1
|
Harris JT, Yang Y, Bentley JP, Chen Y, Ramachandran S. Estimation of optimal adherence threshold for tumor necrosis factor inhibitors in rheumatoid arthritis. Clin Rheumatol 2024:10.1007/s10067-024-06971-y. [PMID: 38853227 DOI: 10.1007/s10067-024-06971-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 03/27/2024] [Accepted: 04/14/2024] [Indexed: 06/11/2024]
Abstract
INTRODUCTION Optimal adherence thresholds can vary across medications and disease states. The objective of the study was to determine the optimal threshold of the proportion of days covered (PDC) for tumor necrosis factor (TNF) inhibitors in patients with rheumatoid arthritis (RA). METHODS Patients with RA initiating self-administered TNF inhibitors were identified using 2012-18 Medicare fee-for-service claims. Time-varying PDC was calculated every day for the preceding 90 days during follow-up. Oral and injected glucocorticoid use, hospitalizations, emergency room (ER) visits, serious infections, and a composite of these were measured as outcomes. Time to first occurrence of each outcome as a function of time-varying PDC for TNF inhibitors was evaluated using Cox regression. Incident/dynamic time-dependent receiver operating characteristic curves and Youden's J index were used to obtain the optimal PDC threshold for outcomes at 365 days. RESULTS Of the 1190 patients who met the study inclusion criteria, almost 75% (865 patients) experienced at least one of the outcomes. Increasing PDC by 10% was significantly associated with decreased risks of the composite outcome (HR 0.98, 95% CI 0.96-1.00), oral glucocorticoid use (HR 0.93, 95% CI 0.91-0.96), and hospitalization (HR 0.96, 95% CI 0.94-0.99) but an increased risk of ER visits (HR 1.04, 95% 1.01-1.07). Optimal PDC thresholds for the composite outcome, oral glucocorticoid use, and hospitalization were 0.64, 0.59, and 0.56, respectively. CONCLUSIONS Increased PDC was associated with a decreased risk of adverse outcomes, except ER visits. The optimal PDC for TNF inhibitors in Medicare patients with RA based on clinical outcomes was about 60%. Key Points • The optimal proportion of days covered threshold for tumor necrosis factor inhibitors at 365 days based on clinical outcomes was found to be about 60%, which is lower than the traditional 80% used to define adherence. • Increased adherence was associated with decreased risks of oral glucocorticoid use, hospitalization, and the composite outcome. However, it was also associated with an increased risk of emergency room visits. • The mean time-varying 90-day proportion of days covered decreased throughout the study starting 92% at day 1 of follow-up to 62% at day 365.
Collapse
Affiliation(s)
| | - Yi Yang
- University of Mississippi, P.O. Box 1848, University, MS, 38677, USA
| | - John P Bentley
- University of Mississippi, P.O. Box 1848, University, MS, 38677, USA
| | - Yixin Chen
- University of Mississippi, P.O. Box 1848, University, MS, 38677, USA
| | | |
Collapse
|
2
|
Deakin CT, Littlejohn GO, Griffiths H, Ciciriello S, O'Sullivan C, Smith T, Youssef P, Bird P. Comparative effectiveness of etanercept originator and biosimilar for treating rheumatoid arthritis: implications for cost-savings. Intern Med J 2024; 54:795-801. [PMID: 38009675 DOI: 10.1111/imj.16296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 11/06/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND AND AIMS This study aimed to assess the comparative effectiveness of the etanercept (ETN) originator (Enbrel) and ETN biosimilar SB4 (Brenzys) as first-line treatment in patients with rheumatoid arthritis (RA), while also exploring the potential cost-savings associated with this approach in Australia. METHODS Clinical data were obtained from the Optimising Patient outcomes in rheumatoLogy Australian real-world data set. Adult patients with RA who had initiated treatment with the ETN originator or biosimilar as their first-recorded biologic or targeted synthetic disease-modifying antirheumatic drug between 1 April 2017 and 31 December 2020 were included. Treatment persistence was analysed using survival analysis. Cost-savings were estimated based on data reported by the Australian National Prescribing Service MedicineWise. RESULTS Propensity score matching followed by inverse probability of treatment weighting selected patients taking originator (n = 209) or biosimilar (n = 141) with similar baseline characteristics and eliminated small differences in baseline disease activity. The median time for 50% of the patients to stop treatment was 19.4 months (95% confidence interval [CI], 14.7-36.4 months) for the originator and 22.4 months (95% CI, 15.0-33.1 months) for the biosimilar (P = 0.95). As a result of pricing policies established by the Australian Government, introduction of the ETN biosimilar would have resulted in a cost-savings of over AU$9.5 million for 1 year of treatment for the patients reported in this study. CONCLUSION Treatment persistence using either ETN originator or biosimilar was similar. The cost of all brands of ETN markedly reduced upon listing of the ETN biosimilar, resulting in significant savings for the Australian Government.
Collapse
Affiliation(s)
- Claire T Deakin
- OPAL Rheumatology Ltd, Sydney, New South Wales, Australia
- Centre for Adolescent Rheumatology at University College London, University College London Hospitals and Great Ormond Street Hospital, London, UK
- National Institute of Health Research Biomedical Centre at Great Ormond Street Hospital, London, UK
| | - Geoffrey O Littlejohn
- OPAL Rheumatology Ltd, Sydney, New South Wales, Australia
- Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Hedley Griffiths
- OPAL Rheumatology Ltd, Sydney, New South Wales, Australia
- Barwon Rheumatology Service, Geelong, Victoria, Australia
| | - Sabina Ciciriello
- OPAL Rheumatology Ltd, Sydney, New South Wales, Australia
- Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | | | - Tegan Smith
- OPAL Rheumatology Ltd, Sydney, New South Wales, Australia
| | - Peter Youssef
- OPAL Rheumatology Ltd, Sydney, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Paul Bird
- OPAL Rheumatology Ltd, Sydney, New South Wales, Australia
- Department of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
3
|
Zubrzycka-Sienkiewicz A, Klama K, Ullmann M, Petit-Frere C, Baker P, Monnet J, Illes A. Comparison of the efficacy and safety of a proposed biosimilar MSB11456 with tocilizumab reference product in subjects with moderate-to-severe rheumatoid arthritis: results of a randomised double-blind study. RMD Open 2024; 10:e003596. [PMID: 38316489 PMCID: PMC11148666 DOI: 10.1136/rmdopen-2023-003596] [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: 08/09/2023] [Accepted: 01/20/2024] [Indexed: 02/07/2024] Open
Abstract
OBJECTIVE To evaluate the efficacy, immunogenicity and safety of the proposed biosimilar MSB11456 versus European Union (EU)-approved tocilizumab reference product in patients with rheumatoid arthritis (RA) in a multicentre, randomised, double-blind, multinational, parallel-group study (NCT04512001). METHODS Adult patients with moderate-to-severe active RA and inadequate clinical response to ≥1 disease-modifying antirheumatic drug (synthetic or biologic) receiving methotrexate were randomised to receive 24 weekly subcutaneous 162 mg injections of either MSB11456 or EU-approved tocilizumab. Equivalence between treatments was considered if the 95% CI (European Medicines Agency)/90% CI (US Food and Drug Administration) for the difference in mean change from baseline to week 24 in Disease Activity Score-28 Joint Count with erythrocyte sedimentation rate (DAS28-ESR) between treatments was entirely within prespecified equivalence intervals (-0.6 to 0.6 and -0.6 to 0.5, respectively). At week 24, patients were rerandomised to continued treatment or MSB11456. Secondary efficacy endpoints to week 52, and safety and immunogenicity to week 55 were also evaluated. RESULTS At week 24, the least squares mean difference in the change from baseline in DAS28-ESR between treatments was 0.01 (95% CI -0.19 to 0.22) in the 604 randomised patients. Similarity between treatments was shown for all other efficacy, safety and immunogenicity endpoints, including in patients who switched from EU-approved tocilizumab to MSB114466. CONCLUSIONS Therapeutic equivalence was demonstrated for efficacy endpoints, and safety and immunogenicity analyses support the similarity of the two treatments. The results of this study strengthen the evidence that the proposed biosimilar MSB11456 and EU-approved tocilizumab exert similar clinical effects.
Collapse
Affiliation(s)
| | | | | | | | - Peter Baker
- Fresenius Kabi SwissBioSim GmbH, Eysins, Switzerland
| | - Joëlle Monnet
- Fresenius Kabi SwissBioSim GmbH, Eysins, Switzerland
| | - Andras Illes
- Fresenius Kabi SwissBioSim GmbH, Eysins, Switzerland
| |
Collapse
|
4
|
Konzett V, Kerschbaumer A, Smolen JS, Aletaha D. Determination of the most appropriate ACR response definition for contemporary drug approval trials in rheumatoid arthritis. Ann Rheum Dis 2024; 83:58-64. [PMID: 37758287 DOI: 10.1136/ard-2023-224477] [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: 05/25/2023] [Accepted: 09/06/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVES To evaluate which American College of Rheumatology (ACR) response definition (ACR20, 50 or 70) should primarily be used for efficacy claims in future drug approval trials of rheumatoid arthritis (RA). METHODS We systematically searched EMBASE, Medline and the Cochrane Library for randomised controlled RA drug approval trials of biological and targeted synthetic disease-modifying antirheumatic drugs (DMARDs). We included full-text articles reporting ACR response rates for multiple time points over a 24-week placebo-controlled period and visualised normalised response trajectories over time in different patient populations. Using mixed-effect logistic regression, we calculated the proportion of ACR responders per outcome and time point, and compared the discriminant validity of these metrics at multiple time points. RESULTS We screened 12 680 records and included 45 in the final analysis. Discriminative capacity of the ACR20 was high across all time points, whereas ACR50 and ACR70 showed highest discrimination towards the end of the placebo-controlled periods. This effect could be observed in all patient populations and compound groups. Faster response to treatment was observed in DMARD naïve patient populations when compared with DMARD insufficient responders. CONCLUSION ACR20 remains the most powerful discriminator between active treatment and placebo, especially when early discrimination is of primary interest. At the same time, our results support the selection of more stringent thresholds if later time points shall be evaluated, given their comparable discriminant but higher clinical face validity.
Collapse
Affiliation(s)
- Victoria Konzett
- Department of Internal Medicine III, Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Andreas Kerschbaumer
- Department of Internal Medicine III, Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Josef S Smolen
- Department of Internal Medicine III, Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Daniel Aletaha
- Department of Internal Medicine III, Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
5
|
Hackett S, Coates LC. Outcome measures in psoriatic arthritis: Where next? Musculoskeletal Care 2022; 20 Suppl 1:S22-S31. [PMID: 36356107 PMCID: PMC9828057 DOI: 10.1002/msc.1692] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 08/26/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To provide an overview of commonly used outcome measure in psoriatic arthritis (PsA). BACKGROUND PsA is a heterogenous inflammatory arthritis, associated with psoriasis that affects between 0.1% and 2% of the population and approximately one in three patients with psoriasis. Psoriatic arthritis places a significant burden on patients' overall quality of life and is associated with a range of comorbidities. Although assessment of patients and monitoring of symptoms has greatly improved over the last 2 decades, capturing disease activity in this multisystem disease remains challenging. Previous efforts have traditionally focussed on assessment of individual disease domains, however recent evidence suggests that composite measurements, particularly those incorporating patient reported outcomes may not only help monitor disease activity more accurately, but also help in accurately validating therapy outcomes in PsA patients. PURPOSE This review discusses currently used outcome measurements in PsA and also highlights the importance of emerging measurements such as biomarkers and their possible role in capturing treatment response.
