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Matsubara T, Inoue H, Nakajima T, Tanimura K, Sagawa A, Sato Y, Osano K, Nagano S, Ueki Y, Hanyu T, Hashizume K, Amano N, Tanaka Y, Takeuchi T. Abatacept in combination with methotrexate in Japanese biologic-naive patients with active rheumatoid arthritis: a randomised placebo-controlled phase IV study. RMD Open 2018; 4:e000813. [PMID: 30622737 PMCID: PMC6307574 DOI: 10.1136/rmdopen-2018-000813] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/02/2018] [Accepted: 11/04/2018] [Indexed: 12/15/2022] Open
Abstract
Objectives To evaluate efficacy and safety of abatacept+methotrexate (MTX) in biologic-naive, anticitrullinated protein antibody (ACPA)-positive Japanese patients with active rheumatoid arthritis (RA) and early erosion versus placebo+MTX. Methods In this phase IV, multicentre, double-blind study (NCT01758198), patients were randomised (1:1) to receive intravenous abatacept (~10 mg/kg) or placebo, plus MTX (≥6 mg/week). Primary efficacy objectives were to compare American College of Rheumatology 20 (ACR20) response rates at week 16 and mean change from baseline in van der Heijde-modified total Sharp score (vdH-mTSS) at week 24 between abatacept+MTX and placebo+MTX groups. Results Overall, 203 and 202 patients received abatacept+MTX and placebo+MTX, respectively. At week 16, ACR20 response rates were higher in the abatacept (75.4%) versus placebo group (27.7%; p<0.001). Mean change from baseline in vdH-mTSS at week 24 was 0.84 in the abatacept and 1.26 in the placebo group (p=0.017). Radiographic non-progression rates (change in vdH-mTSS≤smallest detectable change (1.9)) were 88.1% and 75.4% in abatacept and placebo groups, respectively. Adjusted mean change from baseline in Disease Activity Score 28 (C-reactive protein) (DAS28 (CRP)) at week 16 demonstrated a numerically greater reduction in the abatacept versus placebo group. Proportions of patients with DAS28 (CRP), Simplified Disease Activity Index and Clinical Disease Activity Index remission up to week 52 were higher in the abatacept versus placebo group. The abatacept safety profile was consistent with previous observations. Conclusions Compared with MTX alone, abatacept+MTX improved clinical symptoms and inhibited structural damage progression in ACPA-positive, Japanese patients with RA, early erosion and inadequate response to MTX.
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Affiliation(s)
- Tsukasa Matsubara
- Department of Orthopedics, Matsubara Mayflower Hospital, Hyogo, Japan
| | - Hiroshi Inoue
- Department of Orthopaedic Surgery, Inoue Hospital, Gunma, Japan
| | - Toshihiro Nakajima
- Department of Rheumatology, Bay Side Misato Medical Center, Kochi, Japan.,Department of Locomotor Science, Institute of Medical Science, Tokyo Medical University, Tokyo, Japan
| | - Kazuhide Tanimura
- Department of Rheumatology, Hokkaido Medical Center for Rheumatic Diseases, Sapporo, Japan
| | - Akira Sagawa
- Akira Sagawa Rheumatology Clinic, Sapporo, Japan
| | - Yukio Sato
- Sendai Taihaku Hospital, Sendai, Japan.,Sendai Medical Imaging Clinic, Sendai, Japan
| | - Kei Osano
- Department of Orthopaedics, Fukuoka Mirai Hospital, Fukuoka, Japan
| | - Shuji Nagano
- Department of Rheumatology, Center for Rheumatology, Iizuka Hospital, Fukuoka, Japan
| | - Yukitaka Ueki
- Rheumatic and Collagen Disease Center, Sasebo Chuo Hospital, Nagasaki, Japan
| | - Tadamasa Hanyu
- Department of Rheumatology, Nagaoka Red Cross Hospital, Niigata, Japan
| | | | | | - Yoshiya Tanaka
- First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
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Biros E, Gäbel G, Moran CS, Schreurs C, Lindeman JHN, Walker PJ, Nataatmadja M, West M, Holdt LM, Hinterseher I, Pilarsky C, Golledge J. Differential gene expression in human abdominal aortic aneurysm and aortic occlusive disease. Oncotarget 2016; 6:12984-96. [PMID: 25944698 PMCID: PMC4536993 DOI: 10.18632/oncotarget.3848] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 03/21/2015] [Indexed: 11/25/2022] Open
Abstract
Abdominal aortic aneurysm (AAA) and aortic occlusive disease (AOD) represent common causes of morbidity and mortality in elderly populations which were previously believed to have common aetiologies. The aim of this study was to assess the gene expression in human AAA and AOD. We performed microarrays using aortic specimen obtained from 20 patients with small AAAs (≤ 55mm), 29 patients with large AAAs (> 55mm), 9 AOD patients, and 10 control aortic specimens obtained from organ donors. Some differentially expressed genes were validated by quantitative-PCR (qRT-PCR)/immunohistochemistry. We identified 840 and 1,014 differentially expressed genes in small and large AAAs, respectively. Immune-related pathways including cytokine-cytokine receptor interaction and T-cell-receptor signalling were upregulated in both small and large AAAs. Examples of validated genes included CTLA4 (2.01-fold upregulated in small AAA, P = 0.002), NKTR (2.37-and 2.66-fold upregulated in small and large AAA with P = 0.041 and P = 0.015, respectively), and CD8A (2.57-fold upregulated in large AAA, P = 0.004). 1,765 differentially expressed genes were identified in AOD. Pathways upregulated in AOD included metabolic and oxidative phosphorylation categories. The UCP2 gene was downregulated in AOD (3.73-fold downregulated, validated P = 0.017). In conclusion, the AAA and AOD transcriptomes were very different suggesting that AAA and AOD have distinct pathogenic mechanisms.
