1
|
Pina Vegas L, Iggui S, Sbidian E, Claudepierre P. Impact of initiation of targeted therapy on the use of psoriatic arthritis-related treatments and healthcare consumption: a cohort study of 9793 patients from the French health insurance database (SNDS). RMD Open 2024; 10:e004631. [PMID: 39117446 PMCID: PMC11409354 DOI: 10.1136/rmdopen-2024-004631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Accepted: 07/16/2024] [Indexed: 08/10/2024] Open
Abstract
OBJECTIVES To assess the potential impact of targeted therapies for psoriatic arthritis (PsA) on symptomatic treatments (non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, opioid analgesics), methotrexate and mood disorder treatments and on hospitalisation and sick leave. METHODS Using the French health insurance database, this nationwide cohort study included adults with PsA who were new users (not in the year before the index date) of targeted therapies for ≥9 months during 2015-2021. Main endpoints were difference in proportion of users of associated treatments, hospitalisations and sick leaves between 3 and 9 months after and 6 months before targeted therapy initiation. Logistic regression models adjusted for sex, age, psoriasis, inflammatory bowel disease and Charlson Comorbidity Index compared the impact of biologics initiation (tumour necrosis factor inhibitor (TNFi)/interleukin 17 inhibitor (IL17i)/IL12/23i) on associated treatment discontinuation. RESULTS Among 9793 patients initiating targeted therapy for PsA (mean age: 51±13 years, 47% men), 62% initiated TNFi, 14% IL17i, 10% IL12/23i, 1% Janus kinase inhibitor, 12% phosphodiesterase-4 inhibitor. After treatment initiation, the proportion of treatment users was significantly reduced for NSAIDs (-15%), opioid analgesics (-9%), prednisone (-9%), methotrexate (-15%) and mood disorder treatments (-2%), along with decreased hospitalisations (-12%) and sick leaves (-4%). TNFi had a greater sparing effect on NSAIDs and prednisone use than IL17i (ORa=1.04, 95% CI=1.01 to 1.07; 1.04, 1.02 to 1.06) and IL12/23i (1.07, 1.04 to 1.10; 1.06, 1.04 to 1.09). Odds of methotrexate discontinuation was reduced with TNFi versus IL17i (0.96, 0.94 to 0.98) and IL12/23i (0.94, 0.92 to 0.97). CONCLUSIONS Targeted therapy initiation for PsA reduced the use of associated treatment and healthcare, with TNFi having a slightly greater effect than IL17i and IL12/23i, except for methotrexate discontinuation.
Collapse
Affiliation(s)
- Laura Pina Vegas
- Service de Rhumatologie, Hôpital Henri Mondor, Créteil, Île-de-France, France
- EpiDermE, Université Paris-Est Créteil Val de Marne, Créteil, Île-de-France, France
| | - Siham Iggui
- Service de Rhumatologie, Hôpital Henri Mondor, Créteil, Île-de-France, France
| | - Emilie Sbidian
- Inserm, Centre d'investigation clinique 1430, Hôpital Henri Mondor, Créteil, Île-de-France, France
- Service de Dermatologie, Hôpital Henri Mondor, Créteil, Île-de-France, France
| | - Pascal Claudepierre
- Service de Rhumatologie, Hôpital Henri Mondor, Créteil, Île-de-France, France
- EpiDermE, Université Paris-Est Créteil Val de Marne, Créteil, Île-de-France, France
| |
Collapse
|
2
|
Mocritcaia A, Chacur C, Adao Abe CD, Azuaga-Piñango AB, Frade-Sosa B, Sarmiento-Monroy JC, Alascio L, Gómez-Puerta JA, Sanmartí R, Cañete JD, Ramírez J. Clinical and structural damage outcomes in axial spondyloarthritis patients receiving NSAIDs or advanced therapies: a description of a real-life cohort. Front Med (Lausanne) 2024; 11:1425449. [PMID: 38966536 PMCID: PMC11222589 DOI: 10.3389/fmed.2024.1425449] [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: 04/29/2024] [Accepted: 06/10/2024] [Indexed: 07/06/2024] Open
Abstract