Collapse
Affiliation(s)
- Simon Hackett
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal SciencesUniversity of OxfordBotnar Research CentreOxfordUK
| | - Laura C. Coates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal SciencesUniversity of OxfordBotnar Research CentreOxfordUK
| |
Collapse
|
6
|
Wan Y, Yang J, Ma T, Wang W, Wang H, Sun W, Ye W, Yang L, Kou Q. A chinese medicine formula (kunbixiao granule) for female rheumatoid arthritis: Study protocol for a double-blind, randomized, placebo-controlled trial. Front Pharmacol 2022; 13:945565. [PMID: 36299880 PMCID: PMC9592086 DOI: 10.3389/fphar.2022.945565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 09/21/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction: Rheumatoid arthritis (RA) is a chronic autoimmune disease affecting females more than males. Clinical symptoms, disease activity and comorbidities are more severe in females. Moreover, the choice of treatment for females is limited during childbearing age due to the side effects of current drugs. Therefore, developing novel and safer drugs for females is urgently needed. Kunbixiao granules (KBXG), a Chinese medicine formula, has been applied to treat female RA patients in our center as a complementary therapy. However, there is insufficient evidence for its effect. Therefore, we aim to conduct a randomized, controlled, double-blind clinical trial to confirm the efficacy and safety of KBXG for the treatment of female RA. Methods: This study is a single-center, double-blind, randomized, parallel group, placebo-controlled clinical trial. A total of 90 female RA patients with Disease Activity Score for 28 joints (DAS28) > 3.2 will be enrolled. They will be randomly assigned to receive either KBXG or placebo for 12 weeks. The change in DAS28 based on C-reactive protein (DAS28-CRP) and the Clinical Disease Activity Index (CDAI) are the primary outcomes. The secondary outcomes include a rate of achieving 20%, 50% and 70% improvement in the American College Rheumatology criteria (ACR20, ACR50, ACR70), TCM syndrome score, visual analogue scale (VAS), average hands grip strength, the consumption of concomitant medication, Hospital Anxiety and Depression Scale (HADS), lumbar spine bone mineral density (L-BMD) and 7-joint ultrasound score (US7). Any adverse events will also be recorded. Discussion: This trial will provide evidence of KBXG in reducing disease activity, and improving clinical symptoms and quality of life of female RA patients. The long-term effects of KBXG on female RA patients still needs a further follow-up.
Collapse
Affiliation(s)
- Yingying Wan
- Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Jiaxi Yang
- Graduate School of Beijing, Beijing University of Chinese Medicine, Beijing, China
| | - Tianyue Ma
- Graduate School of Beijing, Beijing University of Chinese Medicine, Beijing, China
| | - Wenqian Wang
- Graduate School of Beijing, Beijing University of Chinese Medicine, Beijing, China
| | - Haonan Wang
- Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Wenting Sun
- Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Wanting Ye
- Graduate School of Beijing, Beijing University of Chinese Medicine, Beijing, China
| | - Lin Yang
- Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Qiuai Kou
- Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
- *Correspondence: Qiuai Kou,
| |
Collapse
|
7
|
Drugs Targeting the A3 Adenosine Receptor: Human Clinical Study Data. Molecules 2022; 27:molecules27123680. [PMID: 35744805 PMCID: PMC9229414 DOI: 10.3390/molecules27123680] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 05/30/2022] [Accepted: 06/02/2022] [Indexed: 02/04/2023] Open
Abstract
The A3 adenosine receptor (A3AR) is overexpressed in pathological human cells. Piclidenoson and namodenoson are A3AR agonists with high affinity and selectivity to A3AR. Both induce apoptosis of cancer and inflammatory cells via a molecular mechanism entailing deregulation of the Wnt and the NF-κB signaling pathways. Our company conducted phase I studies showing the safety of these 2 molecules. In the phase II studies in psoriasis patients, piclidenoson was safe and demonstrated efficacy manifested in significant improvements in skin lesions. Namodenoson is currently being developed to treat liver cancer, where prolonged overall survival was observed in patients with advanced liver disease and a Child–Pugh B score of 7. A pivotal phase III study in this patient population has been approved by the FDA and the EMA and is currently underway. Namodenoson is also being developed to treat non-alcoholic steatohepatitis (NASH). A Phase IIa study has been successfully concluded and showed that namodenoson has anti-inflammatory, anti-fibrosis, and anti-steatosis effects. A phase IIb study in NASH is currently enrolling patients. In conclusion, A3AR agonists are promising drug candidates in advanced stages of clinical development and demonstrate safety and efficacy in their targeted indications.
Collapse
|
8
|
Han R, Ren HC, Zhou S, Gu S, Gu YY, Sze DMY, Chen MH. Conventional disease-modifying anti-rheumatic drugs combined with Chinese Herbal Medicine for rheumatoid arthritis: A systematic review and meta-analysis. J Tradit Complement Med 2022; 12:437-446. [PMID: 36081815 PMCID: PMC9446108 DOI: 10.1016/j.jtcme.2022.01.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 01/04/2022] [Accepted: 01/22/2022] [Indexed: 11/18/2022] Open
Abstract
Rheumatoid Arthritis (RA) remains a major global public health challenge. Disease-modifying anti-rheumatic drugs (DMARDs) are standard therapeutic drugs for RA. Conventional DMARDs (c-DMARDs) are a subgroup of approved synthetic DMARDs. The c-DMARDs experienced lesser response with longer disease duration or drug exposure, and unwanted adverse events (AEs). The combination treatments (CTs) of c-DMARDs and Chinese Herbal Medicines (CHMs) were often used in RA clinical trials for increasing the therapeutic effectiveness and reducing the AEs. This systematic review aimed to evaluate the efficacy and safety of the CTs for RA. Databases were searched from inception to October 2020 for identification of randomized controlled trials (RCTs) that investigated the CTs in the management of RA. Twenty-three RCTs with 2,441 participants were included. The assessments and analyses found CTs improved American College of Rheumatology (ACR) 20 (RR: 1.33, 95% CI [1.21, 1.45], 10 studies, n=1,075) and alleviated AEs (RR: -0.40, 95% CI [-0.30, -0.53], 19 studies, n=2,011) in comparison with c-DMARDs. The CTs also significantly improved RA symptoms and patient-reported outcomes; reduced disease activity score (DAS) 28, serum acute-phase reactants and RA biomarkers. The five most commonly used herbs in included studies were Angelicae Sinensis Radix, Paeoniae Radix Alba, Cinnamomi Ramulus, Glycyrrhizae Radix et Rhizoma, and Clematidis Radix et Rhizoma. Pharmacological studies indicated these CHMs could contribute to the outcomes. The integrated CHMs potentially increased the overall effectiveness of c-DMARDs and alleviated AEs in management of RA. Large sample and rigorously designed RCTs are required for future studies. An up-to-date systematic review of conventional DMARDs combined with Chinese Herbal Medicines (CHMs) for rheumatoid arthritis. Integrated CHMs increased overall effectiveness of conventional DMARDs and reduced adverse events. Five most commonly used CHMs possessed multi-pharmacological effects contributing to the outcomes.
Collapse
Affiliation(s)
- Rong Han
- Hong Kong Polytechnic University, Faculty of Engineering, Department of Biomedical Engineering, Hong Kong
| | - Hong Cheng Ren
- Hong Kong Polytechnic University, Faculty of Engineering, Department of Biomedical Engineering, Hong Kong
| | - Sitong Zhou
- Hong Kong Polytechnic University, Faculty of Engineering, Department of Biomedical Engineering, Hong Kong
| | - Sherman Gu
- Knox Chinese Healing & Myotherapy, Melbourne, VIC, Australia
| | - Yue-Yu Gu
- The Second Clinical College, Guangzhou University of Chinese Medicine and Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510080, China
| | - Daniel Man-yuen Sze
- School of Health and Biomedical Science, RMIT University, Melbourne, Australia
- Corresponding authors.
| | - Meng-Hua Chen
- School of Health and Biomedical Science, RMIT University, Melbourne, Australia
- Aussway Chinese Medicine Centre, Melbourne, VIC, Australia
- Corresponding author. School of Health and Biomedical Science, RMIT University, Melbourne, Australia.
| |
Collapse
|
9
|
Behrens F, Koehm M, Rossmanith T, Alten R, Aringer M, Backhaus M, Burmester GR, Feist E, Herrmann E, Kellner H, Krueger K, Lehn A, Müller-Ladner U, Rubbert-Roth A, Tony HP, Wassenberg S, Burkhardt H. Rituximab plus leflunomide in rheumatoid arthritis: a randomized, placebo-controlled, investigator-initiated clinical trial (AMARA study). Rheumatology (Oxford) 2021; 60:5318-5328. [PMID: 33738492 PMCID: PMC8566251 DOI: 10.1093/rheumatology/keab153] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 02/03/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To investigate the efficacy and safety of rituximab + LEF in patients with RA. METHODS In this investigator-initiated, randomized, double-blind, placebo-controlled phase 3 trial, patients with an inadequate response to LEF who had failed one or more DMARD were randomly assigned 2:1 to i.v. rituximab 1000 mg or placebo on day 1 and 15 plus ongoing oral LEF. The primary efficacy outcome was the difference between ≥50% improvement in ACR criteria (ACR50 response) rates at week 24 (P ≤ 0.025). Secondary endpoints included ACR20/70 responses, ACR50 responses at earlier timepoints and adverse event (AE) rates. The planned sample size was not achieved due to events beyond the investigators' control. RESULTS Between 13 August 2010 and 28 January 2015, 140 patients received rituximab (n = 93) or placebo (n = 47) plus ongoing LEF. Rituximab + LEF resulted in an increase in the ACR50 response rate that was significant at week 16 (32 vs 15%; P = 0.020), but not week 24 (27 vs 15%; P = 0.081), the primary endpoint. Significant differences favouring the rituximab + LEF arm were observed in some secondary endpoints, including ACR20 rates from weeks 12 to 24. The rituximab and placebo arms had similar AE rates (71 vs 70%), but the rituximab arm had a higher rate of serious AEs (SAEs 20 vs 2%), primarily infections and musculoskeletal disorders. CONCLUSION The primary endpoint was not reached, but rituximab + LEF demonstrated clinical benefits vs LEF in secondary endpoints. Although generally well tolerated, the combination was associated with additional SAEs and requires monitoring. TRIAL REGISTRATION EudraCT: 2009-015950-39; ClinicalTrials.gov: NCT01244958.
Collapse
Affiliation(s)
- Frank Behrens
- Division of Rheumatology, University Hospital Frankfurt, Goethe University
- Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Branch for Translational Medicine & Pharmacology TMP and Fraunhofer Cluster of Exellence for Immunemediated Diseases (CIMD), Frankfurt am Main
| | - Michaela Koehm
- Division of Rheumatology, University Hospital Frankfurt, Goethe University
- Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Branch for Translational Medicine & Pharmacology TMP and Fraunhofer Cluster of Exellence for Immunemediated Diseases (CIMD), Frankfurt am Main
| | - Tanja Rossmanith
- Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Branch for Translational Medicine & Pharmacology TMP and Fraunhofer Cluster of Exellence for Immunemediated Diseases (CIMD), Frankfurt am Main
| | | | - Martin Aringer
- Department of Medicine III, University Medical Centre and Faculty of Medicine at the TU Dresden, Dresden
| | | | - Gerd R Burmester
- Department of Rheumatology and Clinical Immunology, Charité–Universitätsmedizin Berlin, Berlin
| | - Eugen Feist
- Department of Rheumatology and Clinical Immunology, Charité–Universitätsmedizin Berlin, Berlin
| | - Eva Herrmann
- Institute of Biostatistics and Mathematic Modeling, Goethe University, Frankfurt
| | | | | | - Annette Lehn
- Institute of Biostatistics and Mathematic Modeling, Goethe University, Frankfurt
| | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University, Bad Nauheim, Germany
| | | | - Hans-Peter Tony
- Department of Rheumatology/Immunology, University of Würzburg, Würzburg
| | | | - Harald Burkhardt
- Division of Rheumatology, University Hospital Frankfurt, Goethe University
- Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Branch for Translational Medicine & Pharmacology TMP and Fraunhofer Cluster of Exellence for Immunemediated Diseases (CIMD), Frankfurt am Main
| |
Collapse
|
10
|
Abstract
Upadacitinib, a selective JAK1 inhibitor, has been evaluated for efficacy and safety in the treatment of psoriatic arthritis (PsA). Relevant literature using the terms 'upadacitinib' and 'PsA' were identified via PubMed and Google Scholar. Efficacy of upadacitinib in the treatment of PsA versus placebo was demonstrated in the SELECT-PsA I and II trials. SELECT-PsA1 also showed upadacitinib was noninferior to adalimumab in the treatment of PsA. The most common adverse events in patients treated with upadacitinib were infections, malignancies and thromboembolic events. Upadacitinib is an effective medication that can be used in the treatment of active PsA. Despite its proven efficacy and safety, upadacitinib does not yet have long-term safety data.
