1
|
Smolen JS, Feist E, Fatenejad S, Grishin SA, Korneva EV, Nasonov EL, Samsonov MY, Fleischmann RM. Olokizumab versus Placebo or Adalimumab in Rheumatoid Arthritis. N Engl J Med 2022; 387:715-726. [PMID: 36001712 DOI: 10.1056/nejmoa2201302] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The cytokine interleukin-6 is involved in the pathogenesis of rheumatoid arthritis. Olokizumab, a humanized monoclonal antibody targeting the interleukin-6 cytokine directly, is being tested for the treatment of rheumatoid arthritis. METHODS In a 24-week, phase 3, multicenter, placebo- and active-controlled trial, we randomly assigned (in a 2:2:2:1 ratio) patients with rheumatoid arthritis and an inadequate response to methotrexate to receive subcutaneous olokizumab at a dose of 64 mg every 2 or 4 weeks, adalimumab (40 mg every 2 weeks), or placebo; all patients continued methotrexate therapy. The primary end point was an American College of Rheumatology 20 (ACR20) response (≥20% fewer tender and swollen joints and ≥20% improvement in three of five other domains) at week 12, with each olokizumab dose tested for superiority to placebo. We also tested the noninferiority of each olokizumab dose to adalimumab with respect to the percentage of patients with an ACR20 response (noninferiority margin, -12 percentage points in the lower boundary of the 97.5% confidence interval for the difference between groups). RESULTS A total of 464 patients were assigned to receive olokizumab every 2 weeks, 479 to receive olokizumab every 4 weeks, 462 to receive adalimumab, and 243 to receive placebo. An ACR20 response at week 12 occurred in 44.4% of the patients receiving placebo, in 70.3% receiving olokizumab every 2 weeks (difference vs. placebo, 25.9 percentage points; 97.5% confidence interval [CI], 17.1 to 34.1), in 71.4% receiving olokizumab every 4 weeks (difference vs. placebo, 27.0 percentage points; 97.5% CI, 18.3 to 35.2), and in 66.9% receiving adalimumab (difference vs. placebo, 22.5 percentage points; 95% CI, 14.8 to 29.8) (P<0.001 for the superiority of each olokizumab dose to placebo). Both olokizumab doses were noninferior to adalimumab with respect to the percentage of patients with an ACR20 response at week 12 (difference, 3.4 percentage points [97.5% CI, -3.5 to 10.2] with olokizumab every 2 weeks and 4.5 percentage points [97.5% CI, -2.2 to 11.2] with olokizumab every 4 weeks). Adverse events, most commonly infections, occurred in approximately 70% of the patients who received olokizumab. Antibodies against olokizumab were detected in 3.8% of the patients receiving the drug every 2 weeks and in 5.1% of those receiving it every 4 weeks. CONCLUSIONS In patients with rheumatoid arthritis who were receiving maintenance methotrexate, olokizumab was superior to placebo and noninferior to adalimumab in producing an ACR20 response at 12 weeks. Larger and longer trials are required to determine the efficacy and safety of olokizumab in patients with rheumatoid arthritis. (Supported by R-Pharm; CREDO2 ClinicalTrials.gov number, NCT02760407.).
Collapse
Affiliation(s)
- Josef S Smolen
- From the Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna (J.S.S.); Helios Fachklinik Vogelsang-Gommern, Vogelsang-Gommern, Germany (E.F.); SFC Medica, Charlotte, NC (S.F.); R-Pharm (S.A.G., E.V.K., M.Y.S.), V.A. Nasonova Research Institute of Rheumatology (E.L.N.), and Sechenov Medical University (M.Y.S.) - all in Moscow; and the University of Texas Southwestern Medical Center at Dallas and Metroplex Clinical Research Center - both in Dallas (R.M.F.)
| | - Eugen Feist
- From the Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna (J.S.S.); Helios Fachklinik Vogelsang-Gommern, Vogelsang-Gommern, Germany (E.F.); SFC Medica, Charlotte, NC (S.F.); R-Pharm (S.A.G., E.V.K., M.Y.S.), V.A. Nasonova Research Institute of Rheumatology (E.L.N.), and Sechenov Medical University (M.Y.S.) - all in Moscow; and the University of Texas Southwestern Medical Center at Dallas and Metroplex Clinical Research Center - both in Dallas (R.M.F.)
| | - Saeed Fatenejad
- From the Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna (J.S.S.); Helios Fachklinik Vogelsang-Gommern, Vogelsang-Gommern, Germany (E.F.); SFC Medica, Charlotte, NC (S.F.); R-Pharm (S.A.G., E.V.K., M.Y.S.), V.A. Nasonova Research Institute of Rheumatology (E.L.N.), and Sechenov Medical University (M.Y.S.) - all in Moscow; and the University of Texas Southwestern Medical Center at Dallas and Metroplex Clinical Research Center - both in Dallas (R.M.F.)
| | - Sergey A Grishin
- From the Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna (J.S.S.); Helios Fachklinik Vogelsang-Gommern, Vogelsang-Gommern, Germany (E.F.); SFC Medica, Charlotte, NC (S.F.); R-Pharm (S.A.G., E.V.K., M.Y.S.), V.A. Nasonova Research Institute of Rheumatology (E.L.N.), and Sechenov Medical University (M.Y.S.) - all in Moscow; and the University of Texas Southwestern Medical Center at Dallas and Metroplex Clinical Research Center - both in Dallas (R.M.F.)
| | - Elena V Korneva
- From the Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna (J.S.S.); Helios Fachklinik Vogelsang-Gommern, Vogelsang-Gommern, Germany (E.F.); SFC Medica, Charlotte, NC (S.F.); R-Pharm (S.A.G., E.V.K., M.Y.S.), V.A. Nasonova Research Institute of Rheumatology (E.L.N.), and Sechenov Medical University (M.Y.S.) - all in Moscow; and the University of Texas Southwestern Medical Center at Dallas and Metroplex Clinical Research Center - both in Dallas (R.M.F.)
| | - Evgeniy L Nasonov
- From the Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna (J.S.S.); Helios Fachklinik Vogelsang-Gommern, Vogelsang-Gommern, Germany (E.F.); SFC Medica, Charlotte, NC (S.F.); R-Pharm (S.A.G., E.V.K., M.Y.S.), V.A. Nasonova Research Institute of Rheumatology (E.L.N.), and Sechenov Medical University (M.Y.S.) - all in Moscow; and the University of Texas Southwestern Medical Center at Dallas and Metroplex Clinical Research Center - both in Dallas (R.M.F.)
| | - Mikhail Y Samsonov
- From the Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna (J.S.S.); Helios Fachklinik Vogelsang-Gommern, Vogelsang-Gommern, Germany (E.F.); SFC Medica, Charlotte, NC (S.F.); R-Pharm (S.A.G., E.V.K., M.Y.S.), V.A. Nasonova Research Institute of Rheumatology (E.L.N.), and Sechenov Medical University (M.Y.S.) - all in Moscow; and the University of Texas Southwestern Medical Center at Dallas and Metroplex Clinical Research Center - both in Dallas (R.M.F.)
| | - Roy M Fleischmann
- From the Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna (J.S.S.); Helios Fachklinik Vogelsang-Gommern, Vogelsang-Gommern, Germany (E.F.); SFC Medica, Charlotte, NC (S.F.); R-Pharm (S.A.G., E.V.K., M.Y.S.), V.A. Nasonova Research Institute of Rheumatology (E.L.N.), and Sechenov Medical University (M.Y.S.) - all in Moscow; and the University of Texas Southwestern Medical Center at Dallas and Metroplex Clinical Research Center - both in Dallas (R.M.F.)
