjects were randomised to receive subcutaneous secukinumab 150 mg, 75 mg or placebo at baseline, weeks 1, 2 and 3 and every 4 weeks from week 4. At week 16, placebo-treated subjects were rerandomised to receive secukinumab 150/75 mg. Results Retention rates were high during weeks 16–156 and were 86% and 76% for secukinumab 150 and 75 mg, respectively. Secukinumab 150 mg provided sustained improvements in the Assessment of Spondyloarthritis International Society ASAS 20/40 response rates at week 156 (70.1%/60.9%) compared with week 52 (74.2%/57.0%); however, there was a slight decrease for secukinumab 75 mg (54.3%/37.0% vs 62.5%/43.2%, respectively). Sustained improvements were observed in all other end points, including Bath Ankylosing Spondylitis Disease Activity Index, AS Disease Activity Score with C reactive protein inactive disease, ASAS 5/6, Short Form-36 Physical Component Summary and ASAS partial remission. Clinical benefits were observed regardless of prior exposure to anti-tumour necrosis factor agents. The safety profile remained favourable and was consistent with previous reports. Conclusions This study showed sustained improvement through 3 years in signs, symptoms and physical function in subjects with AS. Retention rates were high and secukinumab was well tolerated, with a favourable safety profile.
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Affiliation(s)
- Helena Marzo-Ortega
- Leeds Teaching Hospitals Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
| | | | - Alan Kivitz
- Altoona Center for Clinical Research, Duncansville, Pennsylvania, USA
| | - Ricardo Blanco
- Hospital Universitario Marques de Valdecilla, Santander, Cantabria, Spain
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22
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van der Heijde D, Dougados M, Landewé R, Sieper J, Maksymowych WP, Rudwaleit M, Van den Bosch F, Braun J, Mease PJ, Kivitz AJ, Walsh J, Davies O, Bauer L, Hoepken B, Peterson L, Deodhar A. Sustained efficacy, safety and patient-reported outcomes of certolizumab pegol in axial spondyloarthritis: 4-year outcomes from RAPID-axSpA. Rheumatology (Oxford) 2017; 56:1498-1509. [PMID: 28498975 PMCID: PMC5850296 DOI: 10.1093/rheumatology/kex174] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Indexed: 02/07/2023] Open
Abstract
Objective The aim was to assess the long-term safety and efficacy of certolizumab pegol over 4 years of continuous treatment in patients with axial spondyloarthritis (axSpA), including both AS and non-radiographic (nr-) axSpA. Methods RAPID-axSpA was a phase 3 randomized trial, double blind and placebo controlled to week 24, dose blind to week 48 and open label to week 204. Patients had a clinical diagnosis of axSpA, meeting Assessment of SpondyloArthritis international Society (ASAS) criteria, and had active disease. The assessed outcomes included ASAS20, ASAS40, AS DAS (ASDAS), BASDAI, BASFI and BASMI scores, along with selected measures of remission. Further patient-reported outcomes, peripheral arthritis, enthesitis, uveitis and quality-of-life measures are also reported. Results Two hundred and eighteen of 325 patients randomized (AS: 121; nr-axSpA: 97) received certolizumab pegol from week 0. Of these, 65% remained in the study at week 204 (AS: 67%; nr-axSpA: 63%). Across all outcomes, for AS and nr-axSpA, sustained improvements were observed to week 204 [week 204 overall axSpA: ASAS20: 54.1% (non-responder imputation); 83.7% (observed case, OC); ASAS40: 44.0% (non-responder imputation); 68.1% (OC); ASDAS inactive disease: 32.1% (last observation carried forward); 31.4% (OC)]. In the safety set (n = 315), there were 292.8 adverse events and 10.4 serious adverse events per 100 patient-years. No deaths were reported. Conclusion In the first study to evaluate the efficacy of an anti-TNF across both axSpA subpopulations, improvements in clinical and patient-reported outcomes at 24 and 96 weeks were sustained through 4 years of treatment, with no new safety signals. Trial registration ClinicalTrials.gov, http://clinicaltrials.gov, NCT01087762.
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Affiliation(s)
| | | | - Robert Landewé
- Clinical Immunology and Rheumatology, Academic Medical Center, Amsterdam.,Department of Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Joachim Sieper
- Rheumatology Department, Charité - University Medicine, Berlin, Germany
| | | | - Martin Rudwaleit
- Department of Internal Medicine and Rheumatology, Klinikum Bielefeld, Bielefeld, Germany
| | | | | | - Philip J Mease
- Swedish Medical Center, University of Washington, Seattle, WA
| | - Alan J Kivitz
- Altoona Center for Clinical Research, Duncansville, PA
| | - Jessica Walsh
- Division of Rheumatology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | | | | | | | - Atul Deodhar
- Division of Arthritis and Rheumatic Diseases, Oregon Health & Science University, Portland, OR, USA
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23
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Disease activity in axial spondyloarthritis after discontinuation of TNF inhibitors therapy. Reumatologia 2017; 55:157-162. [PMID: 29056769 PMCID: PMC5647530 DOI: 10.5114/reum.2017.69775] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 08/02/2017] [Indexed: 01/07/2023] Open
Abstract
Objective Use of tumour necrosis factor inhibitors (TNFi) has proved to be an important step forward in the treatment of axial spondyloarthritis (axSpA), but the duration of the therapy as well as the management in case of low disease activity (LDA) or remission are not clearly established. Currently, the identification of potential predictors associated with the treatment discontinuation is the basic purpose of many clinical studies. The aim of this study was to analyze the influence of the discontinuation of TNFi therapy on the disease activity in patients with low disease activity. Material and methods The study included 65 patients; 47 of patients (72%) were treated with etanercept, 16 (2%) with adalimumab and 2 (3%) with infliximab. Results The mean age of the patients was 45 years, the mean BASDAI score was 6.8 and VAS for low back pain was 76 mm at baseline. 54 patients with axSpA (83%) achieved LDA after 9 months of anti-TNF therapy. During follow-up 40 patients (74% of patients with LDA) had an increase of the disease activity after mean 14 weeks and needed to restart the treatment with TNFi. After restart of the therapy LDA was regained in all patients after mean 7 weeks. 11 patients (17%) have never achieved LDA and 14 patients (22%) had LDA longer than 6 months without relapse. At baseline higher levels of CRP and ESR were observed in patients with relapse of the disease at the end of treatment and with LDA shorter than 6 months. Conclusions Changes in the values of disease activity indicators (CRP, ESR) correlated with more stable response to TNFi therapy. Over 50% of patients who were treated with TNFi needed to restart the therapy. Treatment resumption allowed to regain a good clinical effect among affected patients.
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24
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Sepriano A, Regel A, van der Heijde D, Braun J, Baraliakos X, Landewé R, Van den Bosch F, Falzon L, Ramiro S. Efficacy and safety of biological and targeted-synthetic DMARDs: a systematic literature review informing the 2016 update of the ASAS/EULAR recommendations for the management of axial spondyloarthritis. RMD Open 2017; 3:e000396. [PMID: 28176964 PMCID: PMC5278329 DOI: 10.1136/rmdopen-2016-000396] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 12/03/2016] [Accepted: 12/09/2016] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To update the evidence for the efficacy and safety of (b)biological and (ts)targeted-synthetic disease-modifying anti-rheumatic drugs (DMARDs) in patients with axial spondyloarthritis (axSpA) to inform the 2016 update of the Assessment of SpondyloArthritis international Society/European League Against Rheumatism (ASAS/EULAR) recommendations for the management of axSpA. METHODS Systematic literature review (2009-2016) for randomised controlled trials (RCT), including long-term extensions, strategy trials and observational studies (the latter was only for safety assessment and a comparator was required). Interventions were any bDMARD or tsDMARD. All relevant efficacy and safety outcomes were included. RESULTS 76 papers and 24 abstracts fulfilled the inclusion criteria. Large treatment effects were found both in radiographic axSpA (r-axSpA) and non-radiographic axSpA (nr-axSpA) for all tumour necrosis factor inhibitors (TNFi) (NNT to achieve ASAS40 response ranged between 2.6-5.2 for r-axSpA and 2.3-5.4 for nr-axSpA). For nr-axSpA, efficacy was superior for those who had objective signs of inflammation (positive C reactive protein or inflammation on MRI-SI). Secukinumab 150 mg has shown efficacy in two phase 3 RCTs (NNT to achieve ASAS40 response: 3.4 and 4.0). Ustekinumab and tofacitinib have shown positive results in phase 2/proof-of-concept trials; trials with apremilast, rituximab, interleukin (IL)-6 antagonists and abatacept have failed their primary end points. New (unknown) safety signals were not found in the trials but long-term observational safety data for TNFi are still scarce. CONCLUSIONS New evidence supports the efficacy and safety of TNFi both in r-axSpA and nr-axSpA. Secukinumab is the first drug targeting the IL-17 pathway in r-axSpA that has shown efficacy.