Collapse
Affiliation(s)
- Yael Ross
- Case Western University at MetroHealth Medical Center, Cleveland, OH 44109, USA
| | - Marina Magrey
- Case Western Reserve University School of Medicine, Division Chief, University Hospital Cleveland, OH 44106, USA
| |
Collapse
|
11
|
Gnanasakthy A, Barrett A, Norcross L, D'Alessio D, Romano CD. Use of Patient and Investigator Global Impression Scales: A Review of Food and Drug Administration-Approved Labeling, 2009 to 2019. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:1016-1023. [PMID: 34243825 DOI: 10.1016/j.jval.2021.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 01/25/2021] [Accepted: 01/31/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Identify disease categories in which single-item global impression (GI) scales were included in product labeling of new drugs approved by the US Food and Drug Administration (FDA) in January 2009-December 2019 and review the characteristics of GIs included in product labeling of new FDA-approved drugs (January 2017-December 2019). METHODS FDA Clinical Outcome Assessment (COA) Compendium was reviewed for drug labels that included GIs for drugs approved in 2009-2016. The indication, year of approval, ICD-10 code, and GI respondent were noted. A manual review of labels of FDA-approved drugs (2017-2019) was undertaken to identify GIs included in the labels. Corresponding drug approval packages were reviewed to identify details of any regulatory reviewer comments related to GIs. GI characteristics were noted from the drug label or the review documents, including the respondent, type of measure (static or dynamic), item wording, concept assessed, and response options. RESULTS Product labeling containing GIs was most common in diseases related to the skin, nervous system, behavioral disorders, and the musculoskeletal system. GIs were included in 30/77 (39.0%) drug labels in the four disease categories. CONCLUSION In the past 10 years, GIs have been included as endpoint measures in confirmatory clinical trials and have generated evidence of treatment benefit in diseases related to the skin, nervous system, behavioral disorders, and the musculoskeletal system. GIs frequently provide important insights into the patient experience. Before GIs are included in clinical trials to assess treatment benefit, it is important to ensure that they are valid, reliable, and responsive.
Collapse
Affiliation(s)
| | - Amy Barrett
- RTI Health Solutions, Research Triangle Park, NC, USA
| | | | | | | |
Collapse
|
12
|
Coghlan J, He H, Schwendeman AS. Overview of Humira® Biosimilars: Current European Landscape and Future Implications. J Pharm Sci 2021; 110:1572-1582. [PMID: 33556387 PMCID: PMC8014989 DOI: 10.1016/j.xphs.2021.02.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/20/2021] [Accepted: 02/01/2021] [Indexed: 02/07/2023]
Abstract
Humira® (adalimumab) by AbbVie has been the top-selling biologic drug product for the last few years - reaching nearly $20 billion in annual sales in 2018. Upon the October 2018 release of four adalimumab biosimilars into the European market, those sales began to shrink. By the end of 2019, the annual sales of Humira®, albeit still high, dipped closer to $19 billion as nearly 35% of European patients had been switched from Humira® to a biosimilar. Diminishing sales are expected to continue as the adoption of adalimumab biosimilars increases in Europe and Humira®'s patent protection is lost in the United States come 2023. In this review we discuss how impactful the availability of biosimilars has been to the European adalimumab market approximately two years after their release. We further analyze the marketed biosimilars with regards to differences in their formulation, delivery devices, biological activity, physicochemical properties, clinical trials data, and current financial foothold. More importantly, though, we highlight how "similar" these biosimilars are to Humira®. In doing so, we seek to educate the public on what they may be able to expect once adalimumab biosimilars enter the United States market in 2023.
Collapse
Affiliation(s)
- Jill Coghlan
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Michigan, NCRC, 2800 Plymouth Road, Ann Arbor, MI 48109, USA
| | - Hongliang He
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Michigan, NCRC, 2800 Plymouth Road, Ann Arbor, MI 48109, USA
| | - Anna S Schwendeman
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Michigan, NCRC, 2800 Plymouth Road, Ann Arbor, MI 48109, USA; Biointerfaces Institute, University of Michigan, NCRC, 2800 Plymouth Road, Ann Arbor, MI 48109, USA.
| |
Collapse
|
13
|
Burmester G, Drescher E, Hrycaj P, Chien D, Pan Z, Cohen S. Efficacy and safety results from a randomized double-blind study comparing proposed biosimilar ABP 798 with rituximab reference product in subjects with moderate-to-severe rheumatoid arthritis. Clin Rheumatol 2020; 39:3341-3352. [PMID: 32876780 PMCID: PMC7567688 DOI: 10.1007/s10067-020-05305-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 07/03/2020] [Accepted: 07/21/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND/OBJECTIVES ABP 798 is a proposed biosimilar to the originator biologic rituximab, an anti-CD20 monoclonal antibody. This comparative clinical study evaluated the pharmacokinetics (PK), safety, and efficacy of ABP 798 versus rituximab reference product (RP) in patients with moderate-to-severe rheumatoid arthritis (RA). METHODS Adults with moderate-to-severe RA with an inadequate response or intolerance to other disease-modifying anti-rheumatic drugs including 1 or more tumor necrosis factor inhibitor therapies (n = 311) received ABP 798, US-sourced rituximab RP (rituximab US), or EU-sourced rituximab RP (rituximab EU) (1000 mg, 2 weeks apart). At week 24, ABP 798- or rituximab EU-treated subjects received a second dose of the same treatment, while rituximab US-treated subjects transitioned to receive ABP 798. The key efficacy endpoint was DAS28-CRP change from baseline at week 24. Other efficacy endpoints included DAS28-CRP at other time points; ACR20, ACR50, and ACR70 criteria; and hybrid ACR. The rituximab RP groups were pooled for all efficacy endpoints since PK equivalence had been established between rituximab US and rituximab EU. RESULTS Clinical equivalence between ABP 798 and rituximab RP was established as the 90% confidence interval for DAS28-CRP change from baseline at week 24 fell within the prespecified equivalence margin (- 0.6, 0.6). Safety and immunogenicity profiles of ABP 798 were comparable across treatment groups and not affected by single transition from RP to ABP 798. CONCLUSIONS Clinical equivalence in terms of efficacy, safety, and immunogenicity was established between ABP 798 and rituximab RP in this comparative clinical trial in patients with moderate-to-severe RA. Key Points • ABP 798 provided similar efficacy as rituximab reference product (RP) in patients with moderate-severe rheumatoid arthritis. • The safety and immunogenicity profiles for ABP 798 were similar to those for the rituximab RP. • The single transition from rituximab RP to ABP 798 did not show differences in efficacy, safety, or immunogenicity.
Collapse
Affiliation(s)
- Gerd Burmester
- Department of Rheumatology and Clinical Immunology, Free University and Humboldt University Berlin, Charité-University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Edit Drescher
- Veszprém Csolnoky Ferenc County Hospital, Veszprém, Hungary
| | - Pawel Hrycaj
- Rheumatology, Koscian Municipal Hospital, Koscian, Poland
| | | | | | | |
Collapse
|
14
|
Pile K, Norager R, Skillecorn M, Gibson KA, Elderton S, Favorito W, Li Z, Mu R, Nakahara H, Kishimoto M, Hirata S, Kaneko Y, Lau CS, Tam LS, Chen YH, Chen P, Wahking B, Furtner D. Elevating the role of carers in rheumatoid arthritis management in the Asia-Pacific region. Int J Rheum Dis 2020; 23:898-910. [PMID: 32613764 PMCID: PMC7496573 DOI: 10.1111/1756-185x.13893] [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: 09/19/2019] [Revised: 03/01/2020] [Accepted: 05/27/2020] [Indexed: 12/21/2022]
Abstract
Aim Carers may offer valuable insight into the true health status of patients with rheumatoid arthritis (RA). This multinational, multi‐stakeholder, exploratory study in Australia, China and Japan aimed to enrich our understanding of the role and potential impact of carers on RA management. Method This study used a 2‐phase sequential mixed methods approach involving 3 key stakeholder groups: rheumatologists, RA patients and carers. The first phase involved an in‐depth qualitative exploratory survey (n = 30), which informed the development of the subsequent quantitative validation survey (n = 908). In both phases, patients and carers provided self‐assessments of disease and support parameters. Results In the qualitative phase, patients usually understated the amount of physical support required, compared to carers. Rheumatologists underestimated the amount of physical and emotional care required, compared to carers and patients; however, in the quantitative phase, rheumatologists overestimated the level of support provided by carers. Levels of support provided by carers increased as disease severity increased. Active participation of carers in clinical consultations and treatment decision‐making was deemed important by 55% of all patients and 82% of all carers. All stakeholders believed carers’ insights into the physical and emotional conditions of patients were useful and should be considered in clinical decision‐making. Over 95% of rheumatologists reported soliciting input from the carer. Conclusion Carers provide valuable input that can give clinicians greater insight into the patients’ physical and emotional states, and treatment adherence. Development of standardized carer‐reported outcomes that correlate with patient‐reported outcomes and clinical parameters will ensure clinical meaningfulness and external validity.
