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Maccora I, Soldovieri S, Oliverio T, de Masi S, Marrani E, Pagnini I, Mastrolia MV, Simonini G. To switch or to swap? Evidence from a meta-analysis for the best treatment approach in childhood chronic uveitis resistant to the I anti-TNF. J Transl Autoimmun 2024; 9:100247. [PMID: 39027719 PMCID: PMC11254593 DOI: 10.1016/j.jtauto.2024.100247] [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: 03/30/2024] [Revised: 06/20/2024] [Accepted: 06/22/2024] [Indexed: 07/20/2024] Open
Abstract
Objective Since adalimumab approval in childhood chronic non-infectious uveitis (cNIU), the prognosis has been dramatically changed, but the 25 % failed to achieve inactivity. There is not accordance if it is better to switch to another anti-TNF or to swap to another category of biologic. Thus, we aim to summarize evidence regarding the best treatment of cNIU refractory to the first anti-TNF. Methods A systematic literature review and meta-analysis, according to PRISMA Guidelines, was performed(Jan2000-Aug2023). Studies investigating the efficacy of treatment in cNIU refractory to the first anti-TNF were considered for inclusion. The primary outcome was the improvement of intraocular inflammation according to SUN. A combined estimation of the proportion of children responding to switch or swap and for each drug was performed. Results 23 articles were eligible, reporting 150 children of whom 109 switched anti-TNF (45 adalimumab, 49 infliximab, 9 golimumab) and 41 swapped to another biologics (31 abatacept, 8 tocilizumab and 1 rituximab). The proportion of responding children was 46 %(95 % CI 23-70) for switch and 38 %(95 % CI 8-73) for swap (χ20.02, p = 0.86). Instead analysing for each drug, the proportion of responding children was the 24 %(95 % CI 2-55) for adalimumab, 43 %(95 % CI 2-80) for abatacept, 79 %(95 % CI 61-93) for infliximab, 56 %(95 % CI 14-95) for golimumab and 96 %(95 % CI 58-100) for tocilizumab. We evaluated a superiority of tocilizumab and infliximab compared to the other drugs(χ2 27.5 p < 0.0001). Conclusion Although non-conclusive, this meta-analysis suggests that, after the first anti-TNF failure, tocilizumab and infliximab are the best available treatment for the management of cNIU.
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Affiliation(s)
- Ilaria Maccora
- Rheumatology Unit, ERN ReCONNET Centre, Meyer Children's Hospital IRCCS, Florence, Italy
- NeuroFARBA Department, University of Florence, Florence, Italy
| | - Sara Soldovieri
- Rheumatology Unit, ERN ReCONNET Centre, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Teodoro Oliverio
- Rheumatology Unit, ERN ReCONNET Centre, Meyer Children's Hospital IRCCS, Florence, Italy
| | | | - Edoardo Marrani
- Rheumatology Unit, ERN ReCONNET Centre, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Ilaria Pagnini
- Rheumatology Unit, ERN ReCONNET Centre, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Maria Vincenza Mastrolia
- Rheumatology Unit, ERN ReCONNET Centre, Meyer Children's Hospital IRCCS, Florence, Italy
- NeuroFARBA Department, University of Florence, Florence, Italy
| | - Gabriele Simonini
- Rheumatology Unit, ERN ReCONNET Centre, Meyer Children's Hospital IRCCS, Florence, Italy
- NeuroFARBA Department, University of Florence, Florence, Italy
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Lovell DJ, Tzaribachev N, Henrickson M, Simonini G, Griffin TA, Alexeeva E, Bohnsack JF, Zeft A, Horneff G, Vehe RK, Staņēviča V, Tarvin S, Trachana M, Del Río AQ, Huber AM, Kietz D, Orbán I, Dare J, Foeldvari I, Quartier P, Dominique A, Simon TA, Martini A, Brunner HI, Ruperto N. Safety and effectiveness of abatacept in juvenile idiopathic arthritis: results from the PRINTO/PRCSG registry. Rheumatology (Oxford) 2024; 63:SI195-SI206. [PMID: 38243722 PMCID: PMC11381685 DOI: 10.1093/rheumatology/keae025] [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: 03/10/2023] [Revised: 11/02/2023] [Accepted: 11/19/2023] [Indexed: 01/21/2024] Open
Abstract
OBJECTIVE The aim of this study was to report the interim 5-year safety and effectiveness of abatacept in patients with JIA in the PRINTO/PRCSG registry. METHODS The Abatacept JIA Registry (NCT01357668) is an ongoing observational study of children with JIA receiving abatacept; enrolment started in January 2013. Clinical sites enrolled patients with JIA starting or currently receiving abatacept. Eligible patients were assessed for safety (primary end point) and effectiveness over 10 years. Effectiveness was measured by clinical 10-joint Juvenile Arthritis Disease Activity Score (cJADAS10) in patients with JIA over 5 years. As-observed analysis is presented according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. RESULTS As of 31 March 2020, 587 patients were enrolled; 569 are included in this analysis (including 134 new users) with 1214.6 patient-years of safety data available. Over 5 years, the incidence rate (IR) per 100 patient-years of follow-up of serious adverse events was 5.52 (95% CI: 4.27, 7.01) and of events of special interest was 3.62 (95% CI: 2.63, 4.86), with 18 serious infections [IR 1.48 (95% CI: 0.88, 2.34)]. As early as month 3, 55.9% of patients achieved cJADAS10 low disease activity and inactive disease (20.3%, 72/354 and 35.6%, 126/354, respectively), sustained over 5 years. Disease activity measures improvement over 5 years across JIA categories. CONCLUSION Abatacept was well tolerated in patients with JIA, with no new safety signals identified and with well-controlled disease activity, including some patients achieving inactive disease or remission. TRIAL REGISTRATION Clinicaltrials.gov, NCT01357668.
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Affiliation(s)
- Daniel J Lovell
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | | | - Michael Henrickson
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - Gabriele Simonini
- IRCCS Meyer Children's Hospital, Rheumatology Unit, ERN-ReCONNECT Center, Florence, Italy
| | | | - Ekaterina Alexeeva
- Department of Rheumatology, National Medical Research Center of Children's Health, Moscow, Russia
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - John F Bohnsack
- Division of Allergy, Immunology and Pediatric Rheumatology, University of Utah, Salt Lake City, UT, USA
| | - Andrew Zeft
- Center for Pediatric Rheumatology and Immunology, Cleveland Clinic, Cleveland, OH, USA
| | - Gerd Horneff
- Asklepios Clinic Sankt Augustin, Sankt Augustin, Germany
- Department of Pediatric and Adolescent Medicine, Medical Faculty, University Hospital of Cologne, Cologne, Germany
| | - Richard K Vehe
- Department of Pediatrics, Division of Pediatric Rheumatology, University of Minnesota, Minneapolis, MN, USA
| | | | - Stacey Tarvin
- Riley Hospital for Children at Indiana University, Indianapolis, IN, USA
| | - Maria Trachana
- Aristotle University of Thessaloniki, Thessaloníki, Greece
| | | | - Adam M Huber
- IWK Health Centre and Dalhousie University, Halifax, NS, Canada
| | - Daniel Kietz
- Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Ilonka Orbán
- National Institute of Locomotor Diseases and Disabilities, Budapest, Hungary
| | - Jason Dare
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ivan Foeldvari
- Hamburg Centre for Pediatric and Adolescent Rheumatology, Hamburg, Germany
| | - Pierre Quartier
- Necker-Enfants Malades University Hospital, Assistance Publique-Hopitaux de Paris, Paris, France
- Université Paris-Cité, Paris, France
| | | | | | - Alberto Martini
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DiNOGMI), Università degli Studi di Genova, Genova, Italy
| | - Hermine I Brunner
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - Nicolino Ruperto
- IRCCS Istituto Giannina Gaslini, UOSID Centro Trial-PRINTO, Genova, Italy
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Kilic Konte E, Akay N, Gul U, Ucak K, Derelioglu EI, Gurleyik D, Aslan E, Gunalp A, Haslak F, Yildiz M, Adrovic A, Sahin S, Barut K, Kasapcopur O. Long-term safety profile and secondary effectiveness of canakinumab in pediatric rheumatic diseases: a single-center experience. Expert Opin Drug Saf 2024:1-9. [PMID: 39069814 DOI: 10.1080/14740338.2024.2386370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 06/06/2024] [Accepted: 06/27/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND To demonstrate the long-term safety profile of canakinumab over a nine-year period by documenting adverse events in patients with various pediatric rheumatic diseases. RESEARCH DESIGN AND METHODS This retrospective observational study was conducted at the Pediatric Rheumatology Department of Istanbul University Cerrahpasa between 2015 and 2023. The analysis concerned individuals who had been administered canakinumab treatment for at least six months. The exposure-adjusted event rates were calculated as adverse events per 100 patient days and were compared among three groups based on the cumulative canakinumab dose of <35 mg/kg, 35-70 mg/kg, and >70 mg/kg. RESULTS Among 189 patients, the median exposure time to canakinumab was 2.9 (1.5-4.1) years, corresponding to 573.4 patient years. The median cumulative dose of canakinumab was 2205 (1312-3600) mg. The most common adverse event was upper respiratory tract infection (0.76), followed by urinary tract infection (0.02), pneumonia (0.009), latent tuberculosis (0.009) and lymphadenitis (0.004). A total of 55 serious adverse events (0.025) were reported, 12 (0.006) of which led to drug discontinuation. The event rate of macrophage activation syndrome and disease exacerbation was statistically higher in patients receiving <35 mg/kg cumulative canakinumab dose (p < 0.05). CONCLUSIONS An increase in side effect was not observed with the increasing cumulative doses of canakinumab. Canakinumab demonstrated long-term safety with appropriate indication and monitoring.
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Affiliation(s)
- Elif Kilic Konte
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Nergis Akay
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Umit Gul
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Kubra Ucak
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ecenur Izzete Derelioglu
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Damla Gurleyik
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Esma Aslan
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Aybuke Gunalp
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Fatih Haslak
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Mehmet Yildiz
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Amra Adrovic
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Sezgin Sahin
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Kenan Barut
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ozgur Kasapcopur
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Oliveira Ramos F, Zinterl C, Fonseca JE. A lifelong journey: Long-term perspectives on Juvenile Idiopathic Arthritis. Best Pract Res Clin Rheumatol 2024:101984. [PMID: 39068102 DOI: 10.1016/j.berh.2024.101984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 07/22/2024] [Accepted: 07/23/2024] [Indexed: 07/30/2024]
Abstract
Juvenile Idiopathic Arthritis (JIA) represents a diverse group of chronic inflammatory conditions that begin in childhood or adolescence and continue into adulthood, with varying severity and outcomes. This review discusses the complexities of transitioning JIA patients emphasizing that inadequate transition from pediatric to adult care leads to loss of follow-up, treatment discontinuation, and increased disease activity. Furthermore, challenges in disease classification hinder continuity of care across lifespan. It is also pointed out that predicting long-term outcomes in JIA remains complex due to heterogeneity and evolving phenotypes. Factors such as disease category, joint involvement, and treatment influence disease activity, functional disability, and quality of life. Despite advancements in treatment strategies, a substantial proportion of patients experience long-term disability and joint damage. Finally, it is underscored that optimising long-term outcomes in adults with JIA requires a multifaceted approach encompassing structured transition processes, personalised treatment strategies, and comprehensive management of comorbidities. Further research is needed to refine predictive models, enhance disease monitoring tools, and understand the complex interplay between disease activity, treatment response, and long-term outcomes.
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Affiliation(s)
- Filipa Oliveira Ramos
- Unidade de Reumatologia Pediátrica, Hospital Universitário Santa Maria, ULS Santa Maria, Centro Académico de Medicina de Lisboa, Portugal; Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Portugal.
| | - Carolina Zinterl
- Unidade de Reumatologia Pediátrica, Hospital Universitário Santa Maria, ULS Santa Maria, Centro Académico de Medicina de Lisboa, Portugal
| | - João Eurico Fonseca
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Portugal; Serviço de Reumatologia, ULS Santa Maria, Centro Académico de Medicina de Lisboa, Portugal
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Tharwat S, Nassar MK, Salem KM, Nassar MK. Extraarticular manifestations of juvenile idiopathic arthritis and their impact on health-related quality of life. Clin Rheumatol 2024; 43:2295-2305. [PMID: 38797812 DOI: 10.1007/s10067-024-07008-0] [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: 02/20/2024] [Revised: 05/06/2024] [Accepted: 05/13/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVES The objective of this study is to investigate extraarticular manifestations (EAMs) in patients with juvenile idiopathic arthritis (JIA) and assess their impact on health-related quality of life (HRQoL) among these patients. METHODS This cross-sectional analytic study was carried out on 117 patients with JIA. EAMs were identified clinically by history and examination. Sicca symptoms, peripheral neuropathy, enthesitis, and skin lesions were picked up during clinical examination. Pulmonary involvement was evaluated by high-resolution CT chest. Patients were assessed by abdominal ultrasonography to assess the size of liver and spleen. Atlantoaxial subluxation was evaluated by cervical spine x-rays. Patients were evaluated by Pediatric Quality of Life Inventory-4 (PedsQL-4) and PedsQL-3 arthritis module. RESULTS The median age of patients was 14 years with a median disease duration 4 years, 82.9% were females. Of the studied 117 JIA patients, 85 patients (72.6%) had at least one EAM. Persistent fatigue (51.3%) was the most prevalent EAM, followed by recurrent skin rash (16.2%), enthesitis (15.4%), recurrent fever (13.7%), and uveitis (12%). Patients with EAMs scored significantly lower in physical functioning (p = 0.001), emotional functioning (p < 0.001), social functioning (p = 0.005), and school functioning (p = 0.001). Regarding PedsQL arthritis module, patients with EAM had also significantly lower scores than did patients without EAM on the domains of pain and hurt (p < 0.001), daily activities (p = 0.008), and worry (p = 0.001). RESULTS EAMs are prevalent among JIA patients and have a negative impact on their HRQoL. So, early identification and treatment are highly recommended. Key Points • A large percentage of JIA patients experienced at least one extraarticular manifestation (EAM). • Persistent fatigue and recurrent skin rash are the most prevalent EAMs in JIA patients. • JIA patients with EAMs have worse scores in almost all domains of HRQoL.
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Affiliation(s)
- Samar Tharwat
- Rheumatology & Immunology Unit, Department of Internal Medicine, Faculty of Medicine, Dakahlia Governorate, Mansoura University Hospital, El Gomhouria St, Mansoura, 35511, Egypt.
- Department of Internal Medicine, Faculty of Medicine, Horus University, New Damietta, Egypt.
| | - Mona Kamal Nassar
- Department of Radiology, Student Hospital, Mansoura University, Mansoura, Egypt
| | - Karem Mohamed Salem
- Department of Internal Medicine, Faculty of Medicine, Nephrology Unit, Fayoum University, Fayoum, Egypt
| | - Mohammed Kamal Nassar
- Mansoura Nephrology & Dialysis Unit (MNDU), Department of Internal Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Triaille C, Quartier P, De Somer L, Durez P, Lauwerys BR, Verschueren P, Taylor PC, Wouters C. Patterns and determinants of response to novel therapies in juvenile and adult-onset polyarthritis. Rheumatology (Oxford) 2024; 63:594-607. [PMID: 37725352 PMCID: PMC10907821 DOI: 10.1093/rheumatology/kead490] [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: 07/14/2023] [Revised: 08/23/2023] [Accepted: 08/29/2023] [Indexed: 09/21/2023] Open
Abstract
Biologic and targeted synthetic DMARDs (b/tsDMARDs) have revolutionized the management of multiple rheumatic inflammatory conditions. Among these, polyarticular JIA (pJIA) and RA display similarities in terms of disease pathophysiology and response pattern to b/tsDMARDs. Indeed, the therapeutic efficacy of novel targeted drugs is variable among individual patients, in both RA and pJIA. The mechanisms and determinants of this heterogeneous response are diverse and complex, such that the development of true 'precision'-medicine strategies has proven highly challenging. In this review, we will discuss pathophysiological, patient-specific, drug-specific and environmental factors contributing to individual therapeutic response in pJIA in comparison with what is known in RA. Although some biomarkers have been identified that stratify with respect to the likelihood of either therapeutic response or non-response, few have proved useful in clinical practice so far, likely due to the complexity of treatment-response mechanisms. Consequently, we propose a pragmatic, patient-centred and clinically based approach, i.e. personalized instead of biomarker-based precision medicine in JIA.
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Affiliation(s)
- Clément Triaille
- Pôle de Pathologies Rhumatismales Systémiques et Inflammatoires, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
- Department of Pediatric Hematology, Oncology, Immunology and Rheumatology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Division of Pediatric Rheumatology, Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium
| | - Pierre Quartier
- Department of Pediatric Immunology, Hematology and Rheumatology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- Université Paris-Cité, Paris, France
- Member of the European Reference Network for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases – Project ID No. 739543
| | - Lien De Somer
- Division of Pediatric Rheumatology, Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium
- Member of the European Reference Network for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases – Project ID No. 739543
- Department of Microbiology and Immunology, University of Leuven, Leuven, Belgium
| | - Patrick Durez
- Pôle de Pathologies Rhumatismales Systémiques et Inflammatoires, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
- Department of Rheumatology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Bernard R Lauwerys
- Pôle de Pathologies Rhumatismales Systémiques et Inflammatoires, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Patrick Verschueren
- Member of the European Reference Network for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases – Project ID No. 739543
- Department of Rheumatology, University Hospitals Leuven, Leuven, Belgium
| | - Peter C Taylor
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Carine Wouters
- Division of Pediatric Rheumatology, Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium
- Department of Pediatric Immunology, Hematology and Rheumatology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- Member of the European Reference Network for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases – Project ID No. 739543
- Department of Microbiology and Immunology, University of Leuven, Leuven, Belgium
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Buchinskaya NV, Isupova EA, Vechkasova AO, Malekov DA, Ivanov DO, Kostik MM. Evaluation of etanercept (a tumor necrosis factor alpha inhibitor) as an effective treatment for joint disease in mucopolysaccharidosis type I. A case report with whole-body magnetic resonance imaging. Front Med (Lausanne) 2024; 10:1252704. [PMID: 38314027 PMCID: PMC10834648 DOI: 10.3389/fmed.2023.1252704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 12/21/2023] [Indexed: 02/06/2024] Open
Abstract
Summary A 12-year-old girl with mucopolysaccharidosis (MPS) type I (Gurler-Scheie syndrome, Q70X/del C683 of the IDUA gene in the compound heterozygous state) regularly received enzyme replacement therapy (laronidase) since the preclinical stage (6 months old) due to positive family history, and started etanercept treatment due to progression of joint pain and decreasing capability to walk. The patient had a significant reduction of pain in the joints and an expansion of daily physical activity without adverse events. A decrease in bone marrow edema without foci progression compared to baseline assessment was observed in the whole-body MRI.During the treatment (baseline/6 months/12 months) the following was observed: childhood health assessment questionnaire (CHAQ) index of 1.88/2.13/1.63 points; patient's pediatric quality of life inventory (PedsQL) of 37/30/31 points; parental PedsQL of 26/27/34 points; and patient's pain visual-analog scale (VAS) of 75/45/40, with no VAS recorded for the mother. Juvenile arthritis functional assessment report (JAFAR) scores of 35/34/8 points were observed. A significant reduction in the taking of NSAIDs was observed. In the second half of the year, the nasal breathing became normal, and remission in chronic rhinitis and adenoiditis was achieved (no infection episodes) without otitis episodes. Conclusion Etanercept in mucopolysaccharidosis type 1 is safe and well tolerated. The reduction of joint pain and increased walking capacity were observed. A decreased number of respiratory infection episodes and nasal breathing improvement were noted during the treatment. The observation shows the role of inflammation in the different aspects of MPS. Further investigations on immune system dysregulation in patients with MPS I are needed. Additional studies on the efficacy and safety of anti-rheumatic biological drugs in patients with MPSI are required.