| |
Collapse
|
2
|
Cohen SB, Tanaka Y, Mariette X, Curtis JR, Lee EB, Nash P, Winthrop KL, Charles-Schoeman C, Wang L, Chen C, Kwok K, Biswas P, Shapiro A, Madsen A, Wollenhaupt J. Long-term safety of tofacitinib up to 9.5 years: a comprehensive integrated analysis of the rheumatoid arthritis clinical development programme. RMD Open 2021; 6:rmdopen-2020-001395. [PMID: 33127856 PMCID: PMC7722371 DOI: 10.1136/rmdopen-2020-001395] [Citation(s) in RCA: 96] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/28/2020] [Accepted: 09/29/2020] [Indexed: 12/26/2022] Open
Abstract
Objective Tofacitinib is an oral Janus kinase (JAK) inhibitor for the treatment of rheumatoid arthritis (RA). We report the largest integrated safety analysis of tofacitinib, as of March 2017, using data from phase I, II, III, IIIb/IV and long-term extension studies in adult patients with RA. Methods Data were pooled for patients with RA who received ≥1 tofacitinib dose. Incidence rates (IRs; patients with events/100 patient-years [PY]; 95% CIs) of first-time occurrences were obtained for adverse events (AEs) of interest. Results 7061 patients received tofacitinib (total exposure: 22 875 PY; median [range] exposure: 3.1 [0 to 9.6] years). IRs (95% CI) for serious AEs, serious infections, herpes zoster (all), opportunistic infections (excluding tuberculosis [TB]) and TB were 9.0 (8.6 to 9.4), 2.5 (2.3 to 2.7), 3.6 (3.4 to 3.9), 0.4 (0.3 to 0.5) and 0.2 (0.1 to 0.2), respectively. IRs (95% CI) for malignancies (excluding non-melanoma skin cancer [NMSC]), NMSC and lymphomas were 0.8 (0.7 to 0.9), 0.6 (0.5 to 0.7) and 0.1 (0.0 to 0.1), respectively. IRs (95% CI) for gastrointestinal perforations, deep vein thrombosis, pulmonary embolism, venous thromboembolism, arterial thromboembolism and major adverse cardiovascular events were 0.1 (0.1 to 0.2), 0.2 (0.1 to 0.2), 0.1 (0.1 to 0.2), 0.3 (0.2 to 0.3), 0.4 (0.3 to 0.5) and 0.4 (0.3 to 0.5), respectively. IR (95% CI) for mortality was 0.3 (0.2 to 0.3). IRs generally remained consistent across 6-month intervals to >78 months. Conclusion This represents the largest clinical dataset for a JAK inhibitor in RA to date. IRs remained consistent with previous reports from the tofacitinib RA clinical development programme, and stable over time. Trial registration numbers NCT01262118; NCT01484561; NCT00147498; NCT00413660; NCT00550446; NCT00603512; NCT00687193; NCT01164579; NCT00976599; NCT01059864; NCT01359150; NCT02147587; NCT00960440; NCT00847613; NCT00814307; NCT00856544; NCT00853385; NCT01039688; NCT02187055; NCT00413699; NCT00661661. For summary of phase I, phase II, phase III, phase IIIb/IV and LTE studies included in the integrated safety analysis, see online supplemental table 1.
Collapse
Affiliation(s)
- Stanley B Cohen
- Metroplex Clinical Research Center and University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Yoshiya Tanaka
- University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Xavier Mariette
- Paris-Saclay University, AP-HP, INSERM, Le Kremlin Bicêtre, France
| | | | - Eun Bong Lee
- Seoul National University, Seoul, Korea (the Democratic People's Republic of)
| | - Peter Nash
- Department of Medicine, Griffith University, Brisbane, Australia
| | | | | | - Lisy Wang
- Pfizer Inc, Groton, Connecticut, USA
| | | | | | | | | | | | - Jürgen Wollenhaupt
- Struenseehaus Centre for Rheumatology and Clinical Immunology, Hamburg, Germany
| |
Collapse
|
3
|
Differences and similarities in clinical and functional responses among patients receiving tofacitinib monotherapy, tofacitinib plus methotrexate, and adalimumab plus methotrexate: a post hoc analysis of data from ORAL Strategy. Arthritis Res Ther 2021; 23:220. [PMID: 34429160 PMCID: PMC8383419 DOI: 10.1186/s13075-021-02591-y] [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: 03/22/2021] [Accepted: 07/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This post hoc analysis assessed clinical and functional responses to tofacitinib monotherapy, tofacitinib + methotrexate (MTX), and adalimumab + MTX, in patients with rheumatoid arthritis enrolled in the ORAL Strategy study, including evaluation of patient-level data using cumulative probability plots. METHODS In the 12-month, phase IIIb/IV ORAL Strategy study, patients with rheumatoid arthritis and an inadequate response to MTX were randomized to receive tofacitinib 5 mg twice daily (BID), tofacitinib 5 mg BID + MTX, or adalimumab 40 mg every other week + MTX. In this post hoc analysis, cumulative probability plots were generated for mean percent change from baseline (%∆) in the Clinical Disease Activity Index (CDAI; clinical response) and mean change from baseline (∆) in the Health Assessment Questionnaire-Disability Index (HAQ-DI; functional response) at month 12. Median C-reactive protein (CRP) levels by time period were summarized by CDAI remission (≤ 2.8) status at months 6 and 12. RESULTS Data for 1146 patients were analyzed. At month 12, cumulative probability plots for %∆CDAI and ∆HAQ-DI were similar across treatments in patients with greater response. At lower levels of response, patients receiving tofacitinib monotherapy did not respond as well as those receiving combination therapies. With tofacitinib + MTX, numerically higher baseline CRP levels and numerically larger post-baseline CRP reductions were seen in patients achieving CDAI remission at months 6 and 12 vs those who did not. CONCLUSIONS These results suggest that patients with a greater response did well, irrespective of which therapy they received. Patients with lesser response had better outcomes with combination therapies vs tofacitinib monotherapy, suggesting they benefitted from MTX. High pre-treatment CRP levels may be associated with better response to tofacitinib + MTX. TRIAL REGISTRATION ClinicalTrials.gov, NCT02187055. Registered on 08 July 2014.
Collapse
|
4
|
Bykerk VP, Lee EB, van Vollenhoven R, Gruben DC, Fallon L, Woolcott JC, Keystone E. Identification of Distinct Disease Activity Trajectories in Methotrexate-Naive Patients With Rheumatoid Arthritis Receiving Tofacitinib Over Twenty-Four Months. Arthritis Care Res (Hoboken) 2021; 74:131-141. [PMID: 34057820 PMCID: PMC9303215 DOI: 10.1002/acr.24709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 05/18/2021] [Indexed: 12/18/2022]
Abstract
Objective Tofacitinib is an oral JAK inhibitor for the treatment of rheumatoid arthritis (RA). To better understand tofacitinib treatment responses, we used group‐based trajectory modeling to investigate distinct disease activity trajectories and associated baseline variables in patients with active RA. Methods This post hoc analysis used data from a phase III study of methotrexate‐naive patients receiving tofacitinib 5 mg twice daily. Changes in the 4‐variable Disease Activity Score in 28 joints, using the erythrocyte sedimentation rate (DAS28‐ESR) from baseline to month 24 were used in group‐based trajectory modeling to identify distinct disease activity trajectories. Patient and disease characteristics, changes in radiographic progression and patient‐reported outcomes, and safety up to month 24 were compared among trajectory groups. Results From 346 methotrexate‐naive patients, 5 disease trajectory groups, defined by DAS28‐ESR scores, were identified, which progressed from high disease activity (HDA) to remission (group 1, n = 28), to low disease activity (LDA) rapidly (group 2, n = 107), to moderate disease activity (group 3, n = 98), to LDA gradually (group 4, n = 46), or remained in HDA (group 5, n = 67), at month 24. At baseline, groups 1 and 2 generally had lower disease activity and more favorable patient‐reported outcomes, compared with other groups. Improvements in radiographic progression and patient‐reported outcomes over 24 months were generally consistent with DAS28‐ESR–predicted disease activity trajectories. Adverse event rates were generally comparable across groups. Conclusion Distinct phenotypic subgroups identified heterogeneity in patients with RA normally analyzed as a single population. Trajectory modeling may enable separation of clinically meaningful subsets of patients with RA, and may help optimize treatment outcomes.
