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Lovell DJ, Brunner HI, Reiff AO, Jung L, Jarosova K, Němcová D, Mouy R, Sandborg C, Bohnsack JF, Elewaut D, Gabriel C, Higgins G, Kone-Paut I, Jones OY, Vargová V, Chalom E, Wouters C, Lagunes I, Song Y, Martini A, Ruperto N. Long-term outcomes in patients with polyarticular juvenile idiopathic arthritis receiving adalimumab with or without methotrexate. RMD Open 2021; 6:rmdopen-2020-001208. [PMID: 32665432 PMCID: PMC7425194 DOI: 10.1136/rmdopen-2020-001208] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/27/2020] [Accepted: 06/01/2020] [Indexed: 11/05/2022] Open
Abstract
Objectives Long-term safety and efficacy of adalimumab among patients with juvenile idiopathic arthritis (JIA) was evaluated through 6 years of treatment. Methods Children aged 4–17 years with polyarticular JIA were enrolled in a phase III, randomised-withdrawal, double-blind, placebo-controlled trial consisting of a 16-week open-label lead-in period, 32-week randomised double-blind period and 360-week long-term extension. Patients were stratified by baseline methotrexate use. Adverse events (AEs) were monitored, and efficacy assessments included JIA American College of Rheumatology (JIA ACR) 30%, 50%, 70% or 90% responses and the proportions of patients achieving 27-joint Juvenile Arthritis Disease Activity Score (JADAS27) low disease activity (LDA, ≤3.8) and inactive disease (ID, ≤1). Results Of 171 patients enrolled, 62 (36%) completed the long-term extension. Twelve serious infections in 11 patients were reported through 592.8 patient-years of exposure. No cases of congestive heart failure-related AEs, demyelinating disease, lupus-like syndrome, malignancies, tuberculosis or deaths were reported. JIA ACR 30/50/70/90 responses and JADAS27 LDA were achieved in 66% to 96% of patients at week 104, and 63 (37%) patients achieved clinical remission (JADAS27 ID sustained for ≥6 continuous months) during the study. Attainment of JIA ACR 50 or higher and JADAS27 LDA or ID in the initial weeks were the best predictors of clinical remission. Mean JADAS27 decreased from baseline, 22.5 (n=170), to 2.5 (n=30) at week 312 (observed analysis). Conclusions Through 6 years of exposure, adalimumab was well tolerated with significant clinical response (up to clinical remission) and a relatively low retention rate.
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Affiliation(s)
- Daniel J Lovell
- Department of Pediatrics, Division of Rheumatology, University of Cincinnati, Cincinnati Children's Hospital Medical Center, PRCSG Coordinating Center, Cincinnati, Ohio, USA
| | - Hermine I Brunner
- Department of Pediatrics, Division of Rheumatology, University of Cincinnati, Cincinnati Children's Hospital Medical Center, PRCSG Coordinating Center, Cincinnati, Ohio, USA
| | - Andreas O Reiff
- Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, California, USA.,Division of Rheumatology, Children's Hospital of Los Angeles, Los Angeles, California, USA
| | - Lawrence Jung
- Department of Rheumatology, Children's National Medical Center for Cancer and Immunology Research, Washington, District of Columbia, USA
| | - Katerina Jarosova
- Institute of Rheumatology, Prague, Czech Republic.,Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Dana Němcová
- Department of Pediatrics and Adolescent Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Richard Mouy
- Pediatric Rheumatology, Univeristé Paris-Descartes and Hôpital Necker-Enfants Malades, Paris, France
| | - Christy Sandborg
- Pediatric Rheumatology, Lucile Packard Children's Hospital at Stanford, Palo Alto, California, USA
| | - John F Bohnsack
- Department of Pediatrics, Division of Allergy, Immunology and Pediatric Rheumatology, University of Utah, Salt Lake City, Utah, USA
| | - Dirk Elewaut
- Rheumatology, University Hospital Gent, Gent, Belgium.,VIB Center for Inflammation Research, Gent University, Gent, Belgium
| | - Christos Gabriel
- Pediatric Rheumatology, Children's Hospital of the King's Daughters, Norfolk, Virginia, USA
| | - Gloria Higgins
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Isabelle Kone-Paut
- Department of Paediatric Rheumatology and CEREMAI, Hôpital De Bicêtre, National Reference Centre for Auto-inflammatory Diseases, Le Kremlin-Bicêtre, Paris, France
| | - Olcay Y Jones
- Pediatric Rheumatology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | | | - Elizabeth Chalom
- Pediatric-Rheumatology, Saint Barnabas Medical Center, Livingston, New Jersey, USA
| | - Carine Wouters
- Pediatric Immunology, University Hospital Gasthuisberg, Leuven, Belgium
| | | | - Yanna Song
- AbbVie Inc, North Chicago, Illinois, USA
| | - Alberto Martini
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DiNOGMI),, Università degli Studi di Genova, Genoa, Italy
| | - Nicolino Ruperto
- Clinica Pediatrica e Reumatologia-PRINTO, IRCCS Istituto Giannina Gaslini, Genova, Italy
