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El Nokrashy A, Lightman S, Tomkins-Netzer O. Efficacy of Infliximab in Disease Control of Refractory Orbital Myositis. Ocul Immunol Inflamm 2023; 31:153-157. [PMID: 34781805 DOI: 10.1080/09273948.2021.2001663] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE Orbital myositis is a common cause of orbital inflammation with localized involvement of the extra ocular muscles. This study aimed to assess the value of infliximab in controlling orbital myositis and reducing its relapse rate. METHODS We conducted a retrospective review of the medical records of all consecutive patients with orbital myositis treated with infliximab between 2007 and 2016. We examined change in corticosteroid and immunomodulatory doses as well as relapse rates following treatment with infliximab. RESULTS The study included seven patients with an average follow up of 19 ± 13.4 months. The mean dose of systemic corticosteroid was reduced from 28.57 ± 14.35 mg/day at the time of infliximab initiation to 7.00 ± 6.83 mg/day at final follow-up (p = .003). Long-term remission was achieved in 85.7% (n = 6). CONCLUSION This study supports the role of infliximab in treating refractory orbital myositis and this was associated with clinical improvement, decreasing relapse rate with dose reduction of conventional treatment.
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Affiliation(s)
| | - Sue Lightman
- Moorfields Eye Hospital, London, UK.,Institute of Ophthalmology, University College London, London, UK
| | - Oren Tomkins-Netzer
- Moorfields Eye Hospital, London, UK.,Institute of Ophthalmology, University College London, London, UK.,Department of Ophthalmology, Lady Davis Carmel Medical Center, Technion, Haifa, Israel
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Maccora I, dell’Anna MP, Vannacci A, Simonini G. Safety evaluations of adalimumab for childhood chronic rheumatic diseases. Expert Opin Drug Saf 2020; 19:661-671. [DOI: 10.1080/14740338.2020.1763300] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Ilaria Maccora
- Rheumatology Unit, Anna Meyer Children’s Hospital, NEUROFARBA Department, University of Florence, Florence, Italy
| | - Maria Pia dell’Anna
- Rheumatology Unit, Anna Meyer Children’s Hospital, NEUROFARBA Department, University of Florence, Florence, Italy
| | - Alfredo Vannacci
- Department of Neurosciences, Psychology, Drug Research and Child Health, Unit of Adverse Drug Reaction Monitoring and Pharmacoepidemiology, Tuscan Regional Centre of Pharmacovigilance, University of Florence, Florence, Italy
| | - Gabriele Simonini
- Rheumatology Unit, Anna Meyer Children’s Hospital, NEUROFARBA Department, University of Florence, Florence, Italy
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Cimaz R, Maioli G, Calabrese G. Current and emerging biologics for the treatment of juvenile idiopathic arthritis. Expert Opin Biol Ther 2020; 20:725-740. [PMID: 32116038 DOI: 10.1080/14712598.2020.1733524] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION The management of a child with juvenile idiopathic arthritis (JIA) requires a combination of pharmacological, physical, and psychosocial therapies in order to induce disease remission, by controlling articular and systemic inflammation. This review aims to provide a comprehensive discussion on the biological therapies currently in use in the treatment of JIA referring to existing recommendations and clinical evidence. We also discuss on the emerging biological drugs actually under consideration. AREAS COVERED Recent findings on immunological mechanisms involved in the pathogenesis of the disease allowed us to identify several specific targets for biologic therapies. A systematic literature review was conducted between January 1997 and January 2020 on PubMed including national and international guidelines and recommendations, trials and case-control studies. EXPERT OPINION There is now a plethora of therapies that are directed against variable targets, and the physician has to choose the most appropriate available medication in order to achieve early and sustained remission with as few side effects as possible. Research is advancing very fast in order to be more and more specific in suppressing inflammatory pathways without harming natural defenses. Finally, pharmacoeconomic considerations will also be very important to deal with, considering the high cost of most of these molecules.