Collapse
Affiliation(s)
| | - Eun Bong Lee
- Seoul National University College of Medicine, Seoul, Republic of Korea
| | | | | | | | | | | |
Collapse
|
5
|
Khan MAAK, Turjya RR, Islam ABMMK. Computational engineering the binding affinity of Adalimumab monoclonal antibody for designing potential biosimilar candidate. J Mol Graph Model 2021; 102:107774. [DOI: 10.1016/j.jmgm.2020.107774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/15/2020] [Accepted: 10/05/2020] [Indexed: 12/26/2022]
|
6
|
Gearry RB, Frampton C, Inns S, Poppelwell D, Rademaker M, Suppiah R. VITALITY: impact of adalimumab on health and disability outcomes in patients with Crohn's disease, rheumatoid arthritis, or psoriasis treated in clinical practice in New Zealand. Curr Med Res Opin 2019; 35:1837-1846. [PMID: 31233347 DOI: 10.1080/03007995.2019.1634952] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Objective: VITALITY, a 6-month, multicenter, prospective, observational study, assessed the effects of originator adalimumab (HUMIRA) on health and disability outcomes in patients with Crohn's disease (CD), rheumatoid arthritis (RA), or psoriasis treated in routine clinical practice in New Zealand (NZ). Methods: Biologic-naïve adults initiating adalimumab in accordance with NZ funding requirements were recruited. The primary endpoint was 6-month change from baseline in World Health Organization Disability Assessment Schedule (WHODAS) 2.0 score in all participants completing the study (full analysis set). Secondary endpoints included 6-month change in other patient-reported outcomes (PROs) of work activity and wellbeing (Work Productivity and Activity Impairment Questionnaire: General Health, Kessler Psychological Distress Scale, Flourishing Scale, and Subject Vitality Scale) and in disease-specific PRO measures. Results: In total, 164 participants with severe disease initiating adalimumab completed the WHODAS 2.0 at baseline, of whom 114 (69.5%) completed the study at 6 months. Mean WHODAS 2.0 score halved from 15.2 points (SD = ±9.1) at baseline to 7.3 points (SD = ±7.2) after 6 months' adalimumab treatment (mean difference = 7.9 points; 95% CI = 6.4-9.4; p < .001), with statistically significant improvements seen as early as 2 months after adalimumab initiation (p < .001). The proportion of participants with a WHODAS 2.0 score ≥ 10 more than halved, from 68.3% to 28.9%, between baseline and 6 months. Other PROs also improved significantly at 6 months, as did disease-specific measures. No new adalimumab safety signals were observed. Conclusions: Health and disability outcomes improved significantly after 6 months of adalimumab use in NZ patients with severe CD, RA, or psoriasis. Clinicaltrials.gov: NCT02451839.
Collapse
Affiliation(s)
- Richard B Gearry
- Department of Gastroenterology, Christchurch Hospital , Christchurch , New Zealand
- Department of Medicine, University of Otago , Christchurch , New Zealand
| | | | - Stephen Inns
- Department of Medicine, University of Otago , Christchurch , New Zealand
- Hutt Valley District Health Board IBD Service , Lower Hutt , New Zealand
| | | | - Marius Rademaker
- Waikato Clinical School, University of Auckland , Hamilton , New Zealand
| | - Ravi Suppiah
- Department of Rheumatology, Auckland District Health Board , Auckland , New Zealand
| |
Collapse
|
7
|
Strand V, Mysler E, Moots RJ, Wallenstein GV, DeMasi R, Gruben D, Soma K, Iikuni N, Smolen JS, Fleischmann R. Patient-reported outcomes for tofacitinib with and without methotrexate, or adalimumab with methotrexate, in rheumatoid arthritis: a phase IIIB/IV trial. RMD Open 2019; 5:e001040. [PMID: 31673419 PMCID: PMC6802984 DOI: 10.1136/rmdopen-2019-001040] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/21/2019] [Accepted: 08/23/2019] [Indexed: 12/18/2022] Open
Abstract
Objective To provide the first direct comparison of patient-reported outcomes (PROs) following treatment with tofacitinib monotherapy versus tofacitinib or adalimumab (ADA) in combination with methotrexate (MTX) in patients with rheumatoid arthritis (RA) with inadequate response to MTX (MTX-IR). Methods ORAL Strategy (NCT02187055), a phase IIIB/IV, head-to-head, randomised controlled trial, assessed non-inferiority between tofacitinib 5 mg two times per day monotherapy, tofacitinib 5 mg two times per day+MTX and ADA 40 mg every other week+MTX. PROs assessed included the following: Patient Global Assessment of disease activity (PtGA), Pain, Health Assessment Questionnaire-Disability Index, Functional Assessment of Chronic Illness Therapy-Fatigue and 36-Item Short-Form Health Survey (SF-36) summary and domain scores. Results Substantial improvements from baseline were reported across all PROs in all treatment arms, which, in the majority, met or exceeded minimum clinically important differences. Compared with tofacitinib monotherapy, tofacitinib+MTX combination treatment conferred significantly greater improvements in PtGA, Pain and SF-36 physical component summary scores at month 6. Statistically or numerically greater improvements were often, but not uniformly, reported for combination treatments compared with tofacitinib monotherapy at other time points. Conclusion Treatment with tofacitinib+MTX, ADA+MTX and tofacitinib monotherapy resulted in clinically meaningful improvements in PROs in MTX-IR patients with RA. These were comparatively greater with combination treatments versus tofacitinib monotherapy, although differences between treatment arms were small, limiting our ability to confer clinical meaning. Trial registration number NCT02187055.
Collapse
Affiliation(s)
- Vibeke Strand
- Division of Immunology/Rheumatology, Stanford University, Palo Alto, California, USA
| | - Eduardo Mysler
- Reumatólogo en Organización Médica de Investigación, Buenos Aires, Argentina
| | - Robert J Moots
- Department of Musculoskeletal Biology, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | | | | | | | | | | | - Josef S Smolen
- Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Roy Fleischmann
- Rheumatology Division, Metroplex Clinical Research Center and University of Texas Southwestern Medical Center, Dallas, Texas, USA
| |
Collapse
|
8
|
Cohen SB, Czeloth N, Lee E, Klimiuk PA, Peter N, Jayadeva G. Long-term safety, efficacy, and immunogenicity of adalimumab biosimilar BI 695501 and adalimumab reference product in patients with moderately-to-severely active rheumatoid arthritis: results from a phase 3b extension study (VOLTAIRE-RAext). Expert Opin Biol Ther 2019; 19:1097-1105. [DOI: 10.1080/14712598.2019.1645114] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Stanley B. Cohen
- Department of Internal Medicine, Metroplex Clinical Research Center, Dallas, TX, USA
| | | | - Eric Lee
- Inland Rheumatology, Upland, CA, USA
| | - Piotr A. Klimiuk
- Department of Rheumatology and Internal Diseases, Medical University of Bialystok and Gabinet Internistyczno-Reumatologiczny, Bialystok, Poland
| | - Nuala Peter
- Medical, Boehringer Ingelheim, Biberach, Germany
| | | |
Collapse
|
9
|
Burgers LE, Raza K, van der Helm-van Mil AH. Window of opportunity in rheumatoid arthritis - definitions and supporting evidence: from old to new perspectives. RMD Open 2019; 5:e000870. [PMID: 31168406 PMCID: PMC6525606 DOI: 10.1136/rmdopen-2018-000870] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 03/04/2019] [Accepted: 03/05/2019] [Indexed: 12/11/2022] Open
Abstract
The therapeutic window of opportunity in rheumatoid arthritis (RA) is often referred to. However, some have questioned whether such a period, in which the disease is more susceptible to disease-modifying treatment, really exists. Observational studies are most frequently referenced as supporting evidence, but results of such studies are subject to confounding. In addition formal consensus on the definition of the term has never been reached. We first reviewed the literature to establish if there is agreement on the concept of the window of opportunity in terms of its time period and the outcomes influenced. Second, a systemic literature search was performed on the evidence of the benefit of early versus delayed treatment as provided by randomised clinical trials. We observed that the concept of the window of opportunity has changed with respect to timing and outcome since its first description 25 years ago. There is an ‘old definition’ pointing to the first 2 years after diagnosis with increased potential for disease-modifying treatment to prevent severe radiographic damage and disability. Strong evidence supports this concept. A ‘new definition’ presumes a therapeutic window in a pre-RA phase in which the biologic processes could be halted and RA development prevented by very early treatment. This definition is not supported by evidence, although is less well studied in trials. Some suggestions for future research in this area are made.