Introduction This study aims to describe the clinical characteristics, disease activity, and structural damage in patients with axial spondyloarthritis (axSpA) who receive chronic treatment with nonsteroideal anti-inflammatory drugs (NSAIDs) or advanced therapies in a clinical setting. Methods Cross-sectional study on axSpA patients consecutively recruited from the outpatient clinic of a tertiary hospital. We collected data on clinical and demographic characteristics, as well as treatment patterns involving NSAIDs and advanced therapies. Structural damage was assessed using mSASSS. Results Overall, data from 193 axSpA patients (83% ankylosing spondylitis) were gathered, with a mean disease duration of 21.4 years. Of these, 85 patients (44%) were exclusively taking NSAIDs, while 108 (56%) were receiving advanced therapies, with TNF inhibitors being the predominant choice (93 out of 108, 86.1%). Among patients using NSAIDs, 64.7% followed an on-demand dosing regimen, while only 17.6% used full doses. Disease activity was low, with a mean BASDAI of 3.1 and a mean ASDAS-CRP of 1.8. In comparison to patients under chronic NSAID treatment, those taking advanced therapies were primarily male (69.4% versus 51.8%, p = 0.025) and significantly younger (mean age of 49 versus 53.9 years, p = 0.033). Additionally, patients on advanced therapies exhibited lower ASDAS-CRP (p = 0.046), although CRP serum levels and BASDAI scores did not differ between the two groups. In the multivariable analysis, therapy (NSAID versus biological treatment) was not independently associated with ASDAS-CRP, BASDAI or mSASSS. Conclusion This cross-sectional analysis of a real-world cohort of axSpA patients shows positive clinical and radiological outcomes for both NSAIDs and advanced therapies.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Julio Ramírez
- Rheumatology Department, Hospital Clínic, Barcelona, Spain
| |
Collapse
|
3
|
Zádori ZS, Király K, Al-Khrasani M, Gyires K. Interactions between NSAIDs, opioids and the gut microbiota - Future perspectives in the management of inflammation and pain. Pharmacol Ther 2023; 241:108327. [PMID: 36473615 DOI: 10.1016/j.pharmthera.2022.108327] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022]
Abstract
The composition of intestinal microbiota is influenced by a number of factors, including medications, which may have a substantial impact on host physiology. Nonsteroidal anti-inflammatory drugs (NSAIDs) and opioid analgesics are among those widely used medications that have been shown to alter microbiota composition in both animals and humans. Although much effort has been devoted to identify microbiota signatures associated with these medications, much less is known about the underlying mechanisms. Mucosal inflammation, changes in intestinal motility, luminal pH and bile acid metabolism, or direct drug-induced inhibitory effect on bacterial growth are all potential contributors to NSAID- and opioid-induced dysbiosis, however, only a few studies have addressed directly these issues. In addition, there is a notable overlap between the microbiota signatures of these drugs and certain diseases in which they are used, such as spondyloarthritis (SpA), rheumatoid arthritis (RA) and neuropathic pain associated with type 2 diabetes (T2D). The aims of the present review are threefold. First, we aim to provide a comprehensive up-to-date summary on the bacterial alterations caused by NSAIDs and opioids. Second, we critically review the available data on the possible underlying mechanisms of dysbiosis. Third, we review the current knowledge on gut dysbiosis associated with SpA, RA and neuropathic pain in T2D, and highlight the similarities between them and those caused by NSAIDs and opioids. We posit that drug-induced dysbiosis may contribute to the persistence of these diseases, and may potentially limit the therapeutic effect of these medications by long-term use. In this context, we will review the available literature data on the effect of probiotic supplementation and fecal microbiota transplantation on the therapeutic efficacy of NSAIDs and opioids in these diseases.