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Affiliation(s)
- Alexandre Sepriano
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Andrea Regel
- Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Herne, Germany
| | | | - Jürgen Braun
- Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Herne, Germany
| | | | - Robert Landewé
- Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology & Clinical Immunology Center, Amsterdam, The Netherlands
- Zuyderland Medical Center, Heerlen, The Netherlands
| | | | - Louise Falzon
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, USA
| | - Sofia Ramiro
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
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25
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Corbett M, Soares M, Jhuti G, Rice S, Spackman E, Sideris E, Moe-Byrne T, Fox D, Marzo-Ortega H, Kay L, Woolacott N, Palmer S. Tumour necrosis factor-α inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis: a systematic review and economic evaluation. Health Technol Assess 2016; 20:1-334, v-vi. [PMID: 26847392 DOI: 10.3310/hta20090] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Tumour necrosis factor (TNF)-α inhibitors (anti-TNFs) are typically used when the inflammatory rheumatologic diseases ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nr-AxSpA) have not responded adequately to conventional therapy. Current National Institute for Health and Care Excellence (NICE) guidance recommends treatment with adalimumab, etanercept and golimumab in adults with active (severe) AS only if certain criteria are fulfilled but it does not recommend infliximab for AS. Anti-TNFs for patients with nr-AxSpA have not previously been appraised by NICE. OBJECTIVE To determine the clinical effectiveness, safety and cost-effectiveness within the NHS of adalimumab, certolizumab pegol, etanercept, golimumab and infliximab, within their licensed indications, for the treatment of severe active AS or severe nr-AxSpA (but with objective signs of inflammation). DESIGN Systematic review and economic model. DATA SOURCES Fifteen databases were searched for relevant studies in July 2014. REVIEW METHODS Clinical effectiveness data from randomised controlled trials (RCTs) were synthesised using Bayesian network meta-analysis methods. Results from other studies were summarised narratively. Only full economic evaluations that compared two or more options and considered both costs and consequences were included in the systematic review of cost-effectiveness studies. The differences in the approaches and assumptions used across the studies, and also those in the manufacturer's submissions, were examined in order to explain any discrepancies in the findings and to identify key areas of uncertainty. A de novo decision model was developed with a generalised framework for evidence synthesis that pooled change in disease activity (BASDAI and BASDAI 50) and simultaneously synthesised information on function (BASFI) to determine the long-term quality-adjusted life-year and cost burden of the disease in the economic model. The decision model was developed in accordance with the NICE reference case. The model has a lifetime horizon (60 years) and considers costs from the perspective of the NHS and personal social services. Health effects were expressed in terms of quality-adjusted life-years. RESULTS In total, 28 eligible RCTs were identified and 26 were placebo controlled (mostly up to 12 weeks); 17 extended into open-label active treatment-only phases. Most RCTs were judged to have a low risk of bias overall. In both AS and nr-AxSpA populations, anti-TNFs produced clinically important benefits to patients in terms of improving function and reducing disease activity; for AS, the relative risks for ASAS 40 ranged from 2.53 to 3.42. The efficacy estimates were consistently slightly smaller for nr-AxSpA than for AS. Statistical (and clinical) heterogeneity was more apparent in the nr-AxSpA analyses than in the AS analyses; both the reliability of the nr-AxSpA meta-analysis results and their true relevance to patients seen in clinical practice are questionable. In AS, anti-TNFs are approximately equally effective. Effectiveness appears to be maintained over time, with around 50% of patients still responding at 2 years. Evidence for an effect of anti-TNFs delaying disease progression was limited; results from ongoing long-term studies should help to clarify this issue. Sequential treatment with anti-TNFs can be worthwhile but the drug survival response rates and benefits are reduced with second and third anti-TNFs. The de novo model, which addressed many of the issues of earlier evaluations, generated incremental cost-effectiveness ratios ranging from £19,240 to £66,529 depending on anti-TNF and modelling assumptions. CONCLUSIONS In both AS and nr-AxSpA populations anti-TNFs are clinically effective, although more so in AS than in nr-AxSpA. Anti-TNFs may be an effective use of NHS resources depending on which assumptions are considered appropriate. FUTURE WORK RECOMMENDATIONS Randomised trials are needed to identify the nr-AxSpA population who will benefit the most from anti-TNFs. STUDY REGISTRATION This study is registered as PROSPERO CRD42014010182. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Mark Corbett
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Marta Soares
- Centre for Health Economics, University of York, York, UK
| | - Gurleen Jhuti
- Centre for Health Economics, University of York, York, UK
| | - Stephen Rice
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Eldon Spackman
- Centre for Health Economics, University of York, York, UK
| | | | | | - Dave Fox
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Helena Marzo-Ortega
- Division of Rheumatic and Musculoskeletal Disease, Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust and University of Leeds, Leeds, UK
| | - Lesley Kay
- Division of Rheumatic and Musculoskeletal Disease, Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust and University of Leeds, Leeds, UK
| | - Nerys Woolacott
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Stephen Palmer
- Centre for Health Economics, University of York, York, UK
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van Weely SFE, Kneepkens EL, Nurmohamed MT, Dekker J, van der Horst-Bruinsma IE. Continuous Improvement of Physical Functioning in Ankylosing Spondylitis Patients by Tumor Necrosis Factor Inhibitors: Three-Year Followup and Predictors. Arthritis Care Res (Hoboken) 2016; 68:1522-9. [DOI: 10.1002/acr.22869] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 01/04/2016] [Accepted: 02/09/2016] [Indexed: 01/11/2023]
Affiliation(s)
| | - Eva L. Kneepkens
- Reade, Centre for Rehabilitation and Rheumatology; Amsterdam The Netherlands
| | - Mike T. Nurmohamed
- Reade, Centre for Rehabilitation and Rheumatology; Amsterdam The Netherlands
| | - Joost Dekker
- Reade, Centre for Rehabilitation and Rheumatology and VU University Medical Centre; Amsterdam The Netherlands
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Ramonda R, Marchesoni A, Carletto A, Bianchi G, Cutolo M, Ferraccioli G, Fusaro E, De Vita S, Galeazzi M, Gerli R, Matucci-Cerinic M, Minisola G, Montecucco C, Pellerito R, Salaffi F, Paolazzi G, Sarzi-Puttini P, Scarpa R, Bagnato G, Triolo G, Valesini G, Punzi L, Olivieri I. Patient-reported impact of spondyloarthritis on work disability and working life: the ATLANTIS survey. Arthritis Res Ther 2016; 18:78. [PMID: 27037139 PMCID: PMC4818386 DOI: 10.1186/s13075-016-0977-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 03/18/2016] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The aim was to establish how patients experience the impact of spondyloarthritis (SpA) on work disability and working life. METHODS The survey was performed in 17/20 regions in Italy (1 January to 31 March 2013). A multiple-choice questionnaire was published on the official website of the sponsor - the National Association of Rheumatic Patients (ANMAR) - and hard-copies were distributed at outpatient clinics for rheumatic patients. RESULTS Respondents (n = 770) were of both sexes (56 % men), educated (62 % at high school or more), of working age (75 % aged ≤60 years), and affected by SpA. The most common types diagnosed were ankylosing spondylitis (AS) (39 %) and psoriatic arthritis (PsA) (36 %). Respondents were working full-time (45 %), part-time (8 %) or had retired (22 %); 15 % were unemployed (for reasons linked to the disease or for other reasons, students or housewives). Patients reported disability (39 %), were receiving disability benefits (34 %), were experiencing important limitations that were hindering their professional development/career (36 %) and some had to change/leave their job or lost it because of SpA (21 %). Employed respondents (n = 383) had worked on average 32.2 h in the last 7 days. More hours of work were lost over the last 7 days due to SpA (2.39 h vs 1.67 h). The indirect costs of the disease amounted to €106/week for patients reporting well-being/good physical conditions/improvement and €216/week for those reporting permanent impairment. CONCLUSIONS Most patients were in the midst of their productive years and were experiencing considerable difficulties in carrying out their job because of the disease: half of them reported disability and one third were experiencing important limitations in their career perspective.