Collapse
Affiliation(s)
- Kevin Pile
- Department of Medicine, Western Sydney University, Sydney, NSW, Australia.,Campbelltown Hospital, South West Sydney Local Health District, Sydney, NSW, Australia
| | | | | | - Kathryn A Gibson
- Department of Rheumatology, Liverpool Hospital, Sydney, Australia
| | | | | | - Zhanguo Li
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
| | - Rong Mu
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
| | - Hideko Nakahara
- Faculty of Health Science, Osaka Yukioka College of Health Science, Osaka, Japan
| | - Mitsumasa Kishimoto
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Shintaro Hirata
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima, Japan
| | - Yuko Kaneko
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Chak-Sing Lau
- Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Lai-Shan Tam
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yi-Hsing Chen
- Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Pearly Chen
- Johnson & Johnson Pte Ltd, Singapore, Singapore
| | | | | |
Collapse
|
15
|
Sinha S, Ghosh B, Bandyopadhyay S, Fatima F, Bandi VK, Thakur P, Reddy B, Chary S, Talluri L, Gupta A, Kale AR, Gupta AK, P AK, Reddy D, Mohammed Y, Shekar S, T S, Goni VG, Sharma V, Yeligod V. Comparative evaluation of efficacy, pharmacodynamics, and safety of Hetero's adalimumab (Mabura®, Hetero Biopharma Ltd.) and reference adalimumab (Humira®, Abbvie Inc.) in patients with active rheumatoid arthritis on concomitant methotrexate therapy. BMC Rheumatol 2020; 4:24. [PMID: 32518895 PMCID: PMC7271501 DOI: 10.1186/s41927-020-00124-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 03/18/2020] [Indexed: 12/14/2022] Open
Abstract
Background Our study aimed to compare efficacy and safety of Hetero's adalimumab (Mabura®, Hetero Biopharma Limited) versus reference adalimumab (Humira®, Abbvie Inc.) in Indian patients with active rheumatoid arthritis (RA) concomitant on methotrexate (MTX) therapy. Methods Patients (n = 168) were randomized (2:1) to receive either test or reference product for 24 weeks with concomitant MTX. Proportion of patients achieving American College of Rheumatology 20 (ACR20) criteria at week 12 was the primary endpoint. Changes in Disease Activity Score of 28 joints-C-reactive protein (DAS28-CRP), Health Assessment Questionnaire-Disability Index (HAQ-DI), and patients achieving ACR20 at week 24, ACR50/70 at weeks 12 and 24 were secondary endpoints. Results Patients achieving ACR20 responses with test (96.43%) were similar to reference (96.43%) in intention-to-treat (ITT) analysis at week 12. Proportional difference (PD) between groups (PD [95% CI] 0.0 [- 6.0, 6.0], p = 1.000) for ACR20 at week 12 for ITT analysis showed lower limit of the two-sided 95% CI was above the pre-specified noninferiority margin of - 15%. Similar trend in PP analysis (PD [95% CI] 0.0 [- 0.03, 0.07], p = 1.000), confirmed therapeutic equivalence. No significant difference was noted between arms for patients attaining ACR20 at week 24 and ACR50/70 at weeks 12 and 24 (all p > 0.05). DAS28-CRP and HAQ-DI were similar between groups. Total of 54 patients reported 88 AEs during the study. Out of these, 60 AEs were reported in 34 patients with Hetero-Adalimumab and 28 AEs were reported in 20 patients with Reference-Adalimumab. Total two patients, one in each group reported two serious adverse events (Sinusitis and Viral infection) during the study and resolved completely. No deaths and no life threatening AEs were reported. Conclusion Results demonstrated Hetero's adalimumab is as effective and well tolerated as reference adalimumab in patients with active RA concomitantly on MTX therapy. Trial registration CTRI/2016/04/006884, Registered on 28/04/2016.
Collapse
Affiliation(s)
| | - Biswadip Ghosh
- Department of Rheumatology, Institute of Post Graduate Medical Education & Research & SSKM Hospital, 244, AJC Bose Road, Kolkata, West Bengal 700020 India
| | - Syamasis Bandyopadhyay
- Apollo Gleneagles Hospitals, Kolkata 58, Canal Circular Road, Kolkata, West Bengal 700054 India
| | - Firdaus Fatima
- Vasavi Medical & Research Centre, 2nd floor, No.6-1-91, Opposite Meera talkies, Khairatabad, Hyderabad, Telangana 500004 India
| | | | | | - Bala Reddy
- Hetero Biopharma Limited, Hyderabad, India
| | | | | | - Ajay Gupta
- Opp. MLB Medical College, Nirmal Hospital, Gate no-3, Jhansi, Uttar Pradesh 284128 India
| | | | | | - Ashok Kumar P
- Andhra Medical College, Department of Orthopedics, King George Hospital, Visakhapatnam, Andhra Pradesh 530002 India
| | - Diwakar Reddy
- St.Theresa's Hospital Erragadda, Sanathnagar, Hyderabad, Andhra Pradesh 500018 India
| | - Younus Mohammed
- M.Jeevan Jyoti Multispecialty hospital & Infertility Research Centre, 162 Bai Ka Bagh, Lowther Road, Allahabad, Uttar Pradesh 211003 India
| | - Soma Shekar
- Gurushree Hi-Tech Multi speicality Hopsital No.1558 Opp. Chandra layout Bus Stand Chandra Layout Vijaynagar, Bangalore, Karnataka 560040 India
| | - Sudheer T
- Department of Orthopedics, Rajiv Gandhi Insititute of Medical Sciences & RIMS Government General Hospital, Srikakulam, 532001 India
| | - Vijay G Goni
- Department of orthopedic surgery, Post graduate institute of medical education & Research, Sect, Chandigarh, or-12 India
| | - Vishnu Sharma
- B.J. Medical College, Civil Hospital, Asarva, Ahmedabad, Gujarat 380016 India
| | - Vishwanath Yeligod
- Sapthagiri Institute of Medical Sciences and Research Center #15, Chikkasandra, Hesaraghatta Main Road, Bangalore, Karnataka 560090 India
| |
Collapse
|
16
|
Comparative Efficacy and Safety of Biosimilar Rituximab and Originator Rituximab in Rheumatoid Arthritis and Non-Hodgkin's Lymphoma: A Systematic Review and Meta-analysis. BioDrugs 2020; 33:469-483. [PMID: 31446557 DOI: 10.1007/s40259-019-00376-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Rituximab is a biologic medicine widely used for the treatment of autoimmune diseases and lymphoma. Several biosimilars of rituximab have been developed and marketed with the expiration of the originator rituximab's patent; thus, systematic combination and analysis of the latest data on the efficacy and safety of biosimilars and the demonstration of the interchangeability of biosimilar agents are required. OBJECTIVE The objective of this study was to collate available data from head-to-head randomized controlled trials (RCTs) and evaluate the efficacy and safety of biosimilar rituximab compared with the reference drug in patients with rheumatoid arthritis (RA) and non-Hodgkin's lymphoma (NHL). METHODS The PubMed, EMBASE, Cochrane Library, and Google Scholar databases were searched to identify head-to-head RCTs that directly compare the efficacy and safety of biosimilar rituximab and its originator. The efficacy outcome for RA was the American College of Rheumatology (ACR) response rates and the outcome for NHL was the response rate. The occurrence of adverse events (AEs) and anti-drug antibodies (ADAs) were evaluated for the safety outcome. Data on the pharmacokinetic profile were also included as a secondary outcome. RESULTS Eleven head-to-head RCTs with 3163 patients were included (1744 patients with RA and 1419 patients with NHL). Biosimilars of rituximab showed similar efficacy in the clinical response in both RA and NHL. The pooled risk ratio (RR) of the ACR 20% response rate (ACR20) response in patients with RA at weeks 24 and 48 was 0.99 (p = 0.70, 95% confidence interval [CI] 0.92-1.06) and 1.04 (p = 0.73, 95% CI 0.83-1.31), respectively. The pooled RR of the overall response at week 24 in NHL patients was 1.02 (p = 0.31, 95% CI 0.98-1.07). No significant differences were found in the formation of ADAs (RR 0.86, p = 0.20, 95% CI 0.68-1.08) or AEs (RR 1.04, p = 0.30, 95% CI 0.97-1.12). CONCLUSION This systematic review and conventional meta-analysis demonstrated the overall similarity of the long-term efficacy and safety of biosimilar rituximab to those of originator rituximab in RA and NHL patients by combining direct evidence from head-to-head trials. PROSPERO registration No. CRD42019125138.
Collapse
|
17
|
Nagai K, Matsubayashi K, Ide K, Seto K, Kawasaki Y, Kawakami K. Factors Influencing Placebo Responses in Rheumatoid Arthritis Clinical Trials: A Meta-Analysis of Randomized, Double-Blind, Placebo-Controlled Studies. Clin Drug Investig 2020; 40:197-209. [PMID: 31953723 DOI: 10.1007/s40261-020-00887-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND OBJECTIVE A better understanding of placebo responses and the specific factors influencing these outcomes is important for clinical trial design. We investigated the magnitude of placebo responses at 3 months and the potential factors influencing these outcomes in rheumatoid arthritis (RA) clinical trials. METHODS We conducted a systematic review of randomized placebo-controlled trials of pharmacological agents for RA identified from PubMed, Embase, and Cochrane Central Register of Controlled Trials databases. The primary placebo outcome was American College of Rheumatology 20% response rate (ACR20). Data were pooled with a random-effects model. Factors influencing placebo response were assessed by meta-regression analyses. Subgroup analyses were performed for studies conducted in non-Western countries only versus in Western countries (North America and/or Europe) only or both. RESULTS The meta-analysis included 88 studies comprising 8406 patients receiving a placebo. The pooled estimate of placebo ACR20 was 29.0% (range 10.0-46.2; 95% confidence interval 27.2-30.9). Placebo ACR20 was negatively associated with trials in non-Western (Asian) countries and patient populations showing an inadequate response to biological disease-modifying antirheumatic drugs (DMARDs) in the multivariable analysis, whereas it was positively associated with the year of publication. No background DMARD treatment was also a negative predictor (albeit statistically non-significant). In subgroup analyses of Western and multiregional studies, study population and publication year were significant factors. CONCLUSIONS Our meta-analysis suggests that study location, patient population, and a background DMARD treatment influence placebo ACR20. These along with placebo response temporal profiles have important implications for designing and interpreting RA clinical trials.
Collapse
Affiliation(s)
- Kota Nagai
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
- Eisai Co., Ltd., 4-6-10 Koishikawa, Bunkyo-ku, Tokyo, 112-8088, Japan
| | - Keisuke Matsubayashi
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Kazuki Ide
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
- Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto, 606-8501, Japan
| | - Kahori Seto
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Yohei Kawasaki
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8677, Japan
| | - Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan.
- Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto, 606-8501, Japan.
| |
Collapse
|
18
|
Smolen J, Fleischmann R, Aletaha D, Li Y, Zhou Y, Sainsbury I, Galindo IL. Disease activity improvements with optimal discriminatory ability between treatment arms: applicability in early and established rheumatoid arthritis clinical trials. Arthritis Res Ther 2019; 21:231. [PMID: 31707982 PMCID: PMC6842479 DOI: 10.1186/s13075-019-2005-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 09/13/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The ACR20 has been validated as the best discriminator of efficacy in placebo-controlled trials, but not in head-to-head trials comparing effective therapies in patients with rheumatoid arthritis (RA). We assessed the most discriminatory ACR response and most discriminatory percent improvement in disease activity measures for Simplified Disease Activity index (SDAI), Clinical Disease Activity index (CDAI), and 28-joint Disease Activity Score based on C-reactive protein (DAS28(CRP)) using different patient populations and trial designs. METHODS Data from two placebo-controlled studies in established RA and two head-to-head studies in early RA were analyzed. The numeric ACR response for each treatment and P value for the difference between treatments were calculated at multiple time points to determine the ACR response associated with the lowest P value. Similarly, values for percent improvement from baseline in SDAI, CDAI, and DAS28(CRP) with the most discrimination between treatments were examined. RESULTS In the head-to-head early RA trials, the minimum P value and greatest treatment difference between the active comparator arms at 6 months was achieved at higher ACR rates and greater percent improvements in other disease activity measures. In established RA, lower responses (minimum P value and maximum treatment difference) and smaller improvements in disease activity scores had better discriminatory ability at 6 months. CONCLUSIONS The most discriminatory ACR response rate and percent improvement in disease activity measures were higher in head-to-head active comparator trials in early RA versus placebo-controlled trials in established RA. This difference should be considered in future clinical trial designs. TRIAL REGISTRATION NCT00195663, NCT00420927, NCT00195702.