Collapse
Affiliation(s)
- Zoltán S Zádori
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary.
| | - Kornél Király
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary
| | - Mahmoud Al-Khrasani
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary
| | - Klára Gyires
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary
| |
Collapse
|
4
|
Armağan B, Atalar E, Güven SC, Özdemir B, Konak HE, Akyüz Dağlı P, Erden A, Gök K, Maraş Y, Doğan İ, Küçükşahin O, Erten Ş, Omma A. Effects of sulfasalazine in axial spondyloarthritis on COVID-19 outcomes: real-life data from a single center. Immunopharmacol Immunotoxicol 2022:1-7. [PMID: 36537308 DOI: 10.1080/08923973.2022.2160729] [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: 12/24/2022]
Abstract
INTRODUCTION Compared to biological agents, little is known about the impact of sulfasalazine therapy on COVID-19 outcomes in patients with Axial Spondyloarthritis (AxSpA). Therefore, we aimed to evaluate the COVID-19 severity in AxSpAs receiving sulfasalazine and biologic-agent. MATERIALS AND METHODS A total of 219 SARS-CoV-2 positive AxSpA patients were retrospectively analyzed. COVID-19 pneumonia, hospitalization rate, and length of stay were used to determine COVID-19 severity. AxSpA patients were mainly grouped and compared as sulfasalazine and non-sulfasalazine. Afterward, we excluded no-treatment patients to reveal the drug's effects more clearly and regrouped AxSpA patients as sulfasalazine-monotherapy (34.3%), biologic-monotherapy (33.7%), and sulfasalazine + biologic (7.3%). RESULTS Fifty-nine percent of the patients were male and the mean age was 45.0 years. Peripheral arthritis was 35% and uveitis 15%. In total, 41.5% of them have received sulfasalazine and 41.0% biologic agents, and the remaining patients with no AxSpA-specific treatment. In the first comparison, the sulfasalazine group had a higher age, more frequent COVID-19 pneumonia, hospitalization, and longer hospitalization than a non-sulfasalazine group. In the pairwise comparison of 3 treatment groups, the demographic and clinical features, the hospitalization rate and the length of hospital stay were similar but the sulfasalazine-monotherapy group had a higher frequency of COVID-19 pneumonia than the biologic-monotherapy group (23% vs. 7%, p = 0.008). CONCLUSION Our results imply sulfasalazine may be related to more severe COVID-19 in AxSpA patients. These patients should be followed more carefully in the presence of COVID-19, regardless of reasons such as age, comorbidity, and extra-axial disease, and consideration of discontinuing sulfasalazine maybe even thought.
Collapse
Affiliation(s)
- Berkan Armağan
- Rheumatology Clinic, Ankara City Hospital, Ankara, Turkey
| | - Ebru Atalar
- Rheumatology Clinic, Ankara City Hospital, Ankara, Turkey
| | | | - Bahar Özdemir
- Rheumatology Clinic, Ankara City Hospital, Ankara, Turkey
| | | | | | | | - Kevser Gök
- Rheumatology Clinic, Ankara City Hospital, Ankara, Turkey
| | - Yüksel Maraş
- Division of Rheumatology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - İsmail Doğan
- Division of Rheumatology, Department of Internal Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Orhan Küçükşahin
- Division of Rheumatology, Department of Internal Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Şükran Erten
- Division of Rheumatology, Department of Internal Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Ahmet Omma
- Rheumatology Clinic, Ankara City Hospital, Ankara, Turkey
| |
Collapse
|
5
|