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Affiliation(s)
- Roberta Ramonda
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Via Giustiniani, 2, Padova, 35128, Italy.
| | - Antonio Marchesoni
- Division of Rheumatology, Day Hospital Unit, Istituto Ortopedico G. Pini, Milano, Italy
| | | | - Gerolamo Bianchi
- Department of Locomotor System, Division of Rheumatology, ASL3-Azienda Sanitaria Genovese, Arenzano, Genova, Italy
| | - Maurizio Cutolo
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, IRCCS A.O.U. San Martino-IST, University of Genova, Genova, Italy
| | - Gianfranco Ferraccioli
- Division of Rheumatology, Institute of Rheumatology & Affine Sciences, Catholic University School of Medicine, Roma, Italy
| | - Enrico Fusaro
- Rheumatology Unit, Città della Salute e della Scienza, University Hospital of Torino, Torino, Italy
| | - Salvatore De Vita
- Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Ospedaliero-Universitaria S. Maria della Misericordia, Udine, Italy
| | - Mauro Galeazzi
- Research Center of Systemic Autoimmune and Autoinflammatory Diseases, University of Siena, Siena, Italy
| | - Roberto Gerli
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, Division of Rheumatology, Azienda Ospedaliero-Universitaria Careggi (AOUC), University of Firenze, Firenze, Italy
| | | | | | | | - Fausto Salaffi
- Rheumatology Department, Polytechnic University of the Marche Region, Jesi, Italy
| | | | | | - Raffaele Scarpa
- Rheumatology Research Unit, Department of Clinical and Experimental Medicine, University Federico II, Napoli, Italy
| | - Gianfilippo Bagnato
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giovanni Triolo
- Department of Internal Medicine, Rheumatology Unit, University of Palermo, Palermo, Italy
| | - Guido Valesini
- Rheumatology Unit, La Sapienza University of Roma, Roma, Italy
| | - Leonardo Punzi
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Via Giustiniani, 2, Padova, 35128, Italy
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Ribeiro SL, Albuquerque EN, Bortoluzzo AB, Gonçalves CR, Silva JABD, Ximenes AC, Bértolo MB, Keiserman M, Menin R, Skare TL, Carneiro S, Azevedo VF, Vieira WP, Bianchi WA, Bonfiglioli R, Campanholo C, Carvalho HM, Costa IP, Duarte ALP, Kohem CL, Leite NH, Lima SA, Meirelles ES, Pereira IA, Pinheiro MM, Polito E, Resende GG, Rocha FAC, Santiago MB, Sauma MDFL, Valim V, Sampaio‐Barros PD. Qualidade de vida nas espondiloartrites: análise de uma grande coorte brasileira. REVISTA BRASILEIRA DE REUMATOLOGIA 2016. [DOI: 10.1016/j.rbr.2015.03.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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29
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Ribeiro SLE, Albuquerque EN, Bortoluzzo AB, Gonçalves CR, da Silva JAB, Ximenes AC, Bértolo MB, Keiserman M, Menin R, Skare TL, Carneiro S, Azevedo VF, Vieira WP, Bianchi WA, Bonfiglioli R, Campanholo C, Carvalho HMS, Costa IP, Duarte ALBP, Kohem CL, Leite NH, Lima SAL, Meirelles ES, Pereira IA, Pinheiro MM, Polito E, Resende GG, Rocha FAC, Santiago MB, Sauma MDFLC, Valim V, Sampaio-Barros PD. Quality of life in spondyloarthritis: analysis of a large Brazilian cohort. REVISTA BRASILEIRA DE REUMATOLOGIA 2015; 56:22-7. [PMID: 27267330 DOI: 10.1016/j.rbre.2015.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 03/01/2015] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To analyze quality of life and demographic and clinical variables associated to its impairment in a large Brazilian cohort of patients with spondyloarthritis (SpA). METHODS A common protocol of investigation was applied to 1465 Brazilian patients classified as SpA according to the European Spondyloarthropaties Study Group (ESSG) criteria, attended at 29 reference centers for Rheumatology in Brazil. Clinical and demographic variables were recorded. Quality of life was analyzed through the Ankylosing Spondylitis Quality of Life (ASQoL) questionnaire. RESULTS The mean ASQoL score was 7.74 (+5.39). When analyzing the specific diseases in the SpA group, the ASQoL scores did not present statistical significance. Demographic data showed worse scores of ASQoL associated with female gender (p=0.014) and African-Brazilian ethnicity (p<0.001). The analysis of the clinical symptoms showed that buttock pain (p=0.032), cervical pain (p<0.001) and hip pain (p=0.001) were statistically associated with worse scores of ASQoL. Continuous use of nonsteroidal anti-inflammatory drugs (p<0.001) and biologic agents (p=0.044) were associated with higher scores of ASQoL, while the other medications did not interfere with the ASQoL scores. CONCLUSION In this large series of patients with SpA, female gender and African-Brazilian ethnicity, as well as predominant axial symptoms, were associated with impaired quality of life.
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Affiliation(s)
| | | | | | - Célio R Gonçalves
- Disciplina de Reumatologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | | | | | | | - Rita Menin
- Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brazil
| | | | - Sueli Carneiro
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | | | | | | | | | | | - Izaias P Costa
- Universidade Federal do Mato Grosso do Sul, Campo Grande, MS, Brazil
| | | | - Charles L Kohem
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Nocy H Leite
- Faculdade de Medicina Souza Marques, Rio de Janeiro, RJ, Brazil
| | - Sonia A L Lima
- Hospital do Servidor Público Estadual, São Paulo, SP, Brazil
| | - Eduardo S Meirelles
- Instituto de Ortopedia e Traumatologia, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Ivânio A Pereira
- Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | | | | | | | | | | | | | - Valéria Valim
- Universidade Federal do Espírito Santo, Vitória, ES, Brazil
| | - Percival D Sampaio-Barros
- Disciplina de Reumatologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
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Dougados M, Tsai WC, Saaibi DL, Bonin R, Bukowski J, Pedersen R, Vlahos B, Kotak S. Evaluation of Health Outcomes with Etanercept Treatment in Patients with Early Nonradiographic Axial Spondyloarthritis. J Rheumatol 2015; 42:1835-41. [DOI: 10.3899/jrheum.141313] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2015] [Indexed: 01/31/2023]
Abstract
Objective.Analyses were conducted to examine the baseline burden of illness and compare the effect of etanercept (ETN) versus placebo (PBO) on quality of life (QOL) in patients with nonradiographic axial spondyloarthritis (nr-axSpA) who failed nonsteroidal antiinflammatory drugs (NSAID).Methods.Patients fulfilling the Assessment of Spondyloarthritis International Society axSpA criteria, not meeting the modified New York criteria for ankylosing spondylitis (AS), who were symptomatic 3 months to 5 years, with a Bath AS Disease Activity Index score ≥ 4, and failed ≥ 2 NSAID were randomized to ETN 50 mg weekly or PBO (double-blind) for 12 weeks, followed by open-label ETN 50 mg for 92 weeks. Stable NSAID were allowed throughout our study. QOL outcomes over 24 weeks were analyzed using ANCOVA models.Results.At baseline, Multidimensional Fatigue Inventory (MFI; ETN mean 14.7, PBO mean 15.0), EQ-5D utility (0.52, 0.57), EQ-5D visual analog scale (56.5, 56.4), and Medical Outcomes Study (MOS) Sleep Index II (45.5, 48.1) were worse than population norms (6.6–8.0, 0.86, 82.5, and 25.8, respectively). At Week 12, Bath AS Patient Global Score, nocturnal and average back pain, MOS Short Form-36 (SF-36) physical component, and Work Productivity and Activity Index (WPAI) presenteeism and activity impairment favored ETN (p < 0.05). Nonsignificant improvements for ETN were seen in other WPAI domains, MFI, MOS-Sleep Index I and II, Hospital Anxiety and Depression Scale, EQ-5D utility score, and SF-36 mental component (p > 0.05). At Week 24, patients in the PBO group who had switched to ETN at Week 12 showed improvement in most QOL assessments, similar to that seen in patients receiving ETN for 24 weeks.Conclusion.Improvements favored ETN in QOL and productivity measures, with limited improvement on general QOL measures. Short disease duration, a short PBO-controlled period, and a wide range of QOL scores at baseline may have influenced improvements.
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van der Heijde D, Breban M, Halter D, DiVittorio G, Bratt J, Cantini F, Kary S, Pangan AL, Kupper H, Rathmann SS, Sieper J, Mease PJ. Maintenance of improvement in spinal mobility, physical function and quality of life in patients with ankylosing spondylitis after 5 years in a clinical trial of adalimumab. Rheumatology (Oxford) 2014; 54:1210-9. [PMID: 25541333 PMCID: PMC4473764 DOI: 10.1093/rheumatology/keu438] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Chronic pain and progressive loss of physical function with AS may adversely affect health-related quality of life (HRQoL). The objective of this study was to assess the 5-year data regarding spinal mobility, physical function and HRQoL in patients with AS who participated in the Adalimumab Trial Evaluating Long-term Efficacy and Safety for AS (ATLAS) study. METHODS Patients received blinded adalimumab 40 mg or placebo every other week for 24 weeks, then open-label adalimumab for up to 5 years. Spinal mobility was evaluated using linear BASMI (BASMIlin). BASDAI, total back pain, CRP, BASFI, Short Form-36 and AS quality of life (ASQoL) were also assessed. Correlations between BASMIlin and clinical, functional and ASQoL outcomes after 12 weeks and after 5years of adalimumab exposure were evaluated using Spearman's rank correlation. Associations were further analysed using multivariate regression. RESULTS Three hundred and eleven patients received ≥1 dose of adalimumab; 125 of the 208 patients originally randomized to adalimumab received treatment for 5 years. Improvements in BASMIlin were sustained through 5 years, with a mean change of -0.6 from baseline in the population who completed 5 years of treatment with adalimumab. Improvements in disease activity, physical function and ASQoL were also sustained through 5 years. BASMIlin was significantly correlated with all evaluated clinical outcomes (P < 0.001). The highest correlation was with BASFI at 12 weeks (r = 0.52) and at 5 years (r = 0.65). Multivariate regression analysis confirmed this association (P < 0.001). CONCLUSION Treatment with adalimumab for up to 5 years demonstrated sustained benefits in spinal mobility, disease activity, physical function and HRQoL in patients with active AS. Spinal mobility was significantly associated with short- and long-term physical function in these patients. TRIAL REGISTRATION Clinicaltrials.gov; https://clinicaltrials.gov/NCT00085644.