Collapse
Affiliation(s)
- Josef Smolen
- Division of Rheumatology Department of Internal Medicine 3, Medical University of Vienna and Hietzing Hospital, Waehringer Guertel 18-20, A-1090, Vienna, Austria.
| | | | - Daniel Aletaha
- Division of Rheumatology Department of Internal Medicine 3, Medical University of Vienna and Hietzing Hospital, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Yihan Li
- AbbVie Inc, North Chicago, IL, USA
| | | | | | | |
Collapse
|
19
|
Orbai AM, McInnes IB, Coates LC, Husni ME, Gladman DD, Gossec L, Pricop L, Chambenoit O, Meng X, Mease PJ. Effect of Secukinumab on the Different GRAPPA-OMERACT Core Domains in Psoriatic Arthritis: A Pooled Analysis of 2049 Patients. J Rheumatol 2019; 47:854-864. [PMID: 31615919 DOI: 10.3899/jrheum.190507] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To compare the efficacy of secukinumab with that of placebo across the updated Group for Research and Assessment of Psoriasis and Psoriatic Arthritis and Outcome Measures in Rheumatology (GRAPPA-OMERACT) individual psoriatic arthritis (PsA) core domains using pooled data from 4 phase III PsA studies and 1 phase III ankylosing spondylitis (AS) study. METHODS Data were pooled from 2049 patients with PsA participating in 4 on-label phase III PsA studies (FUTURE 2-5), and the efficacy of each GRAPPA-OMERACT PsA core domain (musculoskeletal disease activity, skin disease activity, pain, patient's global assessment, physical function, health-related quality of life, fatigue, and systemic inflammation) was assessed using multiple measures and definitions specific to each domain. The MEASURE 2 study, a phase III clinical trial in patients with AS, was used to assess improvement in spine symptoms at Week 16. RESULTS Treatment with secukinumab demonstrated robust and consistent efficacy across all GRAPPA-OMERACT PsA core domains, with secukinumab 300 mg showing the greatest response rates across most PsA core domains compared with placebo at Week 16. Notably, among patients treated with secukinumab 300 mg, 34.3% and 19.5% achieved complete resolution of swollen and tender joint counts, respectively; 53.2% and 61.5% achieved complete resolution of enthesitis and dactylitis, respectively; and 33.2% achieved 100% improvement in Psoriasis Area and Severity Index (all p < 0.05 vs placebo); similar improvements were shown for all other core domains. CONCLUSION This analysis suggests that secukinumab can benefit people with PsA across the clinical phenotypic spectrum commonly encountered in this disease.
Collapse
Affiliation(s)
- Ana-Maria Orbai
- From the Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; University of Glasgow, Glasgow; University of Oxford, Oxford, UK; Cleveland Clinic, Cleveland, Ohio, USA; Toronto Western Research Institute and University of Toronto, Toronto, Ontario, Canada; Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique; Pitié Salpêtrière Hospital, AP-HP, Paris, France; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle, Washington, USA. .,A.M. Orbai has received grant support and consulting fees from Novartis. I.B. McInnes has received consulting fees from Novartis. L.C. Coates has received grant support, consulting fees, and speakers bureau fees from Novartis. D.D. Gladman has received grant support and consulting fees from Novartis. L. Gossec has received consulting fees from Novartis. L. Pricop, O. Chambenoit, and X. Meng are employees and stockholders of Novartis. P.J. Mease has received research grants, consulting fees, and speakers bureau fees from Novartis. .,A.M. Orbai, MD, MHS, Johns Hopkins University School of Medicine; I.B. McInnes, MD, PhD, University of Glasgow; L.C. Coates, MBChB, PhD, University of Oxford; M.E. Husni, MD, MPH, Cleveland Clinic; D.D. Gladman, MD, FRCPC, Toronto Western Research Institute and University of Toronto; L. Gossec, MD, PhD, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, and Pitié Salpêtrière Hospital, AP-HP; L. Pricop, MD, Novartis Pharmaceuticals Corp.; O. Chambenoit, PhD, Novartis Pharmaceuticals Corp.; X. Meng, PhD, Novartis Pharmaceuticals Corp.; P.J. Mease, MD, Swedish Medical Center/Providence St. Joseph Health and University of Washington.
| | - Iain B McInnes
- From the Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; University of Glasgow, Glasgow; University of Oxford, Oxford, UK; Cleveland Clinic, Cleveland, Ohio, USA; Toronto Western Research Institute and University of Toronto, Toronto, Ontario, Canada; Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique; Pitié Salpêtrière Hospital, AP-HP, Paris, France; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle, Washington, USA.,A.M. Orbai has received grant support and consulting fees from Novartis. I.B. McInnes has received consulting fees from Novartis. L.C. Coates has received grant support, consulting fees, and speakers bureau fees from Novartis. D.D. Gladman has received grant support and consulting fees from Novartis. L. Gossec has received consulting fees from Novartis. L. Pricop, O. Chambenoit, and X. Meng are employees and stockholders of Novartis. P.J. Mease has received research grants, consulting fees, and speakers bureau fees from Novartis.,A.M. Orbai, MD, MHS, Johns Hopkins University School of Medicine; I.B. McInnes, MD, PhD, University of Glasgow; L.C. Coates, MBChB, PhD, University of Oxford; M.E. Husni, MD, MPH, Cleveland Clinic; D.D. Gladman, MD, FRCPC, Toronto Western Research Institute and University of Toronto; L. Gossec, MD, PhD, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, and Pitié Salpêtrière Hospital, AP-HP; L. Pricop, MD, Novartis Pharmaceuticals Corp.; O. Chambenoit, PhD, Novartis Pharmaceuticals Corp.; X. Meng, PhD, Novartis Pharmaceuticals Corp.; P.J. Mease, MD, Swedish Medical Center/Providence St. Joseph Health and University of Washington
| | - Laura C Coates
- From the Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; University of Glasgow, Glasgow; University of Oxford, Oxford, UK; Cleveland Clinic, Cleveland, Ohio, USA; Toronto Western Research Institute and University of Toronto, Toronto, Ontario, Canada; Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique; Pitié Salpêtrière Hospital, AP-HP, Paris, France; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle, Washington, USA.,A.M. Orbai has received grant support and consulting fees from Novartis. I.B. McInnes has received consulting fees from Novartis. L.C. Coates has received grant support, consulting fees, and speakers bureau fees from Novartis. D.D. Gladman has received grant support and consulting fees from Novartis. L. Gossec has received consulting fees from Novartis. L. Pricop, O. Chambenoit, and X. Meng are employees and stockholders of Novartis. P.J. Mease has received research grants, consulting fees, and speakers bureau fees from Novartis.,A.M. Orbai, MD, MHS, Johns Hopkins University School of Medicine; I.B. McInnes, MD, PhD, University of Glasgow; L.C. Coates, MBChB, PhD, University of Oxford; M.E. Husni, MD, MPH, Cleveland Clinic; D.D. Gladman, MD, FRCPC, Toronto Western Research Institute and University of Toronto; L. Gossec, MD, PhD, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, and Pitié Salpêtrière Hospital, AP-HP; L. Pricop, MD, Novartis Pharmaceuticals Corp.; O. Chambenoit, PhD, Novartis Pharmaceuticals Corp.; X. Meng, PhD, Novartis Pharmaceuticals Corp.; P.J. Mease, MD, Swedish Medical Center/Providence St. Joseph Health and University of Washington
| | - M Elaine Husni
- From the Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; University of Glasgow, Glasgow; University of Oxford, Oxford, UK; Cleveland Clinic, Cleveland, Ohio, USA; Toronto Western Research Institute and University of Toronto, Toronto, Ontario, Canada; Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique; Pitié Salpêtrière Hospital, AP-HP, Paris, France; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle, Washington, USA.,A.M. Orbai has received grant support and consulting fees from Novartis. I.B. McInnes has received consulting fees from Novartis. L.C. Coates has received grant support, consulting fees, and speakers bureau fees from Novartis. D.D. Gladman has received grant support and consulting fees from Novartis. L. Gossec has received consulting fees from Novartis. L. Pricop, O. Chambenoit, and X. Meng are employees and stockholders of Novartis. P.J. Mease has received research grants, consulting fees, and speakers bureau fees from Novartis.,A.M. Orbai, MD, MHS, Johns Hopkins University School of Medicine; I.B. McInnes, MD, PhD, University of Glasgow; L.C. Coates, MBChB, PhD, University of Oxford; M.E. Husni, MD, MPH, Cleveland Clinic; D.D. Gladman, MD, FRCPC, Toronto Western Research Institute and University of Toronto; L. Gossec, MD, PhD, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, and Pitié Salpêtrière Hospital, AP-HP; L. Pricop, MD, Novartis Pharmaceuticals Corp.; O. Chambenoit, PhD, Novartis Pharmaceuticals Corp.; X. Meng, PhD, Novartis Pharmaceuticals Corp.; P.J. Mease, MD, Swedish Medical Center/Providence St. Joseph Health and University of Washington
| | - Dafna D Gladman
- From the Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; University of Glasgow, Glasgow; University of Oxford, Oxford, UK; Cleveland Clinic, Cleveland, Ohio, USA; Toronto Western Research Institute and University of Toronto, Toronto, Ontario, Canada; Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique; Pitié Salpêtrière Hospital, AP-HP, Paris, France; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle, Washington, USA.,A.M. Orbai has received grant support and consulting fees from Novartis. I.B. McInnes has received consulting fees from Novartis. L.C. Coates has received grant support, consulting fees, and speakers bureau fees from Novartis. D.D. Gladman has received grant support and consulting fees from Novartis. L. Gossec has received consulting fees from Novartis. L. Pricop, O. Chambenoit, and X. Meng are employees and stockholders of Novartis. P.J. Mease has received research grants, consulting fees, and speakers bureau fees from Novartis.,A.M. Orbai, MD, MHS, Johns Hopkins University School of Medicine; I.B. McInnes, MD, PhD, University of Glasgow; L.C. Coates, MBChB, PhD, University of Oxford; M.E. Husni, MD, MPH, Cleveland Clinic; D.D. Gladman, MD, FRCPC, Toronto Western Research Institute and University of Toronto; L. Gossec, MD, PhD, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, and Pitié Salpêtrière Hospital, AP-HP; L. Pricop, MD, Novartis Pharmaceuticals Corp.; O. Chambenoit, PhD, Novartis Pharmaceuticals Corp.; X. Meng, PhD, Novartis Pharmaceuticals Corp.; P.J. Mease, MD, Swedish Medical Center/Providence St. Joseph Health and University of Washington
| | - Laure Gossec
- From the Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; University of Glasgow, Glasgow; University of Oxford, Oxford, UK; Cleveland Clinic, Cleveland, Ohio, USA; Toronto Western Research Institute and University of Toronto, Toronto, Ontario, Canada; Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique; Pitié Salpêtrière Hospital, AP-HP, Paris, France; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle, Washington, USA.,A.M. Orbai has received grant support and consulting fees from Novartis. I.B. McInnes has received consulting fees from Novartis. L.C. Coates has received grant support, consulting fees, and speakers bureau fees from Novartis. D.D. Gladman has received grant support and consulting fees from Novartis. L. Gossec has received consulting fees from Novartis. L. Pricop, O. Chambenoit, and X. Meng are employees and stockholders of Novartis. P.J. Mease has received research grants, consulting fees, and speakers bureau fees from Novartis.,A.M. Orbai, MD, MHS, Johns Hopkins University School of Medicine; I.B. McInnes, MD, PhD, University of Glasgow; L.C. Coates, MBChB, PhD, University of Oxford; M.E. Husni, MD, MPH, Cleveland Clinic; D.D. Gladman, MD, FRCPC, Toronto Western Research Institute and University of Toronto; L. Gossec, MD, PhD, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, and Pitié Salpêtrière Hospital, AP-HP; L. Pricop, MD, Novartis Pharmaceuticals Corp.; O. Chambenoit, PhD, Novartis Pharmaceuticals Corp.; X. Meng, PhD, Novartis Pharmaceuticals Corp.; P.J. Mease, MD, Swedish Medical Center/Providence St. Joseph Health and University of Washington
| | - Luminita Pricop