Clinical Features and Drug Retention of TNF Inhibitors in Older Patients with Ankylosing Spondylitis: Results from the KOBIO Registry. BioDrugs 2022; 36:411-419. [PMID: 35349115 DOI: 10.1007/s40259-022-00524-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVES This study aimed to analyse the clinical features and outcomes of and reasons for discontinuing tumour necrosis factor (TNF) inhibitor therapy in older patients with ankylosing spondylitis (AS). METHODS Data were extracted from the nationwide Korean College of Rheumatology Biologics registry. Clinical variables and outcomes were compared, and drug retention rate was evaluated. RESULTS Among 1524 patients with AS treated with TNF inhibitors, 306 were aged ≥ 50 years ('older patients'). Fewer patients were male, the incidence of hypertension and diabetes was higher (all p < 0.001), and the proportion of peripheral arthritis (35.6 vs. 27.1%), Ankylosing Spondylitis Disease Activity Score‒erythrocyte sedimentation rate (4.0 ± 1.1 vs. 3.6 ± 1.0), and Bath Ankylosing Spondylitis Functional Index (4.2 ± 2.6 vs. 3.3 ± 2.5) were all higher in older patients. Although the drug retention rate was lower (log-rank p = 0.018) and lack of efficacy and adverse events were more frequent in older patients (both p < 0.001), drug retention rates were not different after propensity score matching (log-rank p = 0.23). Improvements in disease activity and manifestations were comparable between groups, except for the incidence of peripheral arthritis, which decreased significantly less in older patients over 3 and 5 years. CONCLUSION Improvements in disease-related clinical factors and drug retention rates were not different between older and younger patients with AS receiving TNF inhibitors. However, the incidence of adverse events was higher in older patients.
Collapse
|
6
|
Queiro-Silva R, García-Valle A, Alonso-Castro S, Alperi-López M. Do NSAIDs Take Us Away From Treatment Goals in Axial Spondyloarthritis: A Story About Dysbiosis or Just a Matter of Bias? Front Med (Lausanne) 2022; 8:817884. [PMID: 35004794 PMCID: PMC8739512 DOI: 10.3389/fmed.2021.817884] [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] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 12/08/2021] [Indexed: 12/17/2022] Open
Abstract
Non-steroidal anti-inflammatory drugs (NSAIDs) remain the mainstay of treatment for spondyloarthritides (SpA), a group of entities with common clinical and pathophysiological aspects, but also with differential features. Although NSAIDs provide significant symptomatic relief, especially for joint pain and morning stiffness, their role in achieving and maintaining the treatment goals advocated by the treat to target strategy in SpA is not entirely clear. These agents can induce changes in the composition of the intestinal microbiota, also favoring an alteration of the barrier function in the gut epithelium. All of this, favored by a pre-disposing genetic background, could activate a specific type of aberrant immune response in the gut lamina propria, also known as type-3 immunity. This article offers a perspective on how NSAIDs, despite their undeniable value in the short-term SpA treatment, could hinder the achievement of medium and long-term treatment goals by compromising the barrier function of the gut mucosa and potentially altering the composition of the gut microbiota.
Collapse
Affiliation(s)
- Rubén Queiro-Silva
- Rheumatology Division and Instituto de Investigación Sanitaria del Principado de Asturias Translational Immunology Section, Hospital Universitario Central de Asturias, Oviedo, Spain.,Oviedo University School of Medicine, Oviedo, Spain
| | - Andrea García-Valle
- Rheumatology Division, Complejo Asistencial Universitario de Palencia, Palencia, Spain
| | - Sara Alonso-Castro
- Rheumatology Division and Instituto de Investigación Sanitaria del Principado de Asturias Translational Immunology Section, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Mercedes Alperi-López