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Affiliation(s)
- Désirée van der Heijde
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands, Rheumatology Division, Hôpital Ambroise Paré, AP-HP, University of Versailles-Saint-Quentin-en-Yvelines, Boulogne-Billancourt Cedex, France, Houston Institute for Clinical Research, Houston, TX, Coastal Clinical Research, Inc., Mobile, AL, USA, Department of Rheumatology, Karolinska University Hospital, Huddinge, Sweden, Department of Rheumatology, Nuovo Ospedale S. Stefano, Prato, Italy, Pharmaceutical Development, AbbVie Deutschland GmbH & Co. KG, Ludwigshafen, Germany, Pharmaceutical Development, AbbVie, Data and Statistical Sciences, AbbVie, North Chicago, IL, USA, Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany and Rheumatology and Internal Medicine, Seattle Rheumatology Associates, Swedish Medical Center, University of Washington School of Medicine, Seattle, WA, USA
| | - Maxime Breban
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands, Rheumatology Division, Hôpital Ambroise Paré, AP-HP, University of Versailles-Saint-Quentin-en-Yvelines, Boulogne-Billancourt Cedex, France, Houston Institute for Clinical Research, Houston, TX, Coastal Clinical Research, Inc., Mobile, AL, USA, Department of Rheumatology, Karolinska University Hospital, Huddinge, Sweden, Department of Rheumatology, Nuovo Ospedale S. Stefano, Prato, Italy, Pharmaceutical Development, AbbVie Deutschland GmbH & Co. KG, Ludwigshafen, Germany, Pharmaceutical Development, AbbVie, Data and Statistical Sciences, AbbVie, North Chicago, IL, USA, Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany and Rheumatology and Internal Medicine, Seattle Rheumatology Associates, Swedish Medical Center, University of Washington School of Medicine, Seattle, WA, USA
| | - Dale Halter
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands, Rheumatology Division, Hôpital Ambroise Paré, AP-HP, University of Versailles-Saint-Quentin-en-Yvelines, Boulogne-Billancourt Cedex, France, Houston Institute for Clinical Research, Houston, TX, Coastal Clinical Research, Inc., Mobile, AL, USA, Department of Rheumatology, Karolinska University Hospital, Huddinge, Sweden, Department of Rheumatology, Nuovo Ospedale S. Stefano, Prato, Italy, Pharmaceutical Development, AbbVie Deutschland GmbH & Co. KG, Ludwigshafen, Germany, Pharmaceutical Development, AbbVie, Data and Statistical Sciences, AbbVie, North Chicago, IL, USA, Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany and Rheumatology and Internal Medicine, Seattle Rheumatology Associates, Swedish Medical Center, University of Washington School of Medicine, Seattle, WA, USA
| | - Gino DiVittorio
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands, Rheumatology Division, Hôpital Ambroise Paré, AP-HP, University of Versailles-Saint-Quentin-en-Yvelines, Boulogne-Billancourt Cedex, France, Houston Institute for Clinical Research, Houston, TX, Coastal Clinical Research, Inc., Mobile, AL, USA, Department of Rheumatology, Karolinska University Hospital, Huddinge, Sweden, Department of Rheumatology, Nuovo Ospedale S. Stefano, Prato, Italy, Pharmaceutical Development, AbbVie Deutschland GmbH & Co. KG, Ludwigshafen, Germany, Pharmaceutical Development, AbbVie, Data and Statistical Sciences, AbbVie, North Chicago, IL, USA, Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany and Rheumatology and Internal Medicine, Seattle Rheumatology Associates, Swedish Medical Center, University of Washington School of Medicine, Seattle, WA, USA
| | - Johan Bratt
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands, Rheumatology Division, Hôpital Ambroise Paré, AP-HP, University of Versailles-Saint-Quentin-en-Yvelines, Boulogne-Billancourt Cedex, France, Houston Institute for Clinical Research, Houston, TX, Coastal Clinical Research, Inc., Mobile, AL, USA, Department of Rheumatology, Karolinska University Hospital, Huddinge, Sweden, Department of Rheumatology, Nuovo Ospedale S. Stefano, Prato, Italy, Pharmaceutical Development, AbbVie Deutschland GmbH & Co. KG, Ludwigshafen, Germany, Pharmaceutical Development, AbbVie, Data and Statistical Sciences, AbbVie, North Chicago, IL, USA, Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany and Rheumatology and Internal Medicine, Seattle Rheumatology Associates, Swedish Medical Center, University of Washington School of Medicine, Seattle, WA, USA
| | - Fabrizio Cantini
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands, Rheumatology Division, Hôpital Ambroise Paré, AP-HP, University of Versailles-Saint-Quentin-en-Yvelines, Boulogne-Billancourt Cedex, France, Houston Institute for Clinical Research, Houston, TX, Coastal Clinical Research, Inc., Mobile, AL, USA, Department of Rheumatology, Karolinska University Hospital, Huddinge, Sweden, Department of Rheumatology, Nuovo Ospedale S. Stefano, Prato, Italy, Pharmaceutical Development, AbbVie Deutschland GmbH & Co. KG, Ludwigshafen, Germany, Pharmaceutical Development, AbbVie, Data and Statistical Sciences, AbbVie, North Chicago, IL, USA, Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany and Rheumatology and Internal Medicine, Seattle Rheumatology Associates, Swedish Medical Center, University of Washington School of Medicine, Seattle, WA, USA
| | - Sonja Kary
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands, Rheumatology Division, Hôpital Ambroise Paré, AP-HP, University of Versailles-Saint-Quentin-en-Yvelines, Boulogne-Billancourt Cedex, France, Houston Institute for Clinical Research, Houston, TX, Coastal Clinical Research, Inc., Mobile, AL, USA, Department of Rheumatology, Karolinska University Hospital, Huddinge, Sweden, Department of Rheumatology, Nuovo Ospedale S. Stefano, Prato, Italy, Pharmaceutical Development, AbbVie Deutschland GmbH & Co. KG, Ludwigshafen, Germany, Pharmaceutical Development, AbbVie, Data and Statistical Sciences, AbbVie, North Chicago, IL, USA, Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany and Rheumatology and Internal Medicine, Seattle Rheumatology Associates, Swedish Medical Center, University of Washington School of Medicine, Seattle, WA, USA
| | - Aileen L Pangan
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands, Rheumatology Division, Hôpital Ambroise Paré, AP-HP, University of Versailles-Saint-Quentin-en-Yvelines, Boulogne-Billancourt Cedex, France, Houston Institute for Clinical Research, Houston, TX, Coastal Clinical Research, Inc., Mobile, AL, USA, Department of Rheumatology, Karolinska University Hospital, Huddinge, Sweden, Department of Rheumatology, Nuovo Ospedale S. Stefano, Prato, Italy, Pharmaceutical Development, AbbVie Deutschland GmbH & Co. KG, Ludwigshafen, Germany, Pharmaceutical Development, AbbVie, Data and Statistical Sciences, AbbVie, North Chicago, IL, USA, Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany and Rheumatology and Internal Medicine, Seattle Rheumatology Associates, Swedish Medical Center, University of Washington School of Medicine, Seattle, WA, USA
| | - Hartmut Kupper
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands, Rheumatology Division, Hôpital Ambroise Paré, AP-HP, University of Versailles-Saint-Quentin-en-Yvelines, Boulogne-Billancourt Cedex, France, Houston Institute for Clinical Research, Houston, TX, Coastal Clinical Research, Inc., Mobile, AL, USA, Department of Rheumatology, Karolinska University Hospital, Huddinge, Sweden, Department of Rheumatology, Nuovo Ospedale S. Stefano, Prato, Italy, Pharmaceutical Development, AbbVie Deutschland GmbH & Co. KG, Ludwigshafen, Germany, Pharmaceutical Development, AbbVie, Data and Statistical Sciences, AbbVie, North Chicago, IL, USA, Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany and Rheumatology and Internal Medicine, Seattle Rheumatology Associates, Swedish Medical Center, University of Washington School of Medicine, Seattle, WA, USA
| | - Suchitrita S Rathmann
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands, Rheumatology Division, Hôpital Ambroise Paré, AP-HP, University of Versailles-Saint-Quentin-en-Yvelines, Boulogne-Billancourt Cedex, France, Houston Institute for Clinical Research, Houston, TX, Coastal Clinical Research, Inc., Mobile, AL, USA, Department of Rheumatology, Karolinska University Hospital, Huddinge, Sweden, Department of Rheumatology, Nuovo Ospedale S. Stefano, Prato, Italy, Pharmaceutical Development, AbbVie Deutschland GmbH & Co. KG, Ludwigshafen, Germany, Pharmaceutical Development, AbbVie, Data and Statistical Sciences, AbbVie, North Chicago, IL, USA, Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany and Rheumatology and Internal Medicine, Seattle Rheumatology Associates, Swedish Medical Center, University of Washington School of Medicine, Seattle, WA, USA
| | - Joachim Sieper
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands, Rheumatology Division, Hôpital Ambroise Paré, AP-HP, University of Versailles-Saint-Quentin-en-Yvelines, Boulogne-Billancourt Cedex, France, Houston Institute for Clinical Research, Houston, TX, Coastal Clinical Research, Inc., Mobile, AL, USA, Department of Rheumatology, Karolinska University Hospital, Huddinge, Sweden, Department of Rheumatology, Nuovo Ospedale S. Stefano, Prato, Italy, Pharmaceutical Development, AbbVie Deutschland GmbH & Co. KG, Ludwigshafen, Germany, Pharmaceutical Development, AbbVie, Data and Statistical Sciences, AbbVie, North Chicago, IL, USA, Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany and Rheumatology and Internal Medicine, Seattle Rheumatology Associates, Swedish Medical Center, University of Washington School of Medicine, Seattle, WA, USA
| | - Phillip J Mease
