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Karakaş A, Gulle S, Can G, Dalkılıc E, Akar S, Koca SS, Pehlivan Y, Senel S, Tufan A, Ozturk MA, Yilmaz S, Yazici A, Cefle A, Yüce İnel T, Erez Y, Sari I, Birlik M, Direskeneli H, Akkoc N, Onen F. Does obesity affect treatment response to secukinumab and survival in ankylosing spondylitis? Real-life data from the TURKBIO Registry. Mod Rheumatol 2024; 34:584-591. [PMID: 37348053 DOI: 10.1093/mr/road061] [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: 07/27/2022] [Revised: 12/09/2022] [Accepted: 06/13/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the impact of obesity on the treatment response to secukinumab and drug survival rate in patients with ankylosing spondylitis (AS). METHODS We performed an observational cohort study that included AS patients based on the biological drug database in Turkey (TURKBIO) Registry between 2018 and 2021. The patients were divided into three groups: normal [body mass index (BMI) < 25 kg/m2], overweight (BMI: 25-30 kg/m2), and obese (BMI ≥ 30 kg/m2). Disease activity was evaluated at baseline, 3, 6, and 12 months. Drug retention rates at 12 months were also investigated. RESULTS There were 166 AS patients using secukinumab (56.6% male, mean age: 44.9 ± 11.6 years). The median follow-up time was 17.2 (3-33.2) months. Forty-eight (28.9%) patients were obese. The mean age was higher in the obese group than in others (P = .003). There was no statistically significant difference in Bath Ankylosing Spondylitis Disease Activity Index 50, Assessment of SpondyloArthritis international Society 20 (ASAS20), ASAS40, Ankylosing Spondylitis Disease Activity Score (ASDAS) low disease activity, and ASDAS clinically important improvement responses between the three groups at 3, 6, and 12 months, although they were numerically lower in obese patients. Drug retention rates at 12 months were similar in all groups (P > .05). CONCLUSIONS This study suggested that obesity did not affect secukinumab treatment response and drug retention in AS patients.
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Affiliation(s)
- Ali Karakaş
- Department of Rheumatology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Semih Gulle
- Department of Rheumatology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Gerçek Can
- Department of Rheumatology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Ediz Dalkılıc
- Department of Rheumatology, Uludag University School of Medicine, Bursa, Turkey
| | - Servet Akar
- Department of Rheumatology, Katip Celebi University School of Medicine, Izmir, Turkey
| | | | - Yavuz Pehlivan
- Department of Rheumatology, Uludag University School of Medicine, Bursa, Turkey
| | - Soner Senel
- Department of Rheumatology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Abdurrahman Tufan
- Department of Rheumatology, Gazi University School of Medicine, Ankara, Turkey
| | - Mehmet Akif Ozturk
- Department of Rheumatology, Gazi University School of Medicine, Ankara, Turkey
| | - Sema Yilmaz
- Department of Rheumatology, Selcuk University School of Medicine, Konya, Turkey
| | - Ayten Yazici
- Department of Rheumatology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Ayse Cefle
- Department of Rheumatology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Tuba Yüce İnel
- Department of Rheumatology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Yesim Erez
- Department of Rheumatology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Ismail Sari
- Department of Rheumatology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Merih Birlik
- Department of Rheumatology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Haner Direskeneli
- Department of Rheumatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Nurullah Akkoc
- Department of Rheumatology, Celal Bayar University School of Medicine, Manisa, Turkey
| | - Fatos Onen
- Department of Rheumatology, Dokuz Eylul University School of Medicine, Izmir, Turkey
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Al-Homood IA, Al Ghanim N, Fatani MIA, Hussein AH, Alolaiwi AM, Abualiat A, Alqurtas E, Alomari BAA, Khardaly AM, Alenzi KAO, Albarakati RG, Almudaiheem HY, Al-Jedai A, Eshmawi MTY. The Saudi consensus recommendations for the management of psoriatic arthritis (2023). Clin Rheumatol 2024; 43:879-894. [PMID: 38217738 PMCID: PMC10876726 DOI: 10.1007/s10067-024-06867-x] [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: 10/27/2023] [Revised: 12/25/2023] [Accepted: 01/02/2024] [Indexed: 01/15/2024]
Abstract
Psoriatic arthritis (PsA) is a complex inflammatory disease characterized by musculoskeletal and non-musculoskeletal manifestations. It is a distinct disease entity at the interface between rheumatology and dermatology, making it challenging to manage. The diverse clinical presentation and severity of PsA require a multidisciplinary approach for optimal care. Early diagnosis and management are necessary to improving quality of life for patients. In Saudi Arabia, there is currently no unified national consensus on the best practices for managing PsA. This lack of consensus leads to debate and uncertainty in the treatment of the disease, resulting in over or under prescribing of biological agents. To address this issue, a multidisciplinary work group was formed by the Saudi Ministry of Health. This group, consisting of dermatologists, rheumatologists, and pharmacists, aimed to develop evidence-based consensus recommendations for he use and monitoring of biological therapy in PsA management. The work group conducted five consensus workshops between December 2021 to March 2022. Using the nominal group technique, they discussed various aspects of PsA management, including eligibility criteria for biological treatment, monitoring of disease activity, treatment goals, screening, precautions, and management of PsA with biologic therapies. The group also considered special considerations for patients with comorbidities, pregnant and lactating women, as well as pediatric and adolescent populations. The resulting consensus document provides recommendations that are applicable to the Saudi setting, taking into account international guidelines and the specific needs of PsA patients in the country. The consensus document will be regularly updated to incorporate new data and therapeutic agents as they become available. Key Points • In Saudi Arabia, there is a lack of unified national consensus on the optimal management of PsA, therefore, this article aims to provide up-to-date evidence-based consensus recommendations for the optimal use and monitoring of biologic therapy in the management of PsA in Saudi Arabia. • The consensus development process was undertaken by a multidisciplinary work group of 13 experts, including two dermatologists, six rheumatologists, and five pharmacists. • There is more than one disease activity tool used in PsA disease, depending on the disease domain - peripheral arthritis Disease Activity Index in Psoriatic Arthritis (DAPSA) or Minimal Disease Activity (MDA), axial PsA Ankylosing Spondylitis Disease Activity Score (ASDAS), and dactylitis and enthesitis MDA. • The main goal of therapy in all patients with PsA is to achieve the target of remission, or alternatively, low disease activity in all disease domains and improve quality of life (QoL).
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Affiliation(s)
- Ibrahim Abdulrazag Al-Homood
- Medical Specialties Department, Rheumatology Section, King Fahad Medical City, Riyadh, Saudi Arabia.
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
| | - Nayef Al Ghanim
- Department of Internal Medicine, Rheumatology Unit, King Saud Medical City, Riyadh, Saudi Arabia
| | | | - Albader Hamza Hussein
- Department of Rheumatology, King Fahad General Hospital, Ministry of Health, Madinah, Saudi Arabia
| | - Abdulaziz Mohammed Alolaiwi
- Department of Rheumatology, King Saud Medical City, Riyadh, Saudi Arabia
- Deputyship of Therapeutic Affairs, Ministry of Health, Riyadh, Saudi Arabia
| | - Abdullah Abualiat
- Department of Dermatology and Venereology, Armed Forces Hospitals-Southern Region (AFHSR), Khamis Mushait, Saudi Arabia
| | - Eman Alqurtas
- Department of Medicine, College of Medicine, Rheumatology Unit, King Saud University, Riyadh, Saudi Arabia
| | | | | | | | - Rayan G Albarakati
- Department of Obstetrics and Gynecology, Majmaah University, Al-Majmaah, 11952, Saudi Arabia
| | | | - Ahmed Al-Jedai
- Deputyship of Therapeutic Affairs, Ministry of Health, Riyadh, Saudi Arabia
- College of Medicine and College of Pharmacy, Alfaisal University, Riyadh, Saudi Arabia
| | - Maysa Tariq Yousef Eshmawi
- Department of Dermatology, King Abdullah Medical Complex, Jeddah, Saudi Arabia
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
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3
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Dong C, Braun J, Ma KSK. Safety and efficacy of pharmacological treatments for axial spondyloarthritis. Int J Rheum Dis 2023; 26:2130-2133. [PMID: 37910029 DOI: 10.1111/1756-185x.14853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 05/16/2023] [Accepted: 07/18/2023] [Indexed: 11/03/2023]
Affiliation(s)
- Chen Dong
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Jürgen Braun
- Rheumazentrum Ruhrgebiet, Herne, Germany
- Ruhr Universität Bochum, Bochum, Germany
| | - Kevin Sheng-Kai Ma
- Center for Global Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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de Wolff L, Arends S, Brouwer E, Bootsma H, Spoorenberg A. High BMI is associated with lower TNF-α inhibitor serum trough levels and higher disease activity in patients with axial spondyloarthritis. Arthritis Res Ther 2023; 25:202. [PMID: 37848964 PMCID: PMC10580642 DOI: 10.1186/s13075-023-03187-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/07/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND TNF-α inhibitor (TNFi) serum trough levels have previously been found to be related to disease activity in axial spondyloarthritis (axSpA). However, most research regarding serum trough levels has been conducted in patients who only recently started TNFi therapy. Therefore, our objective was to explore TNFi serum trough level measurements in relation to disease activity and BMI in the total axSpA population in daily clinical practice, also including patients on long-term TNFi therapy. METHODS Consecutive patients from the Groningen Leeuwarden Axial Spondyloarthritis (GLAS) cohort were approached for a TNFi serum trough level measurement during their regular outpatient visit at the UMCG. Spearman's correlation coefficient was used to analyse the relation of serum trough levels with disease activity and BMI. Logistic regression was performed to analyse the relation between therapeutic drug levels and disease activity, corrected for potential confounders, including BMI. RESULTS Thirty-four patients on adalimumab and 21 patients on etanercept were included. Mean age was 45 ± 12 years, 47% were male, median BMI was 26.4 (IQR 23.9-32.5) and median treatment duration was 41 months (range 2-126). According to definitions of Sanquin, 47% of patients had therapeutic serum trough levels. No significant correlations were found between TNFi levels and disease activity (ASDAS-CRP: adalimumab: ρ = -0.16, p = 0.39; etanercept: ρ = -0.29, p = 0.20). TNFi levels were moderately correlated with BMI (adalimumab: ρ = -0.48, p = 0.004; etanercept: ρ = -0.50, p = 0.021). Patients with active disease (ASDAS ≥ 2.1) showed higher BMI than patients with inactive disease (median 29.7 vs. 24.6, p = 0.015). In multivariable regression analyses, BMI was identified as the only confounder for the relationship between therapeutic drug levels and ASDAS. CONCLUSION In this cross-sectional, observational study of axSpA patients mainly on long-term treatment with TNFi, higher BMI was significantly associated with lower adalimumab and etanercept serum trough levels and higher disease activity.
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Affiliation(s)
- Liseth de Wolff
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - Suzanne Arends
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Elisabeth Brouwer
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Hendrika Bootsma
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Anneke Spoorenberg
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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García-Vicuña R, Juanola X, Navarro-Compán V, Moreno-Ramos MJ, Castillo-Gallego C, Moreno M, Galíndez E, Montoro M, Gómez I, Rebollo-Laserna FJ, Loza E. Management of Specific Clinical Profiles in Axial Spondyloarthritis: An Expert's Document Based on a Systematic Literature Review and Extended Delphi Process. Rheumatol Ther 2023; 10:1215-1240. [PMID: 37450194 PMCID: PMC10468481 DOI: 10.1007/s40744-023-00575-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 06/14/2023] [Indexed: 07/18/2023] Open
Abstract
INTRODUCTION The management of specific clinical scenarios is not adequately addressed in national and international guidelines for axial spondyloarthritis (axSpA). Expert opinions could serve as a valuable complement to these documents. METHODS Seven expert rheumatologists identified controversial areas or gaps of current recommendations for the management of patients with axSpA. A systematic literature review (SLR) was performed to analyze the efficacy and safety of non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, conventional synthetic, biologic and targeted synthetic disease-modifying antirheumatic drugs (csDMARDs, b/tsDMARDs) in axSpA regarding controversial areas or gaps. In a nominal group meeting, the results of the SLR were discussed and a set of statements were proposed. A Delphi process inviting 150 rheumatologists was followed to define the final statements. Agreement was defined as if at least 70% of the participants voted ≥ 7 (from 1, totally disagree, to 10, totally agree). RESULTS Three overarching principles and 17 recommendations were generated. All reached agreement. According to them, axSpA care should be holistic and individualized, taking into account objective findings, comorbidities, and patients' opinions and preferences. Integrating imaging and clinical assessment with biomarker analysis could also help in decision-making. Connected to treatments, in refractory enthesitis, b/tsDMARDs are recommended. If active peripheral arthritis, csDMARD might be considered before b/tsDMARDs. The presence of significant structural damage, long disease duration, or HLA-B27-negative status do not contraindicate for the use of b/tsDMARDs. CONCLUSIONS These recommendations are intended to complement guidelines by helping health professionals address and manage specific groups of patients, particular clinical scenarios, and gaps in axSpA.
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Affiliation(s)
- Rosario García-Vicuña
- Servicio de Reumatología, Hospital Universitario La Princesa, IIS-Princesa, Madrid, Spain
| | - Xavier Juanola
- Servicio de Reumatología, Hospital Universitario de Bellvitge, Universidad de Barcelona, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | | | - Manuel José Moreno-Ramos
- Servicio de Reumatología, Hospital Clínico Universitario Virgen de La Arrixaca, El Palmar, Murcia, Spain
| | | | - Mireia Moreno
- Servicio de Reumatología, Universitari Parc Taulí Hospital, Institut d’Investigació i Innovació Parc Taulí (I3PT), Sabadell, Spain
| | - Eva Galíndez
- Servicio de Reumatología, Hospital Universitario de Basurto, Bilbao, Spain
| | - María Montoro
- Pfizer Medical Department, Alcobendas, Madrid, Spain
| | - Ismael Gómez
- Pfizer Medical Department, Alcobendas, Madrid, Spain
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Si G, Qiu W, Shen Q, Wang Y, Li W, Yu M, Wang Y. Mini-open Pedicle Subtraction Osteotomy versus Standard Posterior Approach for Ankylosing Spondylitis-related Spinal Kyphosis: A Comparative Study. Orthop Surg 2023; 15:2656-2664. [PMID: 37681279 PMCID: PMC10549849 DOI: 10.1111/os.13873] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 07/19/2023] [Accepted: 07/29/2023] [Indexed: 09/09/2023] Open
Abstract
OBJECTIVE Surgical strategy for spinal kyphosis in patients with ankylosing spondylitis (AS) has been challenging. Pedicle subtraction osteotomy (PSO) through a minimally invasive (MI) approach has been developed with promising clinical outcomes. We aimed to compare the effectiveness and safety of PSO via an MI approach and a standard posterior approach (SPA) for treating AS-related spinal kyphosis. METHODS A total of 41 patients with AS-related spinal kyphosis who underwent PSO through an MI approach (MI surgery [MIS] group: n = 25) or SPA (SPA group: n = 16) between January 2015 and July 2020 were retrospectively included. Spinopelvic parameters were evaluated before the surgery, immediately after the surgery, and at the 2-year follow-up. Clinical data including operative time, estimated blood loss, blood transfusion, level of fusion, incision length, bed rest period, length of hospitalization, and surgical complications were compared between the two groups. The Scoliosis Research Society outcomes instrument-22 (SRS-22) was administered to assess patients' quality of life at the latest follow-up. Comparisons between the two groups were performed using independent sample t-test or Chi-square test. RESULTS Characteristics and baseline kyphosis of the two groups were matched. At the 2-year follow-up, in the MIS group, the average correction values of the sagittal vertical axis and global kyphosis (GK) were 9.5 cm and 44.3°, respectively. Compared with the SPA group, the MIS group had similar correction values and correction losses after surgery. No obvious differences were observed in any radiographic parameters, except for GK, immediately after surgery and at the 2-year follow-up between the two groups (p > 0.05). The MIS group had a significantly shorter operative time, lesser blood loss, lesser transfusion volume, shorter fusion level, and lesser time to mobilization than did the SPA group. Higher average functional activity scores of SRS-22 were obtained in the MIS group than in the SPA group. CONCLUSION Mini-open PSO may be an effective alternative to the SPA for treating AS-related spinal kyphosis, with comparable correction effect, lesser surgical trauma and faster recovery. This comparative study may provide valuable guidance for surgical decision-making and patient counseling.
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Affiliation(s)
- Gao Si
- Peking University Third Hospital, Department of OrthopaedicsBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Weipeng Qiu
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
- Peking University Health Science CenterBeijingChina
| | - Qixian Shen
- Peking University Health Science CenterBeijingChina
| | - Yongqiang Wang
- Peking University Third Hospital, Department of OrthopaedicsBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Weishi Li
- Peking University Third Hospital, Department of OrthopaedicsBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Miao Yu
- Peking University Third Hospital, Department of OrthopaedicsBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Yu Wang
- Peking University First Hospital, Department of OrthopaedicsBeijingChina
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Baraliakos X, Kiltz U, Kononenko I, Ciurea A. Treatment overview of axial spondyloarthritis in 2023. Best Pract Res Clin Rheumatol 2023; 37:101858. [PMID: 37673758 DOI: 10.1016/j.berh.2023.101858] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/19/2023] [Accepted: 07/19/2023] [Indexed: 09/08/2023]
Abstract
The treatment of patients with axial spondyloarthritis (axSpA) is characterized by non-pharmacological and pharmacological treatment options. It may depend on the type and extent of musculoskeletal and extramusculoskeletal manifestations. Recent data on non-pharmacological treatment options, such as physical activity, physiotherapy, and modification of lifestyle factors, are summarized in this review. Moreover, we have provided an overview on non-steroidal anti-inflammatory drugs and the ever-expanding number of biological and targeted synthetic disease-modifying antirheumatic drugs (bDMARDs and tsDMARDs, respectively). In addition to data on efficacy and safety, the review also encompasses data on switching/cycling, tapering, and treatment selection for specific patient subgroups to optimize treatment outcomes.
