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Aletaha D, Kerschbaumer A, Kastrati K, Dejaco C, Dougados M, McInnes IB, Sattar N, Stamm TA, Takeuchi T, Trauner M, van der Heijde D, Voshaar M, Winthrop KL, Ravelli A, Betteridge N, Burmester GRR, Bijlsma JW, Bykerk V, Caporali R, Choy EH, Codreanu C, Combe B, Crow MK, de Wit M, Emery P, Fleischmann RM, Gabay C, Hetland ML, Hyrich KL, Iagnocco A, Isaacs JD, Kremer JM, Mariette X, Merkel PA, Mysler EF, Nash P, Nurmohamed MT, Pavelka K, Poor G, Rubbert-Roth A, Schulze-Koops H, Strangfeld A, Tanaka Y, Smolen JS. Consensus statement on blocking interleukin-6 receptor and interleukin-6 in inflammatory conditions: an update. Ann Rheum Dis 2022; 82:773-787. [PMID: 35953263 DOI: 10.1136/ard-2022-222784] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 07/18/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Targeting interleukin (IL)-6 has become a major therapeutic strategy in the treatment of immune-mediated inflammatory disease. Interference with the IL-6 pathway can be directed at the specific receptor using anti-IL-6Rα antibodies or by directly inhibiting the IL-6 cytokine. This paper is an update of a previous consensus document, based on most recent evidence and expert opinion, that aims to inform on the medical use of interfering with the IL-6 pathway. METHODS A systematic literature research was performed that focused on IL-6-pathway inhibitors in inflammatory diseases. Evidence was put in context by a large group of international experts and patients in a subsequent consensus process. All were involved in formulating the consensus statements, and in the preparation of this document. RESULTS The consensus process covered relevant aspects of dosing and populations for different indications of IL-6 pathway inhibitors that are approved across the world, including rheumatoid arthritis, polyarticular-course and systemic juvenile idiopathic arthritis, giant cell arteritis, Takayasu arteritis, adult-onset Still's disease, Castleman's disease, chimeric antigen receptor-T-cell-induced cytokine release syndrome, neuromyelitis optica spectrum disorder and severe COVID-19. Also addressed were other clinical aspects of the use of IL-6 pathway inhibitors, including pretreatment screening, safety, contraindications and monitoring. CONCLUSIONS The document provides a comprehensive consensus on the use of IL-6 inhibition to treat inflammatory disorders to inform healthcare professionals (including researchers), patients, administrators and payers.
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Affiliation(s)
- Daniel Aletaha
- Division of Rheumatology, Medical University of Vienna, Wien, Austria
| | | | - Kastriot Kastrati
- Division of Rheumatology, Medical University of Vienna, Wien, Austria
| | - Christian Dejaco
- Rheumatology, Medical University of Graz, Graz, Austria.,Rheumatology, Brunico Hospital, Brunico, Italy
| | - Maxime Dougados
- Rheumatology, Universite Paris Descartes Faculte de Medecine Site Cochin, Paris, France
| | - Iain B McInnes
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, Glasgow, UK
| | - Tanja A Stamm
- Section for Outcomes Research, Medical University of Vienna, Wien, Austria
| | - Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine Graduate School of Medicine, Shinjuku-ku, Japan
| | - Michael Trauner
- Division of Gastroenterology and Hepatology, Medical University of Vienna, Wien, Austria
| | - Désirée van der Heijde
- Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.,Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Marieke Voshaar
- Department of Psychology, Health and Technology, Enschede, Netherlands and Stichting Tools Patient Empowerment, University of Twente, Enschede, The Netherlands
| | - Kevin L Winthrop
- Schools of Medicine and Public Health, Division of Infectious Diseases, Oregon Health & Science University, Portland, Oregon, USA
| | - Angelo Ravelli
- UO Pediatria II-Reumatologia, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | | | | | - Johannes Wj Bijlsma
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Vivian Bykerk
- Rheumatology, University of Toronto, Toronto, Ontario, Canada
| | - Roberto Caporali
- Department of Clinical Sciences and Community Health, ASS G. Pini, University of Milan, Milano, Italy
| | - Ernest H Choy
- CREATE Centre, Section of Rheumatology, School of Medicine, Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - Catalin Codreanu
