New era of treatment with biologics in rheumatology - is it time to shift paradigms in treatment with biologics?

Circulating Fetuin-A concentrations in rheumatic diseases: a systematic review and meta-analysis

BACKGROUND

Rheumatic diseases (RDs) include a broad group of disabling conditions with different phenotypes, from autoimmune to autoinflammatory, degenerative, metabolic or mixed manifestations. With the continuous efforts to identify therapeutic targets for new biologic drugs to treat overt clinical manifestations, research is also focusing on the discovery of new biomarkers to diagnose and manage early disease stages. In this context, we conducted a systematic review and meta-analysis of Fetuin-A (FtA), a glycoprotein synthesized by the liver that participates in several biological processes and has been proposed as a biomarker for several disorders, including rheumatoid arthritis.

METHODS

A systematic search in PubMed, Scopus and Web of Science, from inception to the 24th of August 2024, led to the identification of 13 manuscripts from 219 records; six additional studies were identified through reference hand-search, for a total of 19 studies.

RESULTS

There was a significant decrease in FtA concentrations in RD patients (standardized mean difference, SMD = -.91; 95% CI -1.43 to -.39, p = .001), with no substantial contribution from any individual study nor publication bias. The effect size was significantly associated with erythrocyte sedimentation rate, various lipid fractions, geographical area of study conduction, study design and specific type of RD.

CONCLUSION

In conclusion, our study identified significant reductions in FtA concentrations in RD patients versus healthy controls. These alterations were significantly associated with specific study and patient characteristics. Further research is required to identify the exact pathophysiological mechanisms underlying these alterations and the possible utility of measuring FtA for the diagnosis and management of RDs.

Anticytokine Treatment of Rheumatoid Arthritis: An Observational Report

Rheumatoid arthritis (RA) is an autoimmune disease of unknown etiology, characterized by symmetrical arthritis, and deterioration of articular cartilage and epiphyses leading to progressive destruction and deformation of joints, resulting in disability. The purpose of this chapter is to evaluate the effects of treatment with anti-inflammatory biologic medication, Enbrel (Etanercept), during therapeutic rehabilitation in RA patients. The sample comprised 10 hospitalized patients (8 females and 2 males) of the mean age of 32.2 ± 13.4 years treated with Enbrel in 2008-2010. The drug was administered subcutaneously in a dose of 50 mg once a week. Outcomes consisted of differences in the Disease Activity Score (DAS-28) and the degree of joint impairment based on the Health Assessment Questionnaire (HAQ) noted 2 months after treatment onset. The average pre-/post-treatment DAS-28 score was 4.1/2.6, with improvement in 9 patients. The average HAQ score was 1.5/0.6, respectively. We conclude that treatment with Enbrel significantly reduces RA activity and improved joint impairment. The beneficial influence of the drug enabled an earlier commencement of physical rehabilitation, which may have a preventive bearing on the development of disability.

Adherence to biologic disease-modifying antirheumatic drugs in adult patients with rheumatic diseases

INTRODUCTION

The emergence of biologics has revolutionized the management of refractory rheumatic diseases (RD) by improving clinical outcomes. Unfortunately, the impact of non-adherence to the emerging therapy can limit their potential benefit. The objective of our study was to evaluate biologics' adherence in Tunisian patients with RD and to assess the determinants of non-adherence.

METHODS

We conducted a cross-sectional study involving patients with rheumatoid arthritis (RA) and spondyloarthritis (SpA) treated with bDMARDs (biologic disease-modifying antirheumatic drugs) for at least three months. Socio-demographic, clinical and biological data were collected. Biologic adherence was assessed using the compliance questionnaire for rheumatology (CQR).

RESULTS

One hundred patients with RD (45 RA and 55 SpA) were collected. Non-adherence to bDMARDs was found in 70% of cases. In univariate analysis, non-adherence to bDMARDs was statistically related to the absence of coxitis (P=0.003), to a low ASDAS-CRP (ankylosing spondylitis disease activity score) prior to the initiation of the bDMARDs (P=0.01), to a rate of administration of bDMARDs less than one injection per month (P=0.01), to the subcutaneous delivery route (P=0.02) as well as to non-adherence to csDMARDs (conventional disease-modifying antirheumatic drugs) (P=0.001). In multivariate analysis, the predictors of non-adherence were the absence of coxitis (OR=6.01; IC 95% [1.88-19.12]; P=0.002], and a rate of administration of bDMARDs less than one injection per month (OR=8.79; IC 95% [2.13-36.22]; P=0.003).

CONCLUSION

This work has revealed the low rate of adherence to biological treatments in Tunisian patient with RD. Predictors of poor adherence were the absence of coxitis and a rate of administration of bDMARDs less than one injection per month. Detection of these factors could help us to adapt our strategies to improve adherence that are essentially based on therapeutic education program.