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Affiliation(s)
- Natalia V Buchinskaya
- Hospital Pediatry, Saint-Petersburg State Pediatric Medical University, Saint Petersburg, Russia
| | - Eugenia A Isupova
- Hospital Pediatry, Saint-Petersburg State Pediatric Medical University, Saint Petersburg, Russia
| | - Anastasia O Vechkasova
- Hospital Pediatry, Saint-Petersburg State Pediatric Medical University, Saint Petersburg, Russia
| | - Damir A Malekov
- Radiology Department, Saint-Petersburg State Pediatric Medical University, Saint Petersburg, Russia
| | - Dmitry O Ivanov
- Neonatology Department, Saint-Petersburg State Pediatric Medical University, Saint Petersburg, Russia
| | - Mikhail M Kostik
- Hospital Pediatry, Saint-Petersburg State Pediatric Medical University, Saint Petersburg, Russia
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Akgün Ö, Demirkan FG, Kavrul Kayaalp G, Erdemir M, Akay N, Çakmak F, Önel M, Keskindemirci G, Eker Ömeroğlu R, Gökçay EG, Aktay Ayaz N. Vaccination coverage of children with rheumatic diseases compared with healthy controls: a retrospective case-control study. Postgrad Med 2023; 135:824-830. [PMID: 37997766 DOI: 10.1080/00325481.2023.2287988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 11/22/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVE To reveal the vaccination status of patients with pediatric rheumatic disease (PedRD) and to compare this with healthy controls. METHODS The electronic health records of the Ministry of Health regarding the vaccination status of children with PedRD followed in a tertiary hospital were analyzed cross-sectionally and compared with their healthy controls. The missing vaccines were reported according to individual, age-appropriate schedule and causes of skipped vaccines in both groups were investigated with an online survey. RESULTS The vaccination rate of patients in the last examination was 71.4% (90/126) and 95.7% (110/115) in healthy controls (p < 0.001). Measles-mumps-rubella vaccine, diphtheria, the administration rates of the second dose of tetanus-acellular pertussis-inactivated polio and Haemophilus influenzae type B, chickenpox, and hepatitis A vaccines were significantly lower in patients than in controls (p values 0.004, 0.02, 0.01, 0.013, respectively). The pre-diagnosis incomplete vaccination proportion was significantly higher in the patient group (16.6%) than in healthy controls (4.3%) (p = 0.002). In the patient group, the proportion of incomplete live-attenuated vaccines after diagnosis (25%) was more than pre-diagnosis (61.1%) (p = 0.04), while the proportion of incomplete non-live vaccines before and after diagnosis was similar (47.2% and 50%, respectively) (p = 0.73). The major reasons for missed vaccines were physicians' recommendations (15.6%), the presence of PedRD diagnosis (12.5%), and the drugs used (12.5%). CONCLUSION Vaccination coverage of PedRD patients has been shown to lag behind the routine vaccination schedule (71.4%). In addition to new recommendations, electronic health system records for vaccination may be appropriate for the follow-up of these patients, and the addition of reminder alerts may be useful to reduce the rate of missed vaccinations.
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Affiliation(s)
- Özlem Akgün
- Department of Pediatric Rheumatology, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Fatma Gül Demirkan
- Department of Pediatric Rheumatology, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Gülşah Kavrul Kayaalp
- Department of Pediatric Rheumatology, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Merve Erdemir
- Social Pediatrics Doctoral Program, Istanbul University Institute of Health Sciences Institute of Child Health, Istanbul, Turkey
| | - Nergis Akay
- Department of Pediatrics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Figen Çakmak
- Department of Pediatric Rheumatology, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Mustafa Önel
- Department of Microbiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Gonca Keskindemirci
- Department of Social Pediatrics, Institute of Child Health, Istanbul University, Istanbul, Turkey
- Division of Social Pediatrics, Department of Child Health and Diseases, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Rukiye Eker Ömeroğlu
- Department of Pediatric Rheumatology, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Emine Gülbin Gökçay
- Department of Social Pediatrics, Institute of Child Health, Istanbul University, Istanbul, Turkey
- Division of Social Pediatrics, Department of Child Health and Diseases, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Nuray Aktay Ayaz
- Department of Pediatric Rheumatology, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
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Güngörer V, Çelikel E, Ekici Tekin Z, Polat MC, Öner N, Kurt T, Kaplan MM, Sezer M, Tekgöz N, Karagöl C, Coşkun S, Çelikel Acar B. Biological Agent Switching in Patients With Juvenile Idiopathic Arthritis: A Tertiary Center Experience. J Clin Rheumatol 2023; 29:255-261. [PMID: 37068267 DOI: 10.1097/rhu.0000000000001974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
OBJECTIVE The purpose of this study is to investigate the causes and outcomes of switching biological agents in juvenile idiopathic arthritis (JIA) patients using biological agents and compare the characteristics of patients whose biological agents are switched and those whose are not. METHODS This medical records review study was conducted with 128 patients who were diagnosed with JIA at our clinic between January 2009 and January 2022 and were receiving biologic agents. Factors affecting the biologic agent switching were investigated. RESULTS The JIA subtype with the most frequent switching in biological agents was systemic JIA (n = 13, 40.6%). Systemic JIA was followed by rheumatoid factor-negative polyarticular JIA and persistent oligoarticular JIA with 5 patients (15.6%), extended oligoarticular JIA and enthesitis-related JIA with 3 patients (9.3%), rheumatoid factor-positive polyarticular JIA with 2 patients (6.2%), and undifferentiated JIA with 1 patient (3.1%). Among the patients, 32 (25%) patients had their biological agent switched once, and 5 (3.9%) had theirs switched twice. The most frequently used biological agent was etanercept (n = 76, 59.3%), whereas the most frequently observed cases of biological agent switching were from an anti-TNF agent to another anti-TNF agent (40.6%). The reason for switching was unresponsiveness to the agent in 22 patients (68.8%), adverse effects in 6 patients (18.7%), drug intolerance in 1 patient (3.1%), and other reasons in 3 patients (9.3%). CONCLUSIONS The most frequently used biological agent was etanercept; the most frequent cases of biological agents switching were from an anti-TNF agent to another anti-TNF agent.
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Affiliation(s)
- Vildan Güngörer
- From the Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
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10
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Hamad Saied M, van Straalen JW, de Roock S, de Joode-Smink GCJ, Verduyn Lunel FM, Swart JF, Wulffraat NM, Jansen MHA. Long-term immunoprotection after live attenuated measles-mumps-rubella booster vaccination in children with juvenile idiopathic arthritis. Vaccine 2023; 41:5477-5482. [PMID: 37516575 DOI: 10.1016/j.vaccine.2023.07.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/08/2023] [Accepted: 07/24/2023] [Indexed: 07/31/2023]
Abstract
INTRODUCTION Vaccines, especially live attenuated vaccines, in children with JIA pose a great challenge due to both potential lower immunogenicity and safety as a result of immunosuppressive treatment. For many years, in the Netherlands, JIA patients receive a measles-mumps-rubella (MMR) booster vaccine at the age of nine years as part of the national immunization program. OBJECTIVES To study long-term humoral immunoprotection in a large cohort of JIA patients who received the MMR booster vaccine while being treated with immunomodulatory therapies at the Wilhelmina Children's Hospital in Utrecht, the Netherlands. METHODS MMR-specific IgG antibody concentrations in stored serum samples of vaccinated JIA patients were determined with chemiluminescent microparticle immunoassays (CMIA). Samples were analyzed five years after MMR booster vaccination and at last available follow-up visit using both crude and adjusted analyses. Additional clinical data were collected from electronic medical records. RESULTS In total, 236 samples from 182 patients were analyzed, including 67 samples that were available five years post-vaccination, and an additional 169 samples available from last visits with a median duration after vaccination of 6.9 years (IQR: 2.8-8.8). Twenty-eight patients were using biologic disease-modifying antirheumatic drugs (bDMARDS) of whom 96% anti-TNF agents and 4% tocilizumab. Percentages of protective antibody levels against measles after five years were significantly lower for patients who used bDMARD therapy at vaccination compared to patients who did not: 60% versus 86% (P = 0.03). For mumps (80% versus 94%) and rubella (60% versus 83%) this difference did not reach statistical significance (P = 0.11 and P = 0.07, respectively). Antibody levels post-vaccination decreased over time, albeit not significantly different between bDMARD users and non-bDMARD users. CONCLUSION The MMR booster vaccine demonstrated long-term immunogenicity in the majority of children with JIA from a large cohort, although lower percentages of protective measles antibody levels were observed in bDMARD users. Hence, it might be indicated to measure antibody levels at least five years after MMR booster vaccination in the latter group and advice an extra booster accordingly.
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Affiliation(s)
- Mohamad Hamad Saied
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Pediatrics, Carmel Medical Center, Technion Faculty of Medicine, Haifa, Israel.
| | - Joeri W van Straalen
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Sytze de Roock
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Gerrie C J de Joode-Smink
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Frans M Verduyn Lunel
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Joost F Swart
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Nico M Wulffraat
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marc H A Jansen
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
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Lima LDM, Aurilio RB, Fonseca AR, Parente AAAI, Sant’Anna MDFBP, Sant’Anna CC. Tuberculosis in children and adolescents with rheumatic diseases using biologic agents: an integrative review. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2023; 42:e2022084. [PMID: 37436237 PMCID: PMC10332438 DOI: 10.1590/1984-0462/2024/42/2022084] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 02/05/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVE To conduct a bibliographic review on tuberculosis (TB) disease in children and adolescents with rheumatic diseases, being managed with biologic therapy. DATA SOURCE An integrative review with a search in the U.S. National Library of Medicine and the National Institutes of Health (PubMed) using the following descriptors and Boolean operators: (["tuberculosis"] AND (["children"] OR ["adolescent"]) AND ["rheumatic diseases"] AND (["tumor necrosis factor-alpha"] OR ["etanercept"] OR ["adalimumab"] OR ["infliximab"] OR ["biological drugs"] OR ["rituximab"] OR ["belimumab"] OR ["tocilizumab"] OR ["canakinumab"] OR ["golimumab"] OR ["secukinumab"] OR ["ustekinumab"] OR ["tofacitinib"] OR ["baricitinib"] OR ["anakinra"] OR ["rilonacept"] OR ["abatacept"]), between January 2010 and October 2021. DATA SYNTHESIS Thirty-seven articles were included, with the total number of 36,198 patients. There were 81 cases of latent tuberculosis infection (LTBI), 80 cases of pulmonary tuberculosis (PTB), and four of extrapulmonary tuberculosis (EPTB). The main rheumatic disease was juvenile idiopathic arthritis. Among LTBI cases, most were diagnosed at screening and none progressed to TB disease during follow-up. Of the TB cases using biologics, most used tumor necrosis factor-alpha inhibitors (anti-TNFα) drugs. There was only one death. CONCLUSIONS The study revealed a low rate of active TB in pediatric patients using biologic therapy. Screening for LTBI before initiating biologics should be done in all patients, and treatment, in cases of positive screening, plays a critical role in preventing progression to TB disease.
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Affiliation(s)
- Lenita de Melo Lima
- Instituto de Puericultura e Pediatria Martagão Gesteira, Rio de Janeiro, RJ, Brazil
| | | | - Adriana Rodrigues Fonseca
- Instituto de Puericultura e Pediatria Martagão Gesteira, Rio de Janeiro, RJ, Brazil
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Hamad Saied M, van Straalen JW, de Roock S, de Joode-Smink GCJ, Swart JF, Wulffraat NM, Jansen MHA. Safety of Measles-Mumps-Rubella booster vaccination in patients with juvenile idiopathic arthritis: A long-term follow-up study. Vaccine 2023; 41:2976-2981. [PMID: 37032229 DOI: 10.1016/j.vaccine.2023.03.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 03/24/2023] [Accepted: 03/30/2023] [Indexed: 04/11/2023]
Abstract
OBJECTIVES To study short and long-term disease activity and vaccine-related adverse events in a cohort of JIA patients who received the live attenuated measles-mumps-rubella (MMR) booster vaccine while being treated with immunosuppressive and immunomodulatory therapies. METHODS A retrospective study was performed in the UMC Utrecht, clinical and therapeutic data were collected from electronic medical records for two visits before and two visits after the MMR booster vaccine of JIA patients. Drug therapy was collected and adverse events related to the vaccine were requested from the patients during clinical visits or by short phone interviews. Associations between MMR booster vaccination and the active joint count, physician global assessment of disease activity, patient-reported visual analogue scale (VAS) for well-being and clinical Juvenile Arthritis Disease Activity Score (cJADAS) were analyzed using multivariable linear mixed effects analyses. RESULTS A total of 186 JIA patients were included in the study. At the time of vaccination, 51% of the patients used csDMARD and 28% used bDMARD therapy. Overall, adjusted disease activity scores after MMR booster vaccination were not significantly different compared to pre-vaccination. Mild adverse events related to the MMR booster were reported for 7% of the patients. No serious adverse events were reported. CONCLUSION MMR booster vaccination was safe and did not worsen disease activity during long-term follow-up in a large cohort of JIA patients being treated with both csDMARDs and biological DMARDs.
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Affiliation(s)
- Mohamad Hamad Saied
- Department of Paediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Pediatrics, Carmel Medical Center, Technion Faculty of Medicine, Haifa, Israel.
| | - Joeri W van Straalen
- Department of Paediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Sytze de Roock
- Department of Paediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Gerrie C J de Joode-Smink
- Department of Paediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Joost F Swart
- Department of Paediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Nico M Wulffraat
- Department of Paediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marc H A Jansen
- Department of Paediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
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Levälampi T, Kärki J, Rebane K, Vähäsalo P, Malin M, Kröger L, Grönlund MM, Backström M, Pohjankoski H, Kautiainen H, Jokiranta S, Aalto K. Etanercept for patients with juvenile idiopathic arthritis: drug levels and influence of concomitant methotrexate: observational study. Pediatr Rheumatol Online J 2023; 21:27. [PMID: 36949461 PMCID: PMC10035115 DOI: 10.1186/s12969-023-00801-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 02/14/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Etanercept (ETN) is widely used tumour necrosis factor (TNF) blocker in the treatment of juvenile idiopathic arthritis (JIA) when traditional synthetic disease modifying antirheumatic drug (sDMARD) therapy is not sufficient. There is limited information about the effects of methotrexate (MTX) on serum ETN concentration in children with JIA. We aimed to investigate whether ETN dose and concomitant MTX would effect ETN serum trough levels in JIA patients, and whether concomitant MTX have an influence on the clinical response in patients with JIA receiving ETN. METHODS In this study, we collected the medical record data of 180 JIA patients from eight Finnish pediatric rheumatological centres. All these patients were treated with ETN monotherapy or combination therapy with DMARD. To evaluate the ETN concentrations, blood samples of the patients were collected between injections right before the subsequent drug. Free ETN level was measured from serum. RESULTS Ninety-seven (54%) of the patients used concomitant MTX, and 83 (46%) received either ETN monotherapy or used sDMARDs other than MTX. A significant correlation was noted between ETN dose and drug level [r = 0.45 (95% CI: 0.33-0.56)]. The ETN dose and serum drug level were correlated (p = 0.030) in both subgroups - in MTX group [r = 0.35 (95% CI: 0.14-0.52)] and in non-MTX group [r = 0.54 (95% CI: 0.39-0.67)]. CONCLUSION In the present study, we found that concomitant MTX had no effect on serum ETN concentration or on clinical response. In addition, a significant correlation was detected between ETN dose and ETN concentration.
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Affiliation(s)
- Tiina Levälampi
- Pediatric Research Center, New Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
| | - Johanna Kärki
- Department of Pediatrics, Kanta-Häme Central Hospital, Hämeenlinna, Finland
| | - Katariina Rebane
- Pediatric Research Center, New Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Paula Vähäsalo
- PEDEGO Research Unit, University of Oulu, Oulu, Finland
- Department of Pediatrics, Oulu University Hospital, Oulu, Finland
- Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Merja Malin
- Department of Pediatrics, Tampere University Hospital, Tampere, Finland
| | - Liisa Kröger
- Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland
| | | | - Maria Backström
- PEDEGO Research Unit, University of Oulu, Oulu, Finland
- Department of Paediatrics, The Wellbeing Services County of Ostrobothnia, Vaasa, Finland
| | - Heini Pohjankoski
- Department of Pediatrics, Päijät-Häme Central Hospital, Lahti, Finland
| | - Hannu Kautiainen
- Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
- Folkhälsan Research Center, Helsinki, Finland
| | - Sakari Jokiranta
- Department of Bacteriology and Immunology, University of Helsinki, MedicumHelsinki, Finland
- Tammer BioLab Ltd, Tampere, Finland
| | - Kristiina Aalto
- Pediatric Research Center, New Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
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14
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Marinho AKBB. Vaccination in children with immune-mediated disorders. J Pediatr (Rio J) 2023; 99 Suppl 1:S62-S69. [PMID: 36566017 PMCID: PMC10066448 DOI: 10.1016/j.jped.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 11/28/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To present an updated review of recommendations for the vaccination of children with immune-mediated diseases, with an emphasis on rheumatic and inflammatory diseases. SOURCE OF DATA Studies published in the PubMed and Scielo databases between 2002 and 2022, Guidelines of Brazilian Scientific Societies, Manuals and Technical Notes of the Ministry of Health of Brazil, on current immunization schedules for special populations. DATA SYNTHESIS Immunosuppressive drugs and biological agents reduce the immunogenicity of vaccines and favor susceptibility to infections. The safety and efficacy of immunogens are important points for vaccination in children with immune-mediated diseases. The safety threshold of a vaccine applied to immunocompromised individuals can be reduced when compared to healthy individuals. Very often, the recommendations for the immunization of children with immune-mediated diseases follow the recommendations for immunocompromised patients. Vaccination against COVID-19, on the other hand, should ideally occur when the disease is stabilized and in the absence of a low degree of immunosuppression. The patients should be informed about the possibility that the immunization may fail during treatment with immunosuppressants. Specific vaccination schedules should be considered to ensure better protection. CONCLUSIONS Recent studies have allowed updating the recommendations on the safety and immunogenicity of vaccination in children with immune-mediated diseases, especially for live attenuated vaccines. There is a scarcity of data on the safety and efficacy of COVID-19 vaccines in patients, particularly pediatric patients, with rheumatic diseases. The completion of ongoing studies is expected to help guide recommendations on COVID-19 vaccines in this group of patients.
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Affiliation(s)
- Ana Karolina Barreto Berselli Marinho
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Serviço de Imunologia Clínica e Alergia, São Paulo, SP, Brazil.
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15
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Horneff G, Minden K, Rolland C, Daly ACH, Borlenghi C, Ruperto N. Efficacy and safety of TNF inhibitors in the treatment of juvenile idiopathic arthritis: a systematic literature review. Pediatr Rheumatol Online J 2023; 21:20. [PMID: 36829225 PMCID: PMC9951426 DOI: 10.1186/s12969-023-00798-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 01/29/2023] [Indexed: 02/26/2023] Open
Abstract
OBJECTIVE A systematic literature review was conducted to summarize efficacy and safety data from studies that evaluated tumor necrosis factor inhibitors in patients with juvenile idiopathic arthritis (JIA). METHODS Relevant publications were identified via online searches (cutoff: March 16, 2021). After screening search results, outcome data were extracted if the treatment arm included ≥ 30 patients. Outcomes were described narratively, with efficacy assessed by JIA-American College of Rheumatology (ACR) response criteria and safety assessed by the incidence of serious adverse events (SAEs) per 100 patient-years (100PY). RESULTS Among 87 relevant publications included in the qualitative synthesis, 19 publications described 13 clinical trials. Across the 13 trials, the percentages of patients who achieved JIA-ACR30/50/70/90 responses at Week 12 with adalimumab ranged 71-94%, 68-90%, 55-61%, and 39-42%, respectively; with etanercept (Week 12), 73-94%, 53-78%, 36-59%, and 28%; with golimumab (Week 16), 89%, 79%, 66%, and 36%; and with infliximab (Week 14), 64%, 50%, and 22% (JIA-ACR90 not reported). SAE incidence across all time points ranged 0-13.7 SAE/100PY for adalimumab, 0-20.0 SAE/100PY for etanercept, and 10.4-24.3 SAE/100PY for golimumab (1 study). SAE incidence could not be estimated from the 2 infliximab publications. CONCLUSION Tumor necrosis factor inhibitors are effective and well tolerated in the treatment of JIA, but additional evidence from head-to-head studies and over longer periods of time, especially in the context of the transition from pediatric to adult care, would be useful.