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Affiliation(s)
- X Baraliakos
- Ruhr Universität Bochum, and Rheumazentrum Ruhrgebiet, Herne, Germany.
| | - U Kiltz
- Ruhr Universität Bochum, and Rheumazentrum Ruhrgebiet, Herne, Germany.
| | - I Kononenko
- Ruhr Universität Bochum, and Rheumazentrum Ruhrgebiet, Herne, Germany.
| | - A Ciurea
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland.
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Queiro R, Aurrecoechea E, Alonso Castro S, Villa Blanco I, Brandy-Garcia A, Linge R. Interleukin-17-targeted treatment in patients with spondyloarthritis and associated cardiometabolic risk profile. Front Immunol 2023; 14:1203372. [PMID: 37533855 PMCID: PMC10391638 DOI: 10.3389/fimmu.2023.1203372] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/29/2023] [Indexed: 08/04/2023] Open
Abstract
Spondyloarthritis is a group of immune-mediated rheumatic disorders that significantly impact patients' physical function and quality of life. Patients with spondyloarthritis experience a greater prevalence of cardiometabolic disorders, such as obesity, hypertension, dyslipidemia and diabetes mellitus, and these comorbidities are associated with increased spondyloarthritis disease activity and risk of cardiovascular events. This narrative review summarizes the evidence for a physiological link between inflammatory status and cardiometabolic comorbidities in spondyloarthritis, as well as the impact of interleukin (IL)-17 blockade versus other molecular mechanisms in patients with cardiometabolic conditions. The IL-23/IL-17 axis plays a pivotal role in the pathophysiology of spondyloarthritis by promoting inflammation and tissue remodeling at the affected joints and entheses. The importance of the IL-23/IL-17 signaling cascade in underlying sub-clinical inflammation in common cardiometabolic disorders suggests the existence of shared pathways between these processes and spondyloarthritis pathophysiology. Thus, a bidirectional relationship exists between the effects of biologic drugs and patients' cardiometabolic profile, which must be considered during treatment decision making. Biologic therapy may induce changes in patients' cardiometabolic status and cardiometabolic conditions may conversely impact the clinical response to biologic therapy. Available evidence regarding the impact of IL-17 blockade with secukinumab on cardiometabolic parameters suggests this drug does not interfere with traditional cardiovascular risk markers and could be associated with a decreased risk of cardiovascular events. Additionally, the efficacy and retention rates of secukinumab do not appear to be negatively affected by obesity, with some studies reporting a positive impact on clinical outcomes, contrary to that described with other approaches, such as tumor necrosis factor blockade. In this article, we also review evidence for this bidirectional association with other treatments for spondyloarthritis. Current evidence suggests that IL-17-targeted therapy with secukinumab is highly effective in spondyloarthritis patients with cardiometabolic comorbidities and may provide additional cardiometabolic benefits.
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Affiliation(s)
- Rubén Queiro
- Rheumatology and Health Research Institute of the Principality of Asturias (ISPA) Translational Immunology Division, Hospital Universitario Central de Asturias, Oviedo, Spain
- Oviedo University School of Medicine, Oviedo, Spain
| | - Elena Aurrecoechea
- Rheumatology Division, Hospital de Sierrallana, Torrelavega, Spain
- Fundación Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - Sara Alonso Castro
- Rheumatology Division, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Ignacio Villa Blanco
- Rheumatology Division, Hospital de Sierrallana, Torrelavega, Spain
- Fundación Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain
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Gialouri CG, Pappa M, Evangelatos G, Nikiphorou E, Fragoulis GE. Effect of body mass index on treatment response of biologic-/targeted synthetic-DMARDs in patients with rheumatoid arthritis, psoriatic arthritis and axial spondyloarthritis. A systematic review. Autoimmun Rev 2023; 22:103357. [PMID: 37150489 DOI: 10.1016/j.autrev.2023.103357] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 05/04/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND Overweight and/or obese patients with inflammatory arthritis (IA) have higher disease activity and lower chances of achieving and/or maintaining the treatment targets. Weight/obesity also appears to negatively affect the response to tumor necrosis factor (TNF) inhibitors in patients with IA, including rheumatoid arthritis -RA, psoriatic arthritis -PsA, axial spondyloarthritis -AxSpA. We conducted a systematic literature review (SLR) for the effect of weight/body-mass-index (BMI) in the efficacy of all approved b- and targeted-synthetic (ts)- DMARDs for the treatment of IA. METHODS For this PROSPERO-registered SLR, we searched PubMed, Scopus and Cohrane-Library from inception up to June 21st 2022. Clinical-trials (randomized and non-randomized) and observational studies of RA, PsA or AxSpA patients that reported the effect of weight/BMI on response (all possible outcomes) to b/ts-DMARDs were included. Risk-of-bias was assessed via RoB2-Cochrane-tool and Newcastle-Ottawa-scale for randomized and non-randomized studies, respectively. FINDINGS Out of 996 references, 75 eventually fulfilled the inclusion criteria (of which 10 studies were retrieved through manual-search). Among the included studies (TNF-inhibitors: 34, IL-12/23 inhibitors: 4, IL-23 inhibitor: 1, IL-17 inhibitors: 7, tocilizumab: 18, abatacept: 8, rituximab: 3, JAK-inhibitors: 5), most had medium RoB. Efficacy of TNF-inhibitors was affected by BMI in all forms of IA. Data are not robust to compare the effect among various TNF-inhibitors. In contrast, favorable results of IL-23 and IL-17 inhibitors did not appear to be influenced by increased BMI in PsA or AxSpA patients. Similar evidence exists for tocilizumab (in RA) and for abatacept (in RA and PsA), while no conclusion can be drawn for rituximab. More data are needed for JAK-inhibitors, although the effect of weight/BMI does not seem to be significant so far. INTERPRETATION Weight/BMI should be considered in the treatment-plan of patients with IA, with its effect being more pronounced for TNF-inhibitors compared to other b/ts-DMARDs.
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Affiliation(s)
- Chrysoula G Gialouri
- Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Greece; Clinical Immunology-Rheumatology Unit, 2nd Department of Medicine and Laboratory, Medical School, National and Kapodistrian University of Athens, "Hippocration" General Hospital, Athens, Greece
| | - Maria Pappa
- Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Greece; Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, "Laiko" General Hospital, Athens, Greece
| | - Gerasimos Evangelatos
- Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Greece; Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, "Laiko" General Hospital, Athens, Greece
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases, King's College London, London, UK; Rheumatology Department, King's College Hospital, London, UK
| | - George E Fragoulis
- Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Greece; Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, "Laiko" General Hospital, Athens, Greece.; Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK..
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10
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Ku CH, Lee YH, Wei JCC, Braun J. Current aspects for the treatment of axial spondyloarthritis. Int J Rheum Dis 2023; 26:5-7. [PMID: 36591903 DOI: 10.1111/1756-185x.14473] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 10/03/2022] [Indexed: 01/03/2023]
Affiliation(s)
- Chiao-Hsin Ku
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Yung-Heng Lee
- Department of Orthopedics, Cishan Hospital, Ministry of Health and Welfare, Kaohsiung, Taiwan.,Institute of Medical Science and Technology, National Sun Yat-sen University, Kaohsiung, Taiwan.,Department of Senior Services Industry Management, Minghsin University of Science and Technology, Hsinchu, Taiwan.,Department of Recreation and Sport Management, Shu-Te University, Kaohsiung, Taiwan
| | - James Cheng-Chung Wei
- Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan.,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| | - Jürgen Braun
- Rheumazentrum Ruhrgebiet, Herne, Germany and Ruhr-University Bochum, Bochum, Germany
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11
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Nam B, Koo BS, Choi N, Shin JH, Lee S, Joo KB, Kim TH. The impact of smoking status on radiographic progression in patients with ankylosing spondylitis on anti-tumor necrosis factor treatment. Front Med (Lausanne) 2022; 9:994797. [PMID: 36325390 PMCID: PMC9618882 DOI: 10.3389/fmed.2022.994797] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 09/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background Ankylosing spondylitis (AS) is characterized by back pain which can lead to spinal ankylosis. Anti-tumor necrosis factor (TNF) dramatically alleviates symptoms, but spinal damage can still be progressive even during anti-TNF treatment. Smoking is a one of well-known risk factors for structural damage in AS. However, it has not been confirmed that smoking can affect radiographic progression even during anti-TNF treatment. Objective To investigate factors associated with radiographic progression during anti-TNF treatment with a focus on smoking status which is known as one of poor prognostic factors for AS. Materials and methods We conducted a retrospective cohort study of AS patients who began the first-line anti-TNF treatment between 2001 and 2018 according to availability of smoking data. All enrolled patients were observed until the last visit, the first-line anti-TNF discontinuation, or December 2019. Radiographic damage was assessed using the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS). The mSASSS progression rate (units/year) was calculated using the baseline mSASSS, the final mSASSS during observation period, and the duration between them. Univariable and multivariable logistic regression analyses were performed to identify associated factors of mSASSS progression rate > 1 unit/year. Results Among 459 AS patients, 185 (40.3%) patients were never smokers, 62 (13.5%) were ex-smokers and 212 (46.2%) were current smokers at baseline. Ex- and current smokers had higher mSASSS progression rates than never smokers [never smoker 0.1 (0.0–0.7), ex-smoker 0.6 (0.0–1.5), and current smoker 0.6 (0.0–1.5) units/year, P < 0.001]. In the multivariable logistic analysis, current smoking [adjusted odds ratio (OR) 1.69, 95% CI 1.01–2.82, P = 0.047] and higher baseline mSASSS [adjusted OR 1.03, 95% CI 1.01–1.04, P < 0.001] were associated with a mSASSS progression rate > 1 unit/year. Conclusion Current smoking is a modifiable risk factor for radiographic progression in patients with AS on anti-TNF treatment. Quitting smoking should be strongly recommended.
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Affiliation(s)
- Bora Nam
- Hanyang University Institute for Rheumatology Research, Seoul, South Korea
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea
| | - Bon San Koo
- Division of Rheumatology, Department of Internal Medicine, Inje University Seoul Paik Hospital, Inje University College of Medicine, Seoul, South Korea
| | - Nayeon Choi
- Biostatistical Consulting and Research Lab, Medical Research Collaborating Center, Hanyang University, Seoul, South Korea
| | - Ji-Hui Shin
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea
| | - Seunghun Lee
- Department of Radiology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea
| | - Kyung Bin Joo
- Hanyang University Institute for Rheumatology Research, Seoul, South Korea
| | - Tae-Hwan Kim
- Hanyang University Institute for Rheumatology Research, Seoul, South Korea
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea
- *Correspondence: Tae-Hwan Kim,
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12
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Jin Y, Landon JE, Krueger W, Liede A, Desai RJ, Kim SC. Predictors of Treatment Change Among Patients with Rheumatoid Arthritis Treated with TNF Inhibitors as First-Line Biologic Agent in the USA: A Cohort Study from Longitudinal Electronic Health Records. BioDrugs 2022; 36:521-535. [PMID: 35771381 DOI: 10.1007/s40259-022-00542-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Previous observational studies utilizing administrative claims data have largely been unable to consider clinical factors that may be related to patterns of drug use among patients with rheumatoid arthritis (RA). OBJECTIVE To understand predictors of treatment changes following initiation of a tumor necrosis factor inhibitor (TNFi) using nation-wide electronic health record (EHR) data in the USA. METHODS The Optum Immunology Condition EHR data (01/01/2011-09/30/2019) was used to identify a population of adult patients with RA initiating a TNFi as the first line biologic disease-modifying anti-rheumatic drug (DMARD). The primary outcome was any treatment change during the 1-year post-index period defined as cycling to a different TNFi or switching to non-TNFi biologic or targeted synthetic DMARDs. Secondary outcomes were the individual components of TNFi cycling and switching, examined separately. To identify predictors of DMARD treatment changes, we used a least absolute shrinkage and selection operator (LASSO) regression model. Model c-statistics and odds ratios (ORs, 95% confidence intervals (CIs)) of predictors were reported. RESULTS We identified 24,871 patients with RA who initiated a TNFi. The mean age was 55.5 (± 13.7) years and 77.2% were female. Among the TNFi initiators, 22.2% experienced TNFi cycling or switching during the 1-year follow-up time. Predictors that are associated with higher likelihood of TNFi cycling or switching included female gender (OR: 1.26, 95% CI: 1.16-1.36) and glucocorticoid use (OR: 1.30, 95% CI: 1.21-1.40). In contrast, inflammatory bowel disease (OR: 0.62, 95% CI: 0.48-0.78), psoriasis (OR: 0.82, 95% CI: 0.70-0.95), recent use of methotrexate (OR: 0.89, 95% CI: 0.81-0.97), and vitamin D intake (OR: 0.92, 95% CI: 0.85-0.99) were negatively associated with TNFi cycling or switch. CONCLUSIONS Gender, glucocorticoid use, inflammatory bowel disease, psoriasis, and vitamin D intake were identified as significant predictors of TNFi cycling or switching for TNFi initiators in the RA population. Predicting treatment change remains challenging even with large detailed EHR data. This study aimed to identify key determinants of treatment changes among patients with rheumatoid arthritis (RA) initiating a tumor necrosis factor inhibitor (TNFi) as their first-line biologic disease-modifying antirheumatic drug (DMARD) in routine care settings using a US nation-wide longitudinal electronic health record (EHR). Among 24,871 patients with RA who initiated a TNFi, 22.2% experienced TNFi cycling or switching during the 1-year follow-up time. Female patients and those who used glucocorticoids were more likely to experience TNFi cycling or switching, whereas inflammatory bowel disease, psoriasis, recent methotrexate use, and vitamin D intake were negatively associated with the outcome. However, predicting treatment change remains challenging even with larger detailed EHR data potentially due to unmeasured factors such as prescriber's preference or patient's belief in the medication.
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Affiliation(s)
- Yinzhu Jin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, 1620 Tremont Street, Suite 3030, Boston, MA, 02120, USA
| | - Joan E Landon
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, 1620 Tremont Street, Suite 3030, Boston, MA, 02120, USA
| | - Whitney Krueger
- AbbVie Global Epidemiology, Pharmacovigilance and Patient Safety, North Chicago, IL, USA
| | - Alexander Liede
- AbbVie Global Epidemiology, Pharmacovigilance and Patient Safety, North Chicago, IL, USA
| | - Rishi J Desai
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, 1620 Tremont Street, Suite 3030, Boston, MA, 02120, USA
| | - Seoyoung C Kim
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, 1620 Tremont Street, Suite 3030, Boston, MA, 02120, USA. .,Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
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13
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Chuck W, Shadbolt BF, Nordin F, Subramaniam K. BMI is important in predicting the loss of response in inflammatory bowel disease patients on tumour necrosis factor-α inhibitors. Eur J Gastroenterol Hepatol 2022; 34:622-629. [PMID: 35352694 DOI: 10.1097/meg.0000000000002371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
INTRODUCTION Obesity is an emerging phenomenon among patients with inflammatory bowel disease (IBD). This study aims to evaluate whether the response to tumour necrosis factor-α (TNF-α) inhibitors (infliximab and adalimumab) could be influenced by BMI in IBD. METHODS We identified a cohort of 181 IBD patients attending a single-tertiary centre, naive to biologic therapy and stratified them according to their BMI. The primary outcome is the first occurrence of loss of response (LOR). RESULTS The median BMI was 26 kg/m2 (15-63 kg/m2). Approximately 68% of patients had LOR on both adalimumab (ADA) (n = 52) and infliximab (IFX) (n = 71). However, 83% on ADA with BMI ≥30 kg/m2 had LOR compared to 61% on IFX with BMI ≥30 kg/m2. For patients on ADA, Cox regression analysis revealed that after accounting for age, sex, disease type, duration of disease, fistulising disease, smoking status, haemoglobin, C-reactive protein, albumin and platelet levels, there were statistically significant associations between BMI (≥30 kg/m2 vs. <30 kg/m2) and LOR [P = 0.010; hazard ratio (HR) 3.2; confidence interval (CI), 1.3-7.6]. However, for patients on IFX, after accounting for the same factors, the only significant factor was the association of lower rate of LOR with higher albumin levels (P = 0.024; HR 0.95; CI, 0.91-0.99). There was an increased accelerated time to LOR for patients on ADA with BMI ≥30 kg/m2 compared to BMI <30 kg/m2 (P = 0.026). However, there was no difference in time to LOR for patients on IFX (P = 0.177). CONCLUSION BMI is important in predicting the LOR among IBD patients on TNF-α inhibitors, especially among patients receiving ADA.