Collapse
Affiliation(s)
- Leonie E Burgers
- Department of Rheumatology, Leids Universitair Medisch Centrum, Leiden, The Netherlands
| | - Karim Raza
- Immunity and Infection, University of Birmingham, Birmingham, UK.,Rheumatology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Annette H van der Helm-van Mil
- Department of Rheumatology, Leids Universitair Medisch Centrum, Leiden, The Netherlands.,Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
10
|
Duquenne L, Gul H, Emery P. Safety evaluation of adalimumab in immune-mediated inflammatory disorders: a rheumatological point of view. Expert Opin Drug Saf 2018; 18:11-19. [PMID: 30444672 DOI: 10.1080/14740338.2018.1549541] [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: 10/27/2022]
Abstract
INTRODUCTION Immune-mediated inflammatory disorders (IMIDs) are systemic conditions which arise secondary to complex immune mechanism defects and can affect many organs. While previous therapies based on steroids and immunosuppressive agents had a poor risk/benefit balance, TNFα-specific inhibitors such as adalimumab have revolutionized the course of many diseases and patient outcomes. However, concerns were raised regarding the increased risk of infectious diseases and neoplasia due to potential prospective loss of immune control. This is especially true when considering that IMIDs concerns elderly/frail populations, with multiple co-morbidities, organ damage and often long-term steroid therapy. Areas covered: Now prescribed for more than 15 years for a diverse range of indications, long-term data highlighting the efficacy and safety are available and led to recommendations for the daily practice that will be discussed. Expert opinion: The efficacy of adalimumab changed the therapeutic paradigm of many diseases. Its tolerance is good and it is the most widely prescribed therapy in IMIDs. It is now the standard of care arm in head to head trials. In the long term, adalimumab dominant role might be weakened by more targeted therapies but its varied indications among IMIDs should secure its position as an important tool in our future practice.
Collapse
Affiliation(s)
- Laurence Duquenne
- a Leeds Institute of Rheumatic & Musculoskeletal Medicine , University of Leeds , Leeds , UK.,b NIHR Leeds Biomedical Research Centre , The Leeds Teaching Hospitals Trust , Leeds , UK
| | - Hanna Gul
- a Leeds Institute of Rheumatic & Musculoskeletal Medicine , University of Leeds , Leeds , UK.,b NIHR Leeds Biomedical Research Centre , The Leeds Teaching Hospitals Trust , Leeds , UK
| | - Paul Emery
- a Leeds Institute of Rheumatic & Musculoskeletal Medicine , University of Leeds , Leeds , UK.,b NIHR Leeds Biomedical Research Centre , The Leeds Teaching Hospitals Trust , Leeds , UK
| |
Collapse
|
11
|
Murray E, Ellis A, Butylkova Y, Skup M, Kalabic J, Garg V. Systematic review and network meta-analysis: effect of biologics on radiographic progression in rheumatoid arthritis. J Comp Eff Res 2018; 7:959-974. [PMID: 30129776 DOI: 10.2217/cer-2017-0106] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM To evaluate the comparative effectiveness of biologics in inhibiting radiographic progression among rheumatoid arthritis (RA) patients. MATERIALS & METHODS Bayesian network meta-analysis of published trials investigating the USA FDA approved biologics treatment in RA patients, using methotrexate (MTX) as the reference comparator. RESULTS Nine trials met the inclusion criteria for base case analysis. Compared with MTX, most biologics (except golimumab) + MTX had significantly lower rates of radiographic progression at 1 year. Mean difference in radiographic progression rates between MTX monotherapy and biologics + MTX was highest for adalimumab + MTX (-3.8) and lowest for tocilizumab + MTX (-0.7). Inhibition of radiographic progression was sustained. CONCLUSION Biologics inhibit radiographic progression in patients with RA at 1 year; however, published evidence beyond 1 year is limited.
Collapse
Affiliation(s)
- Erin Murray
- Doctor Evidence, Santa Monica, CA, 90401, USA
| | | | | | | | | | | |
Collapse
|
12
|
Nakamura K, Hamaguchi T, Yamada M. Demyelinating polyneuropathy after long-term treatment with infliximab. Int J Rheum Dis 2017; 20:1781-1782. [DOI: 10.1111/1756-185x.12642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Keiko Nakamura
- Department of Neurology and Neurobiology of Ageing; Kanazawa University Graduate School of Medical Science; Kanazawa Japan
| | - Tsuyoshi Hamaguchi
- Department of Neurology and Neurobiology of Ageing; Kanazawa University Graduate School of Medical Science; Kanazawa Japan
| | - Masahito Yamada
- Department of Neurology and Neurobiology of Ageing; Kanazawa University Graduate School of Medical Science; Kanazawa Japan
| |
Collapse
|
13
|
Long-Term Effectiveness of Adalimumab in Patients with Rheumatoid Arthritis: An Observational Analysis from the Corrona Rheumatoid Arthritis Registry. Rheumatol Ther 2017; 4:375-389. [PMID: 28840531 PMCID: PMC5696289 DOI: 10.1007/s40744-017-0077-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Current recommendations for the management of rheumatoid arthritis (RA) focus on a treat-to-target approach with the objective of maximizing long-term health-related quality-of-life in patients with RA. Published studies from randomized clinical trials have reported limited data regarding the long-term efficacy and safety of adalimumab in patients with RA. This study aims to evaluate the long-term (10+ years) persistency and effectiveness of adalimumab in patients with RA in a real-world setting. METHODS Included in this study were biologic-naïve adults with RA initiating adalimumab during follow-up enrolled in the Corrona RA registry. More than 10 years of data on persistency of adalimumab and rheumatologist-supplied reasons for discontinuation were examined. Among patients who persisted on adalimumab over the years, clinical [e.g., clinical disease activity index scores (CDAI), physician global assessment, tender joint count, and swollen joint count] and patient-reported outcomes (PRO), such as physical function, pain, fatigue, and morning stiffness, were examined. RESULTS Of 1791 biologic-naive patients treated with adalimumab who had ≥1 follow-up registry visit, 64.1% were still on therapy at 1 year and 10.2% were still on therapy by the end of year 12. Among patients who persisted on adalimumab for at least 1 year (77.1% female, mean age 53.9 years), 67.0% were in low disease activity (LDA)/remission (CDAI ≤10) and had clinically meaningful improvements from baseline in all clinical assessments and PROs. Initial improvements in LDA/remission and in clinical and PRO assessments observed at year 1 were sustained in those patients who remained on adalimumab over 10 years of follow-up. Among patients who discontinued adalimumab, 61.6% were not in LDA/remission and 41.9% switched to another biologic within 12 months after discontinuing adalimumab. CONCLUSIONS Real-world data demonstrate a sustained effectiveness of adalimumab in the treatment of RA for patients who remained on therapy for 10 years. FUNDING Corrona, LLC and AbbVie.