- From the Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; University of Glasgow, Glasgow; University of Oxford, Oxford, UK; Cleveland Clinic, Cleveland, Ohio, USA; Toronto Western Research Institute and University of Toronto, Toronto, Ontario, Canada; Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique; Pitié Salpêtrière Hospital, AP-HP, Paris, France; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle, Washington, USA.,A.M. Orbai has received grant support and consulting fees from Novartis. I.B. McInnes has received consulting fees from Novartis. L.C. Coates has received grant support, consulting fees, and speakers bureau fees from Novartis. D.D. Gladman has received grant support and consulting fees from Novartis. L. Gossec has received consulting fees from Novartis. L. Pricop, O. Chambenoit, and X. Meng are employees and stockholders of Novartis. P.J. Mease has received research grants, consulting fees, and speakers bureau fees from Novartis.,A.M. Orbai, MD, MHS, Johns Hopkins University School of Medicine; I.B. McInnes, MD, PhD, University of Glasgow; L.C. Coates, MBChB, PhD, University of Oxford; M.E. Husni, MD, MPH, Cleveland Clinic; D.D. Gladman, MD, FRCPC, Toronto Western Research Institute and University of Toronto; L. Gossec, MD, PhD, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, and Pitié Salpêtrière Hospital, AP-HP; L. Pricop, MD, Novartis Pharmaceuticals Corp.; O. Chambenoit, PhD, Novartis Pharmaceuticals Corp.; X. Meng, PhD, Novartis Pharmaceuticals Corp.; P.J. Mease, MD, Swedish Medical Center/Providence St. Joseph Health and University of Washington
| | - Olivier Chambenoit
- From the Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; University of Glasgow, Glasgow; University of Oxford, Oxford, UK; Cleveland Clinic, Cleveland, Ohio, USA; Toronto Western Research Institute and University of Toronto, Toronto, Ontario, Canada; Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique; Pitié Salpêtrière Hospital, AP-HP, Paris, France; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle, Washington, USA.,A.M. Orbai has received grant support and consulting fees from Novartis. I.B. McInnes has received consulting fees from Novartis. L.C. Coates has received grant support, consulting fees, and speakers bureau fees from Novartis. D.D. Gladman has received grant support and consulting fees from Novartis. L. Gossec has received consulting fees from Novartis. L. Pricop, O. Chambenoit, and X. Meng are employees and stockholders of Novartis. P.J. Mease has received research grants, consulting fees, and speakers bureau fees from Novartis.,A.M. Orbai, MD, MHS, Johns Hopkins University School of Medicine; I.B. McInnes, MD, PhD, University of Glasgow; L.C. Coates, MBChB, PhD, University of Oxford; M.E. Husni, MD, MPH, Cleveland Clinic; D.D. Gladman, MD, FRCPC, Toronto Western Research Institute and University of Toronto; L. Gossec, MD, PhD, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, and Pitié Salpêtrière Hospital, AP-HP; L. Pricop, MD, Novartis Pharmaceuticals Corp.; O. Chambenoit, PhD, Novartis Pharmaceuticals Corp.; X. Meng, PhD, Novartis Pharmaceuticals Corp.; P.J. Mease, MD, Swedish Medical Center/Providence St. Joseph Health and University of Washington
| | - Xiangyi Meng
- From the Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; University of Glasgow, Glasgow; University of Oxford, Oxford, UK; Cleveland Clinic, Cleveland, Ohio, USA; Toronto Western Research Institute and University of Toronto, Toronto, Ontario, Canada; Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique; Pitié Salpêtrière Hospital, AP-HP, Paris, France; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle, Washington, USA.,A.M. Orbai has received grant support and consulting fees from Novartis. I.B. McInnes has received consulting fees from Novartis. L.C. Coates has received grant support, consulting fees, and speakers bureau fees from Novartis. D.D. Gladman has received grant support and consulting fees from Novartis. L. Gossec has received consulting fees from Novartis. L. Pricop, O. Chambenoit, and X. Meng are employees and stockholders of Novartis. P.J. Mease has received research grants, consulting fees, and speakers bureau fees from Novartis.,A.M. Orbai, MD, MHS, Johns Hopkins University School of Medicine; I.B. McInnes, MD, PhD, University of Glasgow; L.C. Coates, MBChB, PhD, University of Oxford; M.E. Husni, MD, MPH, Cleveland Clinic; D.D. Gladman, MD, FRCPC, Toronto Western Research Institute and University of Toronto; L. Gossec, MD, PhD, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, and Pitié Salpêtrière Hospital, AP-HP; L. Pricop, MD, Novartis Pharmaceuticals Corp.; O. Chambenoit, PhD, Novartis Pharmaceuticals Corp.; X. Meng, PhD, Novartis Pharmaceuticals Corp.; P.J. Mease, MD, Swedish Medical Center/Providence St. Joseph Health and University of Washington
| | - Philip J Mease
- From the Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; University of Glasgow, Glasgow; University of Oxford, Oxford, UK; Cleveland Clinic, Cleveland, Ohio, USA; Toronto Western Research Institute and University of Toronto, Toronto, Ontario, Canada; Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique; Pitié Salpêtrière Hospital, AP-HP, Paris, France; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle, Washington, USA.,A.M. Orbai has received grant support and consulting fees from Novartis. I.B. McInnes has received consulting fees from Novartis. L.C. Coates has received grant support, consulting fees, and speakers bureau fees from Novartis. D.D. Gladman has received grant support and consulting fees from Novartis. L. Gossec has received consulting fees from Novartis. L. Pricop, O. Chambenoit, and X. Meng are employees and stockholders of Novartis. P.J. Mease has received research grants, consulting fees, and speakers bureau fees from Novartis.,A.M. Orbai, MD, MHS, Johns Hopkins University School of Medicine; I.B. McInnes, MD, PhD, University of Glasgow; L.C. Coates, MBChB, PhD, University of Oxford; M.E. Husni, MD, MPH, Cleveland Clinic; D.D. Gladman, MD, FRCPC, Toronto Western Research Institute and University of Toronto; L. Gossec, MD, PhD, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, and Pitié Salpêtrière Hospital, AP-HP; L. Pricop, MD, Novartis Pharmaceuticals Corp.; O. Chambenoit, PhD, Novartis Pharmaceuticals Corp.; X. Meng, PhD, Novartis Pharmaceuticals Corp.; P.J. Mease, MD, Swedish Medical Center/Providence St. Joseph Health and University of Washington
| |
Collapse
|
20
|
Defining response to TNF-inhibitors in rheumatoid arthritis: the negative impact of anti-TNF cycling and the need for a personalized medicine approach to identify primary non-responders. Clin Rheumatol 2019; 38:2967-2976. [PMID: 31520227 DOI: 10.1007/s10067-019-04684-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/02/2019] [Accepted: 07/05/2019] [Indexed: 02/07/2023]
Abstract
Current guidelines recommend treating rheumatoid arthritis (RA) patients to reach low disease activity or remission, however, most biologic-naive RA patients fail to reach treatment targets on their first biologic therapy. Approximately 90% of biologic-naive RA patients receive a tumor necrosis factor alpha inhibitor (anti-TNF) as their first biologic treatment, even though several alternative mechanism of action (MOA) therapies are approved as first-line options. After 3 months of therapy, patients may remain on anti-TNF therapy even if they fail to achieve the treatment target, mainly due to formulary structures. This means patients have to endure a second and even a third ineffective anti-TNF-called anti-TNF cycling-before changing MOA. This significantly delays patients from reaching their treatment targets. All anti-TNF drugs target the same molecular and inflammatory pathways; thus, it is not surprising that most patients who are primary non-responders to their initial anti-TNF therapy fail to achieve their treatment targets when cycled through alternative anti-TNFs. This suggests that primary non-responders should be switched to an alternative MOA therapy rather than enduring anti-TNF cycling. Avoiding anti-TNF cycling would prevent disease progression and improve quality of life for RA patients who are primary non-responders to anti-TNFs. The development of a personalized medicine approach to identify primary non-responders to anti-TNFs prior to treatment would allow significantly more patients to reach their treatment target by treating them with alternative MOA therapies as first-line therapies.
Collapse
|
21
|
Henkle E, Curtis JR, Chen L, Chan B, Aksamit T, Daley CL, Griffith DE, Winthrop K. Comparative risks of chronic inhaled corticosteroids and macrolides for bronchiectasis. Eur Respir J 2019; 54:13993003.01896-2018. [DOI: 10.1183/13993003.01896-2018] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 03/14/2019] [Indexed: 01/04/2023]
Abstract
IntroductionNon-cystic fibrosis (CF) bronchiectasis (“bronchiectasis”) is a chronic airway disease for which little data exist to inform treatment decisions. We sought to compare the risks of respiratory infections in chronic users of inhaled corticosteroids (ICSs) versus macrolide monotherapy.MethodsWe identified a cohort of US Medicare enrollees with a bronchiectasis diagnosis (International Classification of Diseases, Ninth Revision, Clinical Modification code 494.0 or 494.1) between 2006 and 2014, excluding CF. We defined chronic new use as the first ≥28-day prescription of ICS therapy or macrolide monotherapy. We compared the characteristics of the exposure cohorts using standardised mean differences (SMDs) and computed a propensity score (PS) to account for treatment differences. The risks of acute exacerbation, hospitalised respiratory infection, all-cause hospitalisation and mortality were compared using PS decile-adjusted Cox regression models.ResultsWe identified 83 589 new users of ICSs and 6500 new users of macrolides from 285 043 included Medicare enrollees with bronchiectasis. The crude incidence of hospitalised respiratory infection was 12.6 (ICS therapy) and 10.3 (macrolide monotherapy) per 100 patient-years. The PS-adjusted HRs comparing ICS with macrolide new users were 1.39 (95% CI 1.23–1.57) for hospitalised respiratory infection, 1.56 (95% 1.49–1.64) for acute exacerbation and 1.09 (95% 0.95–1.25) for mortality.InterpretationAmong patients with bronchiectasis, the use of ICSs was associated with an increased risk of hospitalised respiratory infections compared with macrolide monotherapy.
Collapse
|
22
|
Huang RY, Pan HD, Wu JQ, Zhou H, Li ZG, Qiu P, Zhou YY, Chen XM, Xie ZX, Xiao Y, Huang QC, Liu L. Comparison of combination therapy with methotrexate and sinomenine or leflunomide for active rheumatoid arthritis: A randomized controlled clinical trial. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2019; 57:403-410. [PMID: 30851515 DOI: 10.1016/j.phymed.2018.12.030] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 12/18/2018] [Accepted: 12/23/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND A combination of conventional disease-modifying anti-rheumatic drugs improves the treatment of rheumatoid arthritis but with high side-effects. Methotrexate (MTX) combination therapy that with high therapeutic efficacy and low toxicity is in demand in many countries to replace the use of expensive biological agents. STUDY DESIGN This study was an open-label, 24-week, parallel randomized controlled trial conducted between November 2015 and December 2017. METHODS Patients were randomly assigned at a 3:2 ratio to receive MTX combined with sinomenine (SIN) at a dose of 120 mg twice daily, or leflunomide (LEF) at a dose of 20 mg once daily. Efficacy and safety were assessed at weeks 4, 12 and 24. The primary efficacy endpoint was the proportion of patients achieving an American College of Rheumatology (ACR)50 response and a European League Against Rheumatism (EULAR) good response at week 24. RESULTS A total of 101/120 (84.2%) patients completed 24 weeks of observation. In the intention-to-treat (ITT) analysis, 65.3% of patients treated with MTX + SIN showed improved disease activity as determined by the ACR50 response at week 24 compared to 69.6% of patients treated with MTX + LEF. A similar insignificant pattern was found for the ACR20 and ACR70 responses, as well as the clinical disease activity index, EULAR response, and remission and low disease activity rates between these two treatment groups. The per-protocol analysis showed results consistent with those of the ITT analysis. Notably, significant reductions in gastrointestinal adverse reactions and liver toxicity were found in patients treated with MTX + SIN compared to patients treated with MTX + LEF (p < 0.05). CONCLUSION Considering the balance of efficacy and toxicity, the current study provides evidence that MTX + SIN combination therapy is probably one of the choices for treating patients with active rheumatoid arthritis in addition to MTX + LEF combination therapy.