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Affiliation(s)
- Winnie Chuck
- Gastroenterology and Hepatology Unit, Canberra Hospital
| | | | - Fariza Nordin
- Gastroenterology and Hepatology Unit, Canberra Hospital
| | - Kavitha Subramaniam
- Gastroenterology and Hepatology Unit, Canberra Hospital
- ANU Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
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14
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Gwinnutt JM, Wieczorek M, Cavalli G, Balanescu A, Bischoff-Ferrari HA, Boonen A, de Souza S, de Thurah A, Dorner TE, Moe RH, Putrik P, Rodríguez-Carrio J, Silva-Fernández L, Stamm T, Walker-Bone K, Welling J, Zlatković-Švenda MI, Guillemin F, Verstappen SMM. Effects of physical exercise and body weight on disease-specific outcomes of people with rheumatic and musculoskeletal diseases (RMDs): systematic reviews and meta-analyses informing the 2021 EULAR recommendations for lifestyle improvements in people with RMDs. RMD Open 2022; 8:rmdopen-2021-002168. [PMID: 35361692 PMCID: PMC8971792 DOI: 10.1136/rmdopen-2021-002168] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/23/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A European League Against Rheumatism (EULAR) taskforce was convened to develop recommendations for lifestyle behaviours in rheumatic and musculoskeletal diseases (RMDs). This paper reviews the literature on the effects of physical exercise and body weight on disease-specific outcomes of people with RMDs. METHODS Three systematic reviews were conducted to summarise evidence related to exercise and weight in seven RMDs: osteoarthritis, rheumatoid arthritis, systemic lupus erythematosus, axial spondyloarthritis (axSpA), psoriatic arthritis, systemic sclerosis and gout. Systematic reviews and original studies were included if they assessed exercise or weight in one of the above RMDs, and reported results regarding disease-specific outcomes (eg, pain, function, joint damage). Systematic reviews were only included if published between 2013-2018. Search strategies were implemented in the Medline, Embase, Cochrane Library of systematic reviews and CENTRAL databases. RESULTS 236 articles on exercise and 181 articles on weight were included. Exercise interventions resulted in improvements in outcomes such as pain and function across all the RMDs, although the size of the effect varied by RMD and intervention. Disease activity was not influenced by exercise, other than in axSpA. Increased body weight was associated with worse outcomes for the majority of RMDs and outcomes assessed. In general, study quality was moderate for the literature on exercise and body weight in RMDs, although there was large heterogeneity between studies. CONCLUSION The current literature supports recommending exercise and the maintenance of a healthy body weight for people with RMDs.
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Affiliation(s)
- James M Gwinnutt
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Maud Wieczorek
- EA 4360 Apemac, Université de Lorraine, Nancy, France,Center on Aging and Mobility, University of Zurich, Zurich, Switzerland
| | - Giulio Cavalli
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
| | - Andra Balanescu
- Department of Internal Medicine and Rheumatology, “Sf. Maria” Hospital, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Heike A Bischoff-Ferrari
- Center on Aging and Mobility, University of Zurich, Zurich, Switzerland,Department of Aging Medicine and Aging Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland,University Clinic for Aging Medicine, City Hospital Zurich - Waid, Zurich, Switzerland
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands,Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Savia de Souza
- Centre for Rheumatic Diseases, King's College London, London, UK
| | - Annette de Thurah
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark,Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas E Dorner
- Centre for Public Health, Department of Social and Preventive Medicine, Medical University of Vienna, Vienna, Austria,Social Insurance Fund for Public Service, Railway and Mining Industries, Sitzenberg-Reidling, Austria,Karl-Landsteiner Institute for Health Promotion Research, Sitzenberg-Reidling, Austria
| | - Rikke Helene Moe
- National Advisory Unit for Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Polina Putrik
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands,Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Javier Rodríguez-Carrio
- Area of Immunology, Department of Functional Biology, Universidad de Oviedo, Oviedo, Spain,Department of Metabolism, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Lucía Silva-Fernández
- Rheumatology Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Tanja Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria,Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Karen Walker-Bone
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK
| | - Joep Welling
- NVLE Dutch Patient Organization for Systemic Autoimmune Diseases, Utrecht, The Netherlands
| | - Mirjana I Zlatković-Švenda
- Institute of Rheumatology, University of Belgrade School of Medicine, Belgrade, Serbia,Department of Internal Medicine, University of East Sarajevo Faculty of Medicine Foča, Republika Srpska, Bosnia and Herzegovina
| | - Francis Guillemin
- EA 4360 Apemac, Université de Lorraine, Nancy, France,Inserm, CHRU Nancy, CIC-1433 Epidémiologie Clinique, Université de Lorraine, Nancy, France
| | - Suzanne M M Verstappen
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK .,MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK.,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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15
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Wang R, Dasgupta A, Ward MM. Predicting Probability of Response to Tumor Necrosis Factor Inhibitors for Individual Patients With Ankylosing Spondylitis. JAMA Netw Open 2022; 5:e222312. [PMID: 35289857 PMCID: PMC8924712 DOI: 10.1001/jamanetworkopen.2022.2312] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
IMPORTANCE Tumor necrosis factor inhibitors (TNFis) have revolutionized the management of ankylosing spondylitis (AS); however, the lack of notable clinical responses in approximately one-half of patients suggests important heterogeneity in treatment response. Identifying patients likely to respond or not respond to TNFis could provide opportunities to personalize treatment strategies. OBJECTIVE To develop models of the probability of short-term response to TNFi treatment in individual patients with active AS. DESIGN, SETTING, AND PARTICIPANTS This is a retrospective cohort study using data of the TNFi group (ie, treatment group) from 10 randomized clinical trials (RCTs) of TNFi treatment among patients with active AS, conducted from 2002 to 2016. Participants were adult patients with active AS who failed nonsteroidal anti-inflammatory drugs. Included RCTs were phase 3 and 4 studies that assessed the efficacy of an originator TNFi at week 12 and/or week 24, either compared with placebo or an antirheumatic drug. The cohort was divided into a training and a testing set. Data analysis was conducted from July 1, 2019, to November 30, 2020. EXPOSURES All included patients received an originator TNFi for at least 12 weeks. MAIN OUTCOMES AND MEASURES Outcomes included major response and no response based on the change of AS Disease Activity Score at 12 weeks. Machine learning algorithms were applied to estimate the probability of having major response and no response for individual patients. RESULTS The study included 1899 participants from 10 trials. The training set included 1207 individuals (mean [SD] age, 39 [12] years; 908 [75.2%] men), of whom 407 (33.7%) had major response and 414 (34.3%) had no response. In the reduced logistic regression models, accuracy was 0.74 for major response and 0.75 for no response. The probability of major response increased with higher C-reactive protein (CRP) level, patient global assessment (PGA), and Bath AS Disease Activity Index (BASDAI) question 2 score and decreased with higher body mass index (BMI) and Bath AS Functional Index (BASFI) score. The probability of no response increased with age and BASFI score, and decreased with higher CRP level, BASDAI question 2 score, and PGA. In the testing set (692 participants; mean [SD] age, 38 [11] years; 533 [77.0%] men), models demonstrated moderate to high accuracy. CONCLUSIONS AND RELEVANCE In this cohort study, the probability of initial response to TNFi was predicted from baseline variables, which may facilitate personalized treatment decision-making.
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Affiliation(s)
- Runsheng Wang
- Division of Rheumatology, Columbia University Irving Medical Center, New York, New York
- Garden State Rheumatology Consultants, Union, New Jersey
| | - Abhijit Dasgupta
- Intramural Research Program, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland
- now with AstraZeneca, Rockville, Maryland
| | - Michael M. Ward
- Intramural Research Program, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland
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16
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Truong SL, McEwan T, Bird P, Lim I, Saad NF, Schachna L, Taylor AL, Robinson PC. Australian Consensus Statements for the Assessment and Management of Non-radiographic Axial Spondyloarthritis. Rheumatol Ther 2021; 9:1-24. [PMID: 34962620 PMCID: PMC8814294 DOI: 10.1007/s40744-021-00416-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 12/09/2021] [Indexed: 12/02/2022] Open
Abstract
Background The understanding of non-radiographic axial spondyloarthritis (nr-axSpA) has accelerated over the last decade, producing a number of practice-changing developments. Diagnosis is challenging. No diagnostic criteria exist, no single finding is diagnostic, and other causes of back pain may act as confounders. Aim To update and expand the 2014 consensus statement on the investigation and management of non‐radiographic axial spondyloarthritis (nr-axSpA). Methods We created search questions based on our previous statements and four new topics then searched the MEDLINE and Cochrane databases. We assessed relevant publications by full-text review and rated their level of evidence using the GRADE system. We compiled a GRADE evidence summary then produced and voted on consensus statements. Results We identified 5145 relevant publications, full-text reviewed 504, and included 176 in the evidence summary. We developed and voted on 22 consensus statements. All had high agreement. Diagnosis of nr-axSpA should be made by experienced clinicians, considering clinical features of spondyloarthritis, blood tests, and imaging. History and examination should also assess alternative causes of back pain and related conditions including non-specific back pain and fibromyalgia. Initial investigations should include CRP, HLA-B27, and AP pelvic radiography. Further imaging by T1 and STIR MRI of the sacroiliac joints is useful if radiography does not show definite changes. MRI provides moderate-to-high sensitivity and high specificity for nr-axSpA. Acute signs of sacroiliitis on MRI are not specific and have been observed in the absence of spondyloarthritis. Initial management should involve NSAIDs and a regular exercise program, while TNF and IL-17 inhibitors can be used for high disease activity unresponsive to these interventions. Goals of treatment include improving the frequent impairment of social and occupational function that occurs in nr-axSpA. Conclusions We provide 22 evidence-based consensus statements to provide practical guidance in the assessment and management of nr-axSpA. Supplementary Information The online version contains supplementary material available at 10.1007/s40744-021-00416-7.
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Affiliation(s)
- Steven L Truong
- School of Medicine and Dentistry, Griffith University, Brisbane, QLD, Australia.
- Coast Joint Care, Maroochydore, QLD, Australia.
| | - Tim McEwan
- School of Clinical Medicine, University of Queensland, Herston Rd, Herston, QLD, 4006, Australia
| | - Paul Bird
- St George Hospital Clinical School, University of New South Wales, Sydney, Australia
| | | | - Nivene F Saad
- Metro South Hospital and Health Service, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Lionel Schachna
- Department of Rheumatology, Austin Health, Heidelberg, VIC, Australia
- Department of Medicine, University of Melbourne, Parkville, VIC, Australia
| | - Andrew L Taylor
- Department of Rheumatology, Medical School, Fiona Stanley Hospital, University of Western Australia, Perth, Australia
| | - Philip C Robinson
- Metro North, Hospital and Health Service, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
- School of Clinical Medicine, University of Queensland, Royal Brisbane and Women's Hospital, Bowen Bridge Road, Herston, QLD, 4006, Australia
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17
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Lee S, Kang S, Eun Y, Won HH, Kim H, Cha HS, Koh EM, Lee J. A cluster analysis of patients with axial spondyloarthritis using tumour necrosis factor alpha inhibitors based on clinical characteristics. Arthritis Res Ther 2021; 23:284. [PMID: 34782006 PMCID: PMC8591959 DOI: 10.1186/s13075-021-02647-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 10/12/2021] [Indexed: 11/24/2022] Open
Abstract
Background This study aimed to classify the distinct group of patients with axial spondyloarthritis (SpA) on tumour necrosis factor alpha inhibitors (TNFi) according to the baseline characteristics using a clustering algorithm. Methods The clinical characteristics and demographic data of patients with axial SpA included in the Korean College of Rheumatology Biologics and Targeted Therapy registry were investigated. The patterns of disease manifestations were examined using divisive hierarchical cluster analysis. After clustering, we compared the clinical characteristics of patients and the drug survival of TNFi between the classified groups. Results A total of 1042 patients were analysed. The cluster analysis classified patients into two groups: axial group predominantly showing isolated axial manifestations (n = 828) and extra-axial group more frequently showing extra-axial symptoms (n = 214). Almost all extra-axial symptoms (peripheral arthritis, enthesitis, uveitis, and psoriasis) were more frequently observed in the extra-axial group than in the axial group. Moreover, patients in the extra-axial group had shorter disease duration, later disease onset, and higher disease activity than those in the axial group. The disease activity was comparable between the two groups after 1 year of treatment with TNFi. Interestingly, the extra-axial group had a lower drug survival with TNFi than the axial group (p = 0.001). Conclusions Cluster analysis of patients with axial SpA using TNFi classified two distinct clinical phenotypes. These clusters had different TNFi drug survival, clinical characteristics, and disease activity. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-021-02647-z.
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Affiliation(s)
- Seulkee Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Seonyoung Kang
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Yeonghee Eun
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Hong-Hee Won
- Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Samsung Medical Center, Seoul, Republic of Korea
| | - Hyungjin Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Hoon-Suk Cha
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Eun-Mi Koh
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Jaejoon Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
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18
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Huang Y, Deng W, Pan X, Liu M, Zhong Z, Huang Q, Li T. The relationship between platelet to albumin ratio and disease activity in axial spondyloarthritis patients. Mod Rheumatol 2021; 32:974-979. [PMID: 34918121 DOI: 10.1093/mr/roab060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/27/2021] [Accepted: 08/05/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVES The study aims to investigate the clinical significance of platelet to albumin ratio (PAR), neutrophil to albumin ratio (NAR), and monocyte to albumin ratio (MAR) in axial spondyloarthritis (axSpA). METHODS Two hundred and ninety-seven axSpA patients and 71 healthy volunteers were recruited. AxSpA patients were divided into inactive group and active group. Spearman's correlation, receiver operating characteristic (ROC) curves, and binary logistic regression analysis were conducted. RESULTS Albumin was lower in axSpA group, while neutrophil, platelet, monocyte, NAR, PAR, and MAR were higher (p < .05). Albumin was negatively correlated with BASDAI and BASFI (p < .05). Platelet, NAR, PAR, MAR, ESR, and CRP were all positively correlated with BASDAI and BASFI (p < .05). Albumin was lower in axSpA of active group, while platelet, NAR, PAR, MAR, ESR, and CRP were higher (p < .05). ROC curve indicated that the AUC of PAR for axSpA of active group was higher than that of other variables. The optimal cut-off value of PAR was 6.354, with Youden index of 0.337, specificity of 55.4%, and sensitivity of 78.4%. Logistic regression analysis result suggested that PAR was an independent indicator for axSpA disease activity. CONCLUSIONS PAR had a high diagnostic value for axSpA of active group. PAR was a novel and reliable indicator for axSpA disease activity.
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Affiliation(s)
- Yukai Huang
- Department of Rheumatology and Immunology, Guangdong Second Provincial General Hospital, Guangzhou 510317, China
| | - Weiming Deng
- Department of Rheumatology and Immunology, Guangdong Second Provincial General Hospital, Guangzhou 510317, China
| | - Xia Pan
- Department of Rheumatology and Immunology, Guangdong Second Provincial General Hospital, Guangzhou 510317, China
| | - Meng Liu
- Department of Rheumatology and Immunology, Guangdong Second Provincial General Hospital, Guangzhou 510317, China
| | - Zheng Zhong
- Department of Rheumatology and Immunology, Guangdong Second Provincial General Hospital, Guangzhou 510317, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Qidang Huang
- Department of Rheumatology and Immunology, Guangdong Second Provincial General Hospital, Guangzhou 510317, China
| | - Tianwang Li
- Department of Rheumatology and Immunology, Guangdong Second Provincial General Hospital, Guangzhou 510317, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong 510515, China
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Exarchou S, Turesson C, Lindström U, Ramonda R, Landewé RBM, Dagfinrud H, van Gaalen F, van der Heijde D, Jacobsson LTH. Lifestyle Factors and Disease Activity over Time in Early Axial Spondyloarthritis - The SPondyloArthritis Caught Early (SPACE) Cohort. J Rheumatol 2021; 49:365-372. [PMID: 34470793 DOI: 10.3899/jrheum.210046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Our aim was to study the importance of baseline Body Mass Index (BMI), smoking and alcohol consumption (AC) for disease activity (DA) over one year in early axial spondyloarthritis (axSpA), stratified by sex. METHODS In the SPondyloArthritis Caught Early cohort (patients with chronic back pain for ≥3 months, ≤2 years and onset <45 years), ASDAS was recorded at inclusion, 3 and 12 months. All patients included in the analysis had axSpA based on a high physician's level of confidence at baseline. Differences in ASDAS over 1 year by BMI (normal <25, overweight 25-29.9, obese ≥30 kg/m2), smoking history (never/previous/current) and AC (none, 0.1-2, 3-5, ≥6 units/week) at baseline were estimated using mixed linear regression models. RESULTS There were 344 subjects (mean age 30 years; 49% men). In women, obesity was associated with 0.60 (95% CL 0.28, 0.91) higher ASDAS compared to normal BMI. In both sexes, AC tended to be associated with lower DA over one year, with a significant association only in women with the highest AC (mean difference -0.55 (96% CL-1.05, -0.04). Smoking was associated with higher ASDAS over one year compared to never smoking in both sexes, albeit the difference reached statistical significance only in female former smokers. Results were similar in multivariable analysis, adjusted for all lifestyle factors and other confounders. CONCLUSION In early axSpA, BMI and smoking are associated with higher DA over one year, and AC with lower DA. The magnitude of the modest associations may differ between men and women.