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Affiliation(s)
- Erik Biros
- The Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Gabor Gäbel
- Department of Vascular and Endovascular Surgery, Ludwig-Maximillian University, Munich, Germany
| | - Corey S Moran
- The Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Charlotte Schreurs
- Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan H N Lindeman
- Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Philip J Walker
- Royal Brisbane Clinical School, The University of Queensland, Queensland, Australia
| | - Maria Nataatmadja
- The Cardiovascular Research Group, Department of Medicine, The University of Queensland, Queensland, Australia
| | - Malcolm West
- The Cardiovascular Research Group, Department of Medicine, The University of Queensland, Queensland, Australia
| | - Lesca M Holdt
- Institute of Laboratory Medicine, Ludwig Maximilians University Munich, Munich, Germany
| | - Irene Hinterseher
- Department of General, Visceral, Vascular and Thoracic Surgery, Charité Universitätsmedizin Berlin, Charité Campus Mitte, Berlin, Germany
| | - Christian Pilarsky
- Department of Vascular, Thoracic and Visceral Surgery, TU-Dresden, Dresden, Germany
| | - Jonathan Golledge
- The Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.,Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, Queensland, Australia
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Takeuchi T, Matsubara T, Ohta S, Mukai M, Amano K, Tohma S, Tanaka Y, Yamanaka H, Miyasaka N. Biologic-free remission of established rheumatoid arthritis after discontinuation of abatacept: a prospective, multicentre, observational study in Japan. Rheumatology (Oxford) 2014; 54:683-91. [PMID: 25257039 PMCID: PMC4372674 DOI: 10.1093/rheumatology/keu338] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Objective. The aim of this study was to determine whether biologic-free remission of RA is possible with discontinuation of abatacept. Methods. Japanese RA patients in 28-joint DAS with CRP (DAS28-CRP) remission (<2.3) after >2 years of abatacept treatment in a phase II study and its long-term extension entered this 52 week, multicentre, non-blinded, prospective, observational study. At enrolment, the patients were offered the option to continue abatacept or not. The primary endpoint was the proportion of patients who remained biologic-free at 52 weeks after discontinuation. Clinical, functional and structural outcomes were compared between those who continued and those who discontinued abatacept. Results. Of 51 patients enrolled, 34 discontinued and 17 continued abatacept treatment. After 52 weeks, 22 of the 34 patients (64.7%) remained biologic-free. Compared with the continuation group, the discontinuation group had a similar remission rate (41.2% vs 64.7%, P = 0.144) although they had a significantly higher mean DAS28-CRP score at week 52 (2.9 vs 2.0, P = 0.012). The two groups were also similar with regard to mean HAQ Disability Index (HAQ-DI) score (0.6 for both, P = 0.920), mean change in total Sharp score (ΔTSS; 0.80 vs 0.32, P = 0.374) and proportion of patients in radiographic remission (ΔTSS ≤ 0.5) at the endpoint (64.3% vs 70.6%, P = 0.752). Those attaining DAS28-CRP < 2.3 or < 2.7 without abatacept at the endpoint had significantly lower HAQ-DI score and/or CRP at enrolment. Non-serious adverse events occurred in three patients who continued or resumed abatacept. Conclusion. Biologic-free remission of RA is possible in some patients after attaining clinical remission with abatacept. Lower baseline HAQ-DI or CRP may predict maintenance of remission or low disease activity after discontinuation of abatacept. Trial registration: UMIN Clinical Trials Registry, http://www.umin.ac.jp/ctr/ (UMIN000004137).