Collapse
Affiliation(s)
- Run-Yue Huang
- Guangdong Provincial Key Laboratory of Clinical Research on Traditional Chinese Medicine Syndrome, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Hu-Dan Pan
- State Key Laboratory of Quality Research in Chinese Medicine/Macau Institute for Applied Research in Medicine and Health, Macau University of Science and Technology, Macau, China
| | - Jia-Qi Wu
- Guangdong Provincial Key Laboratory of Clinical Research on Traditional Chinese Medicine Syndrome, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Hua Zhou
- State Key Laboratory of Quality Research in Chinese Medicine/Macau Institute for Applied Research in Medicine and Health, Macau University of Science and Technology, Macau, China
| | - Zhan-Guo Li
- State Key Laboratory of Quality Research in Chinese Medicine/Macau Institute for Applied Research in Medicine and Health, Macau University of Science and Technology, Macau, China; Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
| | - Ping Qiu
- Hunan Zheng Qing Pharmaceutical Group Company Limited, Huaihua, China
| | - Ying-Yan Zhou
- Guangdong Provincial Key Laboratory of Clinical Research on Traditional Chinese Medicine Syndrome, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiu-Min Chen
- Guangdong Provincial Key Laboratory of Clinical Research on Traditional Chinese Medicine Syndrome, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhi-Xin Xie
- Hunan Zheng Qing Pharmaceutical Group Company Limited, Huaihua, China
| | - Yao Xiao
- State Key Laboratory of Quality Research in Chinese Medicine/Macau Institute for Applied Research in Medicine and Health, Macau University of Science and Technology, Macau, China
| | - Qing-Chun Huang
- Guangdong Provincial Key Laboratory of Clinical Research on Traditional Chinese Medicine Syndrome, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
| | - Liang Liu
- State Key Laboratory of Quality Research in Chinese Medicine/Macau Institute for Applied Research in Medicine and Health, Macau University of Science and Technology, Macau, China.
| |
Collapse
|
23
|
Al-Gareeb AIA, Gorial FI, Mahmood AS. Niclosamide as an adjuvant to etanercept in treatment patients with active rheumatoid arthritis: an 8-week randomized controlled pilot study. Clin Rheumatol 2018; 37:2633-2641. [PMID: 29882203 DOI: 10.1007/s10067-018-4164-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 05/23/2018] [Accepted: 05/28/2018] [Indexed: 02/07/2023]
Abstract
This study designed to identify the therapeutic efficacy of niclosamide (NCL) in Iraqi patients suffering from active rheumatoid arthritis (RA) who were using etanercept (ETN) for more than 3 months and still had high or moderate active RA. One hundred ten patients suffering from active rheumatoid arthritis (RA) who were using etanercept (ETN) for more than 3 months and still had high or moderate active RA were allocated randomly into two equal groups: one of them treated with 1000 mg/day NCL and the other treated with 1000 mg/day lactose in capsule dosage form. The study duration was 8 weeks. Clinical efficacy of the NCL was measured depending on scoring of the 28-joint Disease Activity Score (DAS28), simple disease activity index (SDAI), clinical disease activity index (CDAI), and Health Assessment Questionnaire Disability Index (HAQ-DI) at the baseline and at the end of the 8-week treatment period. Moreover, blood sample were taken from the patients at baseline and at after 8 weeks of treatment for measurement of the erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), interleukin 1β (IL-1 β), interleukin-6, tumor necrosis factor (TNF-α), intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), and E-selectin. At the end of the clinical study, patients had good response to NCL when added to the ETN with a high significant improvement in the SJC, TJC, DAS-28, CDAI, SDAI, and HAQ-DI compared to patients who were received placebo drug. In addition to that, 33% of patients achieved an ACR 20% response (ACR20) on NCL and ETN. Of these, 4% achieved ACR50 and another 4% achieved ACR70 response. While those group treated by placebo + ETN, 5% achieved ACR20 response and no one reached to ACR50 or ACR70 response. Twenty-seven percent of RA patients who have taken the NCL achieved moderate EULAR score while only 17% from the group that taken placebo with ETN achieved moderate response. On the other hand, no significant reduction was found in CRP, ESR, TNF-α, and IL-6, while IL-1 β reduced significantly after treatment with NCL. Treatment with NCL also exerts a significant lowering in the serum level of the E-selectin, ICAM1, and VCAM1 when compared to their value in baseline level. In RA disease, the use of NCL as adjuvant with ETN has resulted in a marked reduction in clinical assessment scoring indices and significantly decreased the E-selectin, ICAM-1, and VCAM-1 with marked improvement in the quality of life of patients.
Collapse
Affiliation(s)
- Ali Ismail A Al-Gareeb
- Department of Clinical Pharmacology, College of Medicine, Mustansiriyah University , Baghdad, Iraq.
| | - Faiq Isho Gorial
- Department of Medicine, College of Medicine, University of Baghdad, Baghdad, Iraq
| | | |
Collapse
|
24
|
Patient-Centered Research Priorities for Pulmonary Nontuberculous Mycobacteria (NTM) Infection. An NTM Research Consortium Workshop Report. Ann Am Thorac Soc 2018; 13:S379-84. [PMID: 27627485 DOI: 10.1513/annalsats.201605-387ws] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Nontuberculous mycobacteria (NTM) cause an increasingly important chronic and debilitating lung disease in older adults. Diagnosis is often delayed, although awareness among clinicians and patients is increasing. When necessary, treatment often lasts 18-24 months and consists of three or four antibiotics that can have serious side effects. Relapses are common and commonly require resumption of prolonged therapy. Given the need for improved diagnostic techniques and clinical trials to identify new therapies or to improve existing therapies, a group of North American clinicians and researchers formed the NTM Research Consortium (NTMRC) in 2014. The NTMRC recognized the importance of including the patient voice in determining research priorities for NTM. In November 2015, patients, caregivers, patient advocates, clinical experts, and researchers gathered for a 1-day meeting in Portland, Oregon funded by the Patient-Centered Outcomes Research Institute. The meeting goal was to define patient-centered research priorities for NTM lung infections. Patients expressed frustration with the number of people who have endured years of missed diagnoses or inadequate treatment of NTM. Participants identified as top research priorities the prevention of NTM infection; approval of more effective treatments with fewer side effects and easier administration; understanding the best chest physiotherapy methods; validating and using tools to measure quality of life; and developing a disease-specific activity and severity assessment tool. Workshop participants agreed that two complementary objectives are critical to ensure the best achievable outcomes for patients: (1) additional clinician education to improve screening and diagnosis of NTM infections; and (2) development of a geographically distributed network of experts in NTM disease to offer consultation or direct therapy after a diagnosis is made.
Collapse
|
25
|
Li L, Zhang Y, Ma L, Ji P, Yim S, Chowdhury B, Doddapaneni S, Liu J, Wang Y, Sahajwalla C. Exposure-Response Modeling and Power Analysis of Components of ACR Response Criteria in Rheumatoid Arthritis (Part 1: Binary Model). J Clin Pharmacol 2017; 57:1097-1106. [DOI: 10.1002/jcph.891] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 02/20/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Liang Li
- Division of Clinical Pharmacology II; Office of Clinical Pharmacology; Center for Drug Evaluation and Research; Food and Drug Administration; Silver Spring MD USA
| | - Yi Zhang
- Division of Clinical Pharmacology II; Office of Clinical Pharmacology; Center for Drug Evaluation and Research; Food and Drug Administration; Silver Spring MD USA
- Division of Bioequivalence III; Office of Generic Drugs; Center for Drug Evaluation and Research; Food and Drug Administration; Silver Spring MD USA
| | - Lian Ma
- Division of Pharmacometrics; Office of Clinical Pharmacology; Center for Drug Evaluation and Research; Food and Drug Administration; Silver Spring MD USA
| | - Ping Ji
- Division of Clinical Pharmacology II; Office of Clinical Pharmacology; Center for Drug Evaluation and Research; Food and Drug Administration; Silver Spring MD USA
| | - Sarah Yim
- Division of Pulmonary; Allergy, and Rheumatology Products; Office of New Drugs; Center for Drug Evaluation and Research; Food and Drug Administration; Silver Spring MD USA
| | - Badrul Chowdhury
- Division of Pulmonary; Allergy, and Rheumatology Products; Office of New Drugs; Center for Drug Evaluation and Research; Food and Drug Administration; Silver Spring MD USA
| | - Suresh Doddapaneni
- Division of Clinical Pharmacology II; Office of Clinical Pharmacology; Center for Drug Evaluation and Research; Food and Drug Administration; Silver Spring MD USA
| | - Jiang Liu
- Division of Pharmacometrics; Office of Clinical Pharmacology; Center for Drug Evaluation and Research; Food and Drug Administration; Silver Spring MD USA
| | - Yaning Wang
- Division of Pharmacometrics; Office of Clinical Pharmacology; Center for Drug Evaluation and Research; Food and Drug Administration; Silver Spring MD USA
| | - Chandrahas Sahajwalla
- Division of Clinical Pharmacology II; Office of Clinical Pharmacology; Center for Drug Evaluation and Research; Food and Drug Administration; Silver Spring MD USA
| |
Collapse
|
26
|
Li N, Betts KA, Messali AJ, Skup M, Garg V. Real-world Effectiveness of Biologic Disease-modifying Antirheumatic Drugs for the Treatment of Rheumatoid Arthritis After Etanercept Discontinuation in the United Kingdom, France, and Germany. Clin Ther 2017; 39:1618-1627. [DOI: 10.1016/j.clinthera.2017.06.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 06/15/2017] [Accepted: 06/16/2017] [Indexed: 10/19/2022]
|
27
|
Niu J, Clancy M, Aliabadi P, Vasan R, Felson DT. Metabolic Syndrome, Its Components, and Knee Osteoarthritis: The Framingham Osteoarthritis Study. Arthritis Rheumatol 2017; 69:1194-1203. [PMID: 28257604 DOI: 10.1002/art.40087] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 02/28/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Previous studies have suggested that metabolic syndrome is associated with osteoarthritis (OA). However, analyses have often not included adjustment for body mass index (BMI) and have not addressed whether levels of individual metabolic syndrome components are related to OA. This study was undertaken to examine the relationship of metabolic syndrome and its components with radiographic and symptomatic knee OA. METHODS Framingham Study subjects were assessed for OA in 1992-1995 and again in 2002-2005. Near the baseline visit, subjects had components of metabolic syndrome assessed. We defined incident radiographic OA as present when a knee without radiographic OA at baseline had a Kellgren/Lawrence grade of ≥2 at follow-up, and defined incident symptomatic OA as present when a knee developed the new combination of radiographic OA and knee pain. After excluding knees with prevalent OA at baseline, we tested the relationship of metabolic syndrome according to the National Cholesterol Education Program Adult Treatment Panel III criteria and its components with the risk of incident radiographic OA and symptomatic OA before and after adjusting for BMI using the risk ratio from a binary regression with generalized estimating equations. RESULTS A total of 991 subjects (55.1% women) with a mean age of 54.2 years were studied, and 26.7% of men and 22.9% of women had metabolic syndrome. Metabolic syndrome and many of its components were associated with both incident radiographic OA and symptomatic OA, but after adjustment for BMI, almost all of these associations became weak and nonsignificant. An association of high blood pressure, especially diastolic pressure, with OA outcomes persisted in both men and women. CONCLUSION After adjustment for BMI, neither metabolic syndrome nor its components were associated with incident OA. There may be an association between OA and high blood pressure that needs further study.