Collapse
|
14
|
Fleischmann R, Weinblatt ME, Schiff M, Khanna D, Maldonado MA, Nadkarni A, Furst DE. Patient-Reported Outcomes From a Two-Year Head-to-Head Comparison of Subcutaneous Abatacept and Adalimumab for Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2017; 68:907-13. [PMID: 26473625 PMCID: PMC5094537 DOI: 10.1002/acr.22763] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 09/29/2015] [Accepted: 10/13/2015] [Indexed: 12/12/2022]
Abstract
Objective To report 2‐year patient‐reported outcomes (PROs) from the head‐to‐head Abatacept versus Adalimumab Comparison in Biologic‐Naive RA Subjects with Background Methotrexate (MTX) (AMPLE) trial. Methods AMPLE was a phase IIIb, randomized, investigator‐blinded trial. Biologic‐naive patients with rheumatoid arthritis (RA) and an inadequate response to MTX were randomized to subcutaneous (SC) abatacept (125 mg/week) or adalimumab (40 mg every 2 weeks) with background MTX. PROs (pain, fatigue, ability to perform work, and ability to perform daily activities) were compared up to year 2 for patients in each treatment group, as well as those who achieved low disease activity at both years 1 and 2 (responders) and those who did not (nonresponders). Results A total of 646 patients were randomized and treated with SC abatacept (n = 318) or adalimumab (n = 328). Baseline characteristics were balanced between the 2 treatment arms. Comparable improvements in PROs were observed in the abatacept and adalimumab groups over 2 years, with both groups achieving clinically meaningful improvements in PROs from baseline. At year 2, fatigue improved by 23.4 mm and 21.5 mm on a 100‐mm visual analog scale with abatacept and adalimumab, respectively. Clinical responders achieved greater improvements in PROs than nonresponders. Conclusion In biologic‐naive patients with active RA, despite prior MTX, treatment with SC abatacept or adalimumab with background MTX resulted in comparable improvements in PROs, which were highly correlated with physician‐reported clinical response end points.
Collapse
Affiliation(s)
| | | | | | - Dinesh Khanna
- Dinesh Khanna, MD: University of Michigan, Ann Arbor
| | | | | | | |
Collapse
|
15
|
Blandizzi C, Meroni PL, Lapadula G. Comparing Originator Biologics and Biosimilars: A Review of the Relevant Issues. Clin Ther 2017; 39:1026-1039. [DOI: 10.1016/j.clinthera.2017.03.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 03/10/2017] [Accepted: 03/10/2017] [Indexed: 12/30/2022]
|
16
|
Harigai M, Tsuchiya T, Kawana K, Kurimoto S. Long-term safety and effectiveness of adalimumab for the treatment of Japanese patients with rheumatoid arthritis: 3-year results from a postmarketing surveillance of 552 patients. Mod Rheumatol 2017; 28:30-38. [PMID: 28388293 DOI: 10.1080/14397595.2017.1304159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Masayoshi Harigai
- Division of Epidemiology and Pharmacoepidemiology of Rheumatic Diseases, Institute of Rheumatology, Tokyo Women’s Medical University, Tokyo, Japan
| | | | | | | |
Collapse
|
17
|
Recommendations by the Spanish Society of Rheumatology for the management of patients diagnosed with rheumatoid arthritis who cannot be treated with methotrexate. ACTA ACUST UNITED AC 2016; 13:127-138. [PMID: 27825791 DOI: 10.1016/j.reuma.2016.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 09/23/2016] [Accepted: 10/01/2016] [Indexed: 01/08/2023]
Abstract
To establish a set of recommendations for the management of patients diagnosed with rheumatoid arthritis (RA) who cannot be treated with methotrexate (MTX) due to contraindications, drug toxicity or lack of adherence, and to establish therapeutic strategies more effective and safer in these RA patients. A qualitative analysis of the scientific evidence available to June 2015. The 2-round Delphi technique of consensus was used to collect and establish expert opinion based on the participants' clinical experience when only low quality evidence was available. A total of eighteen recommendations were developed for the management of this patient profile. Fourteen of these recommendations were related to drug safety aspects. Recommendations on contraindication and toxicity of MTX have been updated. The experts recommend the use of biological monotherapy, a preferred treatment option, in patients whose profiles reveal a contraindication, intolerance or circumstances that prevent us against the use of MTX. There is some high-quality scientific evidence that supports contraindication and establishes certain conditions of MTX use in RA patients with specific clinical profiles.
Collapse
|
18
|
Smolen JS, Kremer JM, Gaich CL, DeLozier AM, Schlichting DE, Xie L, Stoykov I, Rooney T, Bird P, Sánchez Bursón JM, Genovese MC, Combe B. Patient-reported outcomes from a randomised phase III study of baricitinib in patients with rheumatoid arthritis and an inadequate response to biological agents (RA-BEACON). Ann Rheum Dis 2016; 76:694-700. [PMID: 27799159 PMCID: PMC5530360 DOI: 10.1136/annrheumdis-2016-209821] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 09/09/2016] [Accepted: 10/05/2016] [Indexed: 01/12/2023]
Abstract
Objectives To assess baricitinib on patient-reported outcomes (PROs) in patients with moderately to severely active rheumatoid arthritis, who had insufficient response or intolerance to ≥1 tumour necrosis factor inhibitors (TNFis) or other biological disease-modifying antirheumatic drugs (bDMARDs). Methods In this double-blind phase III study, patients were randomised to once-daily placebo or baricitinib 2 or 4 mg for 24 weeks. PROs included the Short Form-36, EuroQol 5-D, Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), Health Assessment Questionnaire-Disability Index (HAQ-DI), Patient's Global Assessment of Disease Activity (PtGA), patient's assessment of pain, duration of morning joint stiffness (MJS) and Work Productivity and Activity Impairment Questionnaire-Rheumatoid Arthritis. Treatment comparisons were performed with logistic regression for categorical measures or analysis of covariance for continuous variables. Results 527 patients were randomised (placebo, 176; baricitinib 2 mg, 174; baricitinib 4 mg, 177). Both baricitinib-treated groups showed statistically significant improvements versus placebo in most PROs. Improvements were generally more rapid and of greater magnitude for patients receiving baricitinib 4 mg than 2 mg and were maintained to week 24. At week 24, more baricitinib-treated patients versus placebo-treated patients reported normal physical functioning (HAQ-DI <0.5; p≤0.001), reductions in fatigue (FACIT-F ≥3.56; p≤0.05), improvements in PtGA (p≤0.001) and pain (p≤0.001) and reductions in duration of MJS (p<0.01). Conclusions Baricitinib improved most PROs through 24 weeks compared with placebo in this study of treatment-refractory patients with previously inadequate responses to bDMARDs, including at least one TNFi. PRO results aligned with clinical efficacy data for baricitinib. Trial registration number NCT01721044; Results.
Collapse
Affiliation(s)
- Josef S Smolen
- Medical University of Vienna and Hietzing Hospital, Vienna, Austria
| | | | | | | | | | - Li Xie
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | | | | | - Paul Bird
- University of New South Wales, Sydney, New South Wales, Australia
| | | | - Mark C Genovese
- Stanford University Medical Center, Palo Alto, California, USA
| | - Bernard Combe
- Lapeyronie Hospital, Montpellier University, Montpellier, France
| |
Collapse
|
19
|
Use of a risk characterisation approach to contextualise the safety profile of new rheumatoid arthritis treatments: a case study using tofacitinib. Clin Rheumatol 2016; 36:683-688. [PMID: 27470086 PMCID: PMC5323490 DOI: 10.1007/s10067-016-3359-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 07/14/2016] [Accepted: 07/15/2016] [Indexed: 12/30/2022]
Abstract
Tofacitinib is an oral Janus kinase inhibitor for the treatment of rheumatoid arthritis (RA). To characterise the relative safety profile of tofacitinib to biologic disease-modifying antirheumatic drugs (bDMARDs), the accrued patient-years (pt-yrs) of exposure needed in an RA clinical trial programme to detect a potential increase in risk of specific adverse events (AEs) was determined. This case study/framework was constructed on the pt-yrs’ accrual within pooled phase (P)1, P2 and P3, as well as long-term extension, studies of tofacitinib in RA (March 2015 data-cut) and published AE incidence rates for bDMARDs. Sample size calculations were based on a Poisson distribution to estimate pt-yrs’ exposure required for 90 % probability that the lower bound of the 95 % confidence interval for tofacitinib/bDMARD would be >1, assuming that tofacitinib rates were 1.2×/1.5×/2.0× greater than comparator rates. AE rates for bDMARDs were derived from sources intended to optimise similarity with the tofacitinib database in terms of baseline characteristics, study duration and follow-up. Based on the tofacitinib exposure accrued (19,406 pt-yrs), data were sufficient (90 % probability) to detect potential differences over external bDMARD comparator rates in serious infections (≥1.2×), malignancies (excluding non-melanoma skin cancer [NMSC]), NMSC, major adverse cardiovascular events (MACE) and lymphoma (each ≥1.5×), as well as opportunistic infections and gastrointestinal perforations (≥2×), should they exist. This risk characterisation approach can support the comparative safety of new RA medications. To date, tofacitinib safety appears similar to approved published data from bDMARDs with respect to serious infections, malignancies (excluding NMSC), NMSC, MACE, lymphoma, opportunistic infections and gastrointestinal perforations.