- Rheumatology, Carol Davila University of Medicine and Pharmacy, Bucuresti, Romania
| | - Bernard Combe
- Immunorhumatologie, CHU Lapeyronie, Montpellier, France
| | - Mary K Crow
- Mary Kirkland Center for Lupus Research, Hospital for Special Surgery, New York City, New York, USA
| | - Maarten de Wit
- Medical Humanities, Amsterdam University Medical Centres, Duivendrecht, The Netherlands
| | - Paul Emery
- University of Leeds, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, UK.,Leeds Teaching Hospitals NHS Trust, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | - Roy M Fleischmann
- Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Cem Gabay
- Division of Rheumatology, Geneva University Hospitals, Geneve, Switzerland
| | - Merete Lund Hetland
- Department of Clinical Medicine, Copenhagen University Hospital, Kobenhavn, Denmark.,Department of Clinical Medicine, University of Copenhagen, Kobenhavn, Denmark
| | - Kimme L Hyrich
- Centre for Epidemiology Versus Arthritis, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Annamaria Iagnocco
- Scienze Cliniche e Biologiche, Università degli Studi di Torino, Torino, Italy
| | - John D Isaacs
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Joel M Kremer
- Medicine Rheumatology, Albany Medical College, Albany, New York, USA
| | - Xavier Mariette
- Rheumatology, Assistance Publique-Hôpitaux de Paris, Paris, France.,Center for Immunology of Viral Infections and Auto-immune Diseases, Université Paris-Sud, Gif-sur-Yvette, France
| | - Peter A Merkel
- Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Eduardo F Mysler
- Organización Médica de Investigación SA, Buenos Aires, Argentina
| | - Peter Nash
- Griffith University School of Medicine, Gold Coast, Queensland, Australia
| | | | - Karel Pavelka
- Rheumatology Department, Charles University, Praha, Czech Republic
| | - Gyula Poor
- National Institute of Rheumatology & Physiology, Semmelweis University, Budapest, Hungary
| | - Andrea Rubbert-Roth
- Division of Rheumatology, Kantonsspital Sankt Gallen, Sankt Gallen, Switzerland
| | - Hendrik Schulze-Koops
- Division of Rheumatology and Clinical Immunology, Internal Medicine IV, Ludwig-Maximilians-Universitat Munchen, Munchen, Germany
| | - Anja Strangfeld
- Forschungsbereich Epidemiologie, Deutsches Rheuma-Forschungszentrum Berlin, Berlin, Germany
| | - Yoshiya Tanaka
- First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Josef S Smolen
- Division of Rheumatology, Medical University of Vienna, Wien, Austria
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Quartuccio L, Choy EH. Rheumatologists at a crossroads: blocking tumour necrosis factor or interleukin 6 in disease-modifying anti-rheumatic drug inadequate responder patients with rheumatoid arthritis. Rheumatology (Oxford) 2021; 60:4953-4955. [PMID: 33974043 DOI: 10.1093/rheumatology/keab425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/04/2021] [Accepted: 05/06/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Luca Quartuccio
- Rheumatology Clinic, Department of Medicine, University of Udine, ASUFC, Udine, Italy
| | - Ernest H Choy
- Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK
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3
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Ceeraz S, Thompson CR, Beatson R, Choy EH. Harnessing CD8 +CD28 - Regulatory T Cells as a Tool to Treat Autoimmune Disease. Cells 2021; 10:cells10112973. [PMID: 34831195 PMCID: PMC8616472 DOI: 10.3390/cells10112973] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/25/2021] [Accepted: 10/28/2021] [Indexed: 12/30/2022] Open
Abstract
T regulatory cell therapy presents a novel therapeutic strategy for patients with autoimmune diseases or who are undergoing transplantation. At present, the CD4+ Treg population has been extensively characterized, as a result of defined phenotypic and functional readouts. In this review article, we discuss the development and biology of CD8+ Tregs and their role in murine and human disease indications. A subset of CD8+ Tregs that lack the surface expression of CD28 (CD8+CD28− Treg) has proved efficacious in preclinical models. CD8+CD28− Tregs are present in healthy individuals, but their impaired functionality in disease renders them less effective in mediating immunosuppression. We primarily focus on harnessing CD8+ Treg cell therapy in the clinic to support current treatment for patients with autoimmune or inflammatory conditions.