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Affiliation(s)
- Gerd Horneff
- Department of General Paediatrics, Asklepios Clinic Sankt Augustin, Sankt Augustin, Germany. .,Department of Paediatric and Adolescents Medicine, University Hospital of Cologne, Cologne, Germany.
| | - Kirsten Minden
- grid.413453.40000 0001 2224 3060German Rheumatism Research Centre Berlin (DRFZ), Leibniz Association, Berlin, Germany ,grid.6363.00000 0001 2218 4662Department of Pediatric Pulmonology, Immunology, and Intensive Care Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | | - Nicolino Ruperto
- grid.419504.d0000 0004 1760 0109IRCCS Istituto Giannina Gaslini, UOSID Centro Trial, Genoa, Italy
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16
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van Straalen JW, Baas L, Giancane G, Grebenkina L, Brunner J, Vega-Cornejo G, Chasnyk VG, Harel L, Appenzeller S, Gervais E, de Roock S, Wulffraat NM, Ruperto N, Swart JF. Juvenile idiopathic arthritis patients with positive family history of autoimmune thyroid disease might benefit from serological screening: analysis of the international Pharmachild registry. Pediatr Rheumatol Online J 2023; 21:19. [PMID: 36810111 PMCID: PMC9945712 DOI: 10.1186/s12969-023-00802-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 02/14/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Little is known about the association between juvenile idiopathic arthritis (JIA) and autoimmune thyroid disease (AITD) and therefore there are no indications for AITD screening in this population, which is possible using standard blood tests. The objective of this study is to determine the prevalence and predictors of symptomatic AITD in JIA patients from the international Pharmachild registry. METHODS Occurrence of AITD was determined from adverse event forms and comorbidity reports. Associated factors and independent predictors for AITD were determined using univariable and multivariable logistic regression analyses. RESULTS The prevalence of AITD after a median observation period of 5.5 years was 1.1% (96/8965 patients). Patients who developed AITD were more often female (83.3% vs. 68.0%), RF positive (10.0% vs. 4.3%) and ANA positive (55.7% vs. 41.5%) than patients who did not. AITD patients were furthermore older at JIA onset (median 7.8 years vs. 5.3 years) and had more often polyarthritis (40.6% vs. 30.4%) and a family history of AITD (27.5% vs. 4.8%) compared to non-AITD patients. A family history of AITD (OR = 6.8, 95% CI: 4.1 - 11.1), female sex (OR = 2.2, 95% CI: 1.3 - 4.3), ANA positivity (OR = 2.0, 95% CI: 1.3 - 3.2) and older age at JIA onset (OR = 1.1, 95% CI: 1.1 - 1.2) were independent predictors of AITD on multivariable analysis. Based on our data, 16 female ANA positive JIA patients with a family history of AITD would have to be screened during ±5.5 years using standard blood tests to detect one case of AITD. CONCLUSIONS This is the first study to report independent predictor variables for symptomatic AITD in JIA. Female ANA positive JIA patients with positive family history are at increased risk of developing AITD and thus might benefit from yearly serological screening.
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Affiliation(s)
- Joeri W. van Straalen
- grid.417100.30000 0004 0620 3132Department of Pediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, P.O. box 85090, 3508 AB Utrecht, The Netherlands ,grid.5477.10000000120346234Faculty of Medicine, Utrecht University, Utrecht, the Netherlands
| | - Laurie Baas
- grid.417100.30000 0004 0620 3132Department of Pediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, P.O. box 85090, 3508 AB Utrecht, The Netherlands ,grid.5477.10000000120346234Faculty of Medicine, Utrecht University, Utrecht, the Netherlands
| | - Gabriella Giancane
- grid.419504.d0000 0004 1760 0109Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy ,grid.5606.50000 0001 2151 3065Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DiNOGMI), Università degli Studi di Genova, Genoa, Italy
| | - Lyudmila Grebenkina
- Pediatric Department, Togliatti City Clinical Hospital №5, Togliatti, Russia
| | - Jurgen Brunner
- grid.5361.10000 0000 8853 2677Pediatric Rheumatology, Department of Pediatrics, Medical University Innsbruck, Innsbruck, Austria ,grid.465811.f0000 0004 4904 7440Danube Private University, Krems, Austria
| | - Gabriel Vega-Cornejo
- Clínica Pediátrica de Reumatología y Enfermedades Autoinmunes (CREA), Hospital México Americano, Guadalajara, Mexico
| | - Vyacheslav G. Chasnyk
- grid.445931.e0000 0004 0471 4078Department of Hospital Pediatrics, Saint Petersburg State Pediatric Medical University, Saint Petersburg, Russia
| | - Liora Harel
- grid.414231.10000 0004 0575 3167Pediatric Rheumatology Unit, Schneider Children’s Medical Center, Petach-Tikvah, Israel ,grid.12136.370000 0004 1937 0546Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Simone Appenzeller
- grid.411087.b0000 0001 0723 2494Department of Orthopedics, Rheumatology and Traumatology, School of Medical Science, University of Campinas, Campinas, Brazil
| | - Elisabeth Gervais
- grid.411162.10000 0000 9336 4276Rheumatology, Centre Hospitalier Universitaire (CHU) de Poitiers, Poitiers, France
| | - Sytze de Roock
- grid.417100.30000 0004 0620 3132Department of Pediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, P.O. box 85090, 3508 AB Utrecht, The Netherlands ,grid.5477.10000000120346234Faculty of Medicine, Utrecht University, Utrecht, the Netherlands
| | - Nico M. Wulffraat
- grid.417100.30000 0004 0620 3132Department of Pediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, P.O. box 85090, 3508 AB Utrecht, The Netherlands ,grid.5477.10000000120346234Faculty of Medicine, Utrecht University, Utrecht, the Netherlands
| | - Nicolino Ruperto
- grid.419504.d0000 0004 1760 0109UOSID Centro trial, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Joost F. Swart
- grid.417100.30000 0004 0620 3132Department of Pediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, P.O. box 85090, 3508 AB Utrecht, The Netherlands ,grid.5477.10000000120346234Faculty of Medicine, Utrecht University, Utrecht, the Netherlands
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17
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van Straalen JW, Kearsley‐Fleet L, Klotsche J, de Roock S, Minden K, Heiligenhaus A, Hyrich KL, de Boer JH, Lamot L, Olivieri AN, Gallizzi R, Smolewska E, Faugier E, Pastore S, Hashkes PJ, Herrera CN, Emminger W, Consolini R, Wulffraat NM, Ruperto N, Swart JF. Development and External Validation of a Model Predicting New-Onset Chronic Uveitis at Different Disease Durations in Juvenile Idiopathic Arthritis. Arthritis Rheumatol 2023; 75:318-327. [PMID: 36054539 PMCID: PMC10108055 DOI: 10.1002/art.42329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 07/21/2022] [Accepted: 08/11/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To develop and externally validate a prediction model for new-onset chronic uveitis in children with juvenile idiopathic arthritis (JIA) for clinical application. METHODS Data from the international Pharmachild registry were used to develop a multivariable Cox proportional hazards model. Predictors were selected by backward selection, and missing values were handled by multiple imputation. The model was subsequently validated and recalibrated in 2 inception cohorts: the UK Childhood Arthritis Prospective Study (CAPS) study and the German Inception Cohort of Newly diagnosed patients with juvenile idiopathic arthritis (ICON) study. Model performance was evaluated by calibration plots and C statistics for the 2-, 4-, and 7-year risk of uveitis. A diagram and digital risk calculator were created for use in clinical practice. RESULTS A total of 5,393 patients were included for model development, and predictor variables were age at JIA onset (hazard ratio [HR] 0.83 [95% confidence interval (95% CI) 0.77-0.89]), ANA positivity (HR 1.59 [95% CI 1.06-2.38]), and International League of Associations for Rheumatology category of JIA (HR for oligoarthritis, psoriatic arthritis, and undifferentiated arthritis versus rheumatoid factor-negative polyarthritis 1.40 [95% CI 0.91-2.16]). Performance of the recalibrated prediction model in the validation cohorts was acceptable; calibration plots indicated good calibration and C statistics for the 7-year risk of uveitis (0.75 [95% CI 0.72-0.79] for the ICON cohort and 0.70 [95% CI 0.64-0.76] for the CAPS cohort). CONCLUSION We present for the first time a validated prognostic tool for easily predicting chronic uveitis risk for individual JIA patients using common clinical parameters. This model could be used by clinicians to inform patients/parents and provide guidance in choice of uveitis screening frequency and arthritis drug therapy.
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Affiliation(s)
- Joeri W. van Straalen
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, and Faculty of MedicineUtrecht UniversityUtrechtThe Netherlands
| | | | - Jens Klotsche
- Epidemiology UnitGerman Rheumatism Research Centre BerlinBerlinGermany
| | - Sytze de Roock
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, and Faculty of MedicineUtrecht UniversityUtrechtThe Netherlands
| | - Kirsten Minden
- Epidemiology Unit, German Rheumatism Research Centre Berlin, and Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
| | - Arnd Heiligenhaus
- Department of Ophthalmology, St. Franziskus Hospital, Münster, Germany, and University of Duisburg‐EssenEssenGermany
| | - Kimme L. Hyrich
- Centre for Epidemiology Versus Arthritis, The University of Manchester, and NIHR Manchester BRC, Manchester University NHS Foundation TrustManchester Academic Health Science CentreManchesterUK
| | - Joke H. de Boer
- Department of OphthalmologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Lovro Lamot
- Sestre Milosrdnice University Hospital Center Zagreb, Zagreb, Croatia, and University of Zagreb School of MedicineZagrebCroatia
| | - Alma N. Olivieri
- Dipartimento della Donna del Bambino e di Chirurgia Generale e SpecialisticaUniversità degli Studi della Campania L.VanvitelliNaplesItaly
| | - Romina Gallizzi
- Department of Medical of Health SciencesMagna Graecia UniversityCatanzaroItaly
| | - Elzbieta Smolewska
- Department of Pediatric Cardiology and RheumatologyMedical University of LodzLodzPoland
| | - Enrique Faugier
- Dipartimento della Donna del Bambino e di Chirurgia Generale e SpecialisticaUniversità degli Studi della Campania L.VanvitelliNaplesItaly
| | - Serena Pastore
- Institute for Maternal and Child Health, IRCCS Burlo GarofoloTriesteItaly
| | - Philip J. Hashkes
- Pediatric Rheumatology UnitShaare Zedek Medical Center, and Hebrew University Hadassah School of MedicineJerusalemIsrael
| | - Cristina N. Herrera
- Servicio de Reumatología, Hospital de Niños Roberto Gilbert ElizaldeGuayaquilEcuador
| | - Wolfgang Emminger
- Department of PediatricsUniversity Children's Hospital, Medical University of ViennaViennaAustria
| | - Rita Consolini
- Division of Pediatrics, Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
| | - Nico M. Wulffraat
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, and Faculty of MedicineUtrecht UniversityUtrechtThe Netherlands
| | - Nicolino Ruperto
- Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina GasliniGenoaItaly
| | - Joost F. Swart
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, and Faculty of MedicineUtrecht UniversityUtrechtThe Netherlands
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Development of Inflammatory Bowel Disease in Children With Juvenile Idiopathic Arthritis Treated With Biologics. J Pediatr Gastroenterol Nutr 2023; 76:174-182. [PMID: 36399775 DOI: 10.1097/mpg.0000000000003656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of our study was to describe the distinct features of inflammatory bowel disease (IBD) in juvenile idiopathic arthritis (JIA) patients and to identify risk factors for its development. METHODS Data from the German biologics in pediatric rheumatology registry (Biologika in der Kinderrheumatologie) collected between 2001 and 2021 were analyzed retrospectively. RESULTS In 5009 JIA patients, 28 developed confirmed IBD before the age of 18 years: 23 (82.1%) with Crohn disease (CD), 4 (14.3%) with ulcerative colitis (UC), and 1 (3.6%) with IBD-unclassified (IBD-U). The incident rate of IBD during 20 years of observation was 0.56% (0.46% for CD, 0.08% for UC, and 0.02% for IBD-U), of whom 20.3% were HLA-B27 positive, 25% had enthesitis-related arthritis, and 14.3% psoriatic arthritis. Within 90 days before IBD diagnosis, 82.1% (n = 23) received treatment with etanercept (ETA), 39.3% (n = 11) non-steroidal anti-inflammatory drugs, 17.9% (n = 5) systemic corticosteroids, 8 (28.6%) methotrexate (MTX), 14.3% (n = 4) sulfasalazine, 10.7% (n = 3) leflunomide, and 3.6% (n = 1) adalimumab and infliximab, respectively. The incidence of IBD was lower in patients treated with MTX, but higher in patients treated with ETA except if ETA was combined with MTX. Also in patients on leflunomide or sulfasalazine, the IBD incidence was higher. CONCLUSIONS In our JIA cohort, an increased IBD incidence is observed compared to the general population, and the ratio of CD to UC is markedly higher hinting at a distinct phenotype of IBD. Pretreatment with MTX seems to be protective. Treatment with ETA does not prevent IBD development and JIA patients treated with leflunomide and sulfasalazine may be at an increased risk for IBD development.
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Çakmak F, Akgün Ö, Demirkan FG, Tanatar A, Kayaalp GK, Keskindemirci G, Guliyeva V, Ömeroğlu RE, Gökçay EG, Ayaz NA. Live-attenuated measles, mumps, and rubella booster vaccine in children diagnosed with rheumatic disease: A single-center study. Eur J Pediatr 2023; 182:135-140. [PMID: 36224436 DOI: 10.1007/s00431-022-04646-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 09/24/2022] [Accepted: 10/05/2022] [Indexed: 01/13/2023]
Abstract
To evaluate the safety profile of measles, mumps and rubella (MMR) booster in children diagnosed with rheumatic diseases receiving biological agents. The study included retrospective safety data of children administered MMR booster dose receiving biologics or biologics with methotrexate. The files of 182 patients were accessed from the pediatric rheumatology biological therapy archive, and the vaccination status of these children was obtained by accessing electronic records. Of 182 patients, 14 patients were vaccinated with MMR booster dose. Thirteen of the patients were followed up with a diagnosis of juvenile idiopathic arthritis and one with colchicine-resistant familial Mediterranean fever. None of the patients had disease exacerbation after vaccination, and three patients had mild side effects consisting of rash, angioedema, joint pain, and fatigue. Conclusion: This study supports the data regarding evidence of the safety of MMR booster dose administration in children with rheumatic diseases receiving bDMARDs. What is Known: • MMR booster is avoided in immunocompromised pediatric patients receiving bDMARDs except in specific conditions. What is New: • The MMR booster dose may be safe in children with PedRD receiving bDMARDs or bDMARDs with MTX. These bullets can be added to the manuscript.
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Affiliation(s)
- Figen Çakmak
- Department of Pediatric Rheumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Özlem Akgün
- Department of Pediatric Rheumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Fatma Gül Demirkan
- Department of Pediatric Rheumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ayşe Tanatar
- Department of Pediatric Rheumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Gülşah Kavrul Kayaalp
- Department of Pediatric Rheumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Gonca Keskindemirci
- Department of Social Pediatrics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Vafa Guliyeva
- Department of Pediatric Rheumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Rukiye Eker Ömeroğlu
- Department of Pediatric Rheumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Emine Gülbin Gökçay
- Department of Social Pediatrics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Nuray Aktay Ayaz
- Department of Pediatric Rheumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
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20
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van Straalen JW, de Roock S, Giancane G, Alexeeva E, Koskova E, Mesa-del-Castillo Bermejo P, Zulian F, Civino A, Montin D, Wulffraat NM, Ruperto N, Swart JF. Prevalence of familial autoimmune diseases in juvenile idiopathic arthritis: results from the international Pharmachild registry. Pediatr Rheumatol Online J 2022; 20:103. [PMID: 36401230 PMCID: PMC9673358 DOI: 10.1186/s12969-022-00762-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/29/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Little is known about the disposition to autoimmune diseases (ADs) among children diagnosed with JIA. In this study, we provide a comprehensive overview of the prevalence of and factors associated with ADs in parents of children with juvenile idiopathic arthritis (JIA). METHODS Prevalence rates of ADs and 95% Poisson confidence intervals were calculated for parents of JIA patients from the international Pharmachild registry and compared with general population prevalence rates as reported in the literature. Demographic, clinical and laboratory features were compared between JIA patients with and without a family history of AD using χ2 and Mann-Whitney U tests. RESULTS Eight thousand six hundred seventy three patients were included and the most common familial ADs were psoriasis, autoimmune thyroid disease, rheumatoid arthritis and ankylosing spondylitis. The prevalence of several ADs was higher in parents of the included JIA patients than in the general population. Clinical Juvenile Arthritis Disease Activity Scores at study entry and last follow-up were not significantly different between patients with (n = 1231) and without a family history of AD (n = 7442). Factors associated with familial AD were older age at JIA onset (P < 0.01), Scandinavian residence (P < 0.01), enthesitis-related arthritis, psoriatic arthritis and undifferentiated arthritis (P < 0.01), ANA positivity (P = 0.03) and HLA-B27 positivity (P < 0.01). CONCLUSIONS Familial AD proves to be a risk factor for JIA development and certain diseases should therefore not be overlooked during family health history at the diagnosis stage. A family history of AD is associated with the JIA category but does not influence the severity or disease course.
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Affiliation(s)
- Joeri W. van Straalen
- grid.7692.a0000000090126352Department of Pediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, P.O. box 85090, 3508 AB Utrecht, the Netherlands ,grid.5477.10000000120346234Faculty of Medicine, Utrecht University, Utrecht, the Netherlands
| | - Sytze de Roock
- grid.7692.a0000000090126352Department of Pediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, P.O. box 85090, 3508 AB Utrecht, the Netherlands ,grid.5477.10000000120346234Faculty of Medicine, Utrecht University, Utrecht, the Netherlands
| | - Gabriella Giancane
- grid.419504.d0000 0004 1760 0109IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, Genoa, Italy ,grid.5606.50000 0001 2151 3065Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DiNOGMI), Università degli Studi di Genova, Genoa, Italy
| | - Ekaterina Alexeeva
- grid.465370.30000 0004 4914 227XFederal State Autonomous Institution “National Medical Research Center of Children’s Health” of the Ministry of Health of the Russian Federation, Moscow, Russian Federation ,grid.448878.f0000 0001 2288 8774Federal State Autonomous Educational Institution of Higher Education, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Elena Koskova
- grid.419284.20000 0000 9847 3762Department of Pediatric Rheumatology, National Institute of Rheumatic Diseases, Piestany, Slovakia
| | - Pablo Mesa-del-Castillo Bermejo
- grid.411372.20000 0001 0534 3000Rheumatology, Pediatrics, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Francesco Zulian
- grid.5608.b0000 0004 1757 3470Department of Woman and Child Health, University of Padua, Padua, Italy
| | - Adele Civino
- UO Pediatria - Sez. Reumatologia e Immunologia pediatrica, P.O. “Vito Fazzi”, Lecce, Italy
| | - Davide Montin
- Immunology and Rheumatology Unit, Regina Margherita Children Hospital, Turin, Italy
| | - Nico M. Wulffraat
- grid.7692.a0000000090126352Department of Pediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, P.O. box 85090, 3508 AB Utrecht, the Netherlands ,grid.5477.10000000120346234Faculty of Medicine, Utrecht University, Utrecht, the Netherlands
| | - Nicolino Ruperto
- grid.419504.d0000 0004 1760 0109UOSID Centro trial, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Joost F. Swart
- grid.7692.a0000000090126352Department of Pediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, P.O. box 85090, 3508 AB Utrecht, the Netherlands ,grid.5477.10000000120346234Faculty of Medicine, Utrecht University, Utrecht, the Netherlands
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21
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van Straalen JW, de Roock S, Giancane G, Consolaro A, Rygg M, Nordal EB, Rubio-Pérez N, Jelusic M, De Inocencio J, Vojinovic J, Wulffraat NM, Bruijning-Verhagen PCJ, Ruperto N, Swart JF, Scala S, Angioloni S, Villa L. Real-world comparison of the effects of etanercept and adalimumab on well-being in non-systemic juvenile idiopathic arthritis: a propensity score matched cohort study. Pediatr Rheumatol Online J 2022; 20:96. [PMID: 36376976 PMCID: PMC9664631 DOI: 10.1186/s12969-022-00763-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/29/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Etanercept (ETN) and adalimumab (ADA) are considered equally effective biologicals in the treatment of arthritis in juvenile idiopathic arthritis (JIA) but no studies have compared their impact on patient-reported well-being. The objective of this study was to determine whether ETN and ADA have a differential effect on patient-reported well-being in non-systemic JIA using real-world data. METHODS Biological-naive patients without a history of uveitis were selected from the international Pharmachild registry. Patients starting ETN were matched to patients starting ADA based on propensity score and outcomes were collected at time of therapy initiation and 3-12 months afterwards. Primary outcome at follow-up was the improvement in Juvenile Arthritis Multidimensional Assessment Report (JAMAR) visual analogue scale (VAS) well-being score from baseline. Secondary outcomes at follow-up were decrease in active joint count, adverse events and uveitis events. Outcomes were analyzed using linear and logistic mixed effects models. RESULTS Out of 158 eligible patients, 45 ETN starters and 45 ADA starters could be propensity score matched resulting in similar VAS well-being scores at baseline. At follow-up, the median improvement in VAS well-being was 2 (interquartile range (IQR): 0.0 - 4.0) and scores were significantly better (P = 0.01) for ETN starters (median 0.0, IQR: 0.0 - 1.0) compared to ADA starters (median 1.0, IQR: 0.0 - 3.5). The estimated mean difference in VAS well-being improvement from baseline for ETN versus ADA was 0.89 (95% CI: -0.01 - 1.78; P = 0.06). The estimated mean difference in active joint count decrease was -0.36 (95% CI: -1.02 - 0.30; P = 0.28) and odds ratio for adverse events was 0.48 (95% CI: 0.16 -1.44; P = 0.19). One uveitis event was observed in the ETN group. CONCLUSIONS Both ETN and ADA improve well-being in non-systemic JIA. Our data might indicate a trend towards a slightly stronger effect for ETN, but larger studies are needed to confirm this given the lack of statistical significance.
