1
|
Contreras-Yáñez I, Guaracha-Basáñez GA, Cuevas-Montoya M, de Jesús Hernández-Bautista J, Pascual-Ramos V. Early persistence on therapy impacts drug-free remission: a case-control study in a cohort of Hispanic patients with recent-onset rheumatoid arthritis. Arthritis Res Ther 2022; 24:193. [PMID: 35962421 PMCID: PMC9373313 DOI: 10.1186/s13075-022-02884-w] [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: 05/27/2022] [Accepted: 07/26/2022] [Indexed: 11/25/2022] Open
Abstract
Background Medication adherence is suboptimal in rheumatoid arthritis (RA) patients and impacts outcomes. DMARD-free remission (DFR) is a sustainable and achievable outcome in a minority of RA patients. Different factors have been associated with DFR, although persistence in therapy (PT), a component of the adherence construct, has never been examined. The study’s primary aim was to investigate the impact of PT’s characteristics on DFR in a cohort of Hispanic patients with recent-onset RA. Methods A single data abstractor reviewed the charts from 209 early (symptoms duration ≤ 1 year) RA patients. All the patients had prospective assessments of disease activity and PT and at least 1 year of follow-up, which was required for the DFR definition. DFR was defined when patients achieved ≥ 1 year of continuous Disease Activity Score-28 joints evaluated ≤ 2.6, without DMARDs and corticosteroids. PT was defined based on pre-specified criteria and recorded through an interview from 2004 to 2008 and thereafter through a questionnaire. Cases (patients who achieved ≥ 1 DFR status) were paired with controls (patients who never achieved DFR during their entire follow-up) according to ten relevant variables (1:2). Cox regression analysis estimated hazard ratios (HRs) for DFR according to two characteristics of PT: the % of the patient follow-up PT and early PT (first 2 years of patients’ follow-up). Results In March 2022, the population had 112 (55–181) patient/years follow-up. There were 23 patients (11%) with DFR after 74 months (44–122) of follow-up, and the DFR status was maintained during 48 months (18–82). Early PT was associated with DFR, while the % of the patient follow-up PT was not: HR = 3.84 [1.13–13.07] when the model was adjusted for cumulative N of DMARDs/patient and 3.16 [1.14–8.77] when also adjusted for baseline SF-36 physical component score. A lower N of cumulative DMARDs/patient was also retained in the models. Receiving operating curve to define the best cutoff of patient follow-up being PT to predict DFR was 21 months: sensitivity of 0.739, specificity of 0.717, and area under the curve of 0.682 (0.544–0.821). Conclusions DFR status might be added to the benefits of adhering to prescribed treatment. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-022-02884-w.
Collapse
Affiliation(s)
- Irazú Contreras-Yáñez
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador-Zubirán (INCMyN-SZ), Vasco de Quiroga 15, colonia Belisario Domínguez Sección XVI, Tlalpan, 14080, Mexico City, Mexico
| | - Guillermo Arturo Guaracha-Basáñez
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador-Zubirán (INCMyN-SZ), Vasco de Quiroga 15, colonia Belisario Domínguez Sección XVI, Tlalpan, 14080, Mexico City, Mexico.,Emergency Medicine Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador-Zubirán (INCMyN-SZ), Vasco de Quiroga 15, colonia Belisario Domínguez Sección XVI, Tlalpan, 14080, Mexico City, Mexico
| | - Maximiliano Cuevas-Montoya
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador-Zubirán (INCMyN-SZ), Vasco de Quiroga 15, colonia Belisario Domínguez Sección XVI, Tlalpan, 14080, Mexico City, Mexico
| | - José de Jesús Hernández-Bautista
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador-Zubirán (INCMyN-SZ), Vasco de Quiroga 15, colonia Belisario Domínguez Sección XVI, Tlalpan, 14080, Mexico City, Mexico
| | - Virginia Pascual-Ramos
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador-Zubirán (INCMyN-SZ), Vasco de Quiroga 15, colonia Belisario Domínguez Sección XVI, Tlalpan, 14080, Mexico City, Mexico.