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Affiliation(s)
| | | | - Richard Beatson
- School of Cancer & Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King’s College London, London SE1 9RT, UK;
| | - Ernest H. Choy
- CREATE Centre, Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff CF14 4XN, UK
- Correspondence: ; Tel.: +44-(0)29-2068-7092
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Nagy G, Roodenrijs NMT, Welsing PMJ, Kedves M, Hamar A, van der Goes MC, Kent A, Bakkers M, Pchelnikova P, Blaas E, Senolt L, Szekanecz Z, Choy EH, Dougados M, Jacobs JW, Geenen R, Bijlsma JW, Zink A, Aletaha D, Schoneveld L, van Riel P, Dumas S, Prior Y, Nikiphorou E, Ferraccioli G, Schett G, Hyrich KL, Mueller-Ladner U, Buch MH, McInnes IB, van der Heijde D, van Laar JM. EULAR points to consider for the management of difficult-to-treat rheumatoid arthritis. Ann Rheum Dis 2021; 81:20-33. [PMID: 34407926 PMCID: PMC8761998 DOI: 10.1136/annrheumdis-2021-220973] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 07/23/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To develop evidence-based European Alliance of Associations for Rheumatology (EULAR) points to consider (PtCs) for the management of difficult-to-treat rheumatoid arthritis (D2T RA). METHODS An EULAR Task Force was established comprising 34 individuals: 26 rheumatologists, patient partners and rheumatology experienced health professionals. Two systematic literature reviews addressed clinical questions around diagnostic challenges, and pharmacological and non-pharmacological therapeutic strategies in D2T RA. PtCs were formulated based on the identified evidence and expert opinion. Strength of recommendations (SoR, scale A-D: A typically consistent level 1 studies and D level 5 evidence or inconsistent studies) and level of agreement (LoA, scale 0-10: 0 completely disagree and 10 completely agree) of the PtCs were determined by the Task Force members. RESULTS Two overarching principles and 11 PtCs were defined concerning diagnostic confirmation of RA, evaluation of inflammatory disease activity, pharmacological and non-pharmacological interventions, treatment adherence, functional disability, pain, fatigue, goal setting and self-efficacy and the impact of comorbidities. The SoR varied from level C to level D. The mean LoA with the overarching principles and PtCs was generally high (8.4-9.6). CONCLUSIONS These PtCs for D2T RA can serve as a clinical roadmap to support healthcare professionals and patients to deliver holistic management and more personalised pharmacological and non-pharmacological therapeutic strategies. High-quality evidence was scarce. A research agenda was created to guide future research.
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Affiliation(s)
- György Nagy
- Department of Rheumatology & Clinical Immunology, Semmelweis University, Budapest, Hungary .,Department of Genetics, Cell and Immunobiology, Semmelweis University, Budapest, Hungary
| | - Nadia M T Roodenrijs
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Paco M J Welsing
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Melinda Kedves
- Bács-Kiskun County Hospital, Rheumatology Department, Kecskemét, Hungary
| | - Attila Hamar
- Department of Rheumatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Marlies C van der Goes
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Rheumatology, Meander Medical Center, Amersfoort, The Netherlands
| | - Alison Kent
- Salisbury Foundation Trust NHS Hospital, Wiltshire, UK
| | - Margot Bakkers
- EULAR Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), Zurich, Switzerland
| | - Polina Pchelnikova
- EULAR Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), Zurich, Switzerland
| | - Etienne Blaas
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Ladislav Senolt
- Department of Rheumatology, 1st Faculty of Medicine, Charles University and Institute of Rheumatology, Prague, Czech Republic
| | - Zoltan Szekanecz
- Department of Rheumatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Ernest H Choy
- CREATE Centre, Section of Rheumatology, School of Medicine, Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - Maxime Dougados
- Université de Paris Department of Rheumatology - Hôpital Cochin. Assistance Publique - Hôpitaux de Paris INSERM (U1153) Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité, Paris, France
| | - Johannes Wg Jacobs
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Rinie Geenen
- Department of Psychology, Utrecht University, Utrecht, The Netherlands
| | - Johannes Wj Bijlsma
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Angela Zink
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
| | - Daniel Aletaha
- Department of Internal Medicine III, Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Leonard Schoneveld
- Department of Rheumatology, Bravis Hospital, Roosendaal, The Netherlands
| | - Piet van Riel
- Department of Rheumatic Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Sophie Dumas
- Department of Pharmacy, Marin Hospital, Asisstance Publique-Hopitaux de Paris, Hendaye, France
| | - Yeliz Prior
- School of Health and Society, Centre for Health Sciences Research, University of Salford, Salford, UK
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases, King's College London, London, UK.,Rheumatology Department, King's College Hospital, London, UK
| | | | - Georg Schett
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander University of Erlangen-Nuremberg and Universitatsklinikum Erlangen, Erlangen, Germany
| | - Kimme L Hyrich
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
| | - Ulf Mueller-Ladner
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Campus Kerckhoff, Bad Nauheim, Germany
| | - Maya H Buch
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK.,Leeds Institute of Rheumatic & Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Iain B McInnes
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | | | - Jacob M van Laar
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Sarzi-Puttini P, Giorgi V, Atzeni F, Gorla R, Kosek E, Choy EH, Bazzichi L, Häuser W, Ablin JN, Aloush V, Buskila D, Amital H, Da Silva JA, Perrot S, Morlion B, Polati E, Schweiger V, Coaccioli S, Varrassi G, Di Franco M, Torta R, Øien Forseth KM, Mannerkorpi K, Salaffi F, Di Carlo M, Cassisi G, Batticciotto A. Diagnostic and therapeutic care pathway for fibromyalgia. Clin Exp Rheumatol 2021; 39 Suppl 130:120-127. [DOI: 10.55563/clinexprheumatol/zcp5hz] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 04/22/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Piercarlo Sarzi-Puttini
- Rheumatology Unit, Internal Medicine Department, ASST Fatebenefratelli-Sacco, Milan, and University School of Medicine, Milan, Italy
| | - Valeria Giorgi
- Rheumatology Unit, Internal Medicine Department, ASST Fatebenefratelli-Sacco, Milan, and University School of Medicine, Milan, Italy.