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands, Rheumatology Division, Hôpital Ambroise Paré, AP-HP, University of Versailles-Saint-Quentin-en-Yvelines, Boulogne-Billancourt Cedex, France, Houston Institute for Clinical Research, Houston, TX, Coastal Clinical Research, Inc., Mobile, AL, USA, Department of Rheumatology, Karolinska University Hospital, Huddinge, Sweden, Department of Rheumatology, Nuovo Ospedale S. Stefano, Prato, Italy, Pharmaceutical Development, AbbVie Deutschland GmbH & Co. KG, Ludwigshafen, Germany, Pharmaceutical Development, AbbVie, Data and Statistical Sciences, AbbVie, North Chicago, IL, USA, Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany and Rheumatology and Internal Medicine, Seattle Rheumatology Associates, Swedish Medical Center, University of Washington School of Medicine, Seattle, WA, USA
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Physical functioning in patients with ankylosing spondylitis: comparing approaches of experienced ability with self-reported and objectively measured physical activity. J Clin Rheumatol 2014; 20:133-7. [PMID: 24662553 DOI: 10.1097/rhu.0000000000000086] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Physical functioning can be assessed by different approaches that are characterized by increasing levels of individual appraisal. There is insufficient insight into which approach is the most informative in patients with ankylosing spondylitis (AS) compared with control subjects. OBJECTIVE The objective of this study was to compare patients with AS and control subjects regarding 3 approaches of functioning: experienced ability to perform activities (Bath Ankylosing Spondylitis Functional Index [BASFI]), self-reported amount of physical activity (PA) (Baecke questionnaire), and the objectively measured amount of PA (triaxial accelerometer). METHODS This case-control study included 24 AS patients and 24 control subjects (matched for age, gender, and body mass index). Subjects completed the BASFI and Baecke questionnaire and wore a triaxial accelerometer. Subjects also completed other self-reported measures on disease activity (Bath AS Disease Activity Index), fatigue (Multidimensional Fatigue Inventory), and overall health (EuroQol visual analog scale). RESULTS Both groups included 14 men (58%), and the mean age was 48 years. Patients scored significantly worse on the BASFI (3.9 vs 0.2) than their healthy peers, whereas PA assessed by Baecke and the accelerometer did not differ between groups. Correlations between approaches of physical functioning were low to moderate. Bath Ankylosing Spondylitis Functional Index was associated with disease activity (r = 0.49) and physical fatigue (0.73) and Baecke with physical and activity related fatigue (r = 0.54 and r = 0.54), but total PA assessed by accelerometer was not associated with any of these experience-based health outcomes. CONCLUSIONS Different approaches of the concept physical functioning in patients with AS provide different information. Compared with matched control subjects, patients with AS report more difficulties but report and objectively perform the same amount of PA.
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¿Cómo comparar fármacos biológicos? ACTA ACUST UNITED AC 2014; 10:353-9. [DOI: 10.1016/j.reuma.2014.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 06/04/2014] [Accepted: 06/15/2014] [Indexed: 12/17/2022]
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Kotsis K, Voulgari PV, Drosos AA, Carvalho AF, Hyphantis T. Health-related quality of life in patients with ankylosing spondylitis: a comprehensive review. Expert Rev Pharmacoecon Outcomes Res 2014; 14:857-72. [PMID: 25193010 DOI: 10.1586/14737167.2014.957679] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Ankylosing spondylitis (AS) is a complex systemic rheumatological disease which often causes severe disability and impaired quality of life (QoL). We searched the PubMed/MEDLINE electronic database for available literature on QoL and its predictors in patients with AS. Recent evidence indicates that AS patients have poorer QoL compared to the general population, but similar to that of patients with other rheumatological disorders. Disease activity is one of the most powerful predictors of QoL, however latest advances in pharmacological treatment (namely, anti-TNF-α) along with physical exercise can minimize the effects of AS on QoL. Psychological distress symptoms contribute to impaired QoL both directly and indirectly by influencing disease activity. The impact of other psychosocial variables, however, is less studied and more prospective investigations are necessary, which could eventually lead to the development of psychosocial interventions that are personalized to this patient population.
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Affiliation(s)
- Konstantinos Kotsis
- Department of Psychiatry, Division of Medicine, School of Health Sciences, University of Ioannina, Ioannina 45110, Greece
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Kiltz U, Mau W, Repschläger U, Böhle E, Braun J. [German Society for Rheumatology S3 guidelines on axial spondyloarthritis including Bechterew's disease and early forms: 9 International classification of functioning, disability and health (ICF)]. Z Rheumatol 2014; 73 Suppl 2:104-8. [PMID: 25181981 DOI: 10.1007/s00393-014-1434-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- U Kiltz
- Deutsche Gesellschaft für Rheumatologie (DGRh), -, -,
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Kiltz U, Sieper J, Kellner H, Krause D, Rudwaleit M, Chenot JF, Stallmach A, Jaresch S, Braun J. [German Society for Rheumatology S3 guidelines on axial spondyloarthritis including Bechterew's disease and early forms: 8.4 Pharmaceutical therapy, 8.5 Evaluation of therapy success of pharmaceutical measures]. Z Rheumatol 2014; 73 Suppl 2:78-96. [PMID: 25181978 DOI: 10.1007/s00393-014-1443-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- U Kiltz
- Deutsche Gesellschaft für Rheumatologie (DGRh), Berlin, Deutschland,
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Salaffi F, Ciapetti A, Carotti M, Gasparini S, Citera G, Gutierrez M. Construct validity and responsiveness of the simplified version of Ankylosing Spondylitis Disease Activity Score (SASDAS) for the evaluation of disease activity in axial spondyloarthritis. Health Qual Life Outcomes 2014; 12:129. [PMID: 25146299 PMCID: PMC4243811 DOI: 10.1186/s12955-014-0129-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 08/07/2014] [Indexed: 01/21/2023] Open
Abstract
Background Over the last decade, significant progresses have been achieved in the development and validation of new tools for the evaluation of disease activity in axial spondyloarthritis (SpA). Despite they play a key role in the assessment of these patients, the calculation scores are relatively complex and difficult to be quickly assessed in the busy daily clinical practice. Objectives To test the construct validity of the Simplified Ankylosing Spondylitis Disease Activity Score (SADSAS) to define disease activity and compare its internal and external responsiveness with the Ankylosing Spondylitis Disease Activity Score (ASDAS) and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) in patients with axial SpA. Methods The patient cohort comprised 397 consecutive axial SpA patients who had never been treated with tumor necrosis factor (TNF) blockers. Clinical and laboratory outcome assessments were performed at baseline, and at week 24. The following parameters were evaluated: BASDAI, ASDAS-CRP, ASDAS-ESR, and SASDAS. Construct convergent validity was evaluated by correlating SASDAS with ASDAS CRP/ESR, BASDAI, Bath Ankylosing Spondylitis Functional Index (BASFI) and EuroQol five-dimensional (EQ-5D) questionnaire. One hundred and fifty-six patients were observed longitudinally for 6 months. Responsiveness was assessed after six months of treatment with sulfasalazine (SSZ) or biologics. Internal responsiveness was evaluated by using the effect size (ES) and standardized response mean (SRM). External responsiveness was investigated by receiver operating characteristic (ROC) analysis. Change scores were compared by calculating paired t-test statistic for the difference. Results In testing for convergent validity a strong correlations (p < 0.0001) were observed between both SASDAS and ASDAS-ESR (r = 0.835), and ASDAS-CRP (r = 0.805). Strong correlations (p < 0.0001) were also found between SASDAS and BASDAI score (r = −0.886), SASDAS and BASFI scores (rho = 0.588) and SASDAS and EQ-5D scores (rho = −0.579). The cross-classification showed a significant overall agreement (defined as the percentage of observed exact agreements) for SASDAS vs ASDAS-ESR (weighted k = 0.704) and for SASDAS vs ASDAS-CRP (k = 0.661). The most efficient composite measure in detecting change was the ASDAS-CRP (ES 1.95 and SRM 0.97). The responsiveness of SASDAS was slightly higher to ASDAS-ESR with an ES of 1.62 and 1.33, and an SRM of 0.88 and 0.71, respectively. The BASDAI appear to be the less responsive (ES = 0.93 and SRM = 0.52). The area under ROC curve of the SASDAS gives similar results to those provided by ASDAS CRP/ESR. The score changes of all combinations were highly correlated (p < 0.0001). Conclusions The new SASDAS is a highly effective measure in assessing disease activity and it showed comparable internal and external responsiveness with respect to the ASDAS ESR/CRP response criteria in patients with axial SpA. SASDAS is easy to calculate and, therefore, appear suitable for clinical decision making, epidemiologic research, and clinical trials. Electronic supplementary material The online version of this article (doi:10.1186/s12955-014-0129-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fausto Salaffi
- Rheumatology Department, Polytechnic University of the Marche, Jesi, Ancona, Italy.