- Rheumatology Division and Instituto de Investigación Sanitaria del Principado de Asturias Translational Immunology Section, Hospital Universitario Central de Asturias, Oviedo, Spain.,Head of Rheumatology Division, Hospital Universitario Central de Asturias, Oviedo, Spain
| |
Collapse
|
7
|
García-Valle A, Andrés-de Llano JM, Fariña-González AJ, González-Benítez RD, Queiro-Silva R. Construct validity of The Routine Assessment of Patient Index Data 3 (RAPID3) in the evaluation of axial spondyloarthritis. J Rheumatol 2021; 49:36-43. [PMID: 34266987 DOI: 10.3899/jrheum.201362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Although there are different tools to evaluate axial spondyloarthritis (axSpA), they are hardly used in clinical routine due to time constraints. The Routine Assessment of Patient Index Data 3 (RAPID3) is a composite measure feasible to be used as a sole metric in busy clinics. We aimed to test its measurement properties in patients with axial SpA in a real clinical setting. METHODS Cross-sectional study that included 131 consecutive patients with axial SpA. The convergent (Spearman's rho) and discriminant (ROC curve analysis) validity of RAPID3 were tested against several axSpA-specific measures (BASDAI, ASDAS, BASFI, mSASSS). A multivariate model was built to detect disease factors associated with RAPID3 remission (values ≤3). RESULTS The study included 82 men and 49 women, median age of 55 years (IQR: 46-61), and median disease duration of 11 years (IQR: 6-24). Mean RAPID3 was 9.45 ± 6.7. The BASDAI showed moderate correlation with ASDAS (rho: 0.66, p < 0.0001), but higher with BASFI (rho: 0.78, p < 0.0001) and RAPID3 (rho: 0.75, p < 0.0001). The ASDAS had moderate correlations with BASFI, BASDAI, and RAPID3 (ranges from 0.66 to 0.68, p < 0.0001). Higher correlations were found between BASFI and BASDAI (rho: 0.78, p < 0.0001) and BASFI-RAPID3 (rho: 0.73, p < 0.0001). The m-SASSS did not show any correlation with any of the afore-mentioned composite measures. Kappa agreement between RAPID3 remission and other SpA remission criteria was moderate (k: 0.46-0.56). The RAPID3 thresholds to define remission ranged from values ≤2 to ≤ 6 with areas under the ROC curves between 0.86 and 0.91. Female sex (OR 0.34, 95%CI: 0.12- 0.90, p= 0.031) and NSAIDs intake (OR 0.26, 95%CI: 0.10-0.66, p= 0.005) were independently associated with lower odds of achieving RAPID3 remission. CONCLUSION RAPID3 demonstrated construct validity in this cross-sectional study. This index can be useful for a more comprehensive assessment of axSpA in busy clinical settings.
Collapse
Affiliation(s)
- Andrea García-Valle
- Rheumatology Division. Complejo Asistencial Universitario de Palencia, Palencia (Spain). Clinical Research Unit. Complejo Asistencial Universitario de Palencia, Palencia (Spain). Rheumatology & 4ISPA Translational Immunology Division. Hospital Universitario Central de Asturias (HUCA). Oviedo (Spain). Address correspondence to Rubén Queiro. M.D., Ph.D. Associate professor of Medicine. Oviedo University School of Medicine. Rheumatology Division. HUCA. Avenida de Roma s/n, 33011. Oviedo (Spain)
| | - Jesús María Andrés-de Llano
- Rheumatology Division. Complejo Asistencial Universitario de Palencia, Palencia (Spain). Clinical Research Unit. Complejo Asistencial Universitario de Palencia, Palencia (Spain). Rheumatology & 4ISPA Translational Immunology Division. Hospital Universitario Central de Asturias (HUCA). Oviedo (Spain). Address correspondence to Rubén Queiro. M.D., Ph.D. Associate professor of Medicine. Oviedo University School of Medicine. Rheumatology Division. HUCA. Avenida de Roma s/n, 33011. Oviedo (Spain)
| | - Aarón Josué Fariña-González