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Affiliation(s)
- Joeri W. van Straalen
- grid.417100.30000 0004 0620 3132Department of Pediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, P.O. box 85090, 3508 AB Utrecht, The Netherlands ,grid.5477.10000000120346234Faculty of Medicine, Utrecht University, Utrecht, the Netherlands
| | - Sytze de Roock
- grid.417100.30000 0004 0620 3132Department of Pediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, P.O. box 85090, 3508 AB Utrecht, The Netherlands ,grid.5477.10000000120346234Faculty of Medicine, Utrecht University, Utrecht, the Netherlands
| | - Gabriella Giancane
- grid.419504.d0000 0004 1760 0109Clinica Pediatrica E Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy ,grid.5606.50000 0001 2151 3065Dipartimento Di NeuroscienzeRiabilitazioneOftalmologia, Genetica e Scienze Materno-Infantili (DiNOGMI), Università Degli Studi Di Genova, Genoa, Italy
| | - Alessandro Consolaro
- grid.419504.d0000 0004 1760 0109Clinica Pediatrica E Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy ,grid.5606.50000 0001 2151 3065Dipartimento Di NeuroscienzeRiabilitazioneOftalmologia, Genetica e Scienze Materno-Infantili (DiNOGMI), Università Degli Studi Di Genova, Genoa, Italy
| | - Marite Rygg
- grid.5947.f0000 0001 1516 2393Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway ,grid.52522.320000 0004 0627 3560Department of Pediatrics, St. Olavs University Hospital of Trondheim, Trondheim, Norway
| | - Ellen B. Nordal
- grid.412244.50000 0004 4689 5540Department of Pediatrics, University Hospital of North Norway, Tromsø, Norway ,grid.10919.300000000122595234Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Nadina Rubio-Pérez
- grid.411455.00000 0001 2203 0321Departamento de Pediatria, Facultad de Medicina, Hospital Universitario “Dr. J. E. González”, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Marija Jelusic
- grid.4808.40000 0001 0657 4636Department of Paediatrics, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Jaime De Inocencio
- grid.144756.50000 0001 1945 5329Department of Pediatric Rheumatology, University Hospital 12 de Octubre, Madrid, Spain
| | - Jelena Vojinovic
- grid.11374.300000 0001 0942 1176Department of Pediatric Immunology and Rheumatology, Faculty of Medicine, University of Nis, Nis, Serbia ,grid.418653.d0000 0004 0517 2741Department of Pediatric Rheumatology, Clinic of Pediatrics, Clinical Center Nis, Nis, Serbia
| | - Nico M. Wulffraat
- grid.417100.30000 0004 0620 3132Department of Pediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, P.O. box 85090, 3508 AB Utrecht, The Netherlands ,grid.5477.10000000120346234Faculty of Medicine, Utrecht University, Utrecht, the Netherlands
| | - Patricia C. J. Bruijning-Verhagen
- grid.7692.a0000000090126352Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Nicolino Ruperto
- grid.419504.d0000 0004 1760 0109UOSID Centro Trial, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Joost F. Swart
- grid.417100.30000 0004 0620 3132Department of Pediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, P.O. box 85090, 3508 AB Utrecht, The Netherlands ,grid.5477.10000000120346234Faculty of Medicine, Utrecht University, Utrecht, the Netherlands
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Yeo JG, Chia WN, Teh KL, Book YX, Hoh SF, Gao X, Das L, Zhang J, Sutamam N, Lim AJM, Poh SL, Tay SH, Nay Yaung K, Ong XM, Hazirah SN, Chua CJH, Leong JY, Wang LF, Albani S, Arkachaisri T. Robust neutralizing antibody response to SARS-CoV-2 mRNA vaccination in adolescents and young adults with childhood-onset rheumatic diseases. Rheumatology (Oxford) 2022; 61:4472-4481. [PMID: 35199166 PMCID: PMC8903460 DOI: 10.1093/rheumatology/keac105] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 02/09/2022] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES Immunogenicity to the SARS-CoV-2 mRNA vaccines in adolescents and young adults (AYA) with childhood-onset rheumatic diseases (cRD) is unknown. We aimed to evaluate the humoral immunogenicity and safety of the vaccines in our AYA with cRD. METHODS A monocentric observational study with 159 AYA (50.3% female and 70.4% Chinese). Humoral immunogenicity was assessed at 2-3 and 4-6 weeks following first and second vaccination by cPass™ SARS-CoV-2 Neutralization Antibody Assay. Inhibition signal of ≥30% defined the cut-off for positive detection of the SARS-CoV-2 neutralizing antibodies. Vaccine safety and disease activity were assessed within 6 weeks after second vaccination. RESULTS A total of 64.9% and 99.1% of 159 patients (median age: 16.9, IQR: 14.7-19.5) mounted positive SARS-CoV-2 neutralizing responses after first and second vaccination, respectively. Most patients (89.8%) had ≥90% inhibition signal after second vaccination. Methotrexate and mycophenolate mofetil increased the risk associated with negative cPass neutralization responses following the first vaccination. Holding both medications after each vaccination did not affect immunogenicity. There was no symptomatic COVID-19 infection. Local reaction remained the most common (23.3-25.2%) adverse event, without serious complication. Two and seven patients flared following the first and second vaccination, respectively. Subgroup analyses of the 12-18-year-old cohort did not show any differences in vaccine efficacy, predictors of poor response and general safety, but higher proportion of disease flares. CONCLUSIONS SARS-CoV-2 mRNA vaccines were efficacious after the two-dose regimen in almost all AYA with cRD without serious adverse event. The rate of disease flare observed is 4.4% after the second mRNA vaccine dose.
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Affiliation(s)
- Joo Guan Yeo
- Translational Immunology Institute, SingHealth Duke-NUS Academic Medical Centre
- Rheumatology and Immunology Service, Department of Paediatric Subspecialities, KK Women’s and Children’s Hospital
- Duke-NUS Medical School
| | | | - Kai Liang Teh
- Rheumatology and Immunology Service, Department of Paediatric Subspecialities, KK Women’s and Children’s Hospital
| | - Yun Xin Book
- Rheumatology and Immunology Service, Department of Paediatric Subspecialities, KK Women’s and Children’s Hospital
| | - Sook Fun Hoh
- Division of Nursing, KK Women’s and Children’s Hospital, Singapore
| | - Xiaocong Gao
- Division of Nursing, KK Women’s and Children’s Hospital, Singapore
| | - Lena Das
- Rheumatology and Immunology Service, Department of Paediatric Subspecialities, KK Women’s and Children’s Hospital
| | | | - Nursyuhadah Sutamam
- Translational Immunology Institute, SingHealth Duke-NUS Academic Medical Centre
| | - Amanda Jin Mei Lim
- Translational Immunology Institute, SingHealth Duke-NUS Academic Medical Centre
| | - Su Li Poh
- Translational Immunology Institute, SingHealth Duke-NUS Academic Medical Centre
| | - Shi Huan Tay
- Translational Immunology Institute, SingHealth Duke-NUS Academic Medical Centre
- Duke-NUS Medical School
| | - Katherine Nay Yaung
- Translational Immunology Institute, SingHealth Duke-NUS Academic Medical Centre
- Duke-NUS Medical School
| | | | | | | | - Jing Yao Leong
- Translational Immunology Institute, SingHealth Duke-NUS Academic Medical Centre
| | | | - Salvatore Albani
- Translational Immunology Institute, SingHealth Duke-NUS Academic Medical Centre
- Rheumatology and Immunology Service, Department of Paediatric Subspecialities, KK Women’s and Children’s Hospital
- Duke-NUS Medical School
| | - Thaschawee Arkachaisri
- Rheumatology and Immunology Service, Department of Paediatric Subspecialities, KK Women’s and Children’s Hospital
- Duke-NUS Medical School
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23
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Golhen K, Winskill C, Theiler M, Buettcher M, Yeh YH, Zhang N, Welzel T, Pfister M. Understanding efficacy-safety balance of biologics in moderate-to-severe pediatric psoriasis. Front Med (Lausanne) 2022; 9:944208. [PMID: 36226155 PMCID: PMC9548699 DOI: 10.3389/fmed.2022.944208] [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: 05/16/2022] [Accepted: 09/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background Psoriasis is a chronic immune-mediated inflammatory skin disease affecting both adults and children. To better understand the efficacy-safety profile of biologics in children with moderate-to-severe psoriasis, this study aimed to analyze efficacy and safety data of randomized controlled trials (RCTs) performed in pediatric psoriasis and to compare efficacy outcomes in children with those in adults. Methods RCTs investigating biologics in children with moderate-to-severe psoriasis were identified in a systematic literature review. PASI75/90 treatment responses at weeks 11/12 were analyzed comparing biologics with control arms. Serious adverse events (SAEs) were analyzed at the end of each study. Efficacy data from RCTs in adults with psoriasis were selected for the same biologics. Risk ratios (RR) of selected RCTs were pooled together in a statistical random effects model using the inverse variance method. Results For children, there were 1 etanercept, 2 secukinumab, 1 ixekizumab and 1 ustekinumab placebo-controlled RCTs and 1 adalimumab RCT using methotrexate as reference arm at weeks 11/12. For adults, out of 263 RCTs, 7 adalimumab and 15 etanercept (TNF inhibitors) and 4 ixekizumab and 12 ustekinumab (IL-17 and IL-12/23 inhibitors) RCTs reported PASI75/90 efficacy responses at weeks 11/12. Regarding efficacy, all biologics showed improved PASI responses over control arms. RRs ranges were 2.02-7.45 in PASI75 and 4.10-14.50 in PASI90. The highest PASI75 responses were seen for ustekinumab 0.375 mg/kg (RR = 7.25, 95% CI 2.83-18.58) and ustekinumab 0.75 mg/kg (RR = 7.45, 95% CI 2.91-19.06) in the CADMUS study. The highest PASI90 response was seen for ixekizumab (RR = 14.50, 95% CI 4.82-43.58) in the IXORA-PEDS study. SAE incidences in pediatric and adult arms with biologics were 0 to 3% except for a pediatric arm with adalimumab 0.40 mg/kg (8%). For adults, pooled RR also showed improved PASI responses over placebo for all biologics, with highest PASI75 response observed for ixekizumab (pooled RR = 16.18, 95% CI 11.83-22.14). Conclusion Both adults and children with psoriasis show superior efficacy with biologics compared to control arms after 3 months of treatment with SAE incidences in the low percentages. Additional longer-term clinical studies are warranted to fully understand the overall efficacy-safety profile of biologics in children with moderate-to-severe psoriasis.
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Affiliation(s)
- Klervi Golhen
- Pediatric Pharmacology and Pharmacometrics, University Children’s Hospital Basel (UKBB), University of Basel, Basel, Switzerland
| | - Carolyn Winskill
- Integrated Drug Development, Certara LP, Princeton, NJ, United States
| | - Martin Theiler
- Pediatric Skin Center, Dermatology Department, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Michael Buettcher
- Pediatric Pharmacology and Pharmacometrics, University Children’s Hospital Basel (UKBB), University of Basel, Basel, Switzerland
- Pediatric Infectious Diseases Unit, Pediatric Department, Children’s Hospital – Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Yu-Hsin Yeh
- Integrated Drug Development, Certara LP, Princeton, NJ, United States
| | - Nancy Zhang
- Integrated Drug Development, Certara LP, Princeton, NJ, United States
| | - Tatjana Welzel
- Pediatric Pharmacology and Pharmacometrics, University Children’s Hospital Basel (UKBB), University of Basel, Basel, Switzerland
- Pediatric Rheumatology, University Children’s Hospital Basel (UKBB), University of Basel, Basel, Switzerland
| | - Marc Pfister
- Pediatric Pharmacology and Pharmacometrics, University Children’s Hospital Basel (UKBB), University of Basel, Basel, Switzerland
- Integrated Drug Development, Certara LP, Princeton, NJ, United States
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Rosina S, Giancane G, Ruperto N. Emerging therapies for juvenile arthritis: agents in early clinical trials. Expert Opin Investig Drugs 2022; 31:1109-1124. [PMID: 36066506 DOI: 10.1080/13543784.2022.2121698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Juvenile idiopathic arthritis (JIA) is the most common chronic inflammatory rheumatic condition in childhood. The management of JIA has been revolutionized thanks to the development of new powerful drugs and the possibility to conduct controlled clinical trials with support from legislative initiatives and availability of international collaborative networks. Trials are still needed in children because we now have new drugs related to specific JIA category. AREAS COVERED The review is centered on the latest achievements in the field, focusing on new investigational drugs which are currently or have been recently tested for JIA treatment, encompassing agents in early phase of clinical development. EXPERT OPINION Despite the tremendous improvement witnessed in the field of JIA treatment in the past 20 years, there are still many unmet needs to be prioritized. Studies on disease pathogenesis will hopefully help in the identification of new treatment targets for individual JIA categories, that could possibly favor a stricter disease control and contribute to solve the issue of refractory JIA. Novel strategies aimed at the prevention of the risk of long-term joint damage are also desirable, as well as the discovery of predictive biomarkers for treatment efficacy and safety in the individual patient.
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Affiliation(s)
- Silvia Rosina
- Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Gabriella Giancane
- Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genova, Italy.,Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DiNOGMI), Università degli Studi di Genova, Genova, Italy
| | - Nicolino Ruperto
- Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genova, Italy.,UOSID Centro trial, IRCCS Istituto Giannina Gaslini, Genova, Italy
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25
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Oommen PT, Strauss T, Baltruschat K, Foeldvari I, Deuter C, Ganser G, Haas JP, Hinze C, Holzinger D, Hospach A, Huppertz HI, Illhardt A, Jung M, Kallinich T, Klein A, Minden K, Mönkemöller K, Mrusek S, Neudorf U, Dückers G, Niehues T, Schneider M, Schoof P, Thon A, Wachowsky M, Wagner N, Bloedt S, Hofer M, Tenbrock K, Schuetz C. Update of evidence- and consensus-based guidelines for the treatment of juvenile idiopathic arthritis (JIA) by the German Society of Pediatric and Juvenile Rheumatic Diseases (GKJR): New perspectives on interdisciplinary care. Clin Immunol 2022; 245:109143. [DOI: 10.1016/j.clim.2022.109143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 11/15/2022]
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Juvenile Idiopathic Arthritis, Uveitis and Multiple Sclerosis: Description of Two Patients and Literature Review. Biomedicines 2022; 10:biomedicines10082041. [PMID: 36009588 PMCID: PMC9405697 DOI: 10.3390/biomedicines10082041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 12/04/2022] Open
Abstract
Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in childhood, while multiple sclerosis (MS) is a demyelinating disease of the central nervous system, characterized by remission and exacerbation phases. An association between MS and rheumatologic diseases, in particular rheumatoid arthritis, has been described and numerous studies acknowledge anti-TNF-α drugs as MS triggers. Conversely, the association between MS and JIA has been reported merely in five cases in the literature. We describe two cases of adult patients with longstanding JIA and JIA-associated uveitis, who developed MS. The first patient was on methotrexate and adalimumab when she developed dizziness and nausea. Characteristic MRI lesions and oligoclonal bands in cerebrospinal fluid led to MS diagnosis. Adalimumab was discontinued, and she was treated with three pulses of intravenous methylprednisolone. After a few months, rituximab was started. The second patient had been treated with anti-TNF-α and then switched to abatacept. She complained of unilateral arm and facial paraesthesias; brain MRI showed characteristic lesions, and MS was diagnosed. Three pulses of intravenous methylprednisolone were administered; neurological disease remained stable, and abatacept was reintroduced. Further studies are warranted to define if there is an association between JIA and MS, if MS represents JIA comorbidity or if anti-TNF-α underpins MS development.
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Burgos-Vargas R, Loyola-Sanchez A, Ramiro S, Reding-Bernal A, Alvarez-Hernandez E, van der Heijde D, Vázquez-Mellado J. A randomized, double-blind, placebo-controlled 12-week trial of infliximab in patients with juvenile-onset spondyloarthritis. Arthritis Res Ther 2022; 24:187. [PMID: 35941676 PMCID: PMC9358905 DOI: 10.1186/s13075-022-02877-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 07/24/2022] [Indexed: 11/19/2022] Open
Abstract
Objective To assess the efficacy and safety of infliximab versus placebo in the treatment of patients with juvenile-onset spondyloarthritis (JoSpA). Methods Phase III, randomized, double-blind, placebo-controlled trial of 12 weeks that included patients ≤ 18 years old with JoSpA not responding to nonsteroidal anti-inflammatory drugs, sulfasalazine, or methotrexate. Patients were randomly assigned 1:1 to the infusion of infliximab 5mg/kg or placebo; completers entered then an open-label extension (OLE) period of 42 weeks. The primary endpoint was the number of active joints. Secondary outcomes included the assessment of disease activity, tender entheses, spinal mobility, serum C-reactive protein (CRP), the Bath Ankylosing Spondylitis Disease Activity and Functional Index, and the Childhood Health Assessment Questionnaire (CHAQ). Results We randomized 12 patients to infliximab and 14 to placebo. No significant differences were found between groups at baseline. At week 12, the mean number of active joints was 1.4 (SD 2.4) in the infliximab group and 4.1 (SD 3.0) in the placebo group (p = 0.0002). A repeated-measures mixed model analysis that included all endpoints in the study demonstrated sustained favourable outcomes of infliximab for active joints, tender joints, swollen joints, and tender enthesis counts, as well as for CHAQ and CRP (p < 0.01). Adverse events were more frequent in the infliximab group, including infections and infusion reactions, but none of them was serious. Conclusion Infliximab is efficacious for patients with JoSpA with an inadequate response to conventional treatment. No serious adverse events with the use of infliximab were observed.
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Affiliation(s)
- Rubén Burgos-Vargas
- Department of Rheumatology, Hospital General de Mexico Dr. Eduardo Liceaga, Mexico City, Mexico.,Faculty of Medicine, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico
| | - Adalberto Loyola-Sanchez
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada. .,Department of Clinical Neurosciences, Alberta Health Services, Edmonton, Canada.
| | - Sofia Ramiro
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Arturo Reding-Bernal
- Research Division, Hospital General de Mexico Dr. Eduardo Liceaga, Mexico City, Mexico
| | | | | | - Janitzia Vázquez-Mellado
- Department of Rheumatology, Hospital General de Mexico Dr. Eduardo Liceaga, Mexico City, Mexico.,Faculty of Medicine, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico
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28
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Kearsley-Fleet L, Klotsche J, van Straalen JW, Costello W, D’Angelo G, Giancane G, Horneff G, Klein A, Láday M, Lunt M, de Roock S, Ruperto N, Schoemaker C, Vijatov-Djuric G, Vojinovic J, Vougiouka O, Wulffraat NM, Hyrich KL, Minden K, Swart JF. Burden of comorbid conditions in children and young people with juvenile idiopathic arthritis: a collaborative analysis of 3 JIA registries. Rheumatology (Oxford) 2022; 61:2524-2534. [PMID: 34613385 PMCID: PMC9157174 DOI: 10.1093/rheumatology/keab641] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/04/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Burden of comorbidities are largely unknown in JIA. From 2000, national and international patient registries were established to monitor biologic treatment, disease activity and adverse events in patients with JIA. The aim of this analysis was to investigate in parallel, for the first time, three of the largest JIA registries in Europe/internationally-UK JIA Biologic Registers (BCRD/BSPAR-ETN), German biologic registers (BiKeR/JuMBO), multinational Pharmachild-to quantify the occurrence of selected comorbidities in patients with JIA. METHODS Information on which data the registers collect were compared. Patient characteristics and levels of comorbidity were presented, focussing on four key conditions: uveitis, MAS, varicella, and history of tuberculosis. Incidence rates of these on MTX/biologic therapy were determined. RESULTS 8066 patients were registered into the three JIA registers with similar history of the four comorbidities across the studies; however, varicella vaccination coverage was higher in Germany (56%) vs UK/Pharmachild (16%/13%). At final follow-up, prevalence of varicella infection was lower in Germany (15%) vs UK/Pharmachild (37%/50%). Prevalence of TB (0.1-1.8%) and uveitis (15-19%) was similar across all registers. The proportion of systemic-JIA patients who ever had MAS was lower in Germany (6%) vs UK (15%) and Pharmachild (17%). CONCLUSION This analysis is the first and largest to investigate the occurrence of four important comorbidities in three JIA registries in Europe and the role of anti-rheumatic drugs. Combined, these three registries represent one of the biggest collection of cases of JIA worldwide and offer a unique setting for future JIA outcome studies.