Collapse
|
20
|
Iannone F, Sinigaglia L, Favalli EG, Sarzi-Puttini P, Atzeni F, Caporali R, Codullo V, Ferraccioli G, Gremese E, Carletto A, Giollo A, Govoni M, Bergossi F, Galeazzi M, Cantarini L, Salaffi F, Di Carlo M, Bazzani C, Pellerito R, Sebastiani M, Ramonda R, Lapadula G. Drug survival of adalimumab in patients with rheumatoid arthritis over 10 years in the real-world settings: high rate remission together with normal function ability. Clin Rheumatol 2016; 35:2649-2656. [PMID: 27418051 DOI: 10.1007/s10067-016-3349-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 07/03/2016] [Accepted: 07/04/2016] [Indexed: 01/06/2023]
Abstract
The purpose of the study was to estimate the clinical profile of naïve biological patients with rheumatoid arthritis (RA) starting adalimumab through 3-year calendar periods and their clinical outcomes such as drug survival and global clinical disease control (GCDC). RA patients starting adalimumab as first biological drug between 2003 and 2012 were subdivided in 3-year calendar periods. Survival on therapy was estimated using the Kaplan-Meier analysis. One and 2-year clinical response was assessed by calculating percentage of patients attaining GCDC (28-joint Disease Activity Score (DAS28) ≤ 2.6 + Health Assessment Questionnaire (HAQ) ≤ 0.5), low disease activity (DAS28 ≤ 3.2), remission (DAS28 ≤ 2.6) and good European League Against Rheumatism (EULAR) response. Multivariate regression models were used to assess baseline predictors of drug discontinuation or achievement of clinical remission. We recruited 1695 RA patients. Overall drug persistence at 3 years was 40.6 %, while the global rate of nonswitching patients was 54.7 %. Compared to 2003-2005, initiators in more recent years had a significantly lower 3-year crude drug retention rate (log rank, p < 0.0001) and a significantly higher rate of switching to alternative biologics (log rank, p < 0.0001). No difference in adverse events or effectiveness rate among the calendar periods was found. A substantial proportion of patients (up to 27 %) achieved GCDC at 2 years, regardless of the calendar period. In real-life setting, RA patients starting adalimumab in more recent years had a higher rate of drug discontinuation not related to ineffectiveness or side effects but to switching, probably due to a wider availability of biologics. A meaningful proportion of patients attained GCDC without any difference across calendar periods.
Collapse
Affiliation(s)
- Florenzo Iannone
- Interdisciplinary Department of Medicine-Rheumatology Unit, Policlinico, University of Bari, Piazza G. Cesare 11, 70124, Bari, Italy.
| | | | | | | | | | | | | | | | - Elisa Gremese
- Rheumatology Unit, Catholic University of the Sacred Heart, Rome, Italy
| | | | | | | | | | | | | | - Fausto Salaffi
- Rheumatology Unit, Università Politecnica delle Marche, Jesi, Italy
| | - Marco Di Carlo
- Rheumatology Unit, Università Politecnica delle Marche, Jesi, Italy
| | - Chiara Bazzani
- Rheumatology Unit, University of Brescia, Brescia, Italy
| | | | - Marco Sebastiani
- Rheumatology Unit, University of Modena e Reggio Emilia, Modena, Italy
| | | | - Giovanni Lapadula
- Interdisciplinary Department of Medicine-Rheumatology Unit, Policlinico, University of Bari, Piazza G. Cesare 11, 70124, Bari, Italy
| |
Collapse
|
21
|
Burmester GR, Landewé R, Genovese MC, Friedman AW, Pfeifer ND, Varothai NA, Lacerda AP. Adalimumab long-term safety: infections, vaccination response and pregnancy outcomes in patients with rheumatoid arthritis. Ann Rheum Dis 2016; 76:414-417. [PMID: 27338778 PMCID: PMC5284339 DOI: 10.1136/annrheumdis-2016-209322] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 04/25/2016] [Accepted: 05/27/2016] [Indexed: 12/27/2022]
Abstract
Background Adalimumab has been used in patients with moderately to severely active rheumatoid arthritis (RA) for over 10 years and has a well-established safety profile across multiple indications. Objective To update adverse events (AEs) of special interest from global adalimumab clinical trials in patients with RA. Methods This analysis includes 15 132 patients exposed to adalimumab in global RA clinical trials. AEs of interest included overall infections, laboratory abnormalities and AEs associated with influenza vaccination. Pregnancy outcome data were collected from the Adalimumab Pregnancy Registry. Results Serious infections and tuberculosis occurred at a rate of 4.7 and 0.3 events/100 patient-years, respectively. Two patients experienced hepatitis B reactivation. No significant laboratory abnormalities were reported with adalimumab-plus-methotrexate compared with placebo-plus-methotrexate. Influenza-related AEs occurred in 5% of vaccinated patients compared with 14% of patients not vaccinated during the study. Relative risk of major birth defects and spontaneous abortions in adalimumab-exposed women were similar between that of unexposed women with RA and healthy women. Conclusions This analysis confirms and expands the known safety profile of adalimumab and reports no additional safety risk of laboratory abnormalities, hepatitis B reactivation and pregnancy outcomes, including spontaneous abortions and birth defects. The benefits of influenza vaccination are reinforced. Trial registration numbers NCT00195663, NCT00195702, NCT00448383, NCT00049751, NCT00234845, NCT00650390, NCT00235859, NCT00647920, NCT00649545, NCT00647491, NCT00649922, NCT00538902, NCT00420927, NCT00870467, NCT00650156, NCT00647270, NCT01185288, NCT01185301.
Collapse
Affiliation(s)
- Gerd R Burmester
- Department of Rheumatology and Clinical Immunology, Charité-University Medicine Berlin, Free University and Humboldt University of Berlin, Berlin, Germany
| | - Robert Landewé
- Clinical Immunology and Rheumatology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Mark C Genovese
- Division of Immunology and Rheumatology, Stanford University, Palo Alto, California, USA
| | - Alan W Friedman
- Immunology Clinical Development, AbbVie, North Chicago, Illinois, USA
| | - Nathan D Pfeifer
- Clinical Pharmacology and Pharmacometrics, AbbVie, North Chicago, Illinois, USA
| | - Nupun A Varothai
- Data and Statistical Sciences, AbbVie, North Chicago, Illinois, USA
| | - Ana P Lacerda
- Immunology Clinical Development, AbbVie, North Chicago, Illinois, USA
| |
Collapse
|
22
|
Marks JL, Holroyd CR, Dimitrov BD, Armstrong RD, Calogeras A, Cooper C, Davidson BK, Dennison EM, Harvey NC, Edwards CJ. Does combined clinical and ultrasound assessment allow selection of individuals with rheumatoid arthritis for sustained reduction of anti-tumor necrosis factor therapy? Arthritis Care Res (Hoboken) 2015; 67:746-53. [PMID: 25605045 DOI: 10.1002/acr.22552] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 12/03/2014] [Accepted: 01/13/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To investigate whether a strategy combining clinical and ultrasound (US) assessment can select individuals with rheumatoid arthritis (RA) for sustained dose reduction of anti-tumor necrosis factor (anti-TNF) therapies. METHODS As part of a real-world approach, patients with RA receiving anti-TNF therapies were reviewed in a dedicated biologic therapy clinic. Patients not taking oral corticosteroids with both Disease Activity Score in 28 joints (DAS28) remission (≤2.6) and absent synovitis on power Doppler US (PDUS 0) for >6 months were invited to reduce their anti-TNF therapy dose by one-third. RESULTS Between January 2012 and February 2014, a total of 70 patients underwent anti-TNF dose reduction. Combined DAS28 and PDUS remission was maintained by 96% of patients at 3 months followup, 63% at 6 months, 37% at 9 months, and 34% at 18 months followup. However, 88% of patients maintained at least low disease activity (LDA) with DAS28 <3.2 and PDUS ≤1 at 6 months. The addition of PDUS identified 8 patients (25% of those that flared) in DAS28 remission, with subclinically active disease. Those who maintained dose reduction were more likely to be rheumatoid factor (RF) negative (46% versus 17%; P = 0.03) and have lower DAS28 scores at biologic therapy initiation (5.58 versus 5.96; P = 0.038). CONCLUSION Combined clinical and US assessment identifies individuals in remission who may be suitable for anti-TNF dose reduction and enhances safe monitoring for subclinical disease flares. Despite longstanding severe RA, a subset of our cohort sustained prolonged DAS28 and PDUS remission. LDA at biologic therapy initiation and RF status appeared predictive of sustained remission.