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van der Heijde D, Deodhar A, Braun J, Mack M, Hsu B, Gathany TA, Inman RD, Han C. The effect of golimumab therapy on disease activity and health-related quality of life in patients with ankylosing spondylitis: 2-year results of the GO-RAISE trial. J Rheumatol 2014; 41:1095-103. [PMID: 24737912 DOI: 10.3899/jrheum.131003] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To evaluate the effects of golimumab therapy on achieving inactive disease or major improvement, as assessed by the Ankylosing Spondylitis Disease Activity Score (ASDAS), and improvements in health-related quality of life (HRQOL) and productivity through 2 years in patients with AS. METHODS In the phase III GO-RAISE trial, 356 patients were randomized to placebo with crossover to golimumab 50 mg at Week 24 (n = 78), golimumab 50 mg (n = 138), or golimumab 100 mg (n = 140) at baseline and every 4 weeks. The proportions of patients with ASDAS major improvement (improvement ≥ 2.0) or inactive disease (score < 1.3) were determined. HRQOL was assessed using the 36-item Medical Outcomes Study Short Form-36 physical/mental component summary (SF-36 PCS/MCS) scores (normal score ≥ 50). The effect of disease on productivity was assessed by visual analog scale (0-10). Regression analyses on the association of disease activity and HRQOL were performed. The final assessment was at Week 104. RESULTS Significantly greater proportions of golimumab-treated patients achieved ASDAS major improvement or inactive disease at weeks 14 and 24 versus placebo. Through Week 104, patients who achieved ASDAS inactive disease or major improvement had significantly greater improvements in SF-36 PCS and MCS scores and productivity than did patients not meeting these targets. Among all patients, achieving ASDAS inactive disease at weeks 52 and 104 was associated with normalized SF-36 PCS/MCS scores and significant improvements in work productivity. CONCLUSION Greater proportions of golimumab-treated patients achieved ASDAS major improvement or inactive disease and improved HRQOL versus placebo. Achieving an inactive disease state by ASDAS criteria (< 1.3) was associated with normalized HRQOL through 2 years.
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Affiliation(s)
- Désirée van der Heijde
- From the Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; Oregon Health and Science University, Portland, Oregon, USA; Rheumazentrum Ruhrgebiet, Herne, Germany; Biostatistics and Immunology, Janssen Research & Development LLC, Spring House; Janssen Global Services, Malvern, Pennsylvania, USA; Department of Medicine and Immunology, University of Toronto, Toronto, Ontario, Canada.D. van der Heijde, MD, Rheumatology Department, Leiden University Medical Center; A. Deodhar, MD, Oregon Health & Science University; J. Braun, MD, Rheumazentrum Ruhrgebiet; M. Mack, PhD, Biostatistics, Janssen Research & Development LLC; B. Hsu, MD, PhD, Immunology, Janssen Research & Development LLC; T.A. Gathany, MSEd, Janssen Global Services; R.D. Inman, MD, FRCPC, FACP, FRCP Edin, Department of Medicine and Immunology, University of Toronto; C. Han, PhD, Janssen Global Services.
| | - Atul Deodhar
- From the Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; Oregon Health and Science University, Portland, Oregon, USA; Rheumazentrum Ruhrgebiet, Herne, Germany; Biostatistics and Immunology, Janssen Research & Development LLC, Spring House; Janssen Global Services, Malvern, Pennsylvania, USA; Department of Medicine and Immunology, University of Toronto, Toronto, Ontario, Canada.D. van der Heijde, MD, Rheumatology Department, Leiden University Medical Center; A. Deodhar, MD, Oregon Health & Science University; J. Braun, MD, Rheumazentrum Ruhrgebiet; M. Mack, PhD, Biostatistics, Janssen Research & Development LLC; B. Hsu, MD, PhD, Immunology, Janssen Research & Development LLC; T.A. Gathany, MSEd, Janssen Global Services; R.D. Inman, MD, FRCPC, FACP, FRCP Edin, Department of Medicine and Immunology, University of Toronto; C. Han, PhD, Janssen Global Services
| | - Jürgen Braun
- From the Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; Oregon Health and Science University, Portland, Oregon, USA; Rheumazentrum Ruhrgebiet, Herne, Germany; Biostatistics and Immunology, Janssen Research & Development LLC, Spring House; Janssen Global Services, Malvern, Pennsylvania, USA; Department of Medicine and Immunology, University of Toronto, Toronto, Ontario, Canada.D. van der Heijde, MD, Rheumatology Department, Leiden University Medical Center; A. Deodhar, MD, Oregon Health & Science University; J. Braun, MD, Rheumazentrum Ruhrgebiet; M. Mack, PhD, Biostatistics, Janssen Research & Development LLC; B. Hsu, MD, PhD, Immunology, Janssen Research & Development LLC; T.A. Gathany, MSEd, Janssen Global Services; R.D. Inman, MD, FRCPC, FACP, FRCP Edin, Department of Medicine and Immunology, University of Toronto; C. Han, PhD, Janssen Global Services
| | - Michael Mack
- From the Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; Oregon Health and Science University, Portland, Oregon, USA; Rheumazentrum Ruhrgebiet, Herne, Germany; Biostatistics and Immunology, Janssen Research & Development LLC, Spring House; Janssen Global Services, Malvern, Pennsylvania, USA; Department of Medicine and Immunology, University of Toronto, Toronto, Ontario, Canada.D. van der Heijde, MD, Rheumatology Department, Leiden University Medical Center; A. Deodhar, MD, Oregon Health & Science University; J. Braun, MD, Rheumazentrum Ruhrgebiet; M. Mack, PhD, Biostatistics, Janssen Research & Development LLC; B. Hsu, MD, PhD, Immunology, Janssen Research & Development LLC; T.A. Gathany, MSEd, Janssen Global Services; R.D. Inman, MD, FRCPC, FACP, FRCP Edin, Department of Medicine and Immunology, University of Toronto; C. Han, PhD, Janssen Global Services
| | - Benjamin Hsu
- From the Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; Oregon Health and Science University, Portland, Oregon, USA; Rheumazentrum Ruhrgebiet, Herne, Germany; Biostatistics and Immunology, Janssen Research & Development LLC, Spring House; Janssen Global Services, Malvern, Pennsylvania, USA; Department of Medicine and Immunology, University of Toronto, Toronto, Ontario, Canada.D. van der Heijde, MD, Rheumatology Department, Leiden University Medical Center; A. Deodhar, MD, Oregon Health & Science University; J. Braun, MD, Rheumazentrum Ruhrgebiet; M. Mack, PhD, Biostatistics, Janssen Research & Development LLC; B. Hsu, MD, PhD, Immunology, Janssen Research & Development LLC; T.A. Gathany, MSEd, Janssen Global Services; R.D. Inman, MD, FRCPC, FACP, FRCP Edin, Department of Medicine and Immunology, University of Toronto; C. Han, PhD, Janssen Global Services
| | - Timothy A Gathany
- From the Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; Oregon Health and Science University, Portland, Oregon, USA; Rheumazentrum Ruhrgebiet, Herne, Germany; Biostatistics and Immunology, Janssen Research & Development LLC, Spring House; Janssen Global Services, Malvern, Pennsylvania, USA; Department of Medicine and Immunology, University of Toronto, Toronto, Ontario, Canada.D. van der Heijde, MD, Rheumatology Department, Leiden University Medical Center; A. Deodhar, MD, Oregon Health & Science University; J. Braun, MD, Rheumazentrum Ruhrgebiet; M. Mack, PhD, Biostatistics, Janssen Research & Development LLC; B. Hsu, MD, PhD, Immunology, Janssen Research & Development LLC; T.A. Gathany, MSEd, Janssen Global Services; R.D. Inman, MD, FRCPC, FACP, FRCP Edin, Department of Medicine and Immunology, University of Toronto; C. Han, PhD, Janssen Global Services
| | - Robert D Inman
- From the Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; Oregon Health and Science University, Portland, Oregon, USA; Rheumazentrum Ruhrgebiet, Herne, Germany; Biostatistics and Immunology, Janssen Research & Development LLC, Spring House; Janssen Global Services, Malvern, Pennsylvania, USA; Department of Medicine and Immunology, University of Toronto, Toronto, Ontario, Canada.D. van der Heijde, MD, Rheumatology Department, Leiden University Medical Center; A. Deodhar, MD, Oregon Health & Science University; J. Braun, MD, Rheumazentrum Ruhrgebiet; M. Mack, PhD, Biostatistics, Janssen Research & Development LLC; B. Hsu, MD, PhD, Immunology, Janssen Research & Development LLC; T.A. Gathany, MSEd, Janssen Global Services; R.D. Inman, MD, FRCPC, FACP, FRCP Edin, Department of Medicine and Immunology, University of Toronto; C. Han, PhD, Janssen Global Services
| | - Chenglong Han