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Affiliation(s)
- Sofia Exarchou
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden; Department of Rheumatology, Skåne University Hospital, Malmö, Sweden; Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands. Funding: Sofia Exarchou's work with the study was funded by the Swedish Rheumatism Association. Apart from this, the authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Conflict of Interest: Dr. Exarchou reports grants from Swedish Rheumatism Association, during the conduct of the study; personal fees from Novartis, personal fees from Abbvie outside the submitted work. Dr. Turesson reports personal fees from Abbvie, personal fees from Pfizer, grants and personal fees from Bristol-Myers Squibb, personal fees from Roche, outside the submitted work. Dr. Lindström has nothing to disclose. Dr. Ramonda has nothing to disclose. Dr. Landewé has nothing to disclose. Dr. Dagfinrud has nothing to disclose. Dr. van Gaalen reports grants from MSD, grants from AbbVie, grants from Stichting Vrienden van Sole Mio, grants from UCB, grants and personal fees from Novartis, grants from Pfizer, outside the submitted work. Dr. van der Heijde reports personal fees from Abbvie, personal fees from Amgen, personal fees from Astellas, personal fees from AstraZeneca, personal fees from BMS, personal fees from Boehringer Ingelheim, personal fees from Celgene, personal fees from Cyxone, personal fees from Daiichi, personal fees from Eisai, personal fees from Eli-Lilly, personal fees from Galapagos, personal fees from Gilead, personal fees from Glaxo-Smith-Kline, personal fees from Janssen, personal fees from Merck, personal fees from Novartis, personal fees from Pfizer, personal fees from Regeneron, personal fees from Roche, personal fees from Sanofi, personal fees from Takeda, personal fees from UCB Pharma, other from Imaging Rheumatology bv, outside the submitted work. Dr. Jacobsson reports personal fees from Pfizer, personal fees from Abbvie, personal fees from Novartis, personal fees from Eli-Lily, personal fees from Janssen, outside the submitted work. Corresponding author: Sofia Exarchou, M.D., PhD, Rheumatology, Department of Clinical Sciences Malmö, Lund University; Jan Waldenströms gata 1B, 205 02, Malmö, Sweden. E-mail:
| | - Carl Turesson
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden; Department of Rheumatology, Skåne University Hospital, Malmö, Sweden; Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands. Funding: Sofia Exarchou's work with the study was funded by the Swedish Rheumatism Association. Apart from this, the authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Conflict of Interest: Dr. Exarchou reports grants from Swedish Rheumatism Association, during the conduct of the study; personal fees from Novartis, personal fees from Abbvie outside the submitted work. Dr. Turesson reports personal fees from Abbvie, personal fees from Pfizer, grants and personal fees from Bristol-Myers Squibb, personal fees from Roche, outside the submitted work. Dr. Lindström has nothing to disclose. Dr. Ramonda has nothing to disclose. Dr. Landewé has nothing to disclose. Dr. Dagfinrud has nothing to disclose. Dr. van Gaalen reports grants from MSD, grants from AbbVie, grants from Stichting Vrienden van Sole Mio, grants from UCB, grants and personal fees from Novartis, grants from Pfizer, outside the submitted work. Dr. van der Heijde reports personal fees from Abbvie, personal fees from Amgen, personal fees from Astellas, personal fees from AstraZeneca, personal fees from BMS, personal fees from Boehringer Ingelheim, personal fees from Celgene, personal fees from Cyxone, personal fees from Daiichi, personal fees from Eisai, personal fees from Eli-Lilly, personal fees from Galapagos, personal fees from Gilead, personal fees from Glaxo-Smith-Kline, personal fees from Janssen, personal fees from Merck, personal fees from Novartis, personal fees from Pfizer, personal fees from Regeneron, personal fees from Roche, personal fees from Sanofi, personal fees from Takeda, personal fees from UCB Pharma, other from Imaging Rheumatology bv, outside the submitted work. Dr. Jacobsson reports personal fees from Pfizer, personal fees from Abbvie, personal fees from Novartis, personal fees from Eli-Lily, personal fees from Janssen, outside the submitted work. Corresponding author: Sofia Exarchou, M.D., PhD, Rheumatology, Department of Clinical Sciences Malmö, Lund University; Jan Waldenströms gata 1B, 205 02, Malmö, Sweden. E-mail:
| | - Ulf Lindström
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden; Department of Rheumatology, Skåne University Hospital, Malmö, Sweden; Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands. Funding: Sofia Exarchou's work with the study was funded by the Swedish Rheumatism Association. Apart from this, the authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Conflict of Interest: Dr. Exarchou reports grants from Swedish Rheumatism Association, during the conduct of the study; personal fees from Novartis, personal fees from Abbvie outside the submitted work. Dr. Turesson reports personal fees from Abbvie, personal fees from Pfizer, grants and personal fees from Bristol-Myers Squibb, personal fees from Roche, outside the submitted work. Dr. Lindström has nothing to disclose. Dr. Ramonda has nothing to disclose. Dr. Landewé has nothing to disclose. Dr. Dagfinrud has nothing to disclose. Dr. van Gaalen reports grants from MSD, grants from AbbVie, grants from Stichting Vrienden van Sole Mio, grants from UCB, grants and personal fees from Novartis, grants from Pfizer, outside the submitted work. Dr. van der Heijde reports personal fees from Abbvie, personal fees from Amgen, personal fees from Astellas, personal fees from AstraZeneca, personal fees from BMS, personal fees from Boehringer Ingelheim, personal fees from Celgene, personal fees from Cyxone, personal fees from Daiichi, personal fees from Eisai, personal fees from Eli-Lilly, personal fees from Galapagos, personal fees from Gilead, personal fees from Glaxo-Smith-Kline, personal fees from Janssen, personal fees from Merck, personal fees from Novartis, personal fees from Pfizer, personal fees from Regeneron, personal fees from Roche, personal fees from Sanofi, personal fees from Takeda, personal fees from UCB Pharma, other from Imaging Rheumatology bv, outside the submitted work. Dr. Jacobsson reports personal fees from Pfizer, personal fees from Abbvie, personal fees from Novartis, personal fees from Eli-Lily, personal fees from Janssen, outside the submitted work. Corresponding author: Sofia Exarchou, M.D., PhD, Rheumatology, Department of Clinical Sciences Malmö, Lund University; Jan Waldenströms gata 1B, 205 02, Malmö, Sweden. E-mail:
| | - Roberta Ramonda
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden; Department of Rheumatology, Skåne University Hospital, Malmö, Sweden; Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands. Funding: Sofia Exarchou's work with the study was funded by the Swedish Rheumatism Association. Apart from this, the authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Conflict of Interest: Dr. Exarchou reports grants from Swedish Rheumatism Association, during the conduct of the study; personal fees from Novartis, personal fees from Abbvie outside the submitted work. Dr. Turesson reports personal fees from Abbvie, personal fees from Pfizer, grants and personal fees from Bristol-Myers Squibb, personal fees from Roche, outside the submitted work. Dr. Lindström has nothing to disclose. Dr. Ramonda has nothing to disclose. Dr. Landewé has nothing to disclose. Dr. Dagfinrud has nothing to disclose. Dr. van Gaalen reports grants from MSD, grants from AbbVie, grants from Stichting Vrienden van Sole Mio, grants from UCB, grants and personal fees from Novartis, grants from Pfizer, outside the submitted work. Dr. van der Heijde reports personal fees from Abbvie, personal fees from Amgen, personal fees from Astellas, personal fees from AstraZeneca, personal fees from BMS, personal fees from Boehringer Ingelheim, personal fees from Celgene, personal fees from Cyxone, personal fees from Daiichi, personal fees from Eisai, personal fees from Eli-Lilly, personal fees from Galapagos, personal fees from Gilead, personal fees from Glaxo-Smith-Kline, personal fees from Janssen, personal fees from Merck, personal fees from Novartis, personal fees from Pfizer, personal fees from Regeneron, personal fees from Roche, personal fees from Sanofi, personal fees from Takeda, personal fees from UCB Pharma, other from Imaging Rheumatology bv, outside the submitted work. Dr. Jacobsson reports personal fees from Pfizer, personal fees from Abbvie, personal fees from Novartis, personal fees from Eli-Lily, personal fees from Janssen, outside the submitted work. Corresponding author: Sofia Exarchou, M.D., PhD, Rheumatology, Department of Clinical Sciences Malmö, Lund University; Jan Waldenströms gata 1B, 205 02, Malmö, Sweden. E-mail:
| | - Robert B M Landewé
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden; Department of Rheumatology, Skåne University Hospital, Malmö, Sweden; Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands. Funding: Sofia Exarchou's work with the study was funded by the Swedish Rheumatism Association. Apart from this, the authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Conflict of Interest: Dr. Exarchou reports grants from Swedish Rheumatism Association, during the conduct of the study; personal fees from Novartis, personal fees from Abbvie outside the submitted work. Dr. Turesson reports personal fees from Abbvie, personal fees from Pfizer, grants and personal fees from Bristol-Myers Squibb, personal fees from Roche, outside the submitted work. Dr. Lindström has nothing to disclose. Dr. Ramonda has nothing to disclose. Dr. Landewé has nothing to disclose. Dr. Dagfinrud has nothing to disclose. Dr. van Gaalen reports grants from MSD, grants from AbbVie, grants from Stichting Vrienden van Sole Mio, grants from UCB, grants and personal fees from Novartis, grants from Pfizer, outside the submitted work. Dr. van der Heijde reports personal fees from Abbvie, personal fees from Amgen, personal fees from Astellas, personal fees from AstraZeneca, personal fees from BMS, personal fees from Boehringer Ingelheim, personal fees from Celgene, personal fees from Cyxone, personal fees from Daiichi, personal fees from Eisai, personal fees from Eli-Lilly, personal fees from Galapagos, personal fees from Gilead, personal fees from Glaxo-Smith-Kline, personal fees from Janssen, personal fees from Merck, personal fees from Novartis, personal fees from Pfizer, personal fees from Regeneron, personal fees from Roche, personal fees from Sanofi, personal fees from Takeda, personal fees from UCB Pharma, other from Imaging Rheumatology bv, outside the submitted work. Dr. Jacobsson reports personal fees from Pfizer, personal fees from Abbvie, personal fees from Novartis, personal fees from Eli-Lily, personal fees from Janssen, outside the submitted work. Corresponding author: Sofia Exarchou, M.D., PhD, Rheumatology, Department of Clinical Sciences Malmö, Lund University; Jan Waldenströms gata 1B, 205 02, Malmö, Sweden. E-mail:
| | - Hanne Dagfinrud
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden; Department of Rheumatology, Skåne University Hospital, Malmö, Sweden; Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands. Funding: Sofia Exarchou's work with the study was funded by the Swedish Rheumatism Association. Apart from this, the authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Conflict of Interest: Dr. Exarchou reports grants from Swedish Rheumatism Association, during the conduct of the study; personal fees from Novartis, personal fees from Abbvie outside the submitted work. Dr. Turesson reports personal fees from Abbvie, personal fees from Pfizer, grants and personal fees from Bristol-Myers Squibb, personal fees from Roche, outside the submitted work. Dr. Lindström has nothing to disclose. Dr. Ramonda has nothing to disclose. Dr. Landewé has nothing to disclose. Dr. Dagfinrud has nothing to disclose. Dr. van Gaalen reports grants from MSD, grants from AbbVie, grants from Stichting Vrienden van Sole Mio, grants from UCB, grants and personal fees from Novartis, grants from Pfizer, outside the submitted work. Dr. van der Heijde reports personal fees from Abbvie, personal fees from Amgen, personal fees from Astellas, personal fees from AstraZeneca, personal fees from BMS, personal fees from Boehringer Ingelheim, personal fees from Celgene, personal fees from Cyxone, personal fees from Daiichi, personal fees from Eisai, personal fees from Eli-Lilly, personal fees from Galapagos, personal fees from Gilead, personal fees from Glaxo-Smith-Kline, personal fees from Janssen, personal fees from Merck, personal fees from Novartis, personal fees from Pfizer, personal fees from Regeneron, personal fees from Roche, personal fees from Sanofi, personal fees from Takeda, personal fees from UCB Pharma, other from Imaging Rheumatology bv, outside the submitted work. Dr. Jacobsson reports personal fees from Pfizer, personal fees from Abbvie, personal fees from Novartis, personal fees from Eli-Lily, personal fees from Janssen, outside the submitted work. Corresponding author: Sofia Exarchou, M.D., PhD, Rheumatology, Department of Clinical Sciences Malmö, Lund University; Jan Waldenströms gata 1B, 205 02, Malmö, Sweden. E-mail:
| | - Floris van Gaalen
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden; Department of Rheumatology, Skåne University Hospital, Malmö, Sweden; Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands. Funding: Sofia Exarchou's work with the study was funded by the Swedish Rheumatism Association. Apart from this, the authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Conflict of Interest: Dr. Exarchou reports grants from Swedish Rheumatism Association, during the conduct of the study; personal fees from Novartis, personal fees from Abbvie outside the submitted work. Dr. Turesson reports personal fees from Abbvie, personal fees from Pfizer, grants and personal fees from Bristol-Myers Squibb, personal fees from Roche, outside the submitted work. Dr. Lindström has nothing to disclose. Dr. Ramonda has nothing to disclose. Dr. Landewé has nothing to disclose. Dr. Dagfinrud has nothing to disclose. Dr. van Gaalen reports grants from MSD, grants from AbbVie, grants from Stichting Vrienden van Sole Mio, grants from UCB, grants and personal fees from Novartis, grants from Pfizer, outside the submitted work. Dr. van der Heijde reports personal fees from Abbvie, personal fees from Amgen, personal fees from Astellas, personal fees from AstraZeneca, personal fees from BMS, personal fees from Boehringer Ingelheim, personal fees from Celgene, personal fees from Cyxone, personal fees from Daiichi, personal fees from Eisai, personal fees from Eli-Lilly, personal fees from Galapagos, personal fees from Gilead, personal fees from Glaxo-Smith-Kline, personal fees from Janssen, personal fees from Merck, personal fees from Novartis, personal fees from Pfizer, personal fees from Regeneron, personal fees from Roche, personal fees from Sanofi, personal fees from Takeda, personal fees from UCB Pharma, other from Imaging Rheumatology bv, outside the submitted work. Dr. Jacobsson reports personal fees from Pfizer, personal fees from Abbvie, personal fees from Novartis, personal fees from Eli-Lily, personal fees from Janssen, outside the submitted work. Corresponding author: Sofia Exarchou, M.D., PhD, Rheumatology, Department of Clinical Sciences Malmö, Lund University; Jan Waldenströms gata 1B, 205 02, Malmö, Sweden. E-mail:
| | - Désirée van der Heijde
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden; Department of Rheumatology, Skåne University Hospital, Malmö, Sweden; Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands. Funding: Sofia Exarchou's work with the study was funded by the Swedish Rheumatism Association. Apart from this, the authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Conflict of Interest: Dr. Exarchou reports grants from Swedish Rheumatism Association, during the conduct of the study; personal fees from Novartis, personal fees from Abbvie outside the submitted work. Dr. Turesson reports personal fees from Abbvie, personal fees from Pfizer, grants and personal fees from Bristol-Myers Squibb, personal fees from Roche, outside the submitted work. Dr. Lindström has nothing to disclose. Dr. Ramonda has nothing to disclose. Dr. Landewé has nothing to disclose. Dr. Dagfinrud has nothing to disclose. Dr. van Gaalen reports grants from MSD, grants from AbbVie, grants from Stichting Vrienden van Sole Mio, grants from UCB, grants and personal fees from Novartis, grants from Pfizer, outside the submitted work. Dr. van der Heijde reports personal fees from Abbvie, personal fees from Amgen, personal fees from Astellas, personal fees from AstraZeneca, personal fees from BMS, personal fees from Boehringer Ingelheim, personal fees from Celgene, personal fees from Cyxone, personal fees from Daiichi, personal fees from Eisai, personal fees from Eli-Lilly, personal fees from Galapagos, personal fees from Gilead, personal fees from Glaxo-Smith-Kline, personal fees from Janssen, personal fees from Merck, personal fees from Novartis, personal fees from Pfizer, personal fees from Regeneron, personal fees from Roche, personal fees from Sanofi, personal fees from Takeda, personal fees from UCB Pharma, other from Imaging Rheumatology bv, outside the submitted work. Dr. Jacobsson reports personal fees from Pfizer, personal fees from Abbvie, personal fees from Novartis, personal fees from Eli-Lily, personal fees from Janssen, outside the submitted work. Corresponding author: Sofia Exarchou, M.D., PhD, Rheumatology, Department of Clinical Sciences Malmö, Lund University; Jan Waldenströms gata 1B, 205 02, Malmö, Sweden. E-mail:
| | - Lennart T H Jacobsson
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden; Department of Rheumatology, Skåne University Hospital, Malmö, Sweden; Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands. Funding: Sofia Exarchou's work with the study was funded by the Swedish Rheumatism Association. Apart from this, the authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Conflict of Interest: Dr. Exarchou reports grants from Swedish Rheumatism Association, during the conduct of the study; personal fees from Novartis, personal fees from Abbvie outside the submitted work. Dr. Turesson reports personal fees from Abbvie, personal fees from Pfizer, grants and personal fees from Bristol-Myers Squibb, personal fees from Roche, outside the submitted work. Dr. Lindström has nothing to disclose. Dr. Ramonda has nothing to disclose. Dr. Landewé has nothing to disclose. Dr. Dagfinrud has nothing to disclose. Dr. van Gaalen reports grants from MSD, grants from AbbVie, grants from Stichting Vrienden van Sole Mio, grants from UCB, grants and personal fees from Novartis, grants from Pfizer, outside the submitted work. Dr. van der Heijde reports personal fees from Abbvie, personal fees from Amgen, personal fees from Astellas, personal fees from AstraZeneca, personal fees from BMS, personal fees from Boehringer Ingelheim, personal fees from Celgene, personal fees from Cyxone, personal fees from Daiichi, personal fees from Eisai, personal fees from Eli-Lilly, personal fees from Galapagos, personal fees from Gilead, personal fees from Glaxo-Smith-Kline, personal fees from Janssen, personal fees from Merck, personal fees from Novartis, personal fees from Pfizer, personal fees from Regeneron, personal fees from Roche, personal fees from Sanofi, personal fees from Takeda, personal fees from UCB Pharma, other from Imaging Rheumatology bv, outside the submitted work. Dr. Jacobsson reports personal fees from Pfizer, personal fees from Abbvie, personal fees from Novartis, personal fees from Eli-Lily, personal fees from Janssen, outside the submitted work. Corresponding author: Sofia Exarchou, M.D., PhD, Rheumatology, Department of Clinical Sciences Malmö, Lund University; Jan Waldenströms gata 1B, 205 02, Malmö, Sweden. E-mail:
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Hiltunen J, Parmanne P, Sokka T, Lamberg T, Isomäki P, Kaipiainen-Seppänen O, Peltomaa R, Uutela T, Pirilä L, Taimen K, Kauppi MJ, Yli-Kerttula T, Tuompo R, Relas H, Kortelainen S, Paalanen K, Asikainen J, Ekman P, Santisteban A, Vidqvist KL, Tadesse K, Romu M, Borodina J, Elfving P, Valleala H, Leirisalo-Repo M, Rantalaiho V, Kautiainen H, Jokiranta TS, Eklund KK. Immunogenicity of subcutaneous TNF inhibitors and its clinical significance in real-life setting in patients with spondyloarthritis. Rheumatol Int 2021; 42:1015-1025. [PMID: 34357455 PMCID: PMC9124652 DOI: 10.1007/s00296-021-04955-8] [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: 04/29/2021] [Accepted: 07/17/2021] [Indexed: 01/17/2023]
Abstract
Key messages Considerable proportion of patients with SpA have been immunized to the subcutaneous anti-TNF drug they are using. Concomitant use of MTX protects from immunization, whereas SASP does not. Patients with SpA using subcutaneous anti-TNF drugs can benefit from monitoring of the drug trough levels. Abstract Immunization to biological drugs can lead to decreased efficacy and increased risk of adverse effects. The objective of this cross-sectional study was to assess the extent and significance of immunization to subcutaneous tumor necrosis factor (TNF) inhibitors in axial spondyloarthritis (axSpA) patients in real-life setting. A serum sample was taken 1–2 days before the next drug injection. Drug trough concentrations, anti-drug antibodies (ADAb) and TNF-blocking capacity were measured in 273 patients with axSpA using subcutaneous anti-TNF drugs. The clinical activity of SpA was assessed using the Bath AS Disease Activity Index (BASDAI) and the Maastricht AS Entheses Score (MASES). ADAb were found in 11% of the 273 patients: in 21/99 (21%) of patients who used adalimumab, in 0/83 (0%) of those who used etanercept, in 2/79 (3%) of those who used golimumab and in 6/12 (50%) of those who used certolizumab pegol. Use of methotrexate reduced the risk of formation of ADAb, whereas sulfasalazine did not. Presence of ADAb resulted in decreased drug concentration and reduced TNF-blocking capacity. However, low levels of ADAb had no effect on TNF-blocking capacity and did not correlate with disease activity. The drug trough levels were below the consensus target level in 36% of the patients. High BMI correlated with low drug trough concentration. Patients with low drug trough levels had higher disease activity. The presence of anti-drug antibodies was associated with reduced drug trough levels, and the patients with low drug trough levels had higher disease activity. The drug trough levels were below target level in significant proportion of patients and, thus, measuring the drug concentration and ADAb could help to optimize the treatment in SpA patients. Supplementary Information The online version contains supplementary material available at 10.1007/s00296-021-04955-8.