| |
Collapse
|
2
|
Study on the mechanism of moxibustion for rheumatoid arthritis based on liquid chromatography-mass spectrometry. JOURNAL OF ACUPUNCTURE AND TUINA SCIENCE 2022. [DOI: 10.1007/s11726-022-1321-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
|
3
|
Alawneh K, Al-Mistarehi AH, Qandeel A, Jaber R, Alomari S, Kheirallah KA. The Safety and Effectiveness of Infliximab Biosimilar in Managing Rheumatoid Arthritis: A Real-Life Experience from Jordan. Int J Clin Pract 2022; 2022:3406783. [PMID: 36101813 PMCID: PMC9439897 DOI: 10.1155/2022/3406783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 06/20/2022] [Accepted: 07/30/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Infliximab (IFX) biosimilar was the first biosimilar approved in Jordan in 2014, with limited evidence of its safety and effectiveness from the Middle East and North Africa (MENA) region. Thus, this study aimed to evaluate the safety and effectiveness of IFX biosimilar in active rheumatoid arthritis (RA) patients over 34 weeks by investigating (1) the adverse events (AEs), serious adverse events (SAEs), and therapy discontinuation and (2) the score changes of the 28-Joint Disease Activity Score (DAS28) and the Health Assessment Questionnaire Disability Index (HAQ-DI). METHODS This multicenter prospective cohort study collected clinical parameters within hospital settings every four weeks. The numbers and percentages of observed AEs and SAEs were informed. The DAS28 utilizing Erythrocyte Sedimentation Rate (ESR), HAQ-DI, and ESR were reported at baseline and 14th and 30th weeks; thus, they were reported as means (SD). RESULTS A total of 22 RA patients were enrolled and initiated IFX biosimilar, of which nine (41.0%) discontinued the study, but their data were analyzed up to the point of withdrawal. A total of 35 AEs were reported in 14 patients, including two (5.7%) SAEs. None of the participants discontinued treatment due to AEs. The mean (SD) score of DAS28-ESR significantly decreased from 6.55 (1.16) at baseline to 4.59 (1.45) at week 14 (p < 0.0001) and to 4.77 (1.09) at week 30 (p < 0.0001). Similarly, the mean (SD) HAQ-DI score significantly decreased from 0.95 (0.74) at baseline to 0.48 (0.62) at week 14 (p=0.008) and to 0.71 (0.78) at week 30 (p=0.483). The mean (SD) value of ESR decreased from 58.75 (26.94) at baseline to 47.92 (33.89) at week 14 (p=0.082) and to 39.83 (17.38) at week 30 (p=0.005). CONCLUSION IFX biosimilar demonstrated safety and effectiveness in managing RA patients bringing real-world clinical support for biosimilars' role in rheumatology.
Collapse
Affiliation(s)
- Khaldoon Alawneh
- Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Abdel-Hameed Al-Mistarehi
- Department of Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Ali Qandeel
- Department of Rheumatology, Prince Hamzah Hospital, Amman, Jordan
| | - Ruba Jaber
- Clinical Research and Development Department, Hikma Pharmaceuticals LLC, Amman, Jordan
| | - Safwan Alomari
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Khalid A. Kheirallah
- Department of Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| |
Collapse
|
4
|
Makarem YS, Hareedy MS, Hassanien M, Ahmed EA, Hetta HF, Mohamed AA. Frequency and impact of DHODH, ABCG2 and CYP2C19 SNPs on the therapeutic efficacy, tolerability and toxicity of leflunomide. Pharmacogenomics 2021; 22:1201-1209. [PMID: 34747629 DOI: 10.2217/pgs-2020-0146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction: Leflunomide is one of the commonly used drugs in treatment of rheumatoid arthritis (RA), which on administration is converted into its active metabolite teriflunomide. Aim: Our aim is to evaluate the frequencies of dihydrooroate dehydrogenase (DHODH) (rs3213422), ABCG2 (rs2231142) and CYP2C19 (rs4244285) allele distribution among patients receiving leflunomide for RA and their possible impact on leflunomide performance in disease control. Patients & methods: Patients (>18 years) who fulfilled the 2010 ACR classification criteria for RA receiving leflunomide (20 mg/day) were included in the study. Disease activity score 28 was used to assess patients disease activity. Blood samples were collected for full blood count and blood chemistry. Genomic DNA was extracted from peripheral blood. The selection of SNPs was based on the criteria of minor allele frequency among Caucasians. Results: A significant association between the therapeutic outcome of leflunomide and DHODH genotyping was observed but not with CYP2C19 and ABCG2. Importantly, there is a significant association between DHODH (rs3213422) CC genotype and the number of patients with controlled disease. Conclusion: We strongly suggest that polymorphisms in the DHODH are the major factor affecting leflunomide pharmacogenetics and therapeutic efficacy.