Collapse
Affiliation(s)
- Jingbo Niu
- Boston University School of Medicine, Boston, Massachusetts
| | | | | | | | - David T Felson
- Boston University School of Medicine, Boston, Massachusetts, and National Institute for Health Research Manchester Biomedical Research Unit, Manchester, UK
| |
Collapse
|
28
|
Dougados M, van der Heijde D, Chen YC, Greenwald M, Drescher E, Liu J, Beattie S, Witt S, de la Torre I, Gaich C, Rooney T, Schlichting D, de Bono S, Emery P. Baricitinib in patients with inadequate response or intolerance to conventional synthetic DMARDs: results from the RA-BUILD study. Ann Rheum Dis 2016; 76:88-95. [PMID: 27689735 PMCID: PMC5264214 DOI: 10.1136/annrheumdis-2016-210094] [Citation(s) in RCA: 259] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 09/06/2016] [Accepted: 09/08/2016] [Indexed: 12/19/2022]
Abstract
Background Baricitinib is an oral, reversible, selective Janus kinase 1 and 2 inhibitor. Methods In this phase III, double-blind 24-week study, 684 biologic disease-modifying antirheumatic drug (DMARD)-naïve patients with rheumatoid arthritis and inadequate response or intolerance to ≥1 conventional synthetic DMARDs were randomly assigned 1:1:1 to placebo or baricitinib (2 or 4 mg) once daily, stratified by region and the presence of joint erosions. Endpoint measures included American College of Rheumatology 20% response (ACR20, primary endpoint), Disease Activity Score (DAS28) and Simplified Disease Activity Index (SDAI) score ≤3.3. Results More patients achieved ACR20 response at week 12 with baricitinib 4 mg than with placebo (62% vs 39%, p≤0.001). Compared with placebo, statistically significant improvements in DAS28, SDAI remission, Health Assessment Questionnaire-Disability Index, morning joint stiffness, worst joint pain and worst tiredness were observed. In a supportive analysis, radiographic progression of structural joint damage at week 24 was reduced with baricitinib versus placebo. Rates of adverse events during the treatment period and serious adverse events (SAEs), including serious infections, were similar among groups (SAEs: 5% for baricitinib 4 mg and placebo). One patient had an adverse event of tuberculosis (baricitinib 4 mg); one patient had an adverse event of non-melanoma skin cancer (baricitinib 4 mg). Two deaths and three major adverse cardiovascular events occurred (placebo). Baricitinib was associated with a decrease in neutrophils and increases in low-density and high-density lipoprotein. Conclusions In patients with rheumatoid arthritis and an inadequate response or intolerance to conventional synthetic DMARDs, baricitinib was associated with clinical improvement and inhibition of progression of radiographic joint damage. Trial registration number NCT01721057; Results.
Collapse
Affiliation(s)
- Maxime Dougados
- Department of Rheumatology, Paris Descartes University, Hôpital Cochin, Assistance Publique, Hôpitaux de Paris, INSERM (U1151), Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France
| | | | - Ying-Chou Chen
- Division of Rheumatology, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung, Taiwan; Chang Gung Memorial Hospital - Kaohsiung Medical Center, Chang Gung University College of Medicine, Taiwan
| | | | - Edit Drescher
- Veszprém Csolnoky Ferenc County Hospital, Veszprém, Hungary
| | - Jiajun Liu
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | | | - Sarah Witt
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | | | - Carol Gaich
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | | | | | | | - Paul Emery
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, NIHR Leeds Musculoskeletal Biomedical Research Unit, LTHT, University of Leeds, Leeds, UK
| |
Collapse
|
29
|
Gecse KB, Lakatos PL. Biosimilar Monoclonal Antibodies for Inflammatory Bowel Disease: Current Comfort and Future Prospects. Drugs 2016; 76:1413-1420. [DOI: 10.1007/s40265-016-0638-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
30
|
Wason JMS, Jenkins M. Improving the power of clinical trials of rheumatoid arthritis by using data on continuous scales when analysing response rates: an application of the augmented binary method. Rheumatology (Oxford) 2016; 55:1796-802. [PMID: 27338084 PMCID: PMC5034221 DOI: 10.1093/rheumatology/kew263] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Indexed: 12/22/2022] Open
Abstract
Objective. In clinical trials of RA, it is common to assess effectiveness using end points based upon dichotomized continuous measures of disease activity, which classify patients as responders or non-responders. Although dichotomization generally loses statistical power, there are good clinical reasons to use these end points; for example, to allow for patients receiving rescue therapy to be assigned as non-responders. We adopt a statistical technique called the augmented binary method to make better use of the information provided by these continuous measures and account for how close patients were to being responders. Methods. We adapted the augmented binary method for use in RA clinical trials. We used a previously published randomized controlled trial (Oral SyK Inhibition in Rheumatoid Arthritis-1) to assess its performance in comparison to a standard method treating patients purely as responders or non-responders. The power and error rate were investigated by sampling from this study. Results. The augmented binary method reached similar conclusions to standard analysis methods but was able to estimate the difference in response rates to a higher degree of precision. Results suggested that CI widths for ACR responder end points could be reduced by at least 15%, which could equate to reducing the sample size of a study by 29% to achieve the same statistical power. For other end points, the gain was even higher. Type I error rates were not inflated. Conclusion. The augmented binary method shows considerable promise for RA trials, making more efficient use of patient data whilst still reporting outcomes in terms of recognized response end points.
Collapse
Affiliation(s)
- James M S Wason
- MRC Biostatistics Unit, Institute of Public Health, Cambridge
| | - Martin Jenkins
- Global Medicines Development, AstraZeneca Pharmaceuticals, Cambridge, UK
| |
Collapse
|
31
|
Smolen JS, Collaud Basset S, Boers M, Breedveld F, Edwards CJ, Kvien TK, Miossec P, Sokka-Isler T, van Vollenhoven RF, Abadie EC, Bruyère O, Cooper C, Mäkinen H, Thomas T, Tugwell P, Reginster JY. Clinical trials of new drugs for the treatment of rheumatoid arthritis: focus on early disease. Ann Rheum Dis 2016; 75:1268-71. [PMID: 27037326 PMCID: PMC4941171 DOI: 10.1136/annrheumdis-2016-209429] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 03/12/2016] [Indexed: 11/29/2022]
Abstract
The European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases convened a task force of experts in rheumatoid arthritis (RA) and clinical trial methodology to comment on the new draft ‘Guideline on clinical investigation of medicinal products for the treatment of RA’ released by the European Medicines Agency (EMA). Special emphasis was placed by the group on the development of new drugs for the treatment of early RA. In the absence of a clear definition of early RA, it was suggested that clinical investigations in this condition were conducted in disease-modifying antirheumatic drugs naïve patients with no more than 1 year disease duration. The expert group recommended using an appropriate improvement in disease activity (American College of Rheumatology (ACR) or Simplified/Clinical Disease Activity Index (SDAI/CDAI) response criteria) or low disease activity (by any score) as primary endpoints, with ACR/European League Against Rheumatism remission as a secondary endpoint. Finally, as compelling evidence showed that the Disease Acrivity Score using 28-joint counts (DAS28) might not provide a reliable definition of remission, or sometimes even low disease activity, the group suggested replacing DAS28 as a measurement instrument to evaluate disease activity in RA clinical trials. Proposed alternatives included SDAI, CDAI and Boolean criteria.
Collapse
Affiliation(s)
- Josef S Smolen
- Department of Internal Medicine III, Hietzing Hospital, Vienna, Austria Division of Rheumatology, Medical University Vienna, Vienna, Austria
| | | | - Maarten Boers
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands
| | | | - Christopher J Edwards
- Musculoskeletal Research Unit, NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton, Southampton, UK
| | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Pierre Miossec
- Department of Clinical Immunology and Rheumatology, Immunogenomics and Inflammation Research Unit EA 4130, University of Lyon 1, Edouard Herriot Hospital, Lyon, France
| | - Tuulikki Sokka-Isler
- Faculty of Health Sciences, University of Eastern Finland, Jyvaskyla Central Hospital, Jyvaskyla, Finland
| | - Ronald F van Vollenhoven
- Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands Department of Clinical Immunology and Rheumatology, Academic Medical Center, Amsterdam, The Netherlands Department of Rheumatology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Eric C Abadie
- Euremed Consulting, Paris, France Universidade de Lisboa, Lisbon, Portugal
| | - Olivier Bruyère
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, NIHR Nutrition Biomedical Research Centre, University of Southampton, Southampton, UK NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, The Botnar Research Centre, University of Oxford, Oxford, UK
| | - Heidi Mäkinen
- Rheumatology Department, Tampere University Hospital, Tampere, Finland
| | - Thierry Thomas
- Rheumatology Department, University Hospital of Saint-Etienne, Saint-Etienne, France INSERM U1059, Université de Lyon, Lyon, France
| | - Peter Tugwell
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Jean-Yves Reginster
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | | |
Collapse
|
32
|
Th17 Cell Pathway in Human Immunity: Lessons from Genetics and Therapeutic Interventions. Immunity 2015; 43:1040-51. [DOI: 10.1016/j.immuni.2015.12.003] [Citation(s) in RCA: 348] [Impact Index Per Article: 38.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 11/30/2015] [Accepted: 12/01/2015] [Indexed: 01/01/2023]
|
33
|
Swartz TH, Dubyak GR, Chen BK. Purinergic Receptors: Key Mediators of HIV-1 Infection and Inflammation. Front Immunol 2015; 6:585. [PMID: 26635799 PMCID: PMC4659914 DOI: 10.3389/fimmu.2015.00585] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 11/02/2015] [Indexed: 01/04/2023] Open
Abstract
Human immunodeficiency virus type 1 (HIV-1) causes a chronic infection that afflicts more than 30 million individuals worldwide. While the infection can be suppressed with potent antiretroviral therapies, individuals infected with HIV-1 have elevated levels of inflammation as indicated by increased T cell activation, soluble biomarkers, and associated morbidity and mortality. A single mechanism linking HIV-1 pathogenesis to this inflammation has yet to be identified. Purinergic receptors are known to mediate inflammation and have been shown to be required for HIV-1 infection at the level of HIV-1 membrane fusion. Here, we review the literature on the role of purinergic receptors in HIV-1 infection and associated inflammation and describe a role for these receptors as potential therapeutic targets.
Collapse
Affiliation(s)
- Talia H Swartz
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai , New York, NY , USA
| | - George R Dubyak
- Department of Physiology and Biophysics, Case Western Reserve University , Cleveland, OH , USA
| | - Benjamin K Chen
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai , New York, NY , USA
| |
Collapse
|
34
|
Torres T, Faria R. Ustekinumab: The "New Kid on the Block" in the Treatment of Psoriatic Arthritis. Drug Dev Res 2015; 76:428-31. [PMID: 26372543 DOI: 10.1002/ddr.21279] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 08/23/2015] [Indexed: 11/07/2022]
Abstract
Psoriatic arthritis (PsA) is a chronic inflammatory seronegative spondyloarthritis associated with psoriasis. While TNF-α inhibitors have revolutionized the treatment of rheumatic diseases, including PsA, not all patients respond to these agents while others are unsuitable or intolerant to them. Thus, there is a need for additional treatment modalities with a novel mechanism of action. In the past years, the IL-23/Th17 axis has emerged as an important mechanism in the pathogenesis of PsA. Ustekinumab, a fully human IgG1κ monoclonal antibody that targets the common subunit p40 of IL-12 and IL-23, has been shown in clinical trials, to be well-tolerated and effective in patients with active PsA. It improved signs and symptoms of PsA, inhibited radiographic progression and was effective in dactylitis, enthesitis, and skin disease, with a safety profile consistent with the one observed in patients with psoriasis. Moreover, it was to be effective in anti-TNF-α experienced patients, definitely fulfilling an unmet need in the management of PsA.
Collapse
Affiliation(s)
- Tiago Torres
- Department of Dermatology, Centro Hospitalar do Porto, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
| | - Raquel Faria
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal.,Clinical Immunology Unit, Centro Hospitalar do Porto, Porto, Portugal
| |
Collapse
|