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Affiliation(s)
- Lianne Kearsley-Fleet
- Centre for Epidemiology Versus Arthritis, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Jens Klotsche
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
| | - Joeri W van Straalen
- Department of Paediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, University Medical Center, Utrecht, Netherlands
| | - Wendy Costello
- iIrish Children’s Arthritis Network (iCAN), Bansha, Co Tipperary, Ireland
| | | | - Gabriella Giancane
- Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Gerd Horneff
- Department of Pediatrics, Asklepios Kinderklinik Sankt Augustin, Sankt Augustin
- Department of Pediatric and Adolescent Medicine, Medical Faculty, University Hospital of Cologne, Cologne, Germany
| | - Ariane Klein
- Department of Pediatrics, Asklepios Kinderklinik Sankt Augustin, Sankt Augustin
- Department of Pediatric and Adolescent Medicine, Medical Faculty, University Hospital of Cologne, Cologne, Germany
| | - Matilda Láday
- Pediatric Clinical Department 1, Spitalul Clinic Judetean De Urgenta, Tîrgu-Mureș, Romania
| | - Mark Lunt
- Centre for Epidemiology Versus Arthritis, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Sytze de Roock
- Department of Paediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, University Medical Center, Utrecht, Netherlands
| | - Nicolino Ruperto
- Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Casper Schoemaker
- Department of Paediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, University Medical Center, Utrecht, Netherlands
- Dutch JIA Patient and Parent Organisation (Member of ENCA), Rijen, The Netherlands
| | - Gordana Vijatov-Djuric
- Faculty of Medicine, University of Novi Sad
- Department of Immunology, Allergology and Rheumatology, Institute for Child and Youth Health Care of Vojvodina, Novi Sad
| | - Jelena Vojinovic
- Faculty of Medicine, Department of Pediatric Immunology and Rheumatology, University of Nis, University Clinic Center
- Department of Pediatric Rheumatology, Clinical Center Nis, Clinic of Pediatrics, Nis, Serbia
| | - Olga Vougiouka
- ‘P a A Kyriakou’ Children’s Hospital, 2nd Paediatric Department, Athens University School of Medicine, Athens, Greece
| | - Nico M Wulffraat
- Department of Paediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, University Medical Center, Utrecht, Netherlands
| | | | - Kimme L Hyrich
- Centre for Epidemiology Versus Arthritis, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- NIHR Manchester BRC, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Kirsten Minden
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
- Department of Pediatric Pulmonology, Immunology and Critical Care Medicine, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Joost F Swart
- Department of Paediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, University Medical Center, Utrecht, Netherlands
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Haslak F, Varol SE, Gunalp A, Kaynar O, Yildiz M, Adrovic A, Sahin S, Kes G, Ayzit-Kilinc A, Akdeniz B, Onal P, Apaydin G, Aygun D, Arslan H, Kilic-Baskan A, Hepkaya E, Meral O, Barut K, Cokugras HC, Kasapcopur O. Comparisons of Clinical Features and Outcomes of COVID-19 between Patients with Pediatric Onset Inflammatory Rheumatic Diseases and Healthy Children. J Clin Med 2022; 11:jcm11082102. [PMID: 35456195 PMCID: PMC9030434 DOI: 10.3390/jcm11082102] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/05/2022] [Accepted: 04/07/2022] [Indexed: 12/17/2022] Open
Abstract
(1) Background: We aimed to describe the clinical features and outcomes of coronavirus disease-2019 (COVID-19) in children and late adolescents with inflammatory rheumatic diseases (IRD) and to measure their severity risks by comparing them with healthy children. (2) Methods: Among children and late adolescents found to be severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) positive via polymerase chain reaction (PCR) test, IRD patients with an at least six-months follow-up duration, and healthy children were included in the study. Data were obtained retrospectively. (3) Results: A total of 658 (339 (51.5%) females) (healthy children: 506, IRD patients: 152) subjects were included in the study. While 570 of 658 (86.6%) experienced COVID-19-related symptoms, only 21 (3.19%) required hospitalization with a median duration of 5 (1–30) days. Fever, dry cough, and fatigue were the most common symptoms. None of evaluated subjects died, and all recovered without any significant sequelae. The presence of any IRD was found to increase the risk of both hospitalization (OR: 5.205; 95% CI: 2.003–13.524) and symptomatic infection (OR: 2.579; 95% CI: 1.068–6.228). Furthermore, increasing age was significantly associated with symptomatic infection (OR: 1.051; 95% CI: 1.009–1.095). (4) Conclusions: Our study emphasizes that pediatric rheumatologists should monitor their patients closely for relatively poor COVID-19 outcomes.
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Affiliation(s)
- Fatih Haslak
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul 34303, Turkey; (F.H.); (S.E.V.); (A.G.); (O.K.); (M.Y.); (A.A.); (S.S.); (K.B.)
| | - Sevki Erdem Varol
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul 34303, Turkey; (F.H.); (S.E.V.); (A.G.); (O.K.); (M.Y.); (A.A.); (S.S.); (K.B.)
| | - Aybuke Gunalp
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul 34303, Turkey; (F.H.); (S.E.V.); (A.G.); (O.K.); (M.Y.); (A.A.); (S.S.); (K.B.)
| | - Ozge Kaynar
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul 34303, Turkey; (F.H.); (S.E.V.); (A.G.); (O.K.); (M.Y.); (A.A.); (S.S.); (K.B.)
| | - Mehmet Yildiz
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul 34303, Turkey; (F.H.); (S.E.V.); (A.G.); (O.K.); (M.Y.); (A.A.); (S.S.); (K.B.)
| | - Amra Adrovic
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul 34303, Turkey; (F.H.); (S.E.V.); (A.G.); (O.K.); (M.Y.); (A.A.); (S.S.); (K.B.)
| | - Sezgin Sahin
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul 34303, Turkey; (F.H.); (S.E.V.); (A.G.); (O.K.); (M.Y.); (A.A.); (S.S.); (K.B.)
| | - Gulsen Kes
- Department of Pediatric Infectious Diseases, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul 34303, Turkey; (G.K.); (B.A.); (P.O.); (G.A.); (D.A.); (H.C.C.)
| | - Ayse Ayzit-Kilinc
- Department of Pediatric Pulmonology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul 34303, Turkey; (A.A.-K.); (H.A.); (A.K.-B.); (E.H.); (O.M.)
| | - Beste Akdeniz
- Department of Pediatric Infectious Diseases, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul 34303, Turkey; (G.K.); (B.A.); (P.O.); (G.A.); (D.A.); (H.C.C.)
| | - Pinar Onal
- Department of Pediatric Infectious Diseases, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul 34303, Turkey; (G.K.); (B.A.); (P.O.); (G.A.); (D.A.); (H.C.C.)
| | - Gozde Apaydin
- Department of Pediatric Infectious Diseases, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul 34303, Turkey; (G.K.); (B.A.); (P.O.); (G.A.); (D.A.); (H.C.C.)
| | - Deniz Aygun
- Department of Pediatric Infectious Diseases, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul 34303, Turkey; (G.K.); (B.A.); (P.O.); (G.A.); (D.A.); (H.C.C.)
| | - Huseyin Arslan
- Department of Pediatric Pulmonology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul 34303, Turkey; (A.A.-K.); (H.A.); (A.K.-B.); (E.H.); (O.M.)
| | - Azer Kilic-Baskan
- Department of Pediatric Pulmonology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul 34303, Turkey; (A.A.-K.); (H.A.); (A.K.-B.); (E.H.); (O.M.)
| | - Evrim Hepkaya
- Department of Pediatric Pulmonology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul 34303, Turkey; (A.A.-K.); (H.A.); (A.K.-B.); (E.H.); (O.M.)
| | - Ozge Meral
- Department of Pediatric Pulmonology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul 34303, Turkey; (A.A.-K.); (H.A.); (A.K.-B.); (E.H.); (O.M.)
| | - Kenan Barut
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul 34303, Turkey; (F.H.); (S.E.V.); (A.G.); (O.K.); (M.Y.); (A.A.); (S.S.); (K.B.)
| | - Haluk Cezmi Cokugras
- Department of Pediatric Infectious Diseases, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul 34303, Turkey; (G.K.); (B.A.); (P.O.); (G.A.); (D.A.); (H.C.C.)
| | - Ozgur Kasapcopur
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul 34303, Turkey; (F.H.); (S.E.V.); (A.G.); (O.K.); (M.Y.); (A.A.); (S.S.); (K.B.)
- Correspondence:
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Giancane G, Papa R, Vastert S, Bagnasco F, Swart JF, Quartier P, Antón J, Kamphuis S, Sanner H, Glerup M, De Benedetti F, Tsitsami E, Remesal A, Moreno E, De Inocencio J, Myrup C, Pallotti C, Koné-Paut I, Franck-Larsson K, Malmström H, Cederholm S, Pistorio A, Wulffraat N, Ruperto N. Anakinra in Patients With Systemic Juvenile Idiopathic Arthritis: Long-term Safety From the Pharmachild Registry. J Rheumatol 2022; 49:398-407. [PMID: 35105709 DOI: 10.3899/jrheum.210563] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To evaluate the long-term safety profile of anakinra in patients with systemic juvenile idiopathic arthritis (sJIA). METHODS Data from patients with sJIA enrolled in the Pharmachild registry (ClinicalTrials.gov: NCT03932344) prior to September 30, 2018, and treated with anakinra were analyzed. The study endpoints were the occurrence of non-serious adverse events (SAEs) of at least moderate severity and SAEs, including macrophage activation syndrome (MAS), and the duration of anakinra treatment with reasons for discontinuation. All endpoints were analyzed overall by 6-month time windows, and in different treatment sets represented by those patients treated continuously with anakinra for at least 12, 18, and 24 months (set-12, -18, and -24, respectively). RESULTS Three hundred six patients were enrolled. Of these patients, 46%, 34%, and 28% had been treated for at least 12, 18, and 24 months, respectively. Two hundred and one AEs, mostly represented by infections, were reported for 509.3 patient-years (PY) with an overall incidence rate (IR) of 39.5 per 100 PY. Among 56 SAEs (IR 11.0/100 PY), 23.2% were infections and 19.6% MAS episodes. The IR of AEs was higher during the first 6 months of anakinra treatment, followed by decreasing IRs in the long-term treatment sets. Treatment discontinuation occurred in 76% of patients, most frequently in the first 6 months, because of inefficacy (43%), remission (31%), or AEs/intolerance (15%). No deaths or malignancies occurred during anakinra treatment. CONCLUSION The results of the present study confirm the long-term safety profile of anakinra in patients with sJIA and demonstrate an overall decreasing incidence of AEs over time. [ClinicalTrials.gov: NCT01399281 and NCT03932344].
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Affiliation(s)
- Gabriella Giancane
- G. Giancane, MD, PhD, Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, and Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DiNOGMI), Università degli Studi di Genova, Genoa, Italy;
| | - Riccardo Papa
- R. Papa, MD, C. Pallotti, MA, Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Sebastiaan Vastert
- S. Vastert, MD, Department of Pediatric Immunology and Rheumatology, Wilhelmina Kinderziekenhuis, Utrecht, the Netherlands
| | - Francesca Bagnasco
- F. Bagnasco, MSc, A. Pistorio, MD, Servizio di Epidemiologia e Biostatistica, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Joost F Swart
- J.F. Swart, MD, N. Wulffraat, Professor, Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - Pierre Quartier
- P. Quartier, MD, Université de Paris, Institut IMAGINE, Centre de référence national pour les Rhumatismes inflammatoires et les maladies Auto-Immunes Systémiques rares de l'Enfant (RAISE), Unité d'Immunologie, Hématologie et Rhumatologie Pédiatrique, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - Jordi Antón
- J. Antón, MD, Division of Pediatric Rheumatology, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues de Llobregat (Barcelona), Spain
| | - Sylvia Kamphuis
- S. Kamphuis, MD, Department of Paediatric Rheumatology/Department of Rheumatology, Sophia Children's Hospital, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Helga Sanner
- H. Sanner, MD, Department of Rheumatology - Norwegian National Advisory Unit on Rheumatic Diseases in Children and Adolescents, Oslo University Hospital, Oslo, Norway
| | - Mia Glerup
- M. Glerup, MD, Pediatric rheumatology unit, Aarhus University Hospital, Aarhus, Denmark
| | - Fabrizio De Benedetti
- F. De Benedetti, MD, Division of Rheumatology, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Elena Tsitsami
- E. Tsitsami, MD, First Department of Pediatrics, Aghia Sophia Children's Hospital, University of Athens Medical School, Athens, Greece
| | - Agustin Remesal
- A. Remesal, MD, Rheumatology Unit, University Hospital La Paz, Madrid, Spain
| | - Estefania Moreno
- E. Moreno, MD, Rheumatology Unit, University Hospital Valle de Hebron, Barcelona, Spain
| | - Jaime De Inocencio
- J. De Inocencio, MD, Department of Pediatric Rheumatology, 12 de Octubre University Hospital, Madrid, Spain
| | - Charlotte Myrup
- C. Myrup, MD, Pediatric rheumatology unit 4272, Rigshospitalet, Copenhagen, Denmark
| | - Chiara Pallotti
- R. Papa, MD, C. Pallotti, MA, Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Isabelle Koné-Paut
- I. Koné-Paut, MD, Department of Pediatric Rheumatology, National Referral Centre of Auto-Inflammatory Diseases and inflammatory amyloidosis, CEREMAIA, CHU de Biĉetre, AP-HP, University of Paris Sud Saclay, le Kremlin Bicêtre, France
| | - Karin Franck-Larsson
- K. Franck-Larsson, MD, PhD, H. Malmström, PhD, S. Cederholm, MSc Pharm, Sobi, Stockholm, Sweden
| | - Håkan Malmström
- K. Franck-Larsson, MD, PhD, H. Malmström, PhD, S. Cederholm, MSc Pharm, Sobi, Stockholm, Sweden
| | - Susanna Cederholm
- K. Franck-Larsson, MD, PhD, H. Malmström, PhD, S. Cederholm, MSc Pharm, Sobi, Stockholm, Sweden
| | - Angela Pistorio
- F. Bagnasco, MSc, A. Pistorio, MD, Servizio di Epidemiologia e Biostatistica, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Nico Wulffraat
- J.F. Swart, MD, N. Wulffraat, Professor, Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, Utrecht, the Netherlands
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Sozeri B, Ulu K, Kaya-Akça U, Haslak F, Pac-Kisaarslan A, Otar-Yener G, Baba O, Altug-Gucenmez O, Sahin N, Bağlan E, Sönmez HE, Cakmak F, Ozturk K, Gezgin-Yıldırım D, Şener S, Barut K, Batu ED, Yıldız M, Basaran O, Adrovic A, Sahin S, Ozdel S, Bilginer Y, Poyrazoglu MH, Demir F, Yuksel S, Kalyoncu M, Kasapcopur O, Ozen S, Aktay-Ayaz N. The clinical course of SARS-CoV-2 infection among children with rheumatic disease under biologic therapy: a retrospective and multicenter study. Rheumatol Int 2022; 42:469-475. [PMID: 34570263 PMCID: PMC8475421 DOI: 10.1007/s00296-021-05008-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/20/2021] [Indexed: 12/19/2022]
Abstract
The effects of biological disease-modifying antirheumatic drugs (bDMARDs) in the clinical course of COVID-19 on children with underlying rheumatologic diseases have not been fully demonstrated. To evaluate the course of COVID-19 infection in patients with rheumatic disease receiving bDMARD treatment. This was a retrospective, multicenter study conducted in pediatric patients infected by SARS-CoV-2 and under bDMARDs therapy. The study population consisted of 113 patients (72 female/41 male). The mean age of the patients was 12.87 ± 4.69 years. The primary diagnosis of the cohort was as follows: 63 juvenile idiopathic arthritis, 35 systemic autoinflammatory diseases, 10 vasculitides, and five cases of connective tissue diseases. The mean duration of the primary disease was 4.62 ± 3.65 years. A total of 19 patients had additional comorbid diseases. Thirty-five patients were treated with canakinumab, 25 with adalimumab, 18 with etanercept, 10 with infliximab, nine with tocilizumab, six with rituximab, four with anakinra, three with tofacitinib, and one with abatacept. The median exposure time of the biological drug was 13.5 months. Seventy-one patients had symptomatic COVID-19, while 42 were asymptomatic. Twenty-four patients required hospitalization. Five patients presented with MIS-C. The hospitalized patients were younger and had a shorter duration of rheumatic disease compared to ambulatory patients, although the difference was not statistically significant. Steroid usage, presence of fever, and dyspnea were more common among the hospitalized patients. A worsening in the course of both COVID-19 and current disease was not noticed under bDMARDs, however, to end with a strong conclusion multicentric international studies are required.
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Affiliation(s)
- Betul Sozeri
- Department of Pediatric Rheumatology, University of Health Sciences, Ümraniye Research and Training Hospital, Istanbul, Turkey.
| | - Kadir Ulu
- Pediatric Rheumatology, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Ummusen Kaya-Akça
- Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Fatih Haslak
- Pediatric Rheumatology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | | | - Gulcin Otar-Yener
- Pediatric Rheumatology, Sanliurfa Training and Research Hospital, Sanliurfa, Turkey
| | - Ozge Baba
- Pediatric Rheumatology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | | | - Nihal Sahin
- Pediatric Rheumatology, Health Sciences University, Bursa Center Hospital, Bursa, Turkey
| | - Esra Bağlan
- Pediatric Rheumatology, Health Sciences University, Sami Ulus Training and Research Hospital, Ankara, Turkey
| | - Hafize Emine Sönmez
- Pediatric Rheumatology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Figen Cakmak
- Pediatric Rheumatology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Kubra Ozturk
- Pediatric Rheumatology, Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey
| | | | - Seher Şener
- Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Kenan Barut
- Pediatric Rheumatology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ezgi Deniz Batu
- Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mehmet Yıldız
- Pediatric Rheumatology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ozge Basaran
- Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Amra Adrovic
- Pediatric Rheumatology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Sezgin Sahin
- Pediatric Rheumatology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Semanur Ozdel
- Pediatric Rheumatology, Health Sciences University, Sami Ulus Training and Research Hospital, Ankara, Turkey
| | - Yelda Bilginer
- Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | | | - Ferhat Demir
- Pediatric Rheumatology, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Selcuk Yuksel
- Pediatric Rheumatology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Mukaddes Kalyoncu
- Pediatric Rheumatology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Ozgur Kasapcopur
- Pediatric Rheumatology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Seza Ozen
- Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nuray Aktay-Ayaz
- Pediatric Rheumatology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Abstract
Juvenile idiopathic arthritis (JIA) is an umbrella term for arthritis of unknown origin, lasting for >6 weeks with onset before 16 years of age. JIA is the most common chronic inflammatory rheumatic condition of childhood. According to the International League Against Rheumatism (ILAR) classification, seven mutually exclusive categories of JIA exist based on disease manifestations during the first 6 months of disease. Although the ILAR classification has been useful to foster research, it has been criticized mainly as it does not distinguish those forms of chronic arthritis observed in adults and in children from those that may be unique to childhood. Hence, efforts to provide a new evidence-based classification are ongoing. Similar to arthritis observed in adults, pathogenesis involves autoimmune and autoinflammatory mechanisms. The field has witnessed a remarkable improvement in therapeutic possibilities of JIA owing to the availability of new potent drugs and the possibility to perform controlled trials with support from legislative interventions and large networks availability. The goal of drug therapy in JIA is to rapidly reduce disease activity to inactive disease or clinical remission, minimize drug side effects and achieve a quality of life comparable to that of healthy peers. As JIA can influence all aspects of a child's and their family's life, researchers increasingly recognize improvement of health-related quality of life as a key treatment goal.