Collapse
Affiliation(s)
- Yasmine S Makarem
- Department of Rheumatology & Rehabilitation, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mohammad Salem Hareedy
- Department of Pharmacology & Medical Pharmacology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Manal Hassanien
- Department of Rheumatology & Rehabilitation, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Esraa A Ahmed
- Department of Pharmacology & Medical Pharmacology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Helal F Hetta
- Department of Medical Microbiology & Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt.,Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0595, USA
| | - Alaa Aa Mohamed
- Department of Rheumatology & Rehabilitation, Faculty of Medicine, Assiut University, Assiut, Egypt.,Department of Rheumatology, The Betsi Cadwaladr University Health Board, Wales, UK
| |
Collapse
|
5
|
Verstappen M, van Mulligen E, de Jong PHP, van der Helm-Van Mil AHM. DMARD-free remission as novel treatment target in rheumatoid arthritis: A systematic literature review of achievability and sustainability. RMD Open 2021; 6:rmdopen-2020-001220. [PMID: 32393523 PMCID: PMC7299506 DOI: 10.1136/rmdopen-2020-001220] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/01/2020] [Accepted: 04/02/2020] [Indexed: 01/08/2023] Open
Abstract
Objectives Although current treatment guidelines for rheumatoid arthritis (RA) suggest tapering disease-modifying anti-rheumatic drugs (DMARDs), it is unclear whether DMARD-free remission (DFR) is an achievable and sustainable outcome. Therefore, we systematically reviewed the literature to determine the prevalence and sustainability of DFR and evaluated potential predictors for DFR. Methods A systematic literature search was performed in March 2019 in multiple databases. All clinical trials and observational studies reporting on discontinuation of DMARDs in RA patients in remission were included. Our quality assessment included a general assessment and assessment of the description of DFR. Prevalence of DFR and its sustainability and flares during tapering and after DMARD stop were summarised. Also, potential predictors for achieving DFR were reviewed. Results From 631 articles, 51 were included, comprising 14 clinical trials and 5 observational studies. DFR definition differed, especially for the duration of DMARD-free state. Considering only high- and moderate-quality studies, DFR was achieved in 5.0%–24.3% and sustained DFR (duration>12 months) in 11.6%–19.4% (both relative to the number of patients eligible for tapering). Flares occurred frequently during DMARD tapering (41.8%–75.0%) and in the first year after achieving DFR (10.4%–11.8%), while late flares, >1 year after DMARD-stop, were infrequent (0.3%–3.5%). Many patient characteristics lacked association with DFR. Absence of autoantibodies and shared epitope alleles increased the chance of achieving DFR. Conclusions DFR is achievable in RA and is sustainable in ~10%–20% of patients. DFR can become an important outcome measure for clinical trials and requires consistency in the definition. Considering the high rate of flares in the first year after DMARD stop, a DMARD-free follow-up of >12 months is advisable to evaluate sustainability.
Collapse
Affiliation(s)
- M Verstappen
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
| | - E van Mulligen
- Department of Rheumatology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - P H P de Jong
- Department of Rheumatology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - A H M van der Helm-Van Mil
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Rheumatology, Erasmus Medical Center, Rotterdam, the Netherlands
| |
Collapse
|
6
|
Li C, Chen B, Fang Z, Leng YF, Wang DW, Chen FQ, Xu X, Sun ZL. Metabolomics in the development and progression of rheumatoid arthritis: A systematic review. Joint Bone Spine 2020; 87:425-430. [PMID: 32473419 DOI: 10.1016/j.jbspin.2020.05.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 05/19/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVE A systematic review and analysis of data from several rheumatoid arthritis metabolomics studies attempts to determine which metabolites can be used as potential biomarkers for the diagnosis of rheumatoid arthritis and to explore the pathogenesis of rheumatoid arthritis. METHODS We searched all the subject-related documents published by EMBASE, PubMed, Web of Science, and Cochrane Library from the database to the September 2019 publication. Two researchers independently screened the literature and extracted the data. QUADOMICS tool was used to assess the quality of studies included in this systematic review. RESULTS A total of 10 studies met the inclusion criteria of systematic review, including 502 patients with rheumatoid arthritis and 373 healthy people. Among them, the biological samples utilised for metabolomic analysis include: serum (n=8), urine (n=1) and synovial fluid (n=1). Some metabolites play an important role in rheumatoid arthritis: glucose, lactic acid, citric acid, leucine, methionine, isoleucine, valine, phenylalanine, threonine, serine, proline, glutamate, histidine, alanine, cholesterol, glycerol, and ribose. CONCLUSIONS Metabolomics provides important new opportunities for further research in rheumatoid arthritis and is expected to elucidate the pathogenesis of rheumatoid arthritis that has not been fully understood before.
Collapse
Affiliation(s)
- Cheng Li
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
| | - Bin Chen
- Department of nursing, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, Jiangsu Province, China
| | - Zhen Fang
- Medical Oncology, The Second Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210017, Jiangsu Province, China
| | - Yu-Fei Leng
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
| | - Dan-Wen Wang
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
| | - Feng-Qin Chen
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
| | - Xiao Xu
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou 310000, Zhejiang Province, China
| | - Zhi-Ling Sun
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China.
| |
Collapse
|