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Affiliation(s)
- J Hiltunen
- Department of Rheumatology, Helsinki University and Helsinki University Hospital, Haartmaninkatu 4, P. O. Box 372, 00029 HUS, Helsinki, Finland.
| | - P Parmanne
- Department of Rheumatology, Helsinki University and Helsinki University Hospital, Haartmaninkatu 4, P. O. Box 372, 00029 HUS, Helsinki, Finland
| | - T Sokka
- Department of Rheumatology, Jyväskylä Central Hospital, Jyväskylä, Finland.,University of Eastern Finland, Kuopio, Finland
| | - T Lamberg
- United Medix Laboratories, Helsinki, Finland
| | - P Isomäki
- Department of Rheumatology, Tampere University Hospital, Tampere, Finland
| | | | - R Peltomaa
- Department of Rheumatology, Helsinki University and Helsinki University Hospital, Haartmaninkatu 4, P. O. Box 372, 00029 HUS, Helsinki, Finland
| | - T Uutela
- Department of Rheumatology, Central Hospital of Lapland, Rovaniemi, Finland
| | - L Pirilä
- Department of Rheumatology, Turku University Hospital, Turku, Finland
| | - K Taimen
- Department of Rheumatology, Turku University Hospital, Turku, Finland
| | - M J Kauppi
- Department of Rheumatology, Päijät-Häme Central Hospital, Lahti, Finland.,University of Tampere, Tampere, Finland
| | - T Yli-Kerttula
- Department of Rheumatology, Satakunta Central Hospital, Rauma, Finland
| | - R Tuompo
- Department of Rheumatology, Helsinki University and Helsinki University Hospital, Haartmaninkatu 4, P. O. Box 372, 00029 HUS, Helsinki, Finland
| | - H Relas
- Department of Rheumatology, Helsinki University and Helsinki University Hospital, Haartmaninkatu 4, P. O. Box 372, 00029 HUS, Helsinki, Finland
| | - S Kortelainen
- Department of Rheumatology, Turku University Hospital, Turku, Finland
| | - K Paalanen
- Department of Rheumatology, Jyväskylä Central Hospital, Jyväskylä, Finland.,University of Eastern Finland, Kuopio, Finland
| | - J Asikainen
- Department of Rheumatology, Jyväskylä Central Hospital, Jyväskylä, Finland.,University of Eastern Finland, Kuopio, Finland
| | - P Ekman
- Department of Rheumatology, Satakunta Central Hospital, Rauma, Finland
| | - A Santisteban
- Department of Rheumatology, Mikkeli Central Hospital, Mikkeli, Finland
| | - K-L Vidqvist
- Department of Rheumatology, Tampere University Hospital, Tampere, Finland
| | - K Tadesse
- Department of Rheumatology, Helsinki University and Helsinki University Hospital, Haartmaninkatu 4, P. O. Box 372, 00029 HUS, Helsinki, Finland
| | - M Romu
- Department of Rheumatology, Helsinki University and Helsinki University Hospital, Haartmaninkatu 4, P. O. Box 372, 00029 HUS, Helsinki, Finland
| | - J Borodina
- Department of Rheumatology, Jyväskylä Central Hospital, Jyväskylä, Finland.,University of Eastern Finland, Kuopio, Finland
| | - P Elfving
- Department of Rheumatology, Kuopio University Hospital, Kuopio, Finland
| | - H Valleala
- Department of Rheumatology, Helsinki University and Helsinki University Hospital, Haartmaninkatu 4, P. O. Box 372, 00029 HUS, Helsinki, Finland
| | - M Leirisalo-Repo
- Department of Rheumatology, Helsinki University and Helsinki University Hospital, Haartmaninkatu 4, P. O. Box 372, 00029 HUS, Helsinki, Finland
| | - V Rantalaiho
- Department of Rheumatology, Tampere University Hospital, Tampere, Finland
| | | | | | - K K Eklund
- Department of Rheumatology, Helsinki University and Helsinki University Hospital, Haartmaninkatu 4, P. O. Box 372, 00029 HUS, Helsinki, Finland.,Translational Immunology Research Program, Helsinki University and Orton Research Foundation, Orton Hospital, Helsinki, Finland
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21
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Pina Vegas L, Sbidian E, Wendling D, Goupille P, Ferkal S, Le Corvoisier P, Ghaleh B, Luciani A, Claudepierre P. Factors associated with remission at 5-year follow-up in recent onset axial spondyloarthritis: results from the DESIR cohort. Rheumatology (Oxford) 2021; 61:1487-1495. [PMID: 34270707 PMCID: PMC8996779 DOI: 10.1093/rheumatology/keab565] [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: 03/12/2021] [Revised: 07/05/2021] [Indexed: 11/30/2022] Open
Abstract
Objective The factors contributing to long-term remission in axial SpA (axSpA) are unclear. We aimed to characterize individuals with axSpA at the 5-year follow-up to identify baseline factors associated with remission. Methods We included all patients from the DESIR cohort (with recent-onset axSpA) with an available Ankylosing Spondylitis Disease Activity Score–CRP (ASDAS-CRP) at 5-year follow-up. Patients in remission (ASDAS-CRP < 1.3) were compared with those with active disease by demographic, clinical, biological and imaging characteristics. A logistic model stratified on TNF inhibitor (TNFi) exposure was used. Results Overall, 111/449 patients (25%) were in remission after 5 years. Among those never exposed to TNFi, 31% (77/247) were in remission compared with 17% (34/202) of those exposed to TNFi. Patients in remission after 5 years were more likely to be male, HLA-B27+, have a lower BMI, and a higher education level. Baseline factors associated with 5-year remission in patients never exposed to TNFi included lower BASDAI [adjusted odds ratio (ORa) 0.9, 95% CI: 0.8, 0.9) and history of peripheral arthritis (ORa 2.1, 95% CI: 1.2, 5.3). In those exposed to TNFi, remission was associated with higher education level (ORa 2.9, 95% CI: 1.6, 5.1), lower enthesitis index (ORa 0.8, 95% CI: 0.7, 0.9), lower BASDAI (ORa 0.9, 95% CI: 0.9, 0.9) and lower BMI (ORa 0.8, 95% CI: 0.7, 0.9). Conclusion This study highlights the difficulty in achieving 5-year remission in those with recent-onset axSpA, especially for the more active cases, despite the use of TNFi. Socio-economic factors and BMI are implicated in the outcome at 5 years.
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Affiliation(s)
- Laura Pina Vegas
- EpiDermE, Université Paris Est Créteil, Créteil, France.,Service de Rhumatologie, AP-HP, Hôpital Henri Mondor, Créteil, France
| | - Emilie Sbidian
- EpiDermE, Université Paris Est Créteil, Créteil, France.,Service de Dermatologie, AP-HP, Hôpital Henri Mondor, Créteil, France.,INSERM, Centre d'Investigation Clinique 1430, Créteil, France
| | - Daniel Wendling
- Service de rhumatologie, CHRU de Besançon, Besançon, France.,EA 4266 « agents pathogènes et inflammation », université de Franche-Comté, Besançon, France
| | - Philippe Goupille
- Service de Rhumatologie, CHU de Tours, Tours, France.,EA 7501, GICC, Université de Tours, Tours, France
| | - Salah Ferkal
- Service de Dermatologie, AP-HP, Hôpital Henri Mondor, Créteil, France.,INSERM, Centre d'Investigation Clinique 1430, Créteil, France
| | - Philippe Le Corvoisier
- INSERM, Centre d'Investigation Clinique 1430, Créteil, France.,Inserm, U955-IMRB, Équipe 03, UPEC, Ecole Nationale Vétérinaire d'Alfort, Créteil, France
| | - Bijan Ghaleh
- Plateforme de Ressources Biologiques, AP-HP, Hôpital Henri Mondor, Créteil, France
| | - Alain Luciani
- Inserm U955 équipe 18, Université Paris Est Créteil, Créteil, France
| | - Pascal Claudepierre
- EpiDermE, Université Paris Est Créteil, Créteil, France.,Service de Rhumatologie, AP-HP, Hôpital Henri Mondor, Créteil, France
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22
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Liew DFL, Dau J, Robinson PC. Value-Based Healthcare in Rheumatology: Axial Spondyloarthritis and Beyond. Curr Rheumatol Rep 2021; 23:36. [PMID: 33909169 DOI: 10.1007/s11926-021-01003-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE OF REVIEW This review examines axial spondyloarthritis (axSpA) and the wider field of rheumatology through a value-based healthcare (VBHC) lens. VBHC is focused on ensuring patients receive high quality care to improve outcomes and reduce unnecessary costs. RECENT FINDINGS There are many opportunities to apply the principles of VBHC in axSpA. These include the appropriate utilization of diagnostic investigations, such as HLA-B27 and magnetic resonance imaging, assessing outcomes meaningful to patients, and optimizing care pathways. Multidisciplinary care may improve value, and reduced specialist review and medication tapering may be appropriate. Increasing the value of the care we provide to patients can occur across domains and directly and indirectly improves patient outcomes. Taking the time to integrate principles of VBHC into our practice will allow us to justifiably gain and maintain access to diagnostic and therapeutic advances for the benefit of all our patients.
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Affiliation(s)
- David F L Liew
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia.,Department of Rheumatology, Austin Health, Heidelberg, Victoria, Australia.,Department of Clinical Pharmacology and Therapeutics, Austin Health, Heidelberg, Victoria, Australia
| | - Jonathan Dau
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
| | - Philip C Robinson
- Faculty of Medicine, University of Queensland School of Clinical Medicine, Herston, Queensland, 4006, Australia. .,Department of Rheumatology, Royal Brisbane & Women's Hospital, Metro North Hospital & Health Service, Bowen Bridge Road, Herston, Queensland, 4006, Australia.
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23
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Jeong H, Bae EK, Hwang J, Park EJ, Lee J, Jeon CH, Koh EM, Cha HS. The Effects of Sex and Estrogen on Radiographic Progression of Ankylosing Spondylitis in Korean Patients. JOURNAL OF RHEUMATIC DISEASES 2021; 28:76-84. [PMID: 37476018 PMCID: PMC10324893 DOI: 10.4078/jrd.2021.28.2.76] [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: 11/05/2020] [Revised: 12/09/2020] [Accepted: 12/14/2020] [Indexed: 07/22/2023]
Abstract
Objective Ankylosing spondylitis (AS) is a chronic inflammatory disease with obvious male preponderance Males show more severe radiographic manifestations compared with females This study aimed to evaluate the effects of sex and estrogen on the radiographic progression of AS. Methods A total of 101 patients with AS were included in this study All of the radiographs were scored using the modified Stoke AS Spine Score (mSASSS) Serum levels of 17β-estradiol (E2), dickkopf-1 (Dkk1), and leptin were detected by enzyme-linked immunosorbent assay The generalized estimating equations model was used to evaluate factors associated with spinal radiographic progression. Results The mean age at disease onset was 273±107 years, and 16 patients (158%) were female In the multivariable analysis, body mass index (β-coefficient=012; p=0047) and levels of Dkk1 (β-coefficient=-011; p<0001), and female (β-coefficient=-140; p=0001) were associated with radiographic progression Among male patients with AS, baseline C-reactive protein (β=011; p=0005) and mSASSS (β=021; p=0030) were also associated with radiographic progression E2 and leptin levels were not significantly related to the radiographic progression. Conclusion Although female patients were associated with less radiographic progression in AS, there was no significant relationship between serum estrogen level and radiographic progression Results of current study suggests that genetic factors or other environmental factors associated with female may influence radiographic progression in patients with AS.
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Affiliation(s)
- Hyemin Jeong
- Division of Rheumatology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | | | - Jiwon Hwang
- Department of Internal Medicine, Samsung Changwon Hospital, Changwon, Korea
| | - Eun-Jung Park
- Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Jaejoon Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chan Hong Jeon
- Division of Rheumatology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Eun-Mi Koh
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hoon-Suk Cha
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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24
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Morin M, Hellgren K, Lindström U, Frisell T. Is family history a predictor of response to tumour necrosis factor inhibitors in spondyloarthritis? A Swedish nationwide cohort study. Scand J Rheumatol 2021; 51:10-20. [PMID: 33755519 DOI: 10.1080/03009742.2021.1887928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective: To determine whether a family history of spondyloarthritis (SpA) is associated with clinical presentation at the start of tumour necrosis factor inhibitor (TNFi) treatment, or predictive of TNFi drug survival and treatment response in patients with SpA.Method: Family history of SpA in patients with ankylosing spondylitis (AS), psoriatic arthritis (PsA), and undifferentiated SpA (uSpA) from the Swedish Rheumatology Quality register starting a TNFi as their first biologic in 2006-2018 was assessed through national registers. Clinical characteristics at treatment start were compared by family history status. We used Cox regression to estimate hazard ratios for drug discontinuation, and analysed treatment response at 3 and 12 months with linear regression. Multiple imputation was used to address missing data.Results: We included 9608 patients. Patients with family history had an earlier age at onset and longer disease duration at TNFi treatment start, but did not differ regarding disease activity and presence of SpA manifestations. Hazard ratios for drug discontinuation were 1.08 [95% confidence interval (CI) 0.89-1.31] for AS patients with a family history of AS, 1.02 (95% CI 0.89-1.18) for PsA patients with a family history of PsA, and 1.11 (95% CI 0.85-1.45) for uSpA patients with a family history of uSpA, after adjusting for demographic, socioeconomic, and SpA-related factors. Treatment response at 3 and 12 months was similar between groups.Conclusion: Family history of SpA was not found to be associated with clinical presentation at the start of TNFi treatment, nor was it associated with drug survival or treatment response in SpA patients starting a first TNFi.