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Takeuchi T, Miyasaka N, Inui T, Yano T, Yoshinari T, Abe T, Koike T. High titers of both rheumatoid factor and anti-CCP antibodies at baseline in patients with rheumatoid arthritis are associated with increased circulating baseline TNF level, low drug levels, and reduced clinical responses: a post hoc analysis of the RISING study. Arthritis Res Ther 2017; 19:194. [PMID: 28865493 PMCID: PMC5581496 DOI: 10.1186/s13075-017-1401-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 08/01/2017] [Indexed: 01/09/2023] Open
Abstract
Background Although both rheumatoid factor (RF) and anticyclic citrullinated peptide antibodies (anti-CCP) are useful for diagnosing rheumatoid arthritis (RA), the impact of these autoantibodies on the efficacy of tumor necrosis factor (TNF) inhibitors has been controversial. The aim of this post hoc analysis of a randomized double-blind study (the RISING study) was to investigate the influences of RF and anti-CCP on the clinical response to infliximab in patients with RA. Methods Methotrexate-refractory patients with RA received 3 mg/kg of infliximab from weeks 0 to 6 and then 3, 6, or 10 mg/kg every 8 weeks from weeks 14 to 46. In this post hoc analysis, patients were stratified into three classes on the basis of baseline RF/anti-CCP titers: “low/low-C” (RF < 55 IU/ml, anti-CCP < 42 U/ml), “high/high-C” (RF ≥ 160 IU/ml, anti-CCP ≥ 100 U/ml), and “middle-C” (neither low/low-C nor high/high-C). Baseline plasma TNF level, serum infliximab level, and disease activity were compared between the three classes. Results Baseline RF and anti-CCP titers showed significant correlations with baseline TNF and infliximab levels in weeks 2–14. Comparison of the three classes showed that baseline TNF level was lowest in the low/low-C group and highest in the high/high-C group (median 0.73 versus 1.15 pg/ml), that infliximab levels at week 14 were highest in the low/low-C group and lowest in the high/high-C group (median 1.0 versus 0.1 μg/ml), and that Disease Activity Score in 28 joints based on C-reactive protein at week 14 was lowest in the low/low-C group and highest in the high/high-C group (median 3.17 versus 3.82). A similar correlation was observed at week 54 in the 3 mg/kg dosing group, but not in the 6 or 10 mg/kg group. Significant decreases in both RF and anti-CCP were observed during infliximab treatment. Conclusions RF/anti-CCP titers correlated with TNF level. This might explain the association of RF/anti-CCP with infliximab level and clinical response in patients with RA. Baseline RF/anti-CCP titers may serve as indices that aid infliximab treatment. Trial registration ClinicalTrials.gov, NCT00691028. Retrospectively registered on 3 June 2008. Electronic supplementary material The online version of this article (doi:10.1186/s13075-017-1401-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Nobuyuki Miyasaka
- Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Takashi Inui
- Ikuyaku Integrated Value Development Division, Mitsubishi Tanabe Pharma Corporation, 3-2-10, Dosho-machi, Chuo-ku, Osaka, 541-8505, Japan
| | - Toshiro Yano
- Ikuyaku Integrated Value Development Division, Mitsubishi Tanabe Pharma Corporation, 3-2-10, Dosho-machi, Chuo-ku, Osaka, 541-8505, Japan
| | - Toru Yoshinari
- Ikuyaku Integrated Value Development Division, Mitsubishi Tanabe Pharma Corporation, 3-2-10, Dosho-machi, Chuo-ku, Osaka, 541-8505, Japan
| | - Tohru Abe
- Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan
| | - Takao Koike
- Sapporo Medical Center NTT EC, South-1 West-15, Chuo-ku, Sapporo, 060-0061, Japan
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Takasugi K, Nishida K, Natsumeda M, Yamashita M, Yamamoto W, Ezawa K. IL-6 is an independent predictive factor of drug survival after dose escalation of infliximab in patients with rheumatoid arthritis. Mod Rheumatol 2017; 28:452-460. [DOI: 10.1080/14397595.2017.1361802] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Koji Takasugi
- Department of Internal Medicine, Rheumatoid Arthritis Center, Kurashiki Sweet Hospital, Kurashiki, Japan
| | - Keiichiro Nishida
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Masamitsu Natsumeda
- Department of Internal Medicine, Rheumatoid Arthritis Center, Kurashiki Sweet Hospital, Kurashiki, Japan
| | - Misuzu Yamashita
- Department of Internal Medicine, Rheumatoid Arthritis Center, Kurashiki Sweet Hospital, Kurashiki, Japan
| | - Wataru Yamamoto
- Department of Clinical Information Management, Rheumatoid Arthritis Center, Kurashiki Sweet Hospital, Kurashiki, Japan
| | - Kazuhiko Ezawa
- Department of Internal Medicine, Rheumatoid Arthritis Center, Kurashiki Sweet Hospital, Kurashiki, Japan
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van der Heijde D, Deodhar A, Fleischmann R, Mease PJ, Rudwaleit M, Nurminen T, Davies O. Early Disease Activity or Clinical Response as Predictors of Long-Term Outcomes With Certolizumab Pegol in Axial Spondyloarthritis or Psoriatic Arthritis. Arthritis Care Res (Hoboken) 2016; 69:1030-1039. [PMID: 27696727 PMCID: PMC5518306 DOI: 10.1002/acr.23092] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 07/21/2016] [Accepted: 09/13/2016] [Indexed: 01/17/2023]