Collapse
Affiliation(s)
| | | | | | | | | | - Cyrus Cooper
- University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK, and University of Oxford, Oxford, UK
| | | | - Elaine M Dennison
- University Hospital Southampton and University of Southampton, Southampton, UK
| | - Nicholas C Harvey
- University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Christopher J Edwards
- University of Southampton and University Hospital Southampton, Southampton, UK, and University of Oxford, Oxford, UK
| |
Collapse
|
23
|
Furst DE, Kavanaugh A, Florentinus S, Kupper H, Karunaratne M, Birbara CA. Final 10-year effectiveness and safety results from study DE020: adalimumab treatment in patients with rheumatoid arthritis and an inadequate response to standard therapy. Rheumatology (Oxford) 2015. [PMID: 26199453 DOI: 10.1093/rheumatology/kev249] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To evaluate the long-term effectiveness and safety of 10 years of adalimumab (ADA) treatment in DMARD-refractory RA patients and to analyse efficacy based on RF status and baseline disease duration. METHODS DE020 was a multicentre, phase 3, open-label continuation study. Adult RA patients who received s.c. ADA (40 mg every other week or monthly) in one of four early assessment studies could receive ADA for ≤10 years in DE020. Assessments included the 28-joint DAS with CRP (DAS28-CRP), Simplified Disease Activity Index (SDAI), HAQ Disability Index (HAQ-DI) and safety as events per 100 patient-years. RESULTS Of 846 enrolled patients, mean age at baseline was 55.6 years, 78.1% were women, mean disease duration was 11.7 years and 27.0% were RF(-). Among 286 (33.8%) patients who completed 10 years of ADA, 168/236 (71.2%) achieved DAS28-CRP ≤3.2, 101/238 (42.4%) achieved HAQ-DI <0.5 and 90/241 (37.3%) achieved DAS28-CRP ≤3.2 plus HAQ-DI <0.5. DAS28-CRP- or SDAI-based remission was observed in 135/236 (57.2%) and 70/236 (29.7%) patients, respectively. Effectiveness outcomes were similar regardless of RF status. Higher proportions of patients with shorter vs longer baseline disease duration (≤2 vs >2 years) achieved HAQ-DI <0.5 (60.6% vs 39.5%; P = 0.023) and DAS28-CRP ≤3.2 plus HAQ-DI <0.5 (58.1% vs 32.5%; P = 0.006). Adverse events (317.2 events per 100 patient-years) during ADA exposure were consistent with the expected safety profile for TNF inhibitors. CONCLUSION ADA led to sustained clinical and functional responses in the 33.8% of treatment-refractory RA patients who completed 10 years of treatment. Patients with shorter disease duration achieved better outcomes, highlighting the need for early treatment. No unexpected safety findings were observed. TRIAL REGISTRATION ClinicalTrials.gov, http://www.clinicaltrials.gov, NCT00195650.
Collapse
Affiliation(s)
- Daniel E Furst
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles,
| | - Arthur Kavanaugh
- Department of Medicine, University of California San Diego School of Medicine, San Diego, CA, USA
| | | | - Hartmut Kupper
- Pharmaceutical Development, AbbVie Deutschland, Ludwigshafen, Germany
| | | | - Charles A Birbara
- Department of Medicine, University of Massachusetts School of Medicine, Worcester, MA, USA
| |
Collapse
|
24
|
van Bezooijen JS, Prens EP, Pradeepti MS, Atiqi R, Schreurs MWJ, Koch BCP, van Gelder T, van Doorn MBA. Combining biologics with methotrexate in psoriasis: a systematic review. Br J Dermatol 2015; 172:1676-1680. [PMID: 25470815 DOI: 10.1111/bjd.13573] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- J S van Bezooijen
- Department of Hospital Pharmacy, Erasmus MC, Rotterdam, the Netherlands.,Department of Dermatology, Erasmus MC, Rotterdam, the Netherlands
| | - E P Prens
- Department of Dermatology, Erasmus MC, Rotterdam, the Netherlands
| | - M S Pradeepti
- Department of Internal Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - R Atiqi
- Department of Immunology, Erasmus MC, Rotterdam, the Netherlands
| | - M W J Schreurs
- Department of Hospital Pharmacy, Erasmus MC, Rotterdam, the Netherlands
| | - B C P Koch
- Department of Internal Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - T van Gelder
- Department of Hospital Pharmacy, Erasmus MC, Rotterdam, the Netherlands.,Department of Internal Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - M B A van Doorn
- Department of Dermatology, Erasmus MC, Rotterdam, the Netherlands
| |
Collapse
|
25
|
Cohen S, Radominski SC, Gomez-Reino JJ, Wang L, Krishnaswami S, Wood SP, Soma K, Nduaka CI, Kwok K, Valdez H, Benda B, Riese R. Analysis of infections and all-cause mortality in phase II, phase III, and long-term extension studies of tofacitinib in patients with rheumatoid arthritis. Arthritis Rheumatol 2015; 66:2924-37. [PMID: 25047021 DOI: 10.1002/art.38779] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 07/03/2014] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To determine the rate of infection and all-cause mortality across tofacitinib phase II, phase III, and long-term extension (LTE) studies in patients with moderately to severely active rheumatoid arthritis (RA). METHODS Pooled data from studies of tofacitinib in patients with RA were analyzed. In these studies, tofacitinib was administered as monotherapy or in combination with methotrexate or other nonbiologic disease-modifying antirheumatic drugs. The cutoff date for inclusion of data was April 19, 2012. RESULTS Across phase II, phase III, and LTE studies, 4,789 patients received tofacitinib (8,460 patient-years of exposure). The overall rate of serious infection was 3.09 events per 100 patient-years (95% confidence interval [95% CI] 2.73-3.49), and rates were stable over time. A Cox proportional hazards model showed that age, corticosteroid dose, diabetes, and tofacitinib dose were independently linked to the risk of serious infection. Lymphocyte counts of <0.5 × 10(3) /mm(3) were rare but were associated with an increased risk of treated and/or serious infection. Overall, all-cause mortality rates were 0.30 events per 100 patient-years (95% CI 0.20-0.44). CONCLUSION The overall risk of infection (including serious infection) and mortality rates in RA patients treated with tofacitinib appear to be similar to those observed in RA patients treated with biologic agents. The rates of serious infection were stable over time.