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33
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Udaondo C, Núñez Cuadros E, Murias S, Remesal A, Alcobendas R, Guerrero C, Guillen-Martin S, Escuredo M, Aleo E, Alonso D, Tagarro A, De Santiago E, Camacho-Lovillo M, Diaz F, Arenas D, Camacho P, Lirola MJ, Díaz Almirón M, Calvo C. Are infections in children with juvenile idiopathic arthritis more frequent than in healthy children? A prospective multicenter observational study. Front Pediatr 2022; 10:917731. [PMID: 36034561 PMCID: PMC9403004 DOI: 10.3389/fped.2022.917731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/26/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Children with juvenile idiopathic arthritis (JIA) might be at a higher risk of infection. Our objectives are to describe and compare infection rates in patients with JIA vs. healthy patients. METHODS A prospective, multicenter observational study was performed in Spain from January 2017 to June 2019. Patients with JIA from 7 participating hospitals and children without JIA (siblings of patients with JIA, and non-JIA children from primary health centers) were followed up with quarterly questionnaires to record infection episodes. Tuberculosis, herpes zoster, and infections requiring hospital admission were considered severe infections. Rates of infection (episodes/patient/year) were compared using a generalized estimating equations model. RESULTS A total of 371 children (181 with and 190 without JIA) were included. The median age was 8.8 years (IQR 5.5-11.3); 75% of the patients with JIA received immunosuppressive treatment (24% methotrexate, 22% biologic, 26% both). A total of 667 infections were recorded; 15 (2.2%) were considered severe. The infection rate was 1.31 (95%CI 1.1-1.5) in JIA and 1.12 (95%CI 0.9-1.3) in non-JIA participants (p = 0.19). Age <4 years increased the infection rate by 2.5 times (2.72 vs. 1.12, p < 0.001) in both groups. The most frequent infection sites were upper respiratory (62.6% vs. 74.5%) and gastrointestinal (18.8% vs. 11.4%). There were no differences in severe infections (2.5% vs. 2%, p = 0.65) between the groups. In children with JIA, younger age and higher disease activity (JADAS71) were associated with a higher infection rate. CONCLUSION We found no differences in the infection rate or infection severity between patients with and without JIA. Most infections were mild. An age younger than 4 years increased the infection risk in both groups. Higher disease activity was associated with a higher infection rate.
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Affiliation(s)
- Clara Udaondo
- Pediatric Rheumatology Unit, University Hospital La Paz, Madrid, Spain.,La Paz Research Institute (IDIPaz), Madrid, Spain.,CIBERINFEC ISCIII, Madrid, Spain
| | - Esmeralda Núñez Cuadros
- Pediatric Rheumatology Unit, UCG Pediatría, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Sara Murias
- Pediatric Rheumatology Unit, University Hospital La Paz, Madrid, Spain
| | - Agustin Remesal
- Pediatric Rheumatology Unit, University Hospital La Paz, Madrid, Spain
| | - Rosa Alcobendas
- Pediatric Rheumatology Unit, University Hospital La Paz, Madrid, Spain
| | | | - Sara Guillen-Martin
- Pediatric Rheumatology Unit, UCG Pediatría, Hospital Regional Universitario de Málaga, Málaga, Spain.,Pediatrics, Hospital de Getafe, Madrid, Spain
| | | | - Esther Aleo
- Pediatrics, Fundación para la Investigación del Hospital Clínico San Carlos, Hospital Clinico San Carlos, Madrid, Spain
| | | | - Alfredo Tagarro
- Fundación de Investigación Biomédica Hospital 12 de Octubre. Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain.,Department of Pediatrics, Infanta Sofía University Hospital, Madrid, Spain.,Infanta Sofia University Hospital and Henares University Hospital Foundation for Biomedical Research and Innovation (FIIB HUIS HHEN), Madrid, Spain.,Facultad de Medicina, Universidad Europea de Madrid, Madrid, Spain
| | | | - Marisol Camacho-Lovillo
- Pediatric Immunology, Rheumatology and Infectious Diseases Department, Hospital Universitario Virgen del Rocío, Seville, Spain
| | | | | | - Pilar Camacho
- Pediatrics, Centro Alcala de Guadaira, Seville, Spain
| | - Maria Jose Lirola
- Pediatric Rheumatology, Grupo IHP - Instituto Hispalense de Pediatría, Seville, Spain
| | - Mariana Díaz Almirón
- CIBERINFEC ISCIII, Madrid, Spain.,Biostatistics, Investigation department, IDIPaz, University Hospital La Paz, Madrid, Spain
| | - Cristina Calvo
- CIBERINFEC ISCIII, Madrid, Spain.,Pediatric Rheumatology Unit, UCG Pediatría, Hospital Regional Universitario de Málaga, Málaga, Spain.,Pediatric Infectious Diseases Department, University Hospital La Paz, Madrid, Spain
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34
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Bizjak M, Heshin-Bekenstein M, Jansen MHA, Ziv A, Angevare S, Uziel Y, Wulffraat NM, Toplak N. Vaccinology in pediatric rheumatology: Past, present and future. Front Pediatr 2022; 10:1098332. [PMID: 36704144 PMCID: PMC9872015 DOI: 10.3389/fped.2022.1098332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 12/22/2022] [Indexed: 01/11/2023] Open
Abstract
With the introduction of biological disease-modifying antirheumatic drugs (bDMARDs), the treatment of pediatric patients with autoimmune/inflammatory rheumatic diseases (pedAIIRD) has advanced from the "Stone Age" to modern times, resulting in much better clinical outcomes. However, everything comes with a price, and use of new bDMARDs has resulted in an increased risk of infections. Therefore, preventing infections in pedAIIRD patients is one of the top priorities. The most effective preventive measure against infection is vaccination. The first study on humoral immunity after vaccination in pediatric rheumatology was published in 1974 and on safety in 1993. For many years, data about safety and immunogenicity in pedAIIRD patients were available only for non-live vaccines and the first studies on live-attenuated vaccines in pedAIIRD patients treated with immunosuppressive therapy were available only after 2007. Even today the data are limited, especially for children treated with bDMARDs. Vaccinations with non-live vaccines are nowadays recommended, although their long-term immunogenicity and efficacy in pedAIIRD patients are still under investigation. Vaccinations with live-attenuated vaccines are not universally recommended in immunosuppressed patients. However, measles-mumps-rubella booster and varicella zoster virus vaccination can be considered under specific conditions. Additional research is needed to provide more evidence on safety and immunogenicity, especially regarding live-attenuated vaccines in immunosuppressed patients with pedAIIRD. Due to the limited number of these patients, well-designed, prospective, international studies are needed. Further challenges were presented by the COVID-19 pandemic. This mini review article reviews past and present data and discusses the future of vaccinology in pediatric rheumatology.
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Affiliation(s)
- Masa Bizjak
- Department of Allergology, Rheumatology and Clinical Immunology, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Merav Heshin-Bekenstein
- Pediatric Rheumatology Service, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Marc H A Jansen
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Amit Ziv
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Rheumatology Unit, Department of Pediatrics, Meir Medical Center, Kfar Saba, Israel
| | - Saskya Angevare
- European Network for Children with Arthritis, Geneva, Switzerland.,KAISZ, Amsterdam, Netherlands
| | - Yosef Uziel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Rheumatology Unit, Department of Pediatrics, Meir Medical Center, Kfar Saba, Israel
| | - Nicolaas M Wulffraat
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, Netherlands.,Faculty of Medicine, Utrecht University, Utrecht, Netherlands
| | - Natasa Toplak
- Department of Allergology, Rheumatology and Clinical Immunology, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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35
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Ogstrup AK, Spannow AH, Holm M, Rubak S, Veirum JE, Glerup M, Herlin T. Serious Opportunistic Lower Respiratory Tract Infections in Pediatric Rheumatic Diseases During Treatment With Biologics. J Clin Rheumatol 2021; 27:S387-S391. [PMID: 32694355 DOI: 10.1097/rhu.0000000000001480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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36
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Jensen L, Christensen AE, Nielsen S, Pedersen FK, Rosthøj S, Jørgensen CS, Poulsen A. Response to pneumococcal conjugate and polysaccharide vaccination in children with rheumatic disease. Scand J Immunol 2021; 95:e13118. [PMID: 34768311 DOI: 10.1111/sji.13118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 10/18/2021] [Accepted: 11/09/2021] [Indexed: 11/30/2022]
Abstract
Children with rheumatic disease and compromised immune system have an increased risk of infection. Streptococcus pneumoniae is a frequent pathogen, and immunization is recommended. In this study, we investigated whether immunocompromised children with rheumatic disease do respond to pneumococcal immunization with 13-valent pneumococcal conjugate vaccine followed by 23-valent pneumococcal polysaccharide vaccine. The study was conducted at two tertiary referral hospitals in Denmark from 2015 to 2018. Patients with rheumatic disease and compromised immune system aged 2-19 years were eligible. Patients were vaccinated with 13-valent pneumococcal conjugate vaccine followed by 23-valent pneumococcal polysaccharide vaccine. A blood sample was collected before vaccination and after each vaccination. IgG antibodies were quantified for twelve serotypes. Seroprotection for each serotype was defined as IgG ≥0.35 µg/mL. A total of 27 patients were enrolled. After the conjugate vaccine, an increase in antibody titres compared with pre-vaccination was found for all serotypes and 9/12 were significant. After the polysaccharide vaccine, the antibody titres for all serotypes but one was seen to increase but none reached significance. The proportion of patients protected before immunization ranged from 20.8% to 100% for the individual serotypes. Odds ratio for achieving seroprotection after the conjugate vaccine was >1 for 10/12 serotypes but only significant for three serotypes. After the polysaccharide vaccine, the odds ratio was >1 for 9/12 serotypes but none reached significance. In conclusion, children with rheumatic disease and compromised immune system respond to pneumococcal immunization with 13-valent pneumococcal conjugate vaccine and maintain antibody levels upon subsequent immunization with 23-valent pneumococcal polysaccharide vaccine.
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Affiliation(s)
- Lotte Jensen
- The Department of Paediatrics and Adolescent Medicine, Juliane Marie Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Susan Nielsen
- The Department of Paediatrics and Adolescent Medicine, Juliane Marie Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Freddy Karup Pedersen
- The Department of Paediatrics and Adolescent Medicine, Juliane Marie Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Susanne Rosthøj
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Anja Poulsen
- The Department of Paediatrics and Adolescent Medicine, Juliane Marie Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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37
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Trincianti C, Van Dijkhuizen EHP, Alongi A, Mazzoni M, Swart JF, Nikishina I, Lahdenne P, Rutkowska-Sak L, Avcin T, Quartier P, Panaviene V, Uziel Y, Pruunsild C, Vargova V, Vilaiyuk S, Dolezalova P, Ringold S, Garrone M, Ruperto N, Ravelli A, Consolaro A. Definition and Validation of the American College of Rheumatology 2021 Juvenile Arthritis Disease Activity Score Cutoffs for Disease Activity States in Juvenile Idiopathic Arthritis. Arthritis Rheumatol 2021; 73:1966-1975. [PMID: 34582120 PMCID: PMC8597164 DOI: 10.1002/art.41879] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/18/2021] [Indexed: 11/12/2022]
Abstract
Objective To develop and validate new Juvenile Arthritis Disease Activity Score 10 (JADAS10) and clinical JADAS10 (cJADAS10) cutoffs to separate the states of inactive disease (ID), minimal disease activity (MiDA), moderate disease activity (MoDA), and high disease activity (HDA) in children with oligoarthritis and with rheumatoid factor–negative polyarthritis, based on subjective disease assessment by the treating pediatric rheumatologist. Methods The cutoffs definition cohort was composed of 1,936 patients included in the multinational Epidemiology, Treatment and Outcome of Childhood Arthritis (EPOCA) study. Using the subjective physician rating as an external criterion, 4 methods were applied to identify the cutoffs: mapping, Youden index, 90% specificity, and maximum agreement. The validation cohort included 4,014 EPOCA patients, patients from 2 randomized trials, and 88 patients from the PharmaChild registry. Cutoff validation was conducted by assessing discriminative and predictive ability. Results The JADAS10 cutoffs were 1.4, 4, and 13, respectively, for oligoarthritis and 2.7, 6, and 17, respectively, for polyarthritis. The cJADAS10 cutoffs were 1.1, 4, and 12, respectively, for oligoarthritis and 2.5, 5, and 16, respectively, for polyarthritis. The cutoffs discriminated strongly among different levels of pain and morning stiffness, between patients who were and those who were not prescribed a new medication, and between different levels of improvement in clinical trials. Achievement of ID and MiDA according to the new JADAS cutoffs at least twice in the first year of disease predicted better outcome at 2 years. Conclusion The 2021 JADAS and cJADAS cutoffs revealed good metrologic properties in both definition and validation samples, and are therefore suitable for use in clinical trials and routine practice.
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Affiliation(s)
| | - Evert Hendrik Pieter Van Dijkhuizen
- Wilhelmina Children's Hospital, Utrecht, The Netherlands, and Istituto Giannina Gaslini, IRCCS and Clinica Pediatrica e Reumatologia, Genoa, Italy
| | - Alessandra Alongi
- Istituto Giannina Gaslini, IRCCS and Clinica Pediatrica e Reumatologia, Genoa, Italy
| | - Marta Mazzoni
- Istituto Giannina Gaslini, IRCCS and Clinica Pediatrica e Reumatologia, Genoa, Italy
| | - Joost F Swart
- Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Irina Nikishina
- V. A. Nasonova Research Institute of Rheumatology, Moscow, Russia
| | - Pekka Lahdenne
- New Children's Hospital and Helsinki University Hospital, Helsinki, Finland
| | - Lidia Rutkowska-Sak
- National Institute of Geriatrics, Rheumatology, and Rehabilitation, Warsaw, Poland
| | - Tadej Avcin
- University Children's Hospital and University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Pierre Quartier
- Université Paris-Descartes, Institut IMAGINE, Centre de Référence National pour les Rhumatismes Inflammatoires et les Maladies Auto-Immunes Systémiques Rares de l'Enfant (RAISE), Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - Violeta Panaviene
- Children's Hospital, Affiliate of Vilnius University Hospital Santaros Clinic and Clinic of Children's Diseases, Vilnius University, Vilnius, Lithuania
| | - Yosef Uziel
- Meir Medical Centre and Kfar Saba and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Chris Pruunsild
- Tartu University Hospital Children's Clinic, and University of Tartu Institute of Clinical Medicine, Tartu, Estonia
| | | | | | - Pavla Dolezalova
- Charles University in Prague and General University Hospital, Prague, Czech Republic
| | | | - Marco Garrone
- Istituto Giannina Gaslini, IRCCS and Clinica Pediatrica e Reumatologia, Genoa, Italy
| | - Nicolino Ruperto
- Istituto Giannina Gaslini, IRCCS and Clinica Pediatrica e Reumatologia, Genoa, Italy
| | - Angelo Ravelli
- Università degli Studi di Genova, Istituto Giannina Gaslini, IRCCS and Clinica Pediatrica e Reumatologia, Genoa, Italy, and Sechenov First Moscow State Medical University, Moscow, Russia
| | - Alessandro Consolaro
- Università degli Studi di Genova, Istituto Giannina Gaslini, IRCCS and Clinica Pediatrica e Reumatologia, Genoa, Italy
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38
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van Straalen JW, Krol RM, Giancane G, Panaviene V, Ailioaie LM, Doležalová P, Cattalini M, Susic G, Sztajnbok F, Maritsi D, Constantin T, Sawhney S, Rygg M, Oliveira SK, Nordal EB, Saad-Magalhaes C, Rubio-Perez N, Jelusic M, de Roock S, Wulffraat NM, Ruperto N, Swart JF. Increased incidence of inflammatory bowel disease on etanercept in juvenile idiopathic arthritis regardless of concomitant methotrexate use. Rheumatology (Oxford) 2021; 61:2104-2112. [PMID: 34508559 PMCID: PMC9071576 DOI: 10.1093/rheumatology/keab678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/23/2021] [Indexed: 02/07/2023] Open
Abstract
Objective To describe risk factors for IBD development in a cohort of children with JIA. Methods JIA patients who developed IBD were identified from the international Pharmachild register. Characteristics were compared between IBD and non-IBD patients and predictors of IBD were determined using multivariable logistic regression analysis. Incidence rates of IBD events on different DMARDs were calculated, and differences between therapies were expressed as relative risks (RR). Results Out of 8942 patients, 48 (0.54% ) developed IBD. These were more often male (47.9% vs 32.0%) and HLA-B27 positive (38.2% vs 21.0%) and older at JIA onset (median 8.94 vs 5.33 years) than patients without IBD development. They also had more often a family history of autoimmune disease (42.6% vs 24.4%) and enthesitis-related arthritis (39.6% vs 10.8%). The strongest predictors of IBD on multivariable analysis were enthesitis-related arthritis [odds ratio (OR): 3.68, 95% CI: 1.41, 9.40] and a family history of autoimmune disease (OR: 2.27, 95% CI: 1.12, 4.54). Compared with methotrexate monotherapy, the incidence of IBD on etanercept monotherapy (RR: 7.69, 95% CI: 1.99, 29.74), etanercept with methotrexate (RR: 5.70, 95% CI: 1.42, 22.77) and infliximab (RR: 7.61, 95% CI: 1.27, 45.57) therapy was significantly higher. Incidence on adalimumab was not significantly different (RR: 1.45, 95% CI: 0.15, 13.89). Conclusion IBD in JIA was associated with enthesitis-related arthritis and a family history of autoimmune disease. An increased IBD incidence was observed for etanercept therapy regardless of concomitant methotrexate use.
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Affiliation(s)
- Joeri W van Straalen
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Roline M Krol
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Gabriella Giancane
- Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy.,Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DiNOGMI), Università degli Studi di Genova, Genoa, Italy
| | - Violeta Panaviene
- Children's Hospital, Affiliate of Vilnius University Hospital Santaros Clinic, Vilnius, Lithuania.,Clinic of Children's Diseases, Vilnius University, Vilnius, Lithuania
| | | | - Pavla Doležalová
- Department of Pediatrics and Inherited Metabolic Disorders, 1st Faculty of Medicine and General University Hospital, Charles University in Prague, Prague, Czech Republic
| | - Marco Cattalini
- Unita' di Immunologia e Reumatologia Pediatrica, Clinica Pediatrica dell'Universita' di Brescia, Spedali Civili, Brescia, Italy
| | - Gordana Susic
- Division of Pediatric Rheumatology, Institute of Rheumatology of Belgrade, Belgrade, Serbia
| | - Flavio Sztajnbok
- Hospital Universitario Pedro Ernesto, Nucleo de Estudos da Saúde do Adolescente, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Despoina Maritsi
- 2nd Department of Pediatrics Athens Medical School, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Tamas Constantin
- Unit of Pediatric Rheumatology-Immunology, Second Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Sujata Sawhney
- Sir Ganga Ram Hospital Marg, Centre for Child Health, Sir Ganga Ram Hospital, New Delhi, India
| | - Marite Rygg
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.,Department of Pediatrics, St. Olavs University Hospital of Trondheim, Trondheim, Norway
| | - Sheila Knupp Oliveira
- Instituto de Puericultura e Pediatria Martagao Gesteira (IPPMG), Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ellen Berit Nordal
- Department of Pediatrics, University Hospital of North Norway, Tromso, Norway.,Department of Clinical Medicine, UiT the Arctic University of Norway, Tromso, Norway
| | | | - Nadina Rubio-Perez
- Departamento de Pediatria, Facultad de Medicina, Hospital Universitario "Dr. J. E. González", Universidad Autónoma de Nuevo León, Monterrey, NL, Mexico
| | - Marija Jelusic
- Department of Paediatrics, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Sytze de Roock
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Nico M Wulffraat
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Nicolino Ruperto
- Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Joost F Swart
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, Utrecht, The Netherlands
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Beukelman T, Lougee A, Matsouaka RA, Collier D, Rumsey DG, Schenfeld J, Stryker S, Twilt M, Kimura Y. Patterns of etanercept use in juvenile idiopathic arthritis in the Childhood Arthritis and Rheumatology Research Alliance Registry. Pediatr Rheumatol Online J 2021; 19:131. [PMID: 34419107 PMCID: PMC8380401 DOI: 10.1186/s12969-021-00625-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/31/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND We aimed to characterize etanercept (ETN) use in juvenile idiopathic arthritis (JIA) patients enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry. METHODS The CARRA Registry is a convenience cohort of patients with paediatric onset rheumatic diseases, including JIA. JIA patients treated with ETN for whom the month and year of ETN initiation were available were included. Patterns of ETN and methotrexate (MTX) use were categorized as follows: combination therapy (ETN and MTX started concurrently), step-up therapy (MTX started first and ETN added later), switchers (MTX started and then stopped when or before ETN started), MTX add-on (ETN started first and MTX added later), and ETN only (no MTX use). Data were described using parametric and non-parametric statistics as appropriate. RESULTS Two thousand thirty-two of the five thousand six hundred forty-one patients with JIA met inclusion criteria (74% female, median age at diagnosis 6.0 years [interquartile range 2.0, 11.0]. Most patients (66.9%) were treated with a non-biologic disease modifying anti-rheumatic drug (DMARD), primarily MTX, prior to ETN. There was significant variability in patterns of MTX use prior to starting ETN. Step-up therapy was the most common approach. Only 34.0% of persistent oligoarticular JIA patients continued treatment with a non-biologic DMARD 3 months or more after ETN initiation. ETN persistence overall was 66.3, 49.4, and 37.3% at 24, 36 and 48 months respectively. ETN persistence among spondyloarthritis patients (enthesitis related arthritis and psoriatic JIA) varied by MTX initiation pattern, with higher ETN persistence rates in those who initiated combination therapy (68.9%) and switchers/ETN only (73.3%) patients compared to step-up (65.4%) and MTX add-on (51.1%) therapy. CONCLUSION This study characterizes contemporary patterns of ETN use in the CARRA Registry. Treatment was largely in keeping with American College of Rheumatology guidelines.