- From the Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; Oregon Health and Science University, Portland, Oregon, USA; Rheumazentrum Ruhrgebiet, Herne, Germany; Biostatistics and Immunology, Janssen Research & Development LLC, Spring House; Janssen Global Services, Malvern, Pennsylvania, USA; Department of Medicine and Immunology, University of Toronto, Toronto, Ontario, Canada.D. van der Heijde, MD, Rheumatology Department, Leiden University Medical Center; A. Deodhar, MD, Oregon Health & Science University; J. Braun, MD, Rheumazentrum Ruhrgebiet; M. Mack, PhD, Biostatistics, Janssen Research & Development LLC; B. Hsu, MD, PhD, Immunology, Janssen Research & Development LLC; T.A. Gathany, MSEd, Janssen Global Services; R.D. Inman, MD, FRCPC, FACP, FRCP Edin, Department of Medicine and Immunology, University of Toronto; C. Han, PhD, Janssen Global Services
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Lu G, Kounali D, Ades AE. Simultaneous multioutcome synthesis and mapping of treatment effects to a common scale. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2014; 17:280-287. [PMID: 24636388 PMCID: PMC3991420 DOI: 10.1016/j.jval.2013.12.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 11/26/2013] [Accepted: 12/09/2013] [Indexed: 05/31/2023]
Abstract
OBJECTIVES A new method is presented for both synthesizing treatment effects on multiple outcomes subject to measurement error and estimating coherent mapping coefficients between all outcomes. It can be applied to sets of trials reporting different combinations of patient- or clinician-reported outcomes, including both disease-specific measures and generic health-related quality-of-life measures. It is underpinned by a structural equation model that includes measurement error and latent common treatment effect factor. Treatment effects can be expressed on any of the test instruments that have been used. METHODS This is illustrated in a synthesis of eight placebo-controlled trials of TNF-α inhibitors in ankylosing spondylitis, each reporting treatment effects on between two and five of a total six test instruments. RESULTS The method has advantages over other methods for synthesis of multiple outcome data, including standardization and multivariate normal synthesis. Unlike standardization, it allows synthesis of treatment effect information from test instruments sensitive to different underlying constructs. It represents a special case of previously proposed multivariate normal models for evidence synthesis, but unlike the former, it also estimates mappings. Combining synthesis and mapping as a single operation makes more efficient use of available data than do current mapping methods and generates treatment effects that are consistent with the mappings. A limitation, however, is that it can only generate mappings to and from those instruments on which some trial data exist. CONCLUSIONS The method should be assessed in a wide range of data sets on different clinical conditions, before it can be used routinely in health technology assessment.
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Affiliation(s)
- Guobing Lu
- School of Social & Community Medicine, University of Bristol, Bristol, UK
| | - Daphne Kounali
- School of Social & Community Medicine, University of Bristol, Bristol, UK
| | - A E Ades
- School of Social & Community Medicine, University of Bristol, Bristol, UK.
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Wang H, Zuo D, Sun M, Hua Y, Cai Z. Randomized, placebo controlled and double-blind trials of efficacy and safety of adalimumab for treating ankylosing spondylitis: a meta-analysis. Int J Rheum Dis 2014; 17:142-8. [PMID: 24506823 DOI: 10.1111/1756-185x.12245] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Adalimumab is a fully human, anti-TNF monoclonal antibody of proven efficacy and safety in the treatment of the signs, symptoms and functional disability of ankylosing spondylitis (AS). A systematic review and meta-analysis was performed to assess the efficacy and safety of adalimumab treatment, relative to a placebo, in adult patients with AS. In the efficacy meta-analysis, significantly more patients in the adalimumab group achieved Assessment in AS International Working Group (ASAS)20 and Bath AS Disease Activity Index (BASDAI)50 compared with patients in the placebo group. Patients in the adalimumab group also showed significant improvement in BASDAI and health-related quality of life. With regard to adverse events, any adverse events and injection-site reaction were significantly higher in the adalimumab group compared with the control group. This meta-analysis shows a higher efficacy of adalimumab relative to placebo, but clinicians should be careful regarding adverse events in adalimumab-treated patients.
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Affiliation(s)
- Hongsheng Wang
- Shanghai 10th People's Hospital, Tongji University School of Medicine, Shanghai, China
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Poddubnyy D, Rudwaleit M. Adalimumab for the treatment of ankylosing spondylitis and nonradiographic axial spondyloarthritis - a five-year update. Expert Opin Biol Ther 2013; 13:1599-611. [PMID: 24074224 DOI: 10.1517/14712598.2013.839653] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Following its marketing authorization for the treatment of ankylosing spondylitis (AS) in 2006 in the United States und in the European Union, adalimumab became one of the most frequently prescribed tumor necrosis factor (TNF) α blockers available for this indication. Recently, the label for adalimumab was extended to nonradiographic axial spondyloarthritis (nr-axSpA), which might be considered as an early stage of AS. The increasing number of patients with AS being treated with adalimumab raises issues concerning long-term safety, efficacy in the prevention of structural damage in the spine and high treatment costs. AREAS COVERED Herein, we summarize data on efficacy and safety of adalimumab treatment in AS and nr-axSpA obtained over the past 5 years. EXPERT OPINION Adalimumab is clinically effective and reasonably safe in the short-term and long-term treatment of patients with AS who do not respond to standard therapy. Recent data indicate good efficacy of adalimumab also in patients with nr-axSpA but only in the presence of objective signs of active inflammation. Yet unresolved questions relate to the ability of adalimumab to stop or retard structural damage development in the spine in patients with AS and nr-axSpA. The introduction of biosimilar drugs in the near future may potentially reduce the currently very high treatment costs associated with adalimumab treatment.
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Affiliation(s)
- Denis Poddubnyy
- Endokrinologikum Berlin, Rheumatologie , Jägerstraße 61, Berlin , Germany
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Sampaio-Barros PD, Keiserman M, Souza Meirelles ED, Medeiros Pinheiro MD, Ximenes AC, Azevedo VF, Bonfiglioli R, Carneiro S, Ranza R, Marques Bernardo W, Gonçalves CR. Recomendações sobre diagnóstico e tratamento da espondilite anquilosante. REVISTA BRASILEIRA DE REUMATOLOGIA 2013. [DOI: 10.1590/s0482-50042013000300003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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Huang F, Gu J, Zhu P, Bao C, Xu J, Xu H, Wu H, Wang G, Shi Q, Andhivarothai N, Anderson J, Pangan AL. Efficacy and safety of adalimumab in Chinese adults with active ankylosing spondylitis: results of a randomised, controlled trial. Ann Rheum Dis 2013; 73:587-94. [DOI: 10.1136/annrheumdis-2012-202533] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background and objectivesEfficacy of adalimumab for ankylosing spondylitis (AS) has been established for Western populations but not in the Chinese population. This study is the first to evaluate the efficacy and safety of adalimumab in Chinese patients with AS.MethodsChinese adults with active AS who had an inadequate response or were intolerant to ≥1 non-steroidal anti-inflammatory drugs were randomised to adalimumab 40 mg (N=229) or matching placebo (N=115) subcutaneously every other week (EOW) for 12 weeks, followed by a 12-week open-label adalimumab 40 mg EOW phase. The primary efficacy endpoint was the percentage of patients meeting the Assessment in Spondyloarthritis International Society (ASAS20) response criteria at week 12. The recently developed AS Disease Activity Score (ASDAS), as well as efficacy measures of spinal mobility, disease activity, physical function and quality of life were evaluated.ResultsAt week 12, adalimumab treatment resulted in a significantly greater percentage of ASAS20 responders than placebo (67.2% versus 30.4%, respectively; p<0.001). Differences in ASAS20 were observed as early as week 2 (42.8% vs 6.1%, respectively; p<0.001). The percentages of patients achieving ASAS40, ASAS 5/6 and ASDAS inactive disease were significantly greater with adalimumab than placebo at week 12 (all p<0.001). Tuberculosis was reported in one patient. No cases of malignancy, lymphoma, demyelinating disease or lupus-like syndrome were reported during the study.ConclusionsAdalimumab significantly reduced the signs and symptoms, improved physical function and quality of life of Chinese patients with active AS, and was generally safe and well tolerated in this population.