Abstract
Objective Early identification of patients unlikely to achieve good long‐term disease control with anti–tumor necrosis factor therapy in axial spondyloarthritis (SpA) and psoriatic arthritis (PsA) is important for physicians following treat‐to‐target recommendations. Here we assess associations between disease activity or clinical response during the first 12 weeks of treatment and attainment of treatment targets at week 48 in axial SpA and PsA patients receiving certolizumab pegol. Methods The relationship between disease activity or clinical response during the first 12 weeks of treatment and achievement of week‐48 targets (for axial SpA: inactive disease based on Ankylosing Spondylitis Disease Activity Score [ASDAS] using the C‐reactive protein [CRP] level, or Bath Ankylosing Spondylitis Disease Activity Index <2 with normal CRP level; and for PsA: minimal disease activity) was assessed post hoc using RAPID‐axSpA and RAPID‐PsA trial data. Results A clear relationship between disease activity from week 2 to 12 and achievement of week‐48 treatment targets was observed in both axial SpA and PsA populations. In axial SpA, week‐48 ASDAS inactive disease was achieved by 0% of patients (0 of 21) with ASDAS very high disease activity at week 12, compared to 68% of patients (34 of 50) with week‐12 ASDAS inactive disease. For PsA, week‐48 minimal disease activity was achieved by 0% of patients (0 of 26) with Disease Activity Score in 28 joints (DAS28) using the CRP level >5.1 at week 12, compared to 73% of patients (57 of 78) with DAS28‐CRP <2.6. Similar results were observed regardless of the disease activity measure used. Clinical response at week 12 also predicted week‐48 outcomes, though to a lesser extent than disease activity. Conclusion Using disease activity and the clinical response state during the first 12 weeks of certolizumab pegol treatment, it was possible to identify a subset of axial SpA and PsA patients unlikely to achieve long‐term treatment goals.
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Affiliation(s)
| | - A Deodhar
- Oregon Health and Science University, Portland
| | | | - P J Mease
- Swedish Medical Center and University of Washington, Seattle
| | - M Rudwaleit
- Klinikum Bielefeld and Charité Berlin, Berlin, Germany, and Ghent University, Ghent, Belgium
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Hayashi S, Suzuki K, Yoshimoto K, Takeshita M, Kurasawa T, Yamaoka K, Takeuchi T. Early Prognostic Factors Associated with the Efficacy of Infliximab Treatment for Patients with Rheumatoid Arthritis with Inadequate Response to Methotrexate. Rheumatol Ther 2015; 3:155-166. [PMID: 27747509 DOI: 10.1007/s40744-015-0022-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Early prognostic factors for the clinical response in patients with rheumatoid arthritis (RA) after 1 year of treatment with infliximab (IFX) as part of routine clinical practice were investigated. METHODS Thirty-five patients with RA with an inadequate response to methotrexate were enrolled and administered IFX (3-9 mg/kg, every 4-8 weeks). Serum trough levels of IFX and levels of 9 cytokines were measured at baseline and at 3, 6 months, and 1 year. Associations between these parameters and clinical indicators were statistically analyzed. RESULTS Serum trough levels of IFX and serum levels of interleukin (IL)-6 in the early phase of IFX treatment were investigated. Patients with low serum IL-6 achieved a higher clinical response as evaluated by the European League Against Rheumatism response criteria. Notably, the serum levels of IL-6 and IL-10 at baseline exhibited a significant positive correlation with disease activity at 1 year. Low serum levels of IL-6 and IL-10 at baseline were associated with low Disease Activity Score 28 erythrocyte sedimentation rate (DAS28-ESR). Cut-off values of IL-6 (5.45 pg/mL) and IL-10 and (1.68 pg/mL) enabled discrimination of DAS28-ESR remission from non-remission with high sensitivity and moderate specificity. CONCLUSION Following the initiation of IFX treatment, early disease activity and remission were associated with serum levels of IL-6. Serum levels of IL-6 and IL-10 at baseline predict the efficacy after 1 year of treatment with IFX. Patients with high serum levels of IL-6 and IL-10 at baseline before IFX treatment might require more intensive therapy to achieve higher rates of clinical remission at 1 year. FUNDING Eisai Co., Ltd.
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Affiliation(s)
- Satoko Hayashi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Katsuya Suzuki
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Keiko Yoshimoto
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Masaru Takeshita
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Takahiko Kurasawa
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kunihiro Yamaoka
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
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