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Affiliation(s)
- Timothy Beukelman
- Department of Pediatrics, University of Alabama at Birmingham, CPPN G10, 1600 7th Ave South, Birmingham, AL, 35233, USA.
| | - Aimee Lougee
- grid.26009.3d0000 0004 1936 7961Duke University, Duke Clinical Research Institute, 200 Morris Street, Durham, NC 27701 USA
| | - Roland A. Matsouaka
- grid.26009.3d0000 0004 1936 7961Department of Biostatistics and Bioinformatics, Duke University, Duke Clinical Research Institute, 200 Morris Street, Durham, NC 27701 USA
| | - David Collier
- grid.417886.40000 0001 0657 5612Global Medical Affairs, Amgen Inc., One Amgen Center Drive, Thousand Oaks, California 91320-1799 USA
| | - Dax G. Rumsey
- grid.17089.37Department of Pediatrics, University of Alberta, 3-502 ECHA; 11405 87 Ave NW, Edmonton, Alberta T6G 1C9 Canada
| | - Jennifer Schenfeld
- grid.417886.40000 0001 0657 5612Center for Observational Research, Amgen Inc., One Amgen Center Drive, Thousand Oaks, California 91320-1799 USA
| | - Scott Stryker
- grid.417886.40000 0001 0657 5612Center for Observational Research, Amgen Inc., One Amgen Center Drive, Thousand Oaks, California 91320-1799 USA
| | - Marinka Twilt
- grid.22072.350000 0004 1936 7697Department of Pediatrics, Alberta Children’s Hospital, Cumming School of Medicine, University of Calgary, 28 Oki Drive NW, Calgary, Alberta T3B 6A8 Canada
| | - Yukiko Kimura
- grid.239835.60000 0004 0407 6328Joseph M. Sanzari Children’s Hospital, Hackensack University Medical Center, Hackensack Meridian School of Medicine, Hackensack, NJ USA
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Sellam J, Morel J, Tournadre A, Bouhnik Y, Cornec D, Devauchelle-Pensec V, Dieudé P, Goupille P, Jullien D, Kluger N, Lazaro E, Le Goff B, de Lédinghen V, Lequerré T, Nocturne G, Seror R, Truchetet ME, Verhoeven F, Pham T, Richez C. PRACTICAL MANAGEMENT of patients on anti-TNF therapy: Practical guidelines drawn up by the Club Rhumatismes et Inflammation (CRI). Joint Bone Spine 2021; 88:105174. [PMID: 33992225 DOI: 10.1016/j.jbspin.2021.105174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Jérémie Sellam
- Service de Rhumatologie, CHU Saint-Antoine, Paris, France
| | - Jacques Morel
- Service de Rhumatologie, CHU Montpellier, Montpellier, France
| | - Anne Tournadre
- Service de Rhumatologie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Yoram Bouhnik
- Service de Gastro-entérologie, CHU Hôpital Beaujon, Clichy, France
| | - Divi Cornec
- Service de Rhumatologie, CHRU La Cavale Blanche, Brest, France
| | | | - Philippe Dieudé
- Service de Rhumatologie, CHU Bichat-Claude Bernard, Paris, France
| | | | | | - Nicolas Kluger
- Dpt Dermatology, Helsinki, Finland; Service de Dermatologie, CHU Bichat-Claude Bernard, Paris, France
| | - Estibaliz Lazaro
- Service de Médecine interne, Hôpital Haut-Lévêque, CHU Bordeaux, Pessac, France
| | | | - Victor de Lédinghen
- Unité d'Hépatologie et transplantation hépatique, Hôpital Haut-Lévêque, CHU Bordeaux, Pessac, France
| | | | | | - Raphaèle Seror
- Service de Rhumatologie, Bicêtre, Le Kremlin-Bicêtre, France
| | | | | | - Thao Pham
- Service de Rhumatologie, CHU Sainte-Marguerite, Marseille, France
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van Straalen JW, Giancane G, Amazrhar Y, Tzaribachev N, Lazar C, Uziel Y, Telcharova-Mihaylovska A, Len CA, Miniaci A, Boteanu AL, Filocamo G, Mastri MV, Arkachaisri T, Magnolia MG, Hoppenreijs E, de Roock S, Wulffraat NM, Ruperto N, Swart JF. A clinical prediction model for estimating the risk of developing uveitis in patients with juvenile idiopathic arthritis. Rheumatology (Oxford) 2021; 60:2896-2905. [PMID: 33274366 PMCID: PMC8213427 DOI: 10.1093/rheumatology/keaa733] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 10/02/2020] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE To build a prediction model for uveitis in children with JIA for use in current clinical practice. METHODS Data from the international observational Pharmachild registry were used. Adjusted risk factors as well as predictors for JIA-associated uveitis (JIA-U) were determined using multivariable logistic regression models. The prediction model was selected based on the Akaike information criterion. Bootstrap resampling was used to adjust the final prediction model for optimism. RESULTS JIA-U occurred in 1102 of 5529 JIA patients (19.9%). The majority of patients that developed JIA-U were female (74.1%), ANA positive (66.0%) and had oligoarthritis (59.9%). JIA-U was rarely seen in patients with systemic arthritis (0.5%) and RF positive polyarthritis (0.2%). Independent risk factors for JIA-U were ANA positivity [odds ratio (OR): 1.88 (95% CI: 1.54, 2.30)] and HLA-B27 positivity [OR: 1.48 (95% CI: 1.12, 1.95)] while older age at JIA onset was an independent protective factor [OR: 0.84 (9%% CI: 0.81, 0.87)]. On multivariable analysis, the combination of age at JIA onset [OR: 0.84 (95% CI: 0.82, 0.86)], JIA category and ANA positivity [OR: 2.02 (95% CI: 1.73, 2.36)] had the highest discriminative power among the prediction models considered (optimism-adjusted area under the receiver operating characteristic curve = 0.75). CONCLUSION We developed an easy to read model for individual patients with JIA to inform patients/parents on the probability of developing uveitis.
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Affiliation(s)
- Joeri W van Straalen
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, Utrecht, Netherlands
| | - Gabriella Giancane
- Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DiNOGMI), Università degli Studi di Genova, Genoa, Italy
| | - Yasmine Amazrhar
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, Utrecht, Netherlands
| | | | - Calin Lazar
- Pediatrics, Spitalul Clinic de Urgenta pentru Copii, Cluj-Napoca, Romania
| | - Yosef Uziel
- Department of Pediatrics, Pediatric Rheumatology Unit, Meir Medical Center, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Claudio A Len
- Pediatrics Department, Universidade Federal de São Paulo, Sao Paulo, Brazil
| | - Angela Miniaci
- Salute della Donna, del Bambino e dell’Adolescente-Padiglione 16 Ambulatorio di reumatologia, Azienda Ospedaliero-Universitaria S. Orsola-Malpighi, Bologna, Italy
| | - Alina L Boteanu
- Pediatric Rheumatology Unit, University Hospital Ramón y Cajal, Madrid, Spain
| | - Giovanni Filocamo
- Pediatric Rheumatology, Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Mariel V Mastri
- Unidad de Reumatologia, Hospital Sor Maria Ludovica, La Plata, Argentina
| | - Thaschawee Arkachaisri
- Rheumatology and Immunology Service, Department of Paediatric Subspecialties, KK Women’s and Children’s Hospital, Singapore
- Duke-NUS Medical School, Singapore
| | - Maria G Magnolia
- Paediatrics, Santa Maria della Stella Hospital, Ciconia, Orvieto (TR), Italy
| | - Esther Hoppenreijs
- Pediatric Rheumatology, Radboud University Medical Center/Sint Maartenskliniek, Nijmegen, Netherlands
| | - Sytze de Roock
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, Utrecht, Netherlands
| | - Nico M Wulffraat
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, Utrecht, Netherlands
| | - Nicolino Ruperto
- Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Joost F Swart
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, Utrecht, Netherlands
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Kimura Y, Schanberg LE, Tomlinson GA, Riordan ME, Dennos AC, Del Gaizo V, Murphy KL, Weiss PF, Natter MD, Feldman BM, Ringold S. Optimizing the Start Time of Biologics in Polyarticular Juvenile Idiopathic Arthritis: A Comparative Effectiveness Study of Childhood Arthritis and Rheumatology Research Alliance Consensus Treatment Plans. Arthritis Rheumatol 2021; 73:1898-1909. [PMID: 34105312 PMCID: PMC8518909 DOI: 10.1002/art.41888] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 06/01/2021] [Indexed: 01/17/2023]
Abstract
Objective The optimal time to start biologics in polyarticular juvenile idiopathic arthritis (JIA) remains uncertain. The Childhood Arthritis and Rheumatology Research Alliance (CARRA) developed 3 consensus treatment plans (CTPs) for untreated polyarticular JIA to compare strategies for starting biologics. Methods Start Time Optimization of Biologics in Polyarticular JIA (STOP‐JIA) was a prospective, observational, CARRA Registry study comparing the effectiveness of 3 CTPs: 1) the step‐up plan (initial nonbiologic disease‐modifying antirheumatic drug [DMARD] monotherapy, adding a biologic if needed, 2) the early combination plan (DMARD and biologic started together), and 3) the biologic first plan (biologic monotherapy). The primary outcome measure was clinically inactive disease according to the provisional American College of Rheumatology (ACR) criteria, without glucocorticoids, at 12 months. Secondary outcome measures included Patient‐Reported Outcomes Measurement Information System (PROMIS) pain interference and mobility scores, inactive disease as defined by the clinical Juvenile Arthritis Disease Activity Score in 10 joints (JADAS‐10), and the ACR Pediatric 70 criteria (Pedi 70). Results Of 400 patients enrolled, 257 (64%) began the step‐up plan, 100 (25%) the early combination plan, and 43 (11%) the biologic first plan. After propensity score weighting and multiple imputation, clinically inactive disease according to the ACR criteria was achieved in 37% of those on the early combination plan, 32% on the step‐up plan, and 24% on the biologic first plan (P = 0.17). Inactive disease according to the clinical JADAS‐10 (score ≤2.5) was also achieved in more patients on the early combination plan than the step‐up plan (59% versus 43%; P = 0.03), as was ACR Pedi 70 (81% versus 62%; P = 0.008), but generalizability was limited by missing data. PROMIS measures improved in all groups, but without significant differences. Twenty serious adverse events were reported (mostly infections). Conclusion Achievement of clinically inactive disease without glucocorticoids did not significantly differ between groups at 12 months. While there was a significantly higher likelihood of early combination therapy achieving inactive disease according to the clinical JADAS‐10 and ACR Pedi 70, these results require further exploration.
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Affiliation(s)
- Yukiko Kimura
- Joseph M. Sanzari Children's Hospital and Hackensack Meridian School of Medicine, Hackensack, New Jersey
| | - Laura E Schanberg
- Duke Clinical Research Institute and Duke University Medical Center, Durham, North Carolina
| | | | - Mary Ellen Riordan
- Joseph M. Sanzari Children's Hospital and Hackensack Meridian School of Medicine, Hackensack, New Jersey
| | - Anne C Dennos
- Duke Clinical Research Institute and Duke University School of Medicine, Durham, North Carolina
| | - Vincent Del Gaizo
- Childhood Arthritis and Rheumatology Research Alliance (CARRA), Milwaukee, Wisconsin
| | | | - Pamela F Weiss
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Marc D Natter
- Boston Children's Hospital, Massachusetts General Hospital, and Harvard Medical School, Boston
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Noguera-Julian A, Calzada-Hernández J, Brinkmann F, Basu Roy R, Bilogortseva O, Buettcher M, Carvalho I, Chechenyeva V, Falcón L, Goetzinger F, Guerrero-Laleona C, Hoffmann P, Jelusic M, Niehues T, Ozere I, Shackley F, Suciliene E, Welch SB, Schölvinck EH, Ritz N, Tebruegge M. Tuberculosis Disease in Children and Adolescents on Therapy With Antitumor Necrosis Factor-ɑ Agents: A Collaborative, Multicenter Paediatric Tuberculosis Network European Trials Group (ptbnet) Study. Clin Infect Dis 2021; 71:2561-2569. [PMID: 31796965 DOI: 10.1093/cid/ciz1138] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 11/19/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In adults, anti-tumor necrosis factor-α (TNF-α) therapy is associated with progression of latent tuberculosis (TB) infection (LTBI) to TB disease, but pediatric data are limited. METHODS Retrospective multicenter study within the Paediatric Tuberculosis Network European Trials Group, capturing patients <18 years who developed TB disease during anti-TNF-α therapy. RESULTS Sixty-six tertiary healthcare institutions providing care for children with TB participated. Nineteen cases were identified: Crohn's disease (n = 8; 42%) and juvenile idiopathic arthritis (n = 6; 32%) were the commonest underlying conditions. Immune-based TB screening (tuberculin skin test and/or interferon-γ release assay) was performed in 15 patients before commencing anti-TNF-α therapy but only identified 1 LTBI case; 13 patients were already receiving immunosuppressants at the time of screening. The median interval between starting anti-TNF-α therapy and TB diagnosis was 13.1 (IQR, 7.1-20.3) months. All cases presented with severe disease, predominantly miliary TB (n = 14; 78%). One case was diagnosed postmortem. TB was microbiologically confirmed in 15 cases (79%). The median duration of anti-TB treatment was 50 (IQR, 46-66) weeks. Five of 15 (33%) cases who had completed TB treatment had long-term sequelae. CONCLUSIONS LTBI screening is frequently false-negative in this patient population, likely due to immunosuppressants impairing test performance. Therefore, patients with immune-mediated diseases should be screened for LTBI at the point of diagnosis, before commencing immunosuppressive medication. Children on anti-TNF-α therapy are prone to severe TB disease and significant long-term morbidity. Those observations underscore the need for robust LTBI screening programs in this high-risk patient population, even in low-TB-prevalence settings.
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Affiliation(s)
- Antoni Noguera-Julian
- Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria, Unitat d´Infeccions, Servei de Pediatria, Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain.,Departament de Pediatria, Universitat de Barcelona, Barcelona, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Red de Investigación Translacional en Infectología Pediátrica (RITIP), Madrid, Spain
| | - Joan Calzada-Hernández
- Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria, Unitat d´Infeccions, Servei de Pediatria, Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain
| | - Folke Brinkmann
- Department of Pulmonology, University Children's Hospital, Ruhr University, Bochum, Germany
| | - Robindra Basu Roy
- Department of Paediatrics, Oxford University, Oxford, United Kingdom.,Children's Hospital, John Radcliffe Hospital, Oxford, United Kingdom
| | - Olga Bilogortseva
- Department of Child Phthisiology, National Institute of Phthisiology and Pulmonology, National Academy of Medical Sciences of Ukraine, Kiev, Ukraine
| | - Michael Buettcher
- Lucerne Children's Hospital, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Isabel Carvalho
- Department of Pediatrics, Vila Nova de Gaia Hospital Centre, Vila Nova de Gaia, Portugal
| | - Vira Chechenyeva
- Department of Child Phthisiology, National Institute of Phthisiology and Pulmonology, National Academy of Medical Sciences of Ukraine, Kiev, Ukraine.,Center of Infectious Diseases, "Clinic for Children With HIV/AIDS", National Specialized Children's Hospital (Okhmatdyt), Kiev, Ukraine
| | - Lola Falcón
- Department of Paediatric Infectious Diseases, Rheumatology and Immunodeficiency, Hospital Virgen del Rocío, Seville, Spain
| | - Florian Goetzinger
- Department of Pediatrics and Adolescent Medicine, Wilhelminenspital, Vienna, Austria
| | - Carmelo Guerrero-Laleona
- Infectious Diseases Unit, Pediatric Department, Miguel Servet University Hospital-University of Zaragoza, Zaragoza, Spain
| | - Peter Hoffmann
- Department of Internal Medicine, Gastroenterology, and Diabetology, Evang. Kliniken Essen-Mitte, Essen, Germany
| | - Marija Jelusic
- Department of Pediatrics, University of Zagreb, School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Tim Niehues
- Immunodeficiency and Rheumatology Center, Helios Klinikum Krefeld, Krefeld, Germany
| | - Iveta Ozere
- Department of Infectious Diseases and Dermatology, Riga Stradinš University, Riga, Latvia.,Center of Tuberculosis and Lung Diseases, Riga East University Hospital, Riga, Latvia
| | - Fiona Shackley
- Department of Paediatrics, Sheffield Children's National Health Service Foundation Trust, Sheffield, United Kingdom
| | - Elena Suciliene
- Children Hospital, Affiliate of Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Steven B Welch
- Birmingham Chest Clinic and Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Elisabeth H Schölvinck
- University of Groningen, University Medical Center Groningen/Beatrix Children's Hospital, Groningen, the Netherlands
| | - Nicole Ritz
- Paediatric Infectious Diseases and Vaccinology Unit, University of Basel Children's Hospital, Basel, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland.,Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Marc Tebruegge
- Department of Paediatrics, University of Melbourne, Parkville, Australia.,Department of Paediatric Infectious Diseases and Immunology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.,Department of Infection, Immunity, and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
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Segú-Vergés C, Coma M, Kessel C, Smeets S, Foell D, Aldea A. Application of systems biology-based in silico tools to optimize treatment strategy identification in Still's disease. Arthritis Res Ther 2021; 23:126. [PMID: 33892792 PMCID: PMC8063416 DOI: 10.1186/s13075-021-02507-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 04/07/2021] [Indexed: 01/06/2023] Open
Abstract
Background Systemic juvenile idiopathic arthritis (sJIA) and adult-onset Still’s disease (AOSD) are manifestations of an autoinflammatory disorder with complex pathophysiology and significant morbidity, together also termed Still’s disease. The objective of the current study is to set in silico models based on systems biology and investigate the optimal treat-to-target strategy for Still’s disease as a proof-of-concept of the modeling approach. Methods Molecular characteristics of Still’s disease and data on biological inhibitors of interleukin (IL)-1 (anakinra, canakinumab), IL-6 (tocilizumab, sarilumab), and glucocorticoids as well as conventional disease-modifying anti-rheumatic drugs (DMARDs, methotrexate) were used to construct in silico mechanisms of action (MoA) models by means of Therapeutic Performance Mapping System (TPMS) technology. TPMS combines artificial neuronal networks, sampling-based methods, and artificial intelligence. Model outcomes were validated with published expression data from sJIA patients. Results Biologicals demonstrated more pathophysiology-directed efficiency than non-biological drugs. IL-1 blockade mainly acts on proteins implicated in the innate immune system, while IL-6 signaling blockade has a weaker effect on innate immunity and rather affects adaptive immune mechanisms. The MoA models showed that in the autoinflammatory/systemic phases of Still’s disease, in which the innate immunity plays a pivotal role, the IL-1β-neutralizing antibody canakinumab is more efficient than the IL-6 receptor-inhibiting antibody tocilizumab. MoA models reproduced 67% of the information obtained from expression data. Conclusions Systems biology-based modeling supported the preferred use of biologics as an immunomodulatory treatment strategy for Still’s disease. Our results reinforce the role for IL-1 blockade on innate immunity regulation, which is critical in systemic autoinflammatory diseases. This further encourages early use on Still’s disease IL-1 blockade to prevent the development of disease or drug-related complications. Further analysis at the clinical level will validate the findings and help determining the timeframe of the window of opportunity for canakinumab treatment. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-021-02507-w.