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Affiliation(s)
- Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Department of Rheumatology, Matsubara Mayflower Hospital, Kato, Department of Rheumatology, Taga General Hospital, Hitachi, Division of Rheumatology and Clinical Immunology, Department of Medicine, Sapporo City General Hospital, Sapporo, Department of Rheumatology and Clinical Immunology, Saitama Medical Center, Saitama Medical University, Kawagoe, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health Hospital, Kitakyushu, Institute of Rheumatology, Tokyo Women's Medical University, Tokyo and Tokyo Medical and Dental University, Tokyo, Japan.
| | - Tsukasa Matsubara
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Department of Rheumatology, Matsubara Mayflower Hospital, Kato, Department of Rheumatology, Taga General Hospital, Hitachi, Division of Rheumatology and Clinical Immunology, Department of Medicine, Sapporo City General Hospital, Sapporo, Department of Rheumatology and Clinical Immunology, Saitama Medical Center, Saitama Medical University, Kawagoe, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health Hospital, Kitakyushu, Institute of Rheumatology, Tokyo Women's Medical University, Tokyo and Tokyo Medical and Dental University, Tokyo, Japan
| | - Shuji Ohta
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Department of Rheumatology, Matsubara Mayflower Hospital, Kato, Department of Rheumatology, Taga General Hospital, Hitachi, Division of Rheumatology and Clinical Immunology, Department of Medicine, Sapporo City General Hospital, Sapporo, Department of Rheumatology and Clinical Immunology, Saitama Medical Center, Saitama Medical University, Kawagoe, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health Hospital, Kitakyushu, Institute of Rheumatology, Tokyo Women's Medical University, Tokyo and Tokyo Medical and Dental University, Tokyo, Japan
| | - Masaya Mukai
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Department of Rheumatology, Matsubara Mayflower Hospital, Kato, Department of Rheumatology, Taga General Hospital, Hitachi, Division of Rheumatology and Clinical Immunology, Department of Medicine, Sapporo City General Hospital, Sapporo, Department of Rheumatology and Clinical Immunology, Saitama Medical Center, Saitama Medical University, Kawagoe, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health Hospital, Kitakyushu, Institute of Rheumatology, Tokyo Women's Medical University, Tokyo and Tokyo Medical and Dental University, Tokyo, Japan
| | - Koichi Amano
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Department of Rheumatology, Matsubara Mayflower Hospital, Kato, Department of Rheumatology, Taga General Hospital, Hitachi, Division of Rheumatology and Clinical Immunology, Department of Medicine, Sapporo City General Hospital, Sapporo, Department of Rheumatology and Clinical Immunology, Saitama Medical Center, Saitama Medical University, Kawagoe, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health Hospital, Kitakyushu, Institute of Rheumatology, Tokyo Women's Medical University, Tokyo and Tokyo Medical and Dental University, Tokyo, Japan
| | - Shigeto Tohma
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Department of Rheumatology, Matsubara Mayflower Hospital, Kato, Department of Rheumatology, Taga General Hospital, Hitachi, Division of Rheumatology and Clinical Immunology, Department of Medicine, Sapporo City General Hospital, Sapporo, Department of Rheumatology and Clinical Immunology, Saitama Medical Center, Saitama Medical University, Kawagoe, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health Hospital, Kitakyushu, Institute of Rheumatology, Tokyo Women's Medical University, Tokyo and Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshiya Tanaka
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Department of Rheumatology, Matsubara Mayflower Hospital, Kato, Department of Rheumatology, Taga General Hospital, Hitachi, Division of Rheumatology and Clinical Immunology, Department of Medicine, Sapporo City General Hospital, Sapporo, Department of Rheumatology and Clinical Immunology, Saitama Medical Center, Saitama Medical University, Kawagoe, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health Hospital, Kitakyushu, Institute of Rheumatology, Tokyo Women's Medical University, Tokyo and Tokyo Medical and Dental University, Tokyo, Japan
| | - Hisashi Yamanaka
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Department of Rheumatology, Matsubara Mayflower Hospital, Kato, Department of Rheumatology, Taga General Hospital, Hitachi, Division of Rheumatology and Clinical Immunology, Department of Medicine, Sapporo City General Hospital, Sapporo, Department of Rheumatology and Clinical Immunology, Saitama Medical Center, Saitama Medical University, Kawagoe, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health Hospital, Kitakyushu, Institute of Rheumatology, Tokyo Women's Medical University, Tokyo and Tokyo Medical and Dental University, Tokyo, Japan
| | - Nobuyuki Miyasaka
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Department of Rheumatology, Matsubara Mayflower Hospital, Kato, Department of Rheumatology, Taga General Hospital, Hitachi, Division of Rheumatology and Clinical Immunology, Department of Medicine, Sapporo City General Hospital, Sapporo, Department of Rheumatology and Clinical Immunology, Saitama Medical Center, Saitama Medical University, Kawagoe, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health Hospital, Kitakyushu, Institute of Rheumatology, Tokyo Women's Medical University, Tokyo and Tokyo Medical and Dental University, Tokyo, Japan
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