- Rheumatology Division. Complejo Asistencial Universitario de Palencia, Palencia (Spain). Clinical Research Unit. Complejo Asistencial Universitario de Palencia, Palencia (Spain). Rheumatology & 4ISPA Translational Immunology Division. Hospital Universitario Central de Asturias (HUCA). Oviedo (Spain). Address correspondence to Rubén Queiro. M.D., Ph.D. Associate professor of Medicine. Oviedo University School of Medicine. Rheumatology Division. HUCA. Avenida de Roma s/n, 33011. Oviedo (Spain)
| | - Roberto Daniel González-Benítez
- Rheumatology Division. Complejo Asistencial Universitario de Palencia, Palencia (Spain). Clinical Research Unit. Complejo Asistencial Universitario de Palencia, Palencia (Spain). Rheumatology & 4ISPA Translational Immunology Division. Hospital Universitario Central de Asturias (HUCA). Oviedo (Spain). Address correspondence to Rubén Queiro. M.D., Ph.D. Associate professor of Medicine. Oviedo University School of Medicine. Rheumatology Division. HUCA. Avenida de Roma s/n, 33011. Oviedo (Spain)
| | - Rubén Queiro-Silva
- Rheumatology Division. Complejo Asistencial Universitario de Palencia, Palencia (Spain). Clinical Research Unit. Complejo Asistencial Universitario de Palencia, Palencia (Spain). Rheumatology & 4ISPA Translational Immunology Division. Hospital Universitario Central de Asturias (HUCA). Oviedo (Spain). Address correspondence to Rubén Queiro. M.D., Ph.D. Associate professor of Medicine. Oviedo University School of Medicine. Rheumatology Division. HUCA. Avenida de Roma s/n, 33011. Oviedo (Spain)
| |
Collapse
|
8
|
da Cruz Lage R, Marques CDL, Oliveira TL, Resende GG, Kohem CL, Saad CG, Ximenes AC, Gonçalves CR, Bianchi WA, de Souza Meirelles E, Keiserman MW, Chiereghin A, Campanholo CB, Lyrio AM, Schainberg CG, Pieruccetti LB, Yazbek MA, Palominos PE, Goncalves RSG, Assad RL, Bonfiglioli R, Lima SMAAL, Carneiro S, Azevedo VF, Albuquerque CP, Bernardo WM, Sampaio-Barros PD, de Medeiros Pinheiro M. Brazilian recommendations for the use of nonsteroidal anti-inflammatory drugs in patients with axial spondyloarthritis. Adv Rheumatol 2021; 61:4. [PMID: 33468245 DOI: 10.1186/s42358-020-00160-6] [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] [Received: 07/03/2020] [Accepted: 12/29/2020] [Indexed: 01/04/2023] Open
Abstract
Spondyloarthritis (SpA) is a group of chronic inflammatory systemic diseases characterized by axial and/or peripheral joints inflammation, as well as extra-articular manifestations. Over some decades, nonsteroidal anti-inflammatory drugs (NSAIDs) have been the basis for the pharmacological treatment of patients with axial spondyloarthritis (axSpA). However, the emergence of the immunobiologic agents brought up the discussion about the role of NSAIDs in the management of these patients. The objective of this guideline is to provide recommendations for the use of NSAIDs for the treatment of axSpA. A panel of experts from the Brazilian Society of Rheumatology conducted a systematic review and meta-analysis of randomized clinical trials for 15 predefined questions. The Grading of Recommendations, Assessment, Development and Evaluation methodology to assess the quality of evidence and formulate recommendations were used, and at least 70% agreement of the voting panel was needed. Fourteen recommendations for the use of NSAIDs in the treatment of patients with axSpA were elaborated. The purpose of these recommendations is to support clinicians' decision making, without taking out his/her autonomy when prescribing for an individual patient.
Collapse
Affiliation(s)
- Ricardo da Cruz Lage
- Universidade Federal de Minas Gerais (UFMG), Alameda Álvaro Celso 175, Ambulatório Bias Fortes, 2° andar, Belo Horizonte, MG, 30150-260, Brazil.