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Affiliation(s)
- Cristina Segú-Vergés
- Anaxomics Biotech, Carrer Diputació 237, 1°, 1ª, 08007, Barcelona, Catalonia, Spain
| | - Mireia Coma
- Anaxomics Biotech, Carrer Diputació 237, 1°, 1ª, 08007, Barcelona, Catalonia, Spain
| | - Christoph Kessel
- Department of Pediatric Rheumatology & Immunology, University Children's Hospital, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Serge Smeets
- Novartis, Haaksbergweg, 1101 BX, Amsterdam, The Netherlands
| | - Dirk Foell
- Department of Pediatric Rheumatology & Immunology, University Children's Hospital, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Anna Aldea
- Novartis, Gran Via de les Corts Catalanes, 764, 08013, Barcelona, Catalonia, Spain.
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Hepatitis B vaccination response of treatment-naive patients with juvenile idiopathic arthritis. Rheumatol Int 2021; 42:1199-1205. [PMID: 33738550 DOI: 10.1007/s00296-021-04833-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 03/02/2021] [Indexed: 10/21/2022]
Abstract
To evaluate the vaccine response of treatment-naive juvenile idiopathic arthritis (JIA) patients who were fully vaccinated against Hepatitis B Virus (HBV) and then compare their antibody status with healthy controls. In this multicenter study, initial visit hepatitis B surface antigen (HbsAg) and anti-hepatitis B surface antibody (anti-Hbs) titers of 262 treatment-naive JIA patients who were followed up regularly between May 2015 and October 2019 were evaluated retrospectively from patients' medical records and compared with 276 healthy peers. Both HbsAg and anti-Hbs antibody titers were tested by the ELISA technique. Anti-HBs titers ≥ 10 IU/L were considered as reactive indicating seroprotection against HBV. In the JIA group, seropositivity rate was 59.1% while 72.9% of the control group were immune against HBV (p = 0.002). The median titer for anti-Hbs was 14 (range: 0-1000) IU/L in the patient group and 43.3 (range: 0-1000) IU/L in the control group (p = 0.01). Neither JIA patients nor healthy controls were positive for HbsAg. Patients with JIA vaccinated according to the national vaccination schedule were evaluated at their first visit in pediatric rheumatology outpatient clinics for anti-Hbs presence and it was found that they have lesser seroprotectivity than their age and sex-matched routinely vaccinated, healthy peers. So, to complete missing vaccines and booster vaccine doses, assessing the immune status of the patients at the time of diagnosis against HBV should be in the check-list of physicians dealing with pediatric rheumatic diseases.
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46
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Giancane G, Rosina S, Consolaro A, Ruperto N. Outcome Scores in Pediatric Rheumatology. Curr Rheumatol Rep 2021; 23:23. [PMID: 33683471 DOI: 10.1007/s11926-021-00988-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW Providing a summary of the latest research on outcome measures in juvenile idiopathic arthritis, childhood -onset systemic lupus erythematosus, and juvenile dermatomyositis. RECENT FINDINGS A rational management of patients with pediatric rheumatic diseases requires the regular assessment of the level of disease activity and damage, as well as the evaluation of therapeutic response through validated and standardized outcome measures. Ideally, such tools should be simple, feasible, and easily applicable in routine care. Recently, there has been a great deal of effort to refine existing tools and devise novel outcome measures, aiming to address the various aspects of disease impact and to improve the reliability of research studies and clinical trials. The newest outcome tools in pediatric rheumatology have markedly enlarged the spectrum of health domains assessable in a standardized way, thus increasing the reliability of evaluation of clinical response and fostering future clinical trials.
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Affiliation(s)
- Gabriella Giancane
- Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy.,Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DiNOGMI), Università degli Studi di Genova, Genoa, Italy
| | - Silvia Rosina
- Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Alessandro Consolaro
- Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy.,Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DiNOGMI), Università degli Studi di Genova, Genoa, Italy
| | - Nicolino Ruperto
- Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
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47
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Moore-Hepburn C, Rieder M. Paediatric pharmacotherapy and drug regulation: Moving past the therapeutic orphan. Br J Clin Pharmacol 2021; 88:4250-4257. [PMID: 33576523 DOI: 10.1111/bcp.14769] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/09/2020] [Accepted: 10/14/2020] [Indexed: 12/29/2022] Open
Abstract
The development of specific drug therapy for children was a paradigm-changing event that transformed paediatric medical practice. However, a series of tragedies involving drug treatment for children resulted in a gap developing between drug regulation and practice, with the majority of drugs used in child healthcare being used off-label, rendering children therapeutic orphans. Over the past two decades changes in drug regulation led by the US Food and Drug Administration and followed by the European Union's European Medicines Agency have led to substantial changes in how new drugs with potential use in children are studied and labelled. While these changes have substantially improved labelling for new drugs, there has been much less progress with older drugs. Although the unique challenges of conducting clinical research in children have been addressed by novel clinical trial designs, many of these innovations have not been translated into approaches accepted for the drug approval process. The regulations applying to the need for paediatric studies currently are only applicable in the United States and the European Union, and there is less impetus for paediatric labelling in other jurisdictions. This impacts on a number of issues beyond labelling, including the availability of child-friendly formulations. Finally, the impact of Brexit on paediatric drug studies in the UK remains unclear and is subject to ongoing negotiations between the UK government and the European Union.
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Affiliation(s)
| | - Michael Rieder
- Division of Paediatric Clinical Pharmacology, Department of Paediatrics, University of Western Ontario, Canada
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48
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Ruperto N, Brunner HI, Pacheco-Tena C, Louw I, Vega-Cornejo G, Spindler AJ, Kingsbury DJ, Schmeling H, Borzutzky A, Cuttica R, Inman CJ, Malievskiy V, Scott C, Keltsev V, Terreri MT, Viola DO, Xavier RM, Fernandes TAP, Velázquez MDRM, Henrickson M, Clark MB, Bensley KA, Li X, Lo KH, Leu JH, Hsu CH, Hsia EC, Xu Z, Martini A, Lovell DJ. Open-Label Phase 3 Study of Intravenous Golimumab in Patients With Polyarticular Juvenile Idiopathic Arthritis. Rheumatology (Oxford) 2021; 60:4495-4507. [PMID: 33493312 PMCID: PMC8487314 DOI: 10.1093/rheumatology/keab021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 12/23/2020] [Indexed: 11/12/2022] Open
Abstract
Objectives To assess efficacy, pharmacokinetics (PK) and safety of intravenous (i.v.) golimumab in patients with polyarticular-course JIA (pc-JIA). Methods Children aged 2 to <18 years with active pc-JIA despite MTX therapy for ≥2 months received 80 mg/m2 golimumab at weeks 0, 4, then every 8 weeks through week 52 plus MTX weekly through week 28. The primary and major secondary endpoints were PK exposure and model-predicted steady-state area under the curve (AUCss) over an 8-week dosing interval at weeks 28 and 52, respectively. JIA ACR response and safety were also assessed. Results In total, 127 children were treated with i.v. golimumab. JIA ACR 30, 50, 70, and 90 response rates were 84%, 80%, 70% and 47%, respectively, at week 28 and were maintained through week 52. Golimumab serum concentrations and AUCss were 0.40 µg/ml and 399 µg ⋅ day/ml at week 28. PK exposure was maintained at week 52. Steady-state trough golimumab concentrations and AUCss were consistent across age categories and comparable to i.v. golimumab dosed 2 mg/kg in adults with rheumatoid arthritis. Golimumab antibodies and neutralizing antibodies were detected via a highly sensitive drug-tolerant assay in 31% (39/125) and 19% (24/125) of patients, respectively. Median trough golimumab concentration was lower in antibody-positive vs antibody-negative patients. Serious infections were reported in 6% of patients, including one death due to septic shock. Conclusion Body surface area-based dosing of i.v. golimumab was well tolerated and provided adequate PK exposure for clinical efficacy in paediatric patients with active pc-JIA. ClinicalTrials.gov number NCT02277444
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Affiliation(s)
- Nicolino Ruperto
- IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO, Genoa, Italy
| | - Hermine I Brunner
- Cincinnati Children's Hospital Medical Center, Division of Rheumatology, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - César Pacheco-Tena
- Facultad de Medicina, Universidad Autónoma de Chihuahua, Circuito Universitario Campus II, Chihuahua, México
| | - Ingrid Louw
- Panorama Medical Centre, Rheumatology Private Practice, Cape Town, South Africa
| | - Gabriel Vega-Cornejo
- Centro de Reumatología y Autoinmunidad (CREA)/Hospital México Americano, Guadalajara, Jalisco, México
| | - Alberto J Spindler
- Centro Médico Privado de Reumatología, Rheumatology Section, San Miguel de Tucuman, Tucuman, Argentina
| | - Daniel J Kingsbury
- Randall Children's Hospital at Legacy Emanuel, Portland, Oregon, United States of America
| | - Heinrike Schmeling
- Alberta Children's Hospital and Department of Pediatrics, Cumming School of Medicine/University of Calgary, Calgary, Alberta, Canada
| | - Arturo Borzutzky
- Department of Pediatric Infectious Diseases and Immunology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rubén Cuttica
- Rheumatology Section, Hospital Pedro de Elizalde, Buenos Aires, Argentina
| | - C J Inman
- Pediatric Rheumatology, University of Utah, Salt Lake City, Utah, United States of America
| | - Victor Malievskiy
- Federal State Budget Educational Institution of Higher Education, Bashkir State Medical University of the Ministry of Healthcare of Russian Federation, Cape Town, South Africa
| | - Christiaan Scott
- Red Cross War Memorial Children's Hospital and Groote Schuur Hospital, Paediatric Rheumatology, University of Cape Town, Cape Town, South Africa
| | - Vladimir Keltsev
- Pediatric Department, Togliatti City Clinical Hospital No. 5, Togliatti, Russian Federation
| | - Maria Teresa Terreri
- Escola Paulista de Medicina/Universidade Federal de São Paulo, Pediatrics, São Paulo, Brazil
| | | | - Ricardo M Xavier
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | - Michael Henrickson
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America
| | - Michael B Clark
- Janssen Research & Development, LLC, Spring House, Pennsylvania, United States of America
| | - Karen A Bensley
- Janssen Research & Development, LLC, Spring House, Pennsylvania, United States of America
| | - Xiaoming Li
- Janssen Research & Development, LLC, Spring House, Pennsylvania, United States of America
| | - Kim Hung Lo
- Janssen Research & Development, LLC, Spring House, Pennsylvania, United States of America
| | - Jocelyn H Leu
- Janssen Research & Development, LLC, Spring House, Pennsylvania, United States of America
| | - Chyi-Hung Hsu
- Janssen Research & Development, LLC, Raritan, New Jersey, United States of America
| | - Elizabeth C Hsia
- Janssen Research & Development, LLC, Spring House, Pennsylvania, United States of America
| | - Zhenhua Xu
- Janssen Research & Development, LLC, Spring House, Pennsylvania, United States of America
| | - Alberto Martini
- Università degli Studi di Genova, Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DiNOGMI), Genova, Italy
| | - Daniel J Lovell
- Cincinnati Children's Hospital Medical Center, Division of Rheumatology, University of Cincinnati, Cincinnati, Ohio, United States of America
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49
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Klein A, Klotsche J, Hügle B, Minden K, Hospach A, Weller-Heinemann F, Schwarz T, Dressler F, Trauzeddel R, Hufnagel M, Foeldvari I, Borte M, Kuemmerle-Deschner J, Brunner J, Oommen PT, Föll D, Tenbrock K, Urban A, Horneff G. Long-term surveillance of biologic therapies in systemic-onset juvenile idiopathic arthritis: data from the German BIKER registry. Rheumatology (Oxford) 2021; 59:2287-2298. [PMID: 31846042 DOI: 10.1093/rheumatology/kez577] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 10/22/2019] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Using data from the German Biologics JIA Registry (BIKER), long-term safety of biologics for systemic-onset JIA with regard to adverse events of special interest was assessed. METHODS Safety assessments were based on adverse event reports after first dose through 90 days after last dose. Rates of adverse event, serious adverse event and 25 predefined adverse events of special interest were analysed. Incidence rates were compared for each biologic against all other biologics combined applying a mixed-effect Poisson model. RESULTS Of 260 systemic-onset JIA patients in this analysis, 151 patients received etanercept, 109 tocilizumab, 71 anakinra and 51 canakinumab. Patients with etanercept had higher clinical Juvenile Arthritis Disease Activity Score 10 scores, active joint counts and steroid use at therapy start. Serious adverse events were reported with higher frequency in patients receiving canakinumab [20/100 patient years (PY)] and tocilizumab (21/100 PY). Cytopenia and hepatic events occurred with a higher frequency with tocilizumab and canakinumab. Medically important infections were seen more often in patients with IL-6 or IL-1 inhibition. Macrophage activation syndrome occurred in all cohorts with a higher frequency in patients with canakinumab (3.2/100 PY) and tocilizumab (2.5/100 PY) vs anakinra (0.83/100 PY) and etanercept (0.5/100 PY). After adjustment only an elevated risk for infections in anakinra-treated patients remained significant. Three definite malignancies were reported in patients ever exposed to biologics. Two deaths occurred in patients treated with etanercept. CONCLUSION Surveillance of pharmacotherapy as provided by BIKER is an import approach especially for patients on long-term treatment. Overall, tolerance was acceptable. Differences between several biologics were noted and should be considered in daily patient care.
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Affiliation(s)
- Ariane Klein
- Centre for Paediatric Rheumatology, Department of Paediatrics, Asklepios Clinic Sankt Augustin, Sankt Augustin.,Department of Pediatrics, Medical Faculty, University of Cologne, Cologne
| | - Jens Klotsche
- German Rheumatism Research Centre Berlin, and Charité, University Medicine, Berlin
| | - Boris Hügle
- German Centre Pediatric and Adolescent Rheumatology, Garmisch-Partenkirchen
| | - Kirsten Minden
- German Rheumatism Research Centre Berlin, and Charité, University Medicine, Berlin
| | | | | | - Tobias Schwarz
- Department of Pediatric Rheumatology, St Josef Hospital, Sendenhorst
| | - Frank Dressler
- Pediatric Pneumology, Allergology, Neonatology, Immunology, Medizinische Hochschule Hannover, Hannover
| | | | - Markus Hufnagel
- Department of Pediatrics and Adolescent Medicine, University Medical Center, Freiburg
| | - Ivan Foeldvari
- Hamburg Centre for Pediatric and Adolescent Rheumatology, Hamburg
| | - Michael Borte
- Pediatric Immunology, Children's Hospital Sankt Georg, Leipzig
| | | | - Jürgen Brunner
- Department of Pediatrics I, Medical University, Innsbruck, Austria
| | - Prasad Thomas Oommen
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Medical Faculty, University Children's Hospital, Heinrich-Heine-University, Düsseldorf
| | - Dirk Föll
- Department of Pediatrics, Rheumatology and Immunology, University Hospital, Münster
| | - Klaus Tenbrock
- Department of Pediatric and Adolescent Medicine, RWTH Aachen University, Aachen
| | - Andreas Urban
- Klinikum St Marien Klinik für Kinder und Jugendliche - Rheumatology/Pneumology, Amberg, Germany
| | - Gerd Horneff
- Centre for Paediatric Rheumatology, Department of Paediatrics, Asklepios Clinic Sankt Augustin, Sankt Augustin.,Department of Pediatrics, Medical Faculty, University of Cologne, Cologne
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50
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Ruperto N, Brunner HI, Tzaribachev N, Vega-Cornejo G, Louw I, Cimaz R, Dare J, Espada G, Faugier E, Ferrandiz M, Gerloni V, Quartier P, Silva CA, Wagner-Weiner L, Gandhi Y, Passarell J, Nys M, Wong R, Martini A, Lovell DJ. Absence of Association Between Abatacept Exposure and Initial Infection in Patients With Juvenile Idiopathic Arthritis. J Rheumatol 2021; 48:1073-1081. [PMID: 33452173 DOI: 10.3899/jrheum.200154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the relationship between infection risk and abatacept (ABA) exposure levels in patients with polyarticular-course juvenile idiopathic arthritis (pJIA) following treatment with subcutaneous (SC) and intravenous (IV) ABA. METHODS Data from 2 published studies (ClinicalTrials.gov: NCT01844518, NCT00095173) of ABA treatment in pediatric patients were analyzed. One study treated patients aged 2-17 years with SC ABA and the other treated patients aged 6-17 years with IV ABA. Association between serum ABA exposure measures and infection was evaluated using Kaplan-Meier plots of probability of first infection vs time on treatment by ABA exposure quartiles and log-rank tests. Number of infections by ABA exposure quartiles was investigated. RESULTS Overall, 343 patients were included in this analysis: 219 patients received SC ABA and 124 patients received IV ABA. Overall, 237/343 (69.1%) patients had ≥ 1 infection over 24 months. No significant difference in time to first infection across 4 quartiles of ABA exposure levels was observed in the pooled (P = 0.45), SC (2-5 yrs: P = 0.93; 6-17 yrs: P = 0.48), or IV (P = 0.50) analyses. Concomitant use of methotrexate and glucocorticoids (at baseline and throughout) with ABA did not increase infection risk across the ABA exposure quartiles. There was no evidence of association between number of infections and ABA exposure quartiles. No opportunistic infections related to ABA were reported. CONCLUSION In patients aged 2-17 years with pJIA, no evidence of association between higher levels of exposure to IV ABA or SC ABA and incidence of infection was observed.
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Affiliation(s)
- Nicolino Ruperto
- N. Ruperto, MD, MPH, IRCCS Istituto G Gaslini, Clinica Pediatrica e Reumatologia-UOSID Centro Trial, Genoa, Italy;
| | - Hermine I Brunner
- H.I. Brunner, MD, MSc, MBA, D.J. Lovell, MD, MPH, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Nikolay Tzaribachev
- N. Tzaribachev, MD, Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany
| | - Gabriel Vega-Cornejo
- G. Vega-Cornejo, MD, CREA Hospital México Americano, Guadalajara, Jalisco, Mexico
| | - Ingrid Louw
- I. Louw, MMED, MBChB, Panorama Medical Centre, Cape Town, South Africa
| | - Rolando Cimaz
- R. Cimaz, MD, University Hospital Meyer, Florence, Italy and Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy
| | - Jason Dare
- J. Dare, MD, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Graciela Espada
- G. Espada, MD, Hospital de Niños Dr Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Enrique Faugier
- E. Faugier, MD, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Manuel Ferrandiz
- M. Ferrandiz, MD, Instituto Nacional de Salúd del Niño, Breña, Peru
| | - Valeria Gerloni
- V. Gerloni, MD, Istituto Ortopedico Gaetano Pini, Milan, Italy
| | - Pierre Quartier
- P. Quartier, MD, Université de Paris, IMAGINE Institute, RAISE reference centre for rare diseases, Necker-Enfants Malades hospital, AP-HP, Paris, France
| | - Clovis Artur Silva
- C.A. Silva, MD, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - Yash Gandhi
- Y. Gandhi, PhD, R. Wong, MD, Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Julie Passarell
- J. Passarell, MA, Cognigen Corporation, Buffalo, New York, USA
| | - Marleen Nys
- M. Nys, MSc, Bristol Myers Squibb, Braine-L'Alleud, Belgium
| | - Robert Wong
- Y. Gandhi, PhD, R. Wong, MD, Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Alberto Martini
- A. Martini, MD, IRCCS Istituto G Gaslini, Clinica Pediatrica e Reumatologia, Genoa, Italy and Università di Genova, Genoa, Italy
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