Collapse
|
26
|
Landewé R, Østergaard M, Keystone EC, Florentinus S, Liu S, van der Heijde D. Analysis of Integrated Radiographic Data From Two Long-Term, Open-Label Extension Studies of Adalimumab for the Treatment of Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2015; 67:180-6. [DOI: 10.1002/acr.22426] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 07/22/2014] [Indexed: 01/12/2023]
Affiliation(s)
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital, Glostrup, and University of Copenhagen; Copenhagen Denmark
| | | | | | | | | |
Collapse
|
27
|
Tebbey PW, Varga A, Naill M, Clewell J, Venema J. Consistency of quality attributes for the glycosylated monoclonal antibody Humira® (adalimumab). MAbs 2015; 7:805-11. [PMID: 26230301 PMCID: PMC4622832 DOI: 10.1080/19420862.2015.1073429] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 07/11/2015] [Indexed: 01/19/2023] Open
Abstract
Humira® (adalimumab) is a recombinant human IgG1 monoclonal antibody (mAb) glycoprotein consisting of 1330 amino acids that is specific for human tumor necrosis factor (TNF). The biological activity and clinical profile of mAb therapeutics, including adalimumab, is influenced by their protein structure and glycosylation patterns, which can be affected by the expression system, cell culture conditions and purification process methodology. While clinical outcome cannot yet be attributed to many of the individual structural features that constitute a mAb, it is evident that detailed structural attribute analysis is necessary if structural contributions to function are to be comprehensively defined. Adalimumab product quality data generated from over a decade of manufacturing across multiple production sites and through a series of manufacturing scale changes are presented here. These data reveal a consistent and tightly controlled profile for the product.
Collapse
Affiliation(s)
- Paul W Tebbey
- AbbVie; Global Medical Affairs; Biologics Strategic Development; North Chicago, IL USA
| | - Amy Varga
- AbbVie; Biologics Development and Manufacturing Launch; AbbVie Bioresearch Center; Worcester, MA USA
| | - Michael Naill
- AbbVie; Biologics Development and Manufacturing Launch; AbbVie Bioresearch Center; Worcester, MA USA
| | - Jerry Clewell
- AbbVie; Global Medical Affairs; Biologics Strategic Development; North Chicago, IL USA
| | - Jaap Venema
- AbbVie; Global Medical Affairs; Biologics Strategic Development; North Chicago, IL USA
| |
Collapse
|
28
|
Bergman M, De G, Ganguli A, Signorovitch J, Bao Y. Assessment of income growth in patients with rheumatoid arthritis treated with anti-tumor necrosis factor therapy. J Med Econ 2015; 18:37-44. [PMID: 24841451 DOI: 10.3111/13696998.2014.925465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To compare income growth over time between employees with RA treated with anti-TNFs and those treated with methotrexate (MTX). METHODS Privately insured employees (aged ≥18) with ≥1 RA diagnosis (ICD-9: 714.0) were identified from a large-scale US employer claims database (1998-2011). Patients were stratified into treatment groups (anti-TNF-treated patients and MTX-monotherapy patients) based on their treatment history. The anti-TNF-treated patients comprised patients who filled ≥1 prescription for anti-TNFs, with or without MTX (index date defined as the date of the first anti-TNF prescription). The MTX-treated patients comprised patients who filled ≥1 prescription for MTX-monotherapy (index date randomly selected). The primary study outcome was the annual income growth rate (US dollars). Patients were followed from their index date to health plan disenrollment or the end of data availability (maximum follow-up of 5 years). The effect of treatment type on income growth was assessed using a multivariable generalized estimating equation model, adjusting for key baseline characteristics. Income growth was compared to that of the general employed population using Social Security data (1998-2011). RESULTS The regression-adjusted annual growth rate in income for anti-TNF-treated patients (n = 1848) was 2.8% (CI = 1.9-3.6%), significantly greater (p < 0.05) than the 0.6% (CI = -0.2-1.4%) for MTX-monotherapy patients (n = 1866). Compared to the general employed population, income growth was lower (p < 0.05) for MTX-monotherapy patients and comparable for anti-TNF-treated patients. CONCLUSIONS Compared to MTX-monotherapy, anti-TNF treatment is associated with a higher income growth rate among employees with RA. Anti-TNF-treated patients experienced comparable income growth to the general employed population norm.
Collapse
|
29
|
Liu Y, Fan W, Chen H, Yu MX. Risk of Breast Cancer and Total Malignancies in Rheumatoid Arthritis Patients Undergoing TNF-α Antagonist Therapy: a Meta-analysis of Randomized Control Trials. Asian Pac J Cancer Prev 2014; 15:3403-10. [DOI: 10.7314/apjcp.2014.15.8.3403] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
30
|
Abstract
Introduction: Rheumatoid arthritis (RA) is a systemic inflammatory disease that causes increased morbidity and mortality. The treatment of the disease has considerably advanced with the addition of biological agents targeting pro-inflammatory cytokines such as tumor necrosis factor (TNF). Adalimumab (ADA) is one of the currently available five TNF inhibitors for clinical use in RA. It is a fully humanized monoclonal antibody which may be prescribed as monotherapy or in combination with methotrexate or other disease-modifying antirheumatic drugs. Areas covered: This review summarizes the recent available data on efficacy and safety of ADA in patients with early and established RA as well as improvement of quality of life and finally we provide data on biologic drug comparison. Expert opinion: ADA has been evaluated in various randomized placebo-controlled trials in RA, prospective observational studies as well as open-label extensions of the original double-blind trials providing experience and data about the long-term efficacy and safety of the drug. Effectiveness of the drug is sustained, while in most cases RA patients treated with ADA experienced a slower radiographic progression and consequently less disability and improved health-related quality of life outcomes. Clinical trials demonstrated no new safety signals and a safety profile consistent with that of the anti-TNF class.
Collapse
Affiliation(s)
- Paraskevi V Voulgari
- University of Ioannina Medical School, Department of Internal Medicine, Rheumatology Clinic , 45110 Ioannina , Greece
| | | |
Collapse
|
31
|
Keystone EC, Breedveld FC, van der Heijde D, Landewé R, Florentinus S, Arulmani U, Liu S, Kupper H, Kavanaugh A. Longterm effect of delaying combination therapy with tumor necrosis factor inhibitor in patients with aggressive early rheumatoid arthritis: 10-year efficacy and safety of adalimumab from the randomized controlled PREMIER trial with open-label extension. J Rheumatol 2013; 41:5-14. [PMID: 24241487 DOI: 10.3899/jrheum.130543] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate the longterm safety of adalimumab administered with or without methotrexate (MTX) and compare the efficacy of combination therapy initialization to adalimumab or MTX monotherapy initialization during the open-label extension (OLE) of the PREMIER trial (ClinicalTrials.gov Identifier:NCT00195663). METHODS Patients with early rheumatoid arthritis (RA) were randomized to receive blinded adalimumab + MTX, adalimumab alone, or MTX alone for 2 years. Following the double-blinded period, patients enrolling in the OLE were given adalimumab for up to 8 additional years, beginning as monotherapy; investigators could add MTX at their discretion. Results for clinical, functional, and radiographic progression were collected for up to 10 years of treatment. RESULTS During the PREMIER OLE, 250/497 patients (50.3%) completed the trial without new safety signals arising. Similar proportions of patients discontinued the trial early, although lack of efficacy was reported less often for patients initially randomized to the adalimumab + MTX arm (9.3%; 21.2%, and 23.7% for adalimumab and MTX monotherapies, respectively). Clinical and functional disease control was maintained throughout the trial. Patients initially randomized to adalimumab + MTX displayed better outcomes, particularly in prevention of radiographic progression (modified total Sharp score change = 4.0, 8.8, 11.0 at Year 10 for the initial adalimumab + MTX, adalimumab, and MTX arms, respectively). CONCLUSION Intensive therapy with adalimumab + MTX combination in patients with early RA has longterm benefits compared to patients initiating with 2-year adalimumab or MTX monotherapy that persists up to 10 years following adalimumab OLE. No new safety findings were observed following longterm adalimumab treatment.
Collapse
Affiliation(s)
- Edward C Keystone
- From the University of Toronto, Toronto, Ontario, Canada; Leiden University Medical Center, Leiden, The Netherlands; Academic Medical Center, Amsterdam, The Netherlands; AbbVie, Rungis, France; AbbVie Inc., North Chicago, Illinois, USA; AbbVie Deutschland GmbH and Co KG, Ludwigshafen, Germany; University of California San Diego, La Jolla, California, USA
| | | | | | | | | | | | | | | | | |
Collapse
|