| | | | | | - Gustavo Gomes Resende
- Universidade Federal de Minas Gerais (UFMG), Alameda Álvaro Celso 175, Ambulatório Bias Fortes, 2° andar, Belo Horizonte, MG, 30150-260, Brazil
| | | | | | | | | | | | | | | | - Adriano Chiereghin
- Pontifícia Universidade Católica (PUC) de Sorocaba, Sorocaba, SP, Brazil
| | | | - André Marun Lyrio
- Pontifícia Universidade Católica (PUC) de Campinas, Campinas, SP, Brazil
| | | | | | | | | | | | | | - Rubens Bonfiglioli
- Pontifícia Universidade Católica (PUC) de Campinas, Campinas, SP, Brazil
| | | | - Sueli Carneiro
- Universidade Federal do Rio De Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | | | | | | | | | | |
Collapse
|
9
|
Dawidowicz M, Kula A, Świętochowski P, Ostrowska Z. Assessment of the impact of PTGS1, PTGS2 and CYP2C9 polymorphisms on pain, effectiveness and safety of NSAID therapies. POSTEP HIG MED DOSW 2020. [DOI: 10.5604/01.3001.0014.5497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Cyclooxygenase 1 and 2 (COX-1, COX-2) are enzymes that catalyze the first reaction in the arachidonic acid pathway. COXs are the therapeutic target for non-steroidal anti-inflammatory drugs. Inhibition of COX enzymatic activity has an analgesic, anti-inflammatory and sometimes antiplatelet effect. Single-nucleotide polymorphisms (SNPs) within genes encoding COX-1 and COX-2 (PTGS1, PTGS2) influence the risk of pain and their intensity in some diseases. They also affect the effectiveness of NSAID therapy in rheumatoid diseases. Moreover, the relationship between certain polymorphisms of PTGS2 and a higher risk of migraine and the development of aspirin resistance in the prophylaxis of cardiovascular diseases was demonstrated. The isoform of cytochrome P450, CYP2C9 has a significant influence on the efficacy and safety of NSAID use. It is responsible for the metabolism and speed of removal of these drugs. The occurrence of some of its polymorphic forms is associated with a decrease in CYP2C9 enzymatic activity, leading to changes in the pharmacokinetics and pharmacodynamics of NSAIDs. The prolonged half-life and decrease in clearance of these drugs lead to serious side effects such as hepatotoxicity, nephrotoxicity, anaphylactic reactions, cardiovascular or gastrointestinal incidents. Studies on polymorphisms of cyclooxygenases and CYP2C9 may improve the safety and efficacy of NSAIDs therapy by adjusting the dose to individual polymorphic variants, as well as expanding knowledge about the pathomechanism of inflammatory diseases.
Collapse
Affiliation(s)
- Miriam Dawidowicz
- Department of Medical and Molecular Biology, Medical University of Silesia in Zabrze, Poland
| | - Agnieszka Kula
- Department of Medical and Molecular Biology, Medical University of Silesia in Zabrze, Poland
| | | | - Zofia Ostrowska
- Department of Medical and Molecular Biology, Medical University of Silesia in Zabrze, Poland
| |
Collapse
|
10
|
Xiong JH, Liu J, Chen J. Clinical significance and prognostic value of tumor necrosis factor-α and dickkopf related protein-1 in ankylosing spondylitis. World J Clin Cases 2020; 8:1213-1222. [PMID: 32337195 PMCID: PMC7176625 DOI: 10.12998/wjcc.v8.i7.1213] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 03/02/2020] [Accepted: 03/19/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Ankylosing spondylitis (AS) frequently occurs in people aged 30-45 years, and its prevalence is generally believed to be between 0.1% and 1.4% globally. At present, the “gold standard” for diagnosis of AS requires the provision of pelvic X-rays, which makes it more difficult to perform in population-based epidemiological studies. Therefore, the identification of serological indicators related to the diagnosis, treatment, and prognosis of AS patients is of great significance.
AIM To analyze the therapeutic, diagnostic significance and prognostic value of dickkopf-related protein-1 (DKK-1) and tumor necrosis factor-α (TNF-α) in AS.
METHODS A total of 113 patients with active AS were selected as the research group, and 100 healthy subjects who underwent physical examination were selected as the control group. The levels of DKK-1 and TNF-α in peripheral blood in the two groups were compared. The diagnostic and predictive values of DKK-1 and TNF-α for AS were analyzed with ROC curves, and the factors influencing AS recurrence were analyzed with COX regression.