| | - Fabiola Atzeni
- Rheumatology Unit, Department of Internal Medicine, University of Messina, Italy
| | - Roberto Gorla
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili, Brescia, Italy
| | - Eva Kosek
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, and Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Ernest H. Choy
- Section of Rheumatology, School of Medicine, Cardiff University, Cardiff, UK
| | | | - Winfred Häuser
- Department Psychosomatic Medicine and Psychotherapy, Technische Universität München, Munich, Germany
| | - Jacob N. Ablin
- Department of Internal Medicine H, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Valerie Aloush
- Institute of Rheumatology, Tel Aviv Sourasky Medical Centre and the Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Dan Buskila
- Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Howard Amital
- Department of Medicine B and Center of Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jose A.P. Da Silva
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, and Coimbra Institute for Clinical and Biomedical Research (i.CBR), Faculty of Medicine, University of Coimbra, Portugal
| | - Serge Perrot
- CETD, CHU Cochin, APHP, Paris-Descartes University, Inserm U987, Paris, France
| | - Bart Morlion
- Leuven Centre for Algology & Pain Management, University Hospitals Leuven, KU Leuven, Belgium
| | - Enrico Polati
- Department of Surgery, Odontostomatology and Maternal Sciences, Pain Therapy Centre, Verona University Hospital, Policlinico GB Rossi, Verona, Italy
| | - Vittorio Schweiger
- Department of Surgery, Odontostomatology and Maternal Sciences, Pain Therapy Centre, Verona University Hospital, Policlinico GB Rossi, Verona, Italy
| | - Stefano Coaccioli
- General Medical Clinic and Medical Therapy, Rheumatology and Medical Therapy of the Pain, University of Perugia, Polo di Terni, AO Santa Maria of Terni, Italy
| | | | - Manuela Di Franco
- Department of Clinical Internal Medicine, Anaesthesiological and Cardiovascular Sciences, Rheumatology Unit, Policlinico Umberto I, La Sapienza University of Rome, Italy
| | - Riccardo Torta
- Clinical Psychology and Psycho-Oncology Unit, Department of Neuroscience, University of Turin, Azienda Ospedaliera Universitaria (A.O.U.) Città della Salute e della Scienza Hospital, Turin, Italy
| | | | - Kaisa Mannerkorpi
- Institute of Neuroscience and Physiology, Section of Health and Rehabilitation, Physiotherapy, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Fausto Salaffi
- Rheumatology Clinic, Department of Clinical and Molecular Science, Università Politecnica delle Marche, Jesi, Ancona, Italy
| | - Marco Di Carlo
- Rheumatology Clinic, Department of Clinical and Molecular Science, Università Politecnica delle Marche, Jesi, Ancona, Italy
| | - Gianniantonio Cassisi
- Departmental Unit of Rheumatology, Specialist Outpatients Department, ASL 1 Dolomiti, Belluno, Veneto, Italy
| | - Alberto Batticciotto
- Rheumatology Unit, Internal Medicine Department, ASST Settelaghi, Ospedale Di Circolo, Fondazione Macchi, Varese, Italy
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6
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Galloway J, Raine T, Rivett L, Roberts J, Dews SA, Choy EH. Herpes zoster and Janus kinase inhibition in rheumatology and gastroenterology patients: managing risk and vaccination. Clin Exp Rheumatol 2021; 40:1432-1441. [DOI: 10.55563/clinexprheumatol/0jdyse] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 11/08/2021] [Indexed: 11/13/2022]
Affiliation(s)
- James Galloway
- King’s College London and King’s College Hospital, London, UK.