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Affiliation(s)
- M Morin
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - K Hellgren
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.,Rheumatology, Theme Inflammation and Infection, Karolinska University Hospital, Stockholm, Sweden
| | - U Lindström
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - T Frisell
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
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25
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Ki Min H, Kim HR, Lee SH, Hong YS, Kim MY, Park SH, Kang KY. Retention rate and effectiveness of secukinumab vs TNF inhibitor in ankylosing spondylitis patients with prior TNF inhibitor exposure. Rheumatology (Oxford) 2021; 60:5743-5752. [PMID: 33725088 DOI: 10.1093/rheumatology/keab245] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/25/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES The choice of second-line biologics for ankylosing spondylitis (AS) patients previously treated with a tumour necrosis factor inhibitor (TNFi) remains unclear. Here, we compared drug retention and clinical efficacy between AS patients who switched biologics to secukinumab and those who switched to a different TNFi. METHODS AS patients enrolled in the Korean College of Rheumatology BIOlogics registry were included, and patients with non-radiographic axial spondyloarthritis were excluded. Patients with previous TNFi exposure were divided into the secukinumab group and the TNFi switching group. Drug retention and clinical efficacy (BASDAI50, ASAS20, ASAS40, ASDAS <2.1, ASDAS clinically important improvement, and ASDAS major improvement) were assessed at the 1 year follow-up. Propensity score (PS)-matched and covariate-adjusted logistic regression analyses were performed. RESULTS 246 had available 1 year follow-up data. Secukinumab as third- or later-line biologics was more frequent than alternative TNFi (54% vs 14%). PS-matched and multiple covariate-adjusted analyses showed that the odds ratio (OR) for drug discontinuation was comparable between the secukinumab and TNFi switching groups (OR = 1.136; 95% CI, 0.843-1.531 and OR = 1.000; 95% CI, 0.433-2.308, respectively). The proportion of patients who achieved BASDAI50 was also comparable between the two groups (OR = 0.833; 95% CI, 0.481-1.441 in PS-matched analysis). Other clinical efficacy parameters were also comparable. In the subgroup analysis of AS patients with previous TNFi discontinuation due to ineffectiveness, all clinical efficacy parameters were comparable between the two groups. CONCLUSION In AS patients with previous exposure to a TNFi, switching biologics to secukinumab and switching to an alternative TNFi resulted in comparable drug retention and clinical efficacy.
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Affiliation(s)
- Hong Ki Min
- Division of Rheumatology, Department of Internal Medicine, Konkuk University Medical Center, 120-1 Neungdong-ro, Gwangjin-gu, Seoul
| | - Hae-Rim Kim
- Division of Rheumatology, Department of Internal Medicine, Research Institute of Medical Science, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul
| | - Sang-Heon Lee
- Division of Rheumatology, Department of Internal Medicine, Research Institute of Medical Science, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul
| | - Yeon Sik Hong
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul.,Division of Rheumatology, Department of Internal Medicine, Incheon Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, South Korea
| | - Moon-Young Kim
- Division of Rheumatology, Department of Internal Medicine, Incheon Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, South Korea
| | - Sung-Hwan Park
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul
| | - Kwi Young Kang
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul.,Division of Rheumatology, Department of Internal Medicine, Incheon Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, South Korea
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26
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Gupta L, Guleria A, Rawat A, Kumar D, Aggarwal A. NMR-based clinical metabolomics revealed distinctive serum metabolic profiles in patients with spondyloarthritis. MAGNETIC RESONANCE IN CHEMISTRY : MRC 2021; 59:85-98. [PMID: 32786028 DOI: 10.1002/mrc.5083] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 07/29/2020] [Accepted: 07/30/2020] [Indexed: 06/11/2023]
Abstract
Spondyloarthritis (SpA) is a common rheumatic disorder of the young, marred by delay in diagnosis, and paucity of biomarkers of disease activity. The present study aimed to explore the potential of serum metabolic profiling of patients with SpA to identify biomarker for the diagnosis and assessment of disease activity. The serum metabolic profiles of 81 patients with SpA were compared with that of 86 healthy controls (HCs) using nuclear magnetic resonance (NMR)-based metabolomics approach. Seventeen patients were followed up after 3 months of standard treatment, and paired sera were analyzed for effects of therapy. Comparisons were done using the multivariate partial least squares discriminant analysis (PLS-DA), and the discriminatory metabolic entities were identified based on variable importance in projection (VIP) statistics and further evaluated for statistical significance (p value < 0.05). We found that the serum metabolic profiles differed significantly in SpA as compared with HCs. Compared with HC, the SpA patients were characterized by increased serum levels of amino acids, acetate, choline, N-acetyl glycoproteins, Nα-acetyl lysine, creatine/creatinine, and so forth and decreased levels of low-/very low-density lipoproteins and polyunsaturated lipids. PLS-DA analysis also revealed metabolic differences between axial and peripheral SpA patients. Further metabolite profiles were found to differ with disease activity and treatment in responding patients. The results presented in this study demonstrate the potential of serum metabolic profiling of axial SpA as a useful tool for diagnosis, prediction of peripheral disease, assessment of disease activity, and treatment response.
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Affiliation(s)
- Latika Gupta
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Anupam Guleria
- Centre of Biomedical Research, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Atul Rawat
- Centre of Biomedical Research, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Dinesh Kumar
- Centre of Biomedical Research, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Amita Aggarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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27
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Fragoulis GE, Siebert S. Treatment strategies in axial spondyloarthritis: what, when and how? Rheumatology (Oxford) 2021; 59:iv79-iv89. [PMID: 33053192 PMCID: PMC7566463 DOI: 10.1093/rheumatology/keaa435] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/24/2020] [Indexed: 12/16/2022] Open
Abstract
There have been major advances in the management of axial spondyloarthritis (axSpA) with the introduction of effective biologic agents targeting TNF and IL-17A. Clinicians now have more choice but, despite treatment recommendations, are still faced with significant uncertainty when deciding on the optimal treatment strategy for an individual patient in clinical practice. Management of axSpA typically requires both non-pharmacological and pharmacological interventions. NSAIDs remain the first line drug therapies for axSpA with proven efficacy for symptomatic management but uncertainty remains regarding their optimal long-term use relating to radiographic progression and safety in axSpA. To-date there are no head-to-head trials of biologics in axSpA. Clinicians need to consider other factors, including extra-articular manifestations, comorbidities, safety and radiographic progression when deciding on which biologic to recommend for an individual patient. This article will explore the evidence relating to these factors and highlight areas of unmet need.
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Affiliation(s)
- George E Fragoulis
- First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens, 'Laiko' General Hospital, Athens, Greece
| | - Stefan Siebert
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
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28
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Body Mass Index and Disease Activity in Chronic Inflammatory Rheumatic Diseases: Results of the Cardiovascular in Rheumatology (Carma) Project. J Clin Med 2021; 10:jcm10030382. [PMID: 33498379 PMCID: PMC7864025 DOI: 10.3390/jcm10030382] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/12/2021] [Accepted: 01/17/2021] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Since obesity has been associated with a higher inflammatory burden and worse response to therapy in patients with chronic inflammatory rheumatic diseases (CIRD), we aimed to confirm the potential association between body mass index (BMI) and disease activity in a large series of patients with CIRDs included in the Spanish CARdiovascular in rheuMAtology (CARMA) registry. METHODS Baseline data analysis of patients included from the CARMA project, a 10-year prospective study of patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriatic arthritis (PsA) attending outpatient rheumatology clinics from 67 Spanish hospitals. Obesity was defined when BMI (kg/m2) was >30 according to the WHO criteria. Scores used to evaluate disease activity were Disease Activity Score of 28 joints (DAS28) in RA, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) in AS, and modified DAS for PsA. RESULTS Data from 2234 patients (775 RA, 738 AS, and 721 PsA) were assessed. The mean ± SD BMI at the baseline visit were: 26.9 ± 4.8 in RA, 27.4 ± 4.4 in AS, and 28.2 ± 4.7 in PsA. A positive association between BMI and disease activity in patients with RA (β = 0.029; 95%CI (0.01- 0.05); p = 0.007) and PsA (β = 0.036; 95%CI (0.015-0.058); p = 0.001) but not in those with AS (β = 0.001; 95%CI (-0.03-0.03); p = 0.926) was found. Disease activity was associated with female sex and rheumatoid factor in RA and with Psoriasis Area Severity Index and enthesitis in PsA. CONCLUSIONS BMI is associated with disease activity in RA and PsA, but not in AS. Given that obesity is a potentially modifiable factor, adequate control of body weight can improve the outcome of patients with CIRD and, therefore, weight control should be included in the management strategy of these patients.
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Zhuang J, Huang Y, Liang G. Clinical significance of the monocyte:lymphocyte ratio for ankylosing spondylitis patients with thoracolumbar kyphotic deformities. J Int Med Res 2020; 48:300060519893167. [PMID: 31939332 PMCID: PMC7254163 DOI: 10.1177/0300060519893167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose This study aimed to determine the clinical significance of the monocyte:lymphocyte ratio (MLR) in ankylosing spondylitis (AS) patients with thoracolumbar kyphotic deformity. Methods Ninety AS patients and 45 healthy controls were retrospectively enrolled. AS patients were divided into thoracolumbar kyphotic deformity (AS deformity) and spine normal (AS normal) groups. Blood parameters including C-reactive protein and erythrocyte sedimentation rate were determined. Receiver operating characteristic (ROC) curves and binary logistic regression analysis were conducted. Results Counts of white blood cells, neutrophils, and monocytes, and the neutrophil:lymphocyte ratio, platelet:lymphocyte ratio, and MLR were significantly higher in the AS than the control group. ROC curve results showed that the MLR yielded a higher area under the curve (AUC) value than other parameters, compared with controls. The MLR and monocyte count were higher in the AS deformity group than the AS normal group. ROC curve results indicated that the MLR yielded a higher AUC value than other parameters, compared with the AS normal group. Logistic regression suggested that the MLR was an independent predictor for thoracolumbar kyphotic deformity. Conclusions The MLR was elevated in AS patients, and was shown to be an independent predictor for thoracolumbar kyphotic deformity.
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Affiliation(s)
- Jianxiong Zhuang
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yongxiong Huang
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Guoyan Liang
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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Carvalho PD, Ruyssen-Witrand A, Marreiros A, Machado PM. Long-term association between disease activity and disability in early axial spondyloarthritis: results from the DESIR cohort. Arthritis Care Res (Hoboken) 2020; 74:768-775. [PMID: 33207078 DOI: 10.1002/acr.24515] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 10/20/2020] [Accepted: 11/12/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Our primary objective was to study the long-term association between disease activity and disability in axial spondyloarthritis (axSpA). Our secondary objective was to define patient profiles according to their level of disability. METHODS We analysed data collected during the first five years of follow-up of a large early axSpA cohort - the Devenir des Spondylarthropathies Indifferénciées Récentes (DESIR) cohort. Multivariable models were built to study the association between Ankylosing Spondylitis Health Assessment Questionnaire (HAQ-AS) and Ankylosing Spondylitis Disease Activity Score C-reactive protein (ASDAS-CRP), adjusting for potential confounders. Hierarchical multivariable analysis was conducted using the Chi-square Automatic Interaction Detector (CHAID) method, to help determine how variables best cluster to explain HAQ-AS. RESULTS Data from 644 patients and 5152 visits were analysed. HAQ-AS was longitudinally, independently and positively associated with ASDAS-CRP [adjusted (adj) B=0.205, (95% confidence interval (CI)= 0.187 to 0.222], enthesitis score (adjB=0.011, CI=0.008 to 0.015), Bath Ankylosing Spondylitis Metrology Index (BASMI) (adjB=0.087, CI=0.069 to 0.105) and female gender (adjB=0.172, CI=0.120 to 0.225). The CHAID decision tree revealed ASDAS-CRP as the first variable with discriminative power on HAQ-AS. The cut-offs that separated different patient disability profiles were obtained. CONCLUSION Disease activity contributes longitudinally to disability and is hierarchically superior to any other variable in explaining this health domain. Enthesitis and spinal mobility are also key drivers of disability in early axSpA. ASDAS-CRP cut-offs that separated different patient disability profiles largely mimicked the cut-offs previously defined for ASDAS-CRP disease activity states.
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Affiliation(s)
- Pedro D Carvalho
- Department of Rheumatology, Centro Hospitalar Universitário do Algarve, Faro, Portugal.,Lisbon Academic Medical Center, Universidade de Lisboa, Lisbon, Portugal.,Algarve Biomedical Center, Universidade do Algarve, Faro, Portugal
| | | | - Ana Marreiros
- Algarve Biomedical Center, Universidade do Algarve, Faro, Portugal.,Faculty of Medicine and Biomedical Sciences, Universidade do Algarve, Faro, Portugal
| | - Pedro M Machado
- Centre for Rheumatology &, Department of Neuromuscular Diseases, University College London, London, UK.,National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre, University College London Hospitals National Health Service (NHS) Trust, London, UK.,Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS trust, London, UK
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Biallas RL, Dean LE, Davidson L, Hollick R, Pathan E, Robertson L, Jones GT, Macfarlane GJ, Rotariu O. Role of Metrology in Axial Spondyloarthritis: Does It Provide Unique Information in Assessing Patients and Predicting Outcome? Results From the British Society for Rheumatology Biologic Register for Ankylosing Spondylitis. Arthritis Care Res (Hoboken) 2020; 74:665-674. [PMID: 33140891 DOI: 10.1002/acr.24500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/24/2020] [Accepted: 10/29/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To determine among patients with axial spondyloarthritis (SpA) the factors associated with decreased spinal mobility and to determine whether poor mobility is a predictor of response to anti-tumor necrosis factor (anti-TNF) therapy. METHODS This was a prospective UK cohort study of persons meeting Assessment of Spondylarthritis international Society (ASAS) criteria for axial SpA. At recruitment, clinical and patient-reported factors independently associated with spinal mobility (measured by the Bath Ankylosing Spondylitis Metrology Index [BASMI]) were determined. Among those commencing anti-TNF therapy, factors that were independent predictors of response were determined using ASAS criteria, quality of life, and Ankylosing Spondylitis Disease Activity Score (ASDAS) response criteria. RESULTS A total of 1,960 participants were eligible; 70% were male and the median age was 48 years (interquartile range [IQR] 37,59), median BASMI score 3.6 (IQR 2.2, 5.3). Factors independently associated with poor spinal mobility were poorer function, meeting radiographic criteria for AS, longer symptom duration, higher levels of inflammation (measured by C-reactive protein level), older age, male sex, not being currently employed, and lower levels of education. For 51% of participants, the measured BASMI score was within 1 of that estimated. Poorer mobility (higher BASMI score) was an independent predictor of not meeting response criteria for ASAS 20% improvement (odds ratio [OR] per increasing score 0.80 [IQR 0.66, 0.98]), ASAS 40% improvement (OR 0.69 [IQR 0.50, 0.95]), and quality of life (measured by the Ankylosing Spondylitis Quality of Life Questionnaire) (β = 0.64 [IQR 0.26, 1.02]), but was not related to meeting ASDAS response criteria. CONCLUSION The BASMI score was estimated moderately well by other routinely measured factors in patients with axial SpA and was an independent predictor of response to biologic therapy for some, but not all, commonly used measures. Consensus around its role in disease monitoring and clinical decisions, particularly in the likely context of face-to-face consultations becoming less frequent, remains to be established.
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Affiliation(s)
- Renke L Biallas
- School of Medicine, Medical Science, and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Linda E Dean
- School of Medicine, Medical Science, and Nutrition, University of Aberdeen, Aberdeen, UK
| | | | - Rosemary Hollick
- School of Medicine, Medical Science, and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Ejaz Pathan
- Toronto Western Hospital, Toronto, Ontario, Canada
| | | | - Gareth T Jones
- School of Medicine, Medical Science, and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Gary J Macfarlane
- School of Medicine, Medical Science, and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Ovidiu Rotariu
- School of Medicine, Medical Science, and Nutrition, University of Aberdeen, Aberdeen, UK
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Zhao SS, Goodson NJ, Robertson S, Gaffney K. Smoking in spondyloarthritis: unravelling the complexities. Rheumatology (Oxford) 2020; 59:1472-1481. [PMID: 32236486 DOI: 10.1093/rheumatology/keaa093] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 12/05/2019] [Accepted: 02/04/2020] [Indexed: 12/17/2022] Open
Abstract
Tobacco smoking is a major threat to health. There is no doubt about the need to promote and support cessation at every opportunity. Smoking has a clear role in RA, but what evidence is there that the same relationship exists in SpA? In this review, we examine (the less cited) paradoxes and contradictions in the existing axial SpA (axSpA) and PsA literature; for example, smoking appears to be 'protective' for some axSpA manifestations. We also highlight findings from higher quality evidence: smoking is associated with increased risk of PsA and the risk of psoriasis in axSpA. The relationship between smoking and SpA is far from simple. Our aim is to highlight the harms of smoking in SpA and bring attention to inconsistencies in the literature to inform further research.
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Affiliation(s)
- Sizheng Steven Zhao
- Musculoskeletal biology I, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool.,Department of Academic Rheumatology, Liverpool University Hospitals, Liverpool
| | - Nicola J Goodson
- Musculoskeletal biology I, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool.,Department of Academic Rheumatology, Liverpool University Hospitals, Liverpool
| | - Selina Robertson
- Department of Academic Rheumatology, Liverpool University Hospitals, Liverpool
| | - Karl Gaffney
- Department of Rheumatology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
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Walsh JA, Wan MT, Willinger C, Husni ME, Scher JU, Reddy SM, Ogdie A. Measuring Outcomes in Psoriatic Arthritis: Comparing Routine Assessment of Patient Index Data and Psoriatic Arthritis Impact of Disease. J Rheumatol 2020; 47:1496-1505. [PMID: 31575704 PMCID: PMC11110026 DOI: 10.3899/jrheum.190219] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To examine the construct validity of Routine Assessment of Patient Index Data 3 (RAPID3) and Psoriatic Arthritis Impact of Disease (PsAID) in patients with psoriatic arthritis (PsA). In examining construct validity, we also addressed scores among subgroups with severe psoriasis, poly articular disease, enthesitis, and dactylitis, and evaluated influences of sociodemographic factors and comorbidities (contextual factors) on these patient-reported outcomes (PRO). METHODS Patients with PsA were enrolled in the Psoriatic Arthritis Research Consortium (PARC) between 2014 and 2016. PARC is a longitudinal observational cohort study conducted at 4 US institutions. In this cross-sectional study, construct validity was assessed by examining Spearman correlation coefficients for RAPID3 and PsAID with physician-reported disease activity measures and other PRO [e.g., Medical Outcomes Study Short Form-12 physical component summary/mental component summary (SF-12 PCS/MCS), Functional Assessment of Chronic Illness Therapy-Fatigue scale (FACIT-F)]. Contextual factors and disease subgroups were assessed in multivariable linear regression models with RAPID3 or PsAID12 as outcomes of interest and the hypothesized contextual factors as covariates. RESULTS Among 401 patients enrolled in PARC, 347 completed RAPID3 or PsAID12. Of these, most were white females with a mean age of 51.7 years (SD 14.02). RAPID3 and PsAID were highly correlated (r = 0.90). These measures were also correlated with the SF-12 PCS (r = -0.67) and FACIT-F (r = -0.77). Important contextual factors and disease subgroups included enthesitis, joint counts, education, insurance type, and depression. CONCLUSION RAPID3 and PsAID12 have excellent construct validity in PsA and are strongly correlated despite differing items. Contextual factors (i.e., the presence of depression and obesity) should be considered when interpreting raw scores of the RAPID3 and PsAID12.