RESULTS Before treatment, the research group showed lower DKK-1 levels but higher TNF-α levels than the control group (both aP < 0.05). In the research group, DKK-1 was up-regulated and TNF-α was down-regulated after 12 wk of treatment (aP < 0.05). The area under the curve, sensitivity and specificity of DKK-1 combined with TNF-α for diagnosing AS were 0.934, 82.30% and 97.00%, respectively. Before treatment, the area under the curve, cutoff value, sensitivity and specificity of DKK-1 for predicting the curative effect were 0.825, 68.42 pg/mL, 73.68% and 80.00%, respectively, and those of TNF-α were 0.863, 32.79 ng/L, 92.11% and 77.33%, respectively. DKK-1 and TNF-α levels after treatment were closely related to the curative effect (aP < 0.05). C-reactive protein, the Bath Ankylosing Spondylitis Disease Activity Index, DKK-1, and TNF-α were risk factors for AS recurrence (aP < 0.05).
CONCLUSION DKK-1 and TNF-α are effective in the diagnosis and treatment of AS and are risk factors for its recurrence. In addition, DKK-1 may be a potential target for the diagnosis of AS.
Collapse
Affiliation(s)
- Jun-Hui Xiong
- Department of Rheumatology, Lishui People’s Hospital, Lishui 323000, Zhejiang Province, China
| | - Jian Liu
- Department of Rheumatology, Lishui People’s Hospital, Lishui 323000, Zhejiang Province, China
| | - Jian Chen
- Department of Rheumatology, Lishui People’s Hospital, Lishui 323000, Zhejiang Province, China
| |
Collapse
|
11
|
Shakibaie M, Forootanfar H, Ghaseminejad A, Salimi A, Ameri A, Doostmohammadi M, Jafari E, Rahimi H. Ondansetron enhanced diclofenac‐induced nephrotoxicity in mice. J Biochem Mol Toxicol 2019; 33:e22378. [DOI: 10.1002/jbt.22378] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 04/16/2019] [Accepted: 06/17/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Mojtaba Shakibaie
- Pharmaceutics Research Center, Institute of NeuropharmacologyKerman University of Medical Sciences Kerman Iran
- Department of Pharmaceutical Biotechnology, Faculty of PharmacyKerman University of Medical Sciences Kerman Iran
| | - Hamid Forootanfar
- Pharmaceutics Research Center, Institute of NeuropharmacologyKerman University of Medical Sciences Kerman Iran
- Department of Pharmaceutical Biotechnology, Faculty of PharmacyKerman University of Medical Sciences Kerman Iran
| | - Atoosa Ghaseminejad
- Student Research Committee, School of MedicineKerman University of Medical Sciences Kerman Iran
| | - Azad Salimi
- Student Research Committee, School of MedicineKerman University of Medical Sciences Kerman Iran
- Department of Pharmacology and Toxicology, Faculty of PharmacyKerman University of Medical Sciences Kerman Iran
| | - Atefeh Ameri
- Pharmaceutics Research Center, Institute of NeuropharmacologyKerman University of Medical Sciences Kerman Iran
| | - Mohsen Doostmohammadi
- Pharmaceutics Research Center, Institute of NeuropharmacologyKerman University of Medical Sciences Kerman Iran
- Department of Pharmaceutical Biotechnology, Faculty of PharmacyKerman University of Medical Sciences Kerman Iran
| | - Elham Jafari
- Pathology and Stem Cells Research CenterKerman University of Medical Science Kerman Iran
| | - Hamid‐Reza Rahimi
- Student Research Committee, School of MedicineKerman University of Medical Sciences Kerman Iran
- Department of Pharmacology and Toxicology, Faculty of PharmacyKerman University of Medical Sciences Kerman Iran
| |
Collapse
|