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Affiliation(s)
- Rolando Cimaz
- Pediatric Rheumatology Department, ASST-Gaetano Pini-CTO, Department of Clinical Sciences and Community Health, University of Milan , Milan, Italy.,Pediatric Rheumatology Department, ASST-Gaetano Pini-CTO, University of Milan , Milan, Italy
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Leong JY, Chen P, Yeo JG, Ally F, Chua C, Nur Hazirah S, Poh SL, Pan L, Lai L, Lee ESC, Bathi LDT, Arkachaisri T, Lovell D, Albani S. Immunome perturbation is present in patients with juvenile idiopathic arthritis who are in remission and will relapse upon anti-TNFα withdrawal. Ann Rheum Dis 2019; 78:1712-1721. [PMID: 31540934 PMCID: PMC6900250 DOI: 10.1136/annrheumdis-2019-216059] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 08/26/2019] [Accepted: 09/13/2019] [Indexed: 12/17/2022]
Abstract
Objectives Biologics treatment with antitumour necrosis factor alpha (TNFα) is efficacious in patients with juvenile idiopathic arthritis (JIA). Despite displaying clinical inactivity during treatment, many patients will flare on cessation of therapy. The inability to definitively discriminate patients who will relapse or continue to remain in remission after therapy withdrawal is currently a major unmet medical need. CD4 T cells have been implicated in active disease, yet how they contribute to disease persistence despite treatment is unknown. Methods We interrogated the circulatory reservoir of CD4+ immune subsets at the single-cell resolution with mass cytometry (cytometry by time of flight) of patients with JIA (n=20) who displayed continuous clinical inactivity for at least 6 months with anti-TNFα and were subsequently withdrawn from therapy for 8 months, and scored as relapse or remission. These patients were examined prior to therapy withdrawal for putative subsets that could discriminate relapse from remission. We verified on a separate JIA cohort (n=16) the dysregulation of these circulatory subsets 8 months into therapy withdrawal. The immunological transcriptomic signature of CD4 memory in relapse/remission patients was examined with NanoString. Results An inflammatory memory subset of CD3+CD4+CD45RA−TNFα+ T cells deficient in immune checkpoints (PD1−CD152−) was present in relapse patients prior to therapy withdrawal. Transcriptomic profiling reveals divergence between relapse and remission patients in disease-centric pathways involving (1) T-cell receptor activation, (2) apoptosis, (3) TNFα, (4) nuclear factor-kappa B and (5) mitogen-activated protein kinase signalling. Conclusions A unique discriminatory immunomic and transcriptomic signature is associated with relapse patients and may explain how relapse occurs.
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Affiliation(s)
- Jing Yao Leong
- Translational Immunology Institute, Singhealth/Duke-NUS Academic Medical Centre, Singapore Health Service, Singapore, Singapore
| | - Phyllis Chen
- Translational Immunology Institute, Singhealth/Duke-NUS Academic Medical Centre, Singapore Health Service, Singapore, Singapore
| | - Joo Guan Yeo
- Translational Immunology Institute, Singhealth/Duke-NUS Academic Medical Centre, Singapore Health Service, Singapore, Singapore.,Division of Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Fauziah Ally
- Translational Immunology Institute, Singhealth/Duke-NUS Academic Medical Centre, Singapore Health Service, Singapore, Singapore
| | - Camillus Chua
- Translational Immunology Institute, Singhealth/Duke-NUS Academic Medical Centre, Singapore Health Service, Singapore, Singapore
| | - Sharifah Nur Hazirah
- Translational Immunology Institute, Singhealth/Duke-NUS Academic Medical Centre, Singapore Health Service, Singapore, Singapore
| | - Su Li Poh
- Translational Immunology Institute, Singhealth/Duke-NUS Academic Medical Centre, Singapore Health Service, Singapore, Singapore
| | - Lu Pan
- Translational Immunology Institute, Singhealth/Duke-NUS Academic Medical Centre, Singapore Health Service, Singapore, Singapore
| | - Liyun Lai
- Translational Immunology Institute, Singhealth/Duke-NUS Academic Medical Centre, Singapore Health Service, Singapore, Singapore
| | | | - Loshinidevi D/O Thana Bathi
- Translational Immunology Institute, Singhealth/Duke-NUS Academic Medical Centre, Singapore Health Service, Singapore, Singapore
| | - Thaschawee Arkachaisri
- Translational Immunology Institute, Singhealth/Duke-NUS Academic Medical Centre, Singapore Health Service, Singapore, Singapore.,Division of Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Daniel Lovell
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Paediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Salvatore Albani
- Translational Immunology Institute, Singhealth/Duke-NUS Academic Medical Centre, Singapore Health Service, Singapore, Singapore
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Tu ZQ, Xue HY, Chen W, Cao LF, Zhang WQ. Identification of potential peripheral blood diagnostic biomarkers for patients with juvenile idiopathic arthritis by bioinformatics analysis. Rheumatol Int 2016; 37:423-434. [DOI: 10.1007/s00296-016-3607-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 11/15/2016] [Indexed: 11/28/2022]
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