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Affiliation(s)
- Jessica A Walsh
- J.A. Walsh, MD, MBA, A. Ogdie, MD, MSCE, Division of Rheumatology, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Marilyn T Wan
- M.T. Wan, MBChB, MPH, Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | | | | | - Jose U Scher
- J.U. Scher, MD, S.M. Reddy MD, New York University School of Medicine, New York, New York, USA
| | - Soumya M Reddy
- J.U. Scher, MD, S.M. Reddy MD, New York University School of Medicine, New York, New York, USA
| | - Alexis Ogdie
- J.A. Walsh, MD, MBA, A. Ogdie, MD, MSCE, Division of Rheumatology, University of Pennsylvania Perelman School of Medicine, Philadelphia;
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Influence of smoking and obesity on treatment response in patients with axial spondyloarthritis: a systematic literature review. Clin Rheumatol 2020; 40:1673-1686. [PMID: 32880827 DOI: 10.1007/s10067-020-05319-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/21/2020] [Accepted: 08/04/2020] [Indexed: 10/25/2022]
Abstract
To assess whether smoking and obesity are predictors of poor treatment response in patients with axial spondyloarthritis (axSpA). A systematic literature review was performed by searching in MEDLINE and EMBASE up to June 2019 with a strategy based on the PICO approach: Population: patients with axSpA; Intervention or exposure: smoking or obesity; Comparison: non-smokers (for smoking) and normal-weight individuals (for obesity); and Outcome: any response criteria currently validated for axSpA. The 2009 Oxford Centre for Evidence-based Medicine levels were used for assessing the studies quality. Out of 1873 references retrieved, 46 studies were selected for full-text review and 12 for data extraction: six stratified patients by smoking and six by obesity. All were longitudinal observational studies, except one, which was cross-sectional. Overall, these studies included 5291 patients (3917 for smoking and 1333 for obesity), and all these patients were on anti-tumor necrosis factor (anti-TNF) therapy. The quality of evidence was graded as level 2b except that from the cross-sectional study which was graded level 4. For smoking, the evidence found is inconsistent: two studies finding negative effects in response to anti-TNF while the other four found no differences in clinical response to this therapy. Regarding obesity, the evidence is more consistent: five of the six studies describing a negative influence in response to anti-TNF. According to the scientific evidence in patients with axSpA, obesity is associated with a more unsatisfactory response to anti-TNF therapy. A poorer response in smokers has yet to be demonstrated. Key Points • Identifying predictors of treatment response in axSpA, especially those that are modifiable, is relevant. • Obesity increases the risk of poorer response to anti-TNF agents in patients with axSpA. • Scientific evidence for smoking habit as a predictor of treatment response in axSpA is inconclusive.
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Macfarlane GJ, Pathan E, Jones GT, Dean LE. Predicting response to anti-TNFα therapy among patients with axial spondyloarthritis (axSpA): results from BSRBR-AS. Rheumatology (Oxford) 2020; 59:2481-2490. [PMID: 31990352 PMCID: PMC7449799 DOI: 10.1093/rheumatology/kez657] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 12/06/2019] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES While many axSpA patients, eligible to receive anti-TNFα therapy, derive benefit when prescribed them, some patients do not. The current study aims to identify modifiable targets to improve outcome as well as non-modifiable targets that identify groups less likely to derive benefit. METHODS The BSRBR-AS is a prospective cohort study of axSpA patients who, at recruitment, were naïve to biologic therapy. Those in the 'biologic' sub-cohort commenced their first anti-TNFα therapy at recruitment or during follow-up. Prior to commencement, information was collected on socio-economic, clinical and patient-reported factors. Outcome was assessed according to ASAS20, ASAS40, ASDAS reduction and achieving a moderate/inactive ASDAS disease state. RESULTS 335 participants commenced their first anti-TNFα therapy and were followed up at a median of 14 (inter-quartile range 12-17) weeks. Response varied between 33% and 52% according to criteria used. Adverse socio-economic factors, fewer years in education predicted lower likelihood of response across outcome measures as did not working full-time. Co-morbidities and poor mental health were clinical and patient-reported factors, respectively, associated with lack of response. The models, particularly those using ASDAS, were good at predicting those who did not respond (negative predictive value (NPV) 77%). CONCLUSION Some factors predicting non-response (such as mental health) are modifiable but many (such as social/economic factors) are not modifiable in clinic. They do, however, identify patients who are unlikely to benefit from biologic therapy alone. Priority should focus on how these patients receive the benefits that many derive from such therapies.
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Affiliation(s)
- Gary J Macfarlane
- Epidemiology Group, School of Medicine, Medical Science and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Ejaz Pathan
- Spondylitis Program, Department of Rheumatology, Toronto Western Hospital, Toronto, Canada
| | - Gareth T Jones
- Epidemiology Group, School of Medicine, Medical Science and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Linda E Dean
- Epidemiology Group, School of Medicine, Medical Science and Nutrition, University of Aberdeen, Aberdeen, UK
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Chen C, Chen H, Liu C, Liao H, Chou C, Chen C. Association of obesity with inflammation, disease severity and cardiovascular risk factors among patients with ankylosing spondylitis. Int J Rheum Dis 2020; 23:1165-1174. [DOI: 10.1111/1756-185x.13912] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/22/2020] [Accepted: 06/18/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Chun‐Hsiung Chen
- Division of Allergy, Immunology and Rheumatology Taipei Tzu Chi Hospital Buddhist Tzu Chi Medical Foundation School of Medicine Tzu Chi University Hualien Taiwan
| | - Hung‐An Chen
- Division of Allergy, Immunology and Rheumatology Chi Mei Medical Center Tainan Taiwan
| | - Chin‐Hsiu Liu
- Division of Allergy, Immunology and Rheumatology Taipei Tzu Chi Hospital Buddhist Tzu Chi Medical Foundation School of Medicine Tzu Chi University Hualien Taiwan
| | - Hsien‐Tzung Liao
- Taipei Veterans General Hospital National Yang‐Ming University Taipei Taiwan
| | - Chung‐Tei Chou
- Taipei Veterans General Hospital National Yang‐Ming University Taipei Taiwan
| | - Chen‐Hung Chen
- Division of Allergy, Immunology and Rheumatology Taipei Tzu Chi Hospital Buddhist Tzu Chi Medical Foundation School of Medicine Tzu Chi University Hualien Taiwan
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Ortolan A, Lorenzin M, Felicetti M, Ramonda R. Do obesity and overweight influence disease activity measures in axial spondyloarthritis? A systematic review and meta‐analysis. Arthritis Care Res (Hoboken) 2020; 73:1815-1825. [DOI: 10.1002/acr.24416] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 08/06/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Augusta Ortolan
- Rheumatology Unit Department of Medicine DIMED University of Padova Padova Italy
| | - Mariagrazia Lorenzin
- Rheumatology Unit Department of Medicine DIMED University of Padova Padova Italy
| | - Mara Felicetti
- Rheumatology Unit Department of Medicine DIMED University of Padova Padova Italy
| | - Roberta Ramonda
- Rheumatology Unit Department of Medicine DIMED University of Padova Padova Italy
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Wendling D, Goupille P. From observational studies to personalized treatment in spondylarthritis: focus on IL-17 inhibition. Expert Opin Biol Ther 2020; 20:837-840. [DOI: 10.1080/14712598.2020.1782382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Daniel Wendling
- Service de Rhumatologie, CHRU de Besançon; EA 4266, Université de Franche-Comté, Besançon, France
| | - Philippe Goupille
- Service de Rhumatologie, CHRU de Tours; EA 7501, GICC, Université de Tours, Tours, France
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Proteomic analysis of serum-derived extracellular vesicles in ankylosing spondylitis patients. Int Immunopharmacol 2020; 87:106773. [PMID: 32679547 DOI: 10.1016/j.intimp.2020.106773] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/01/2020] [Accepted: 07/01/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Ankylosing spondylitis (AS) is a chronic inflammatory disease, whose pathogenesis is still unclear. Many studies show the proteins in extracellular vesicle (EVs) would change regularly in many diseases. The study aims to explore the proteins contents of serum-derived EVs in AS patients. METHODS EVs were separated by ExoQuickTM kit. The protein profiles of AS patients and healthy subjects were analyzed by Label-free-liquid chromatography mass spectrometry (LC-MS/MS) technology. Enzyme-linked immunosorbent assay (ELISA) was used to verify the levels of the differently expressed proteins. Receiver operation characteristic (ROC) curves and bioinformatic analysis were conducted. RESULTS Six hundred and ten serum-derived EVs proteins from AS patients were detected. Seventy-three diferentially expressed proteins were found in AS group, compared with healthy subjects. Of these, 31 proteins were up-regulated in AS group, while 42 proteins were down-regulated. ELISA result showed that EVs-derived serum amyloid A-1 (SAA1) was higher in AS group, which was consistent with the Label-free-LC-MS/MS data. ROC curves result revealed that the area under curve (AUC) value of EVs-derived SAA1 for AS was 0.768 (0.652-0.885). Bioinformatic analysis revealed that the differently expressed proteins in AS group were significantly involved in "complement and coagulation cascades", "staphylococcus aureus infection", "systemic lupus erythematosus" and "PI3K-Akt signaling pathway". CONCLUSIONS The protein profiles of serum-derived EVs in AS patients and healthy subjects were different. EVs-derived SAA1 may be a potential biomarkes of AS. The function analysis indicated that the differentially expressed proteins may potentially participate in immune response.
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Mease PJ, Liu M, Rebello S, Hua W, McLean RR, Yi E, Park Y, Ogdie A. Characterization of Patients With Axial Spondyloarthritis by Enthesitis Presence: Data from the Corrona Psoriatic Arthritis/Spondyloarthritis Registry. ACR Open Rheumatol 2020; 2:449-456. [PMID: 32627974 PMCID: PMC7368134 DOI: 10.1002/acr2.11154] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 03/23/2020] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To compare the characteristics of patients with axial spondyloarthritis (axSpA) who had enthesitis versus those without enthesitis. METHODS This study included adult patients with axSpA enrolled in the Corrona Psoriatic Arthritis/Spondyloarthritis Registry (March 2013 to August 2018). Enthesitis was assessed at enrollment via the Spondyloarthritis Research Consortium of Canada Enthesitis Index. Characteristics were compared between patients with and without enthesitis using t tests or Wilcoxon rank-sum tests for continuous variables and χ2 or Fisher exact tests for categorical variables. RESULTS Of 477 patients with axSpA, 121 (25.4%) had enthesitis (mean, 3.9 sites) at enrollment. Higher proportions of patients with enthesitis were female and had nonradiographic axSpA than those without enthesitis (both P < 0.05). Additionally, higher proportions of patients with enthesitis had prior biologic (38.8% vs 27.2%) and conventional synthetic disease-modifying antirheumatic drug (csDMARD; 24.8% vs 13.3%) use and were currently receiving a combination of biologics and csDMARDs (28.6% vs 18.1%) than those without enthesitis. Patients with enthesitis had worse disease activity (tender and swollen joint counts, physician global assessment, Ankylosing Spondylitis Disease Activity Score, Bath Ankylosing Spondylitis Disease Activity Index, and Bath Ankylosing Spondylitis Functional Index), spinal mobility, and quality of life (pain, fatigue, Health Assessment Questionnaire, and EuroQol visual analog scale scores); greater work impairment; and had a history of depression and fibromyalgia than those without enthesitis (all P < 0.05). CONCLUSION In this US-based real-world study, enthesitis in patients with axSpA was associated with worse disease activity and quality of life than those with no enthesitis.
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Affiliation(s)
- Philip J. Mease
- Swedish Medical Center/Providence St. Joseph Health and University of WashingtonSeattleWashington
| | - Mei Liu
- Corrona, LLCWalthamMassachusetts
| | | | | | | | - Esther Yi
- Novartis Pharmaceuticals CorporationEast HanoverNew Jersey
| | - Yujin Park
- Novartis Pharmaceuticals CorporationEast HanoverNew Jersey
| | - Alexis Ogdie
- University of PennsylvaniaPhiladelphiaPennsylvania
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Bindesbøll C, Garrido-Cumbrera M, Bakland G, Dagfinrud H. Obesity Increases Disease Activity of Norwegian Patients with Axial Spondyloarthritis: Results from the European Map of Axial Spondyloarthritis Survey. Curr Rheumatol Rep 2020; 22:43. [PMID: 32577833 PMCID: PMC7311492 DOI: 10.1007/s11926-020-00917-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To investigate the prevalence of overweight and obesity, as well as the association between body mass index (BMI) and disease activity in patients with axial spondyloarthritis (axSpA). METHODS Norwegian axSpA patients from the European Map of Axial Spondyloarthritis (EMAS) survey were included in this analysis. Sociodemographic, anthropomorphic, and disease-related variables (HLA-B27, comorbidities, BASDAI, and self-reported spinal stiffness) were reported. Patients were categorized into under/normal weight (BMI < 25 kg/m2), overweight (BMI ≥ 25 to < 30 kg/m2), and obese (≥ 30 kg/m2). RESULTS Of the 509 participants in the EMAS survey, 35% were categorized as under/normal weight, 39% overweight, and 26% obese. Compared to under/normal-weight patients, overweight patients had significantly higher degree of spinal stiffness (mean (SD) 7.91 ± 2.02 vs 7.48 (2.15) and number of comorbidities (2.45 ± 2.11, vs 1.94), both p < 0.001. Obese patients had significantly higher disease activity (BASDAI mean (SD) 5.87 ± 1.78 vs 4.99 ± 2.08, p < 0.001), degree of spinal stiffness (8.18 ± 2.03 vs 7.48 ± 2.15, p = 0.006), and number of comorbidities (3.43 ± 2.43 vs 1.94. ± .38, p < 0.001) than under/normal weight patients. After adjusting for gender and age, obesity proved to be independently associated with disease activity. CONCLUSION Obesity was associated with higher reported BASDAI score, and being overweight or obese was associated with a higher degree of spinal stiffness and number of comorbidities compared to under/normal weight respondents. The results highlight the serious impact of obesity on health status, and obesity should therefore be considered as a modifiable risk factor for disease activity within the disease management of axSpA.
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Affiliation(s)
| | - Marco Garrido-Cumbrera
- Health & Territory Research (HTR), Universidad de Sevilla, Seville, Spain.,Spanish Federation of Spondyloarthritis Associations (CEADE), Madrid, Spain
| | - Gunnstein Bakland
- Department of Rheumatology, University Hospital of Northern Norway, Tromsø, Norway
| | - Hanne Dagfinrud
- National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
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Bergstra SA, Allaart CF, Vega-Morales D, De Buck M, Murphy E, Salomon Escoto K, Huizinga TWJ. Body mass index and treatment survival in patients with RA starting treatment with TNFα-inhibitors: long-term follow-up in the real-life METEOR registry. RMD Open 2020; 6:rmdopen-2020-001203. [PMID: 32506054 PMCID: PMC7299513 DOI: 10.1136/rmdopen-2020-001203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 04/09/2020] [Accepted: 05/14/2020] [Indexed: 01/22/2023] Open
Abstract
Objectives To study whether there is an association between body mass index (BMI) category and survival of various tumour necrosis factor inhibitors (TNFi) in rheumatoid arthritis (RA) patients in a real-life longitudinal international registry. Methods Data from 5230 patients with RA starting treatment with any TNFi were selected from the METEOR registry. Patients were divided into six BMI categories: 3.7% underweight, BMI<18.5 kg/m2; 46% normal weight, BMI 18.5–25 kg/m2; 32% pre-obesity, BMI 25–30 kg/m2; 13% obesity class I, BMI 30–35 kg/m2; 3.4% obesity class II, BMI 35–40 kg/m2; and 1.6% obesity class III, BMI >40 kg/m2. Time on treatment in the different BMI categories was compared for all TNFi combined and for the infliximab, adalimumab and etanercept separately, using Kaplan–Meier curves and Cox regression analyses. Cox regression analyses were adjusted for potential confounders, with follow-up censored at 5000 days. Results Patients in obesity class II (HR 1.28, 95% CI 1.06 to 1.54) and III (HR 1.67, 95% CI 1.29 to 2.18) and underweight patients (HR 1.30, 95% CI 1.07 to 1.58) showed statistically significantly shorter TNFi survival than normal weight patients. The effect in underweight patients was strongest for infliximab (HR 1.82, 95% CI 1.20 to 2.76), the effect in overweight patients was strongest for infliximab (category II (HR 1.49, 95% CI 0.98 to 2.26); category III (HR 1.46, 95% CI 0.79 to 2.71)) and etanercept (category II (HR 1.27 95% CI 0.98 to 1.65); category III (HR 1.79, 95% CI 1.25 to 2.55)). No significant effect modification from reported pain was found. Conclusion Both underweight and overweight patients discontinued TNFi treatment earlier than normal weight patients, without evidence of reported pain as the main determinant. It remains uncertain what determines TNFi survival in individual patients.