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Zochling J. Measures of symptoms and disease status in ankylosing spondylitis: Ankylosing Spondylitis Disease Activity Score (ASDAS), Ankylosing Spondylitis Quality of Life Scale (ASQoL), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Global Score (BAS-G), Bath Ankylosing Spondylitis Metrology Index (BASMI), Dougados Functional Index (DFI), and Health Assessment Questionnaire for the Spondylarthropathies (HAQ-S). Arthritis Care Res (Hoboken) 2012; 63 Suppl 11:S47-58. [PMID: 22588768 DOI: 10.1002/acr.20575] [Citation(s) in RCA: 196] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Goh L, Samanta A. Update on biologic therapies in ankylosing spondylitis: a literature review. Int J Rheum Dis 2012; 15:445-54. [PMID: 23083034 DOI: 10.1111/j.1756-185x.2012.01765.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
AIM The present paper aims to review the recent advances in diagnosis and management of ankylosing spondylitis (AS). METHOD Medline and abstracts submitted to the recent European League Against Rheumatism (EULAR) congress were searched to obtain quality-controlled information on the management of AS. RESULTS The use of magnetic resonance imaging (MRI) allows the diagnosis of AS to be made in the pre-radiographic stage. The Assessment in Spondylarthritis International Society recommendations for the management of AS have been modified so that patients with non-radiographic spondyloarthritis (SpA) can now be considered for biological therapy. The 'older' anti-tumour necrosis factor (TNF) continued to be effective in longer-term studies. Studies with longer duration of follow-up have shown that some patients with pre-radiographic SpA entered into prolonged drug-free remission. It is likely that in the foreseeable future, more AS patients will be treated with biological therapies at an earlier stage of the disease. New biologic therapies, golimumab and secukinumab, are looking promising in improving the signs and symptoms of AS, at least in the short-term. CONCLUSION Longer-term studies of AS patients treated with infliximab, etanercept and adalimumab continued to show a good clinical response. There is a need for more long-term studies to examine the longitudinal efficacy of golimumab and secukinumab in AS.
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Affiliation(s)
- Leslie Goh
- Department of Rheumatology, Musgrove Park Hospital, Taunton, Somerset, UK.
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Sieper J, van der Heijde D, Dougados M, Brown LS, Lavie F, Pangan AL. Early response to adalimumab predicts long-term remission through 5 years of treatment in patients with ankylosing spondylitis. Ann Rheum Dis 2011; 71:700-6. [PMID: 22128084 PMCID: PMC3329233 DOI: 10.1136/annrheumdis-2011-200358] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Objectives To describe the efficacy and safety through 5 years of adalimumab treatment in patients with ankylosing spondylitis (AS), and to identify predictors of remission. Methods Patients with active AS were followed up to 5 years during a 24-week randomised, controlled period, followed by an open-label extension. Disease activity and clinical improvement were evaluated by Assessment in Spondyloarthritis International Society (ASAS) responses, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score (ASDAS). Kaplan–Meier was used to identify patients with sustained ASAS partial remission (PR) or ASDAS inactive disease (ID) for three or more consecutive visits spanning ≥6 months. Logistic regression was used to identify factors associated with remission. Explanatory variables included baseline demographic and disease characteristics and week 12 responses. Results Of the 311 patients who received at least one dose of adalimumab, 202 (65%) completed the 5-year study. Among 125 patients who received 5 years of adalimumab, 70%, 77%, 51% and 61% achieved ASAS40, BASDAI 50, ASAS PR and ASDAS ID, respectively. Of 311 adalimumab-treated patients, 45% and 55% achieved sustained ASAS PR and ASDAS ID at any time during study participation. The strongest predictor of remission at years 1 and 5 and of sustained remission was achieving remission at 12 weeks of treatment; baseline characteristics showed weaker associations. Adverse events were comparable with previous reports on adalimumab safety. Conclusions In patients with active AS, the efficacy and safety of adalimumab were maintained through 5 years with about half of the patients experiencing sustained remission at any time during the study. Early achievement of remission was the best predictor of long-term and sustained remission.
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Affiliation(s)
- Joachim Sieper
- University Clinic Benjamin Franklin, Medical Department I, Rheumatology, PO Box, Berlin 12200, Germany.
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Poddubnyy D, Rudwaleit M. Efficacy and safety of adalimumab treatment in patients with rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis. Expert Opin Drug Saf 2011; 10:655-73. [PMID: 21554150 DOI: 10.1517/14740338.2011.581661] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION In the last couple of years, the number of patients with chronic inflammatory rheumatic diseases being treated with TNF α antagonist has increased dramatically. Adalimumab, a fully human monoclonal antibody against TNF α, is one of the most frequently administered TNF α antagonists. Yet, unresolved issues are the long-term safety of TNF α antagonists and high treatment costs. AREAS COVERED The authors summarize the available data on short- and long-term efficacy and safety of adalimumab in the treatment of rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis. The reader will find a comprehensive overview on the safety and efficacy of adalimumab for these conditions. Clinically relevant questions of adalimumab therapy are discussed. A special focus of this review is on the safety of adalimumab therapy. EXPERT OPINION Adalimumab is effective and reasonably safe in the short- and long-term treatment of patients with rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis who do not respond to the standard therapy. It inhibits radiographic progression in rheumatoid and psoriatic arthritis. Treatment with a TNF α inhibitor such as adalimumab is associated with high treatment costs.
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Affiliation(s)
- Denis Poddubnyy
- Charite - Campus Benjamin Franklin, Department of Rheumatology , Hindenburgdamm 30, 12203 Berlin , Germany
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Lian F, Yang X, Liang L, Xu H, Zhan Z, Qiu Q, Ye Y. Treatment efficacy of etanercept and MTX combination therapy for ankylosing spondylitis hip joint lesion in Chinese population. Rheumatol Int 2011; 32:1663-7. [PMID: 21387110 DOI: 10.1007/s00296-011-1844-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2010] [Accepted: 12/26/2010] [Indexed: 11/29/2022]
Abstract
To investigate the efficacy of etanercept and MTX (methotrexate) combination therapy in Chinese patients with ankylosing spondylitis hip joint lesion, the possible courses and maintenance protocol, altogether 97 ankylosing spondylitis patients fulfilling the modified New York criteria with hip joint lesion were enrolled in a 12-month trial treated with combined etanercept and MTX. All these patients were required to be poor responders to SSZ (Sulfasalazine) or MTX therapy for 6 consecutive months or the longer. Etanercept was administered subcutaneously twice a week at a fixed dosage of 25 mg for the first six months, followed by 25 mg once a week in patients with good control of both symptoms and radiological progression, or twice a week for another six months in patients with BASDAI > or = 4. Combined MTX was administered intravenously once a week at the dosage of 15 mg. Demographics, clinical and laboratory features, physical function and quality of life using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Functional Index (BASFI), Harris hip score, and radiological assessment using the BASRI-hip index were recorded. Most patients achieved pain release at the end point of assessment. Significant improvement in Bath AS Disease Activity Index (BASDAI) (P < 0.05), Bath AS Functional Activity Index (BASFI) (P < 0.05), and Harris hip score (P < 0.05) was demonstrated. Radiographic progression was recorded as no exacerbation or alleviated. Larger interval between two etanercept administrations would provide similar advantages to standard method and possibly less adverse events if MTX was combined. Etanercept and MTX combination therapy was beneficial to ankylosing spondylitis patients with hip joint lesion, and staged dosage deduction in the long term proved to be effective as well as adverse event preventing.
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Affiliation(s)
- Fan Lian
- Department of Rheumatology & Clinical Immunology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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Current World Literature. Curr Opin Rheumatol 2011; 23:219-26. [DOI: 10.1097/bor.0b013e3283448536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Documento SER de consenso sobre el uso de terapias biológicas en la espondilitis anquilosante y otras espondiloartritis, excepto la artritis psoriásica. ACTA ACUST UNITED AC 2011; 7:113-23. [DOI: 10.1016/j.reuma.2010.12.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Revised: 12/10/2010] [Accepted: 12/10/2010] [Indexed: 12/17/2022]
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