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Affiliation(s)
| | | | | | - Marieke De Buck
- Rheumatology, Haaglanden Medical Center, The Hague, Netherlands
| | | | - Karen Salomon Escoto
- Rheumatology, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, Massachusetts, USA
| | - Tom W J Huizinga
- Rheumatology, Leiden University Medical Center, Leiden, Netherlands
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Ibáñez Vodnizza S, van der Horst-Bruinsma I. Sex differences in disease activity and efficacy of treatment in spondyloarthritis: is body composition the cause? Curr Opin Rheumatol 2020; 32:337-342. [PMID: 32453036 DOI: 10.1097/bor.0000000000000717] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE OF REVIEW The body composition and fat distribution is different between men and women, with different levels of circulating adipokines. These differences become more evident when suffering from an inflammatory disease, such as spondyloarthritris. In this review, we will explore the influence of obesity, body composition and adipokines on the differences in disease activity, progression and response to treatment, between men and women with spondyloarthritis. RECENT FINDINGS Obesity, mainly determined by the body fat content, which is higher in women, is related to worse disease activity scores. Men with higher disease activity lose more muscle mass than women. Leptin, which is usually found at higher levels in overweight women, seems to be associated with greater spinal radiographic progression when it rises during the course of the disease. Being a woman and obesity, mainly because of the body fat content, are related to a worse response to TNF-α blockers. SUMMARY Overlooking biological sex variation in body composition, circulating adipokines and hormonal levels, and the subsequent differences in clinical presentation, may ultimately hamper clinical treatment.
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Liew JW, Huang IJ, Louden DN, Singh N, Gensler LS. Association of body mass index on disease activity in axial spondyloarthritis: systematic review and meta-analysis. RMD Open 2020; 6:rmdopen-2020-001225. [PMID: 32434828 PMCID: PMC7299511 DOI: 10.1136/rmdopen-2020-001225] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/24/2020] [Accepted: 05/03/2020] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES In axial spondyloarthritis (axSpA), higher body mass index (BMI) is associated with worse outcomes including response to biologics. Further clarity is needed on whether BMI is associated with disease activity overall, independent of treatment response. We performed a systematic review and meta-analysis to assess the association between BMI and disease activity as reported by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) or Ankylosing Spondylitis Disease Activity Score (ASDAS) in axSpA. METHODS We systematically searched for studies evaluating BMI and disease activity as the exposure and outcome of interest, respectively, in axSpA. Using random effects models, we estimated summary standardised mean differences (SMDs) and 95% CIs of BASDAI or ASDAS, comparing obese (BMI>30 kg/m2) or overweight/obese (BMI>25 kg/m2) individuals to those with normal BMI (18.5-24.9 kg/m2). RESULTS Twelve studies were included in the meta-analysis. Among all studies reporting the BASDAI at baseline, the pooled SMD of the BASDAI for those with an obese or overweight/obese BMI compared to a normal BMI was 0.38 (95% CI 0.21 to 0.55, I2 =75.2%), indicating a significant association of higher BMI with higher BASDAI score. The pooled SMD of the ASDAS for those with an obese or overweight/obese BMI compared to a normal BMI was 0.40 (95% CI 0.27 to 0.54, I2=0%). Findings were robust across subgroup analyses. CONCLUSION These results demonstrate an association between an overweight/obese BMI and higher disease activity in studies of axSpA. Future longitudinal studies of BMI and disease activity should assess how this association changes over time.
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Affiliation(s)
- Jean W Liew
- Medicine, Division of Rheumatology, University of Washington, Seattle, Washington, USA
| | - Irvin J Huang
- Medicine, Division of Rheumatology, University of Washington, Seattle, Washington, USA
| | - Diana N Louden
- University Libraries, University of Washington, Seattle, Washington, USA
| | - Namrata Singh
- Medicine, Division of Rheumatology, University of Washington, Seattle, Washington, USA
| | - Lianne S Gensler
- Division of Rheumatology, University of California San Francisco, San Francisco, California, USA
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45
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Toussirot E. The Interrelations between Biological and Targeted Synthetic Agents Used in Inflammatory Joint Diseases, and Obesity or Body Composition. Metabolites 2020; 10:E107. [PMID: 32183053 PMCID: PMC7175105 DOI: 10.3390/metabo10030107] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/08/2020] [Accepted: 03/10/2020] [Indexed: 12/16/2022] Open
Abstract
Obesity is a comorbidity that plays a role in the development and severity of inflammatory joint diseases, including rheumatoid arthritis, psoriatic arthritis and axial spondyloarthritis. The relationships between obesity and adipose tissue and the treatments given for inflammatory joint diseases are bidirectional. In fact, biological agents (bDMARDs) and targeted synthetic agents (tsDMARDs) may influence body weight and body composition of treated patients, while obesity in turn may influence clinical response to these agents. Obesity is a prevalent comorbidity mainly affecting patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA) with specific phenotypes. Tumour necrosis factor alpha (TNFα) inhibitors have been associated with changes in body composition by improving lean mass, but also by significantly increasing fat mass, which localized toward the abdominal/visceral region. The IL-6 inhibitor tocilizumab is associated with an increase in lean mass without change in fat mass. The clinical response to TNFα inhibitors is attenuated by obesity, an effect that is less pronounced with IL-6 inhibitors and the B-cell depletion agent rituximab. Conversely, body weight has no influence on the response to the costimulation inhibitor abatacept. These effects may be of help to the physician in personalized medicine, and may guide the therapeutic choice in obese/overweight patients.
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Affiliation(s)
- Eric Toussirot
- INSERM CIC-1431, CHU de Besançon, Centre d’Investigation Clinique Biothérapie, Pôle Recherche, 25000 Besançon, France; ; Tel.: +33-3-81-21-89-97
- Fédération Hospitalo-Universitaire INCREASE, CHU de Besançon, 25000 Besançon, France
- CHU de Besançon, Rhumatologie, Pôle PACTE (Pathologies Aiguës Chroniques Transplantation Éducation), 25000 Besançon, France
- Département Universitaire de Thérapeutique, Université de Bourgogne Franche-Comté, UFR des Sciences Médicales et Pharmaceutiques de Besançon, CS 71806, 25030 Besançon Cedex, France
- INSERM UMR1098, Relations Hôte Greffon Tumeurs, ingénierie cellulaire et génique, Université de Bourgogne Franche-Comté, 25000 Besançon, France
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Abstract
Drug treatment in patients with axial spondylarthritis (axSpA) aims to modify symptoms and complaints and currently includes the substance groups of nonsteroidal anti-inflammatory drugs (NSAID) and biologicals (disease-modifying antirheumatic drugs, bDMARDS). Treatment with NSAIDs is the first line treatment according to international and national recommendations. Patients with persisting high disease activity despite continuous standard treatment with NSAIDs, should be treated with biologicals. In Germany treatment with tumor necosis factor (TNF) inhibitors or interleukin 17 inhibitor (secukinumab) are currently approved for treating patients with ankylosing spondylitis (AS). Treatment of patients with non-radiographic axSpA (nr-axSpA) is restricted to TNF inhibitors (except infliximab) in Germany. The efficacy and safety are documented for both substance groups; however, due to the longer time since approval longitudinal data for TNF inhibitors are more robust and the data contain information about switching within a substance group. Although overall retention rates of TNF inhibitors are similar despite the difference in formation of antidrug antibodies, data from cohorts provide information about long-term loss of efficacy, switching and also discontinuation strategies. In the meantime, various biosimilars have been approved for infliximab, etanercept and adalimumab. Conventional basic treatment (csDMARDs) and in particular intra-articular administration of glucocorticoids can only be prescribed for axSpA patients with peripheral arthritis.
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Affiliation(s)
- U Kiltz
- Rheumazentrum Ruhrgebiet, Claudiusstr. 45, 44649, Herne, Deutschland.
| | - J Braun
- Rheumazentrum Ruhrgebiet, Claudiusstr. 45, 44649, Herne, Deutschland.,Ruhr-Universität Bochum, Bochum, Deutschland
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Kiltz U, Braun J, Becker A, Chenot JF, Dreimann M, Hammel L, Heiligenhaus A, Hermann KG, Klett R, Krause D, Kreitner KF, Lange U, Lauterbach A, Mau W, Mössner R, Oberschelp U, Philipp S, Pleyer U, Rudwaleit M, Schneider E, Schulte TL, Sieper J, Stallmach A, Swoboda B, Winking M. [Long version on the S3 guidelines for axial spondyloarthritis including Bechterew's disease and early forms, Update 2019 : Evidence-based guidelines of the German Society for Rheumatology (DGRh) and participating medical scientific specialist societies and other organizations]. Z Rheumatol 2020; 78:3-64. [PMID: 31784900 DOI: 10.1007/s00393-019-0670-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- U Kiltz
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Claudiusstr. 45, 44649, Herne, Deutschland.
| | - J Braun
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Claudiusstr. 45, 44649, Herne, Deutschland
| | | | - A Becker
- Allgemeinmedizin, präventive und rehabilitative Medizin, Universität Marburg, Karl-von-Frisch-Str. 4, 35032, Marburg, Deutschland
| | | | - J-F Chenot
- Universitätsmedizin Greifswald, Fleischmann Str. 6, 17485, Greifswald, Deutschland
| | - M Dreimann
- Zentrum für Operative Medizin, Klinik und Poliklinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistraße 52, 20251, Hamburg, Deutschland
| | | | - L Hammel
- Geschäftsstelle des Bundesverbandes der DVMB, Metzgergasse 16, 97421, Schweinfurt, Deutschland
| | | | - A Heiligenhaus
- Augenzentrum und Uveitis-Zentrum, St. Franziskus Hospital, Hohenzollernring 74, 48145, Münster, Deutschland
| | | | - K-G Hermann
- Institut für Radiologie, Charité Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | | | - R Klett
- Praxis Manuelle & Osteopathische Medizin, Fichtenweg 17, 35428, Langgöns, Deutschland
| | | | - D Krause
- , Friedrich-Ebert-Str. 2, 45964, Gladbeck, Deutschland
| | - K-F Kreitner
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - U Lange
- Kerckhoff-Klinik, Rheumazentrum, Osteologie & Physikalische Medizin, Benekestr. 2-8, 61231, Bad Nauheim, Deutschland
| | | | - A Lauterbach
- Schule für Physiotherapie, Orthopädische Universitätsklinik Friedrichsheim, Marienburgstraße 2, 60528, Frankfurt, Deutschland
| | | | - W Mau
- Institut für Rehabilitationsmedizin, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, 06097, Halle (Saale), Deutschland
| | - R Mössner
- Klinik für Dermatologie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland
| | | | - U Oberschelp
- , Barlachstr. 6, 59368, Werne a.d. L., Deutschland
| | | | - S Philipp
- Praxis für Dermatologie, Bernauer Str. 66, 16515, Oranienburg, Deutschland
| | - U Pleyer
- Campus Virchow-Klinikum, Charité Centrum 16, Klinik f. Augenheilkunde, Charité, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - M Rudwaleit
- Klinikum Bielefeld, An der Rosenhöhe 27, 33647, Bielefeld, Deutschland
| | - E Schneider
- Abt. Fachübergreifende Frührehabilitation und Sportmedizin, St. Antonius Hospital, Dechant-Deckersstr. 8, 52249, Eschweiler, Deutschland
| | - T L Schulte
- Klinik für Orthopädie und Unfallchirurgie, Orthopädische Universitätsklinik, Ruhr-Universität Bochum, Gudrunstr. 65, 44791, Bochum, Deutschland
| | - J Sieper
- Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Deutschland
| | - A Stallmach
- Klinik für Innere Medizin IV, Universitätsklinikum Jena, Am Klinikum 1, 07743, Jena, Deutschland
| | | | - B Swoboda
- Abteilung für Orthopädie und Rheumatologie, Orthopädische Universitätsklinik, Malteser Waldkrankenhaus St. Marien, 91054, Erlangen, Deutschland
| | | | - M Winking
- Zentrum für Wirbelsäulenchirurgie, Klinikum Osnabrück, Am Finkenhügel 3, 49076, Osnabrück, Deutschland
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Zhao SS, Yoshida K, Jones GT, Hughes DM, Duffield SJ, Tedeschi SK, Lyu H, Moots RJ, Solomon DH, Goodson NJ. Smoking status and cause-specific discontinuation of tumour necrosis factor inhibitors in axial spondyloarthritis. Arthritis Res Ther 2019; 21:177. [PMID: 31331375 PMCID: PMC6647300 DOI: 10.1186/s13075-019-1958-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 07/08/2019] [Indexed: 01/01/2023] Open
Abstract
Background The impact of smoking on TNF inhibition (TNFi) therapy is unclear. We examined the effect of smoking on all-cause and cause-specific TNFi discontinuation in axial spondyloarthritis (axSpA). Methods We used longitudinal data from the British Society for Rheumatology Biologics Register for Ankylosing Spondylitis (BSRBR-AS). Patients fulfilling the ASAS criteria for axSpA, who started their first TNFi, were eligible for analysis. Inverse-probability weights were used to balance differences in baseline disease severity and other confounders. We used marginal structural Cox proportional hazard models to estimate hazard ratios (HR) for TNFi discontinuation according to smoking status. In analyses of cause-specific discontinuation, competing risk events were considered as censoring, using inverse-probability weights. Results A total of 758 participants were included in the analysis (66% male, mean age 45 years), providing 954 patient-years of follow-up. TNFi was discontinued in 174 (23%) patients, among whom 26% stopped due to infections, 20% due to other adverse events and 44% due to inefficacy or other reasons. Thirty-four percent were current smokers and 30% ex-smokers. Compared to never smokers, current smokers’ risk of TNFi discontinuation was HR 0.79 (95%CI 0.53 to 1.20) and ex-smokers HR 0.68 (95%CI 0.45 to 1.04). Our data did not show evidence that current smoking influenced discontinuation due to infections (HR 0.79, 95%CI 0.40 to 1.54), other adverse events (HR 0.86, 95%CI 0.41 to 1.78) or inefficacy/other causes (HR 1.44, 95%CI 0.86 to 2.41). Conclusion Baseline smoking status did not impact TNFi discontinuation in this UK cohort of axSpA participants. Electronic supplementary material The online version of this article (10.1186/s13075-019-1958-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sizheng Steven Zhao
- Musculoskeletal Biology I, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK.,Department of Academic Rheumatology, Aintree University Hospital, Liverpool, UK.,Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA
| | - Kazuki Yoshida
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA.,Departments of Epidemiology and Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Gareth T Jones
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.,Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - David M Hughes
- Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Stephen J Duffield
- Musculoskeletal Biology I, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Sara K Tedeschi
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA
| | - Houchen Lyu
- Department of Medicine, Harvard Medical School, Boston, MA, USA.,Department of Orthopaedics, General Hospital of Chinese PLA, Beijing, China
| | - Robert J Moots
- Musculoskeletal Biology I, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK.,Department of Academic Rheumatology, Aintree University Hospital, Liverpool, UK
| | - Daniel H Solomon
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA.,Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Nicola J Goodson
- Musculoskeletal Biology I, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK. .,Department of Academic Rheumatology, Aintree University Hospital, Liverpool, UK.
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Lee YX, Kwan YH, Lim KK, Tan CS, Lui NL, Phang JK, Chew EH, Ostbye T, Thumboo J, Fong W. A systematic review of the association of obesity with the outcomes of inflammatory rheumatic diseases. Singapore Med J 2019; 60:270-280. [PMID: 31243460 DOI: 10.11622/smedj.2019057] [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] [Indexed: 12/15/2022]
Abstract
This was a systematic review of the literature on the association between obesity and the outcome of inflammatory rheumatic diseases. We conducted a literature search using PubMed®, Embase and PsycINFO®. Articles were classified into three categories based on the effects of obesity on the outcomes of inflammatory rheumatic diseases. The subject population, country, type of studies, number of patients, measurement of obesity and outcomes assessed were presented. Quality was appraised using Kmet et al's criteria. 4,331 articles were screened and 60 were relevant to the objective. Obesity had a negative, positive and neutral association with outcomes of inflammatory rheumatic diseases in 38 (63.3%) studies with 57,612 subjects, 11 (18.3%) studies with 3,866 subjects, and 11 (18.3%) studies with 3,834 subjects, respectively. In most studies, the disease population had been diagnosed with rheumatoid arthritis (RA). Tumour necrosis factor-α inhibitors were mostly associated with negative outcomes. More studies examining subjects outside Europe and North America and diseases other than RA are warranted.
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Affiliation(s)
- Yi Xuan Lee
- Department of Pharmacy, National University of Singapore, Singapore
| | - Yu Heng Kwan
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Ka Keat Lim
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Nai Lee Lui
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
| | - Jie Kie Phang
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
| | - Eng Hui Chew
- Department of Pharmacy, National University of Singapore, Singapore
| | - Truls Ostbye
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Julian Thumboo
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
| | - Warren Fong
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
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50
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Clinical relevance of monitoring serum adalimumab levels in axial spondyloarthritis. Rheumatol Int 2019; 39:841-849. [DOI: 10.1007/s00296-019-04288-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 03/16/2019] [Indexed: 12/11/2022]
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