| | - Tim Raine
- Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Lucy Rivett
- Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | | | - Ernest H. Choy
- CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK
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7
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Sarzi-Puttini P, Giorgi V, Atzeni F, Gorla R, Kosek E, Choy EH, Bazzichi L, Häuser W, Ablin JN, Aloush V, Buskila D, Amital H, Da Silva JAP, Perrot S, Morlion B, Polati E, Schweiger V, Coaccioli S, Varrassi G, Di Franco M, Torta R, Øien Forseth KM, Mannerkorpi K, Salaffi F, Di Carlo M, Cassisi G, Batticciotto A. Fibromyalgia position paper. Clin Exp Rheumatol 2021; 39 Suppl 130:186-193. [PMID: 34001303 DOI: 10.55563/clinexprheumatol/i19pig] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 04/15/2021] [Indexed: 11/13/2022]
Abstract
Fibromyalgia syndrome is one of the most common causes of chronic widespread pain, but pain accompanies a wide range of ancillary symptoms. To date, its aetiopathogenesis remains elusive, and diagnosis is exquisitely clinical, due to the lack of biomarkers or specific laboratory alterations in fibromyalgia patients. This position paper has the purpose to summarise the current scientific knowledge and expert opinions about the main controversies regarding fibromyalgia syndrome, namely: (i) fibromyalgia definition and why it is still not recognised in many countries as a distinct clinical entity; (ii) fibromyalgia severity and how to evaluate treatment outcome; (iii) how to treat fibromyalgia and which is a correct approach to fibromyalgia patients.
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Affiliation(s)
- Piercarlo Sarzi-Puttini
- Rheumatology Unit, Internal Medicine Department, ASST Fatebenefratelli-Sacco, Milan, and University School of Medicine, Milan, Italy
| | - Valeria Giorgi
- Rheumatology Unit, Internal Medicine Department, ASST Fatebenefratelli-Sacco, Milan, and University School of Medicine, Milan, Italy.
| | - Fabiola Atzeni
- Rheumatology Unit, Department of Internal Medicine, University of Messina, Italy
| | - Roberto Gorla
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili, Brescia, Italy
| | - Eva Kosek
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, and Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Ernest H Choy
- Section of Rheumatology, School of Medicine, Cardiff University, Cardiff, UK
| | | | - Winfred Häuser
- Department Psychosomatic Medicine and Psychotherapy, Technische Universität München, Munich, Germany
| | - Jacob N Ablin
- Department of Internal Medicine H, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Valerie Aloush
- Institute of Rheumatology, Tel Aviv Sourasky Medical Centre and the Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Dan Buskila
- Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Howard Amital
- Department of Medicine B and Center of Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jose A P Da Silva
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, and Coimbra Institute for Clinical and Biomedical Research (i.CBR), Faculty of Medicine, University of Coimbra, Portugal
| | - Serge Perrot
- CETD, CHU Cochin, APHP, Paris-Descartes University, Inserm U987, Paris, France
| | - Bart Morlion
- Leuven Centre for Algology & Pain Management, University Hospitals Leuven, KU Leuven, Belgium
| | - Enrico Polati
- Department of Surgery, Odontostomatology and Maternal Sciences, Pain Therapy Centre, Verona University Hospital, Policlinico GB Rossi, Verona, Italy
| | - Vittorio Schweiger
- Department of Surgery, Odontostomatology and Maternal Sciences, Pain Therapy Centre, Verona University Hospital, Policlinico GB Rossi, Verona, Italy
| | - Stefano Coaccioli
- General Medical Clinic and Medical Therapy, Rheumatology and Medical Therapy of the Pain, University of Perugia, "Polo di Terni", "AO Santa Maria" of Terni, Italy
| | | | - Manuela Di Franco
- Department of Clinical Internal Medicine, Anaesthesiological and Cardiovascular Sciences, Rheumatology Unit, Policlinico Umberto I, La Sapienza University of Rome, Italy
| | - Riccardo Torta
- Clinical Psychology and Psycho-Oncology Unit, Department of Neuroscience, University of Turin, Azienda Ospedaliera Universitaria (A.O.U.) "Città della Salute e della Scienza" Hospital, Turin, Italy
| | | | - Kaisa Mannerkorpi
- Institute of Neuroscience and Physiology, Section of Health and Rehabilitation, Physiotherapy, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Fausto Salaffi
- Rheumatology Clinic, Department of Clinical and Molecular Science, Università Politecnica delle Marche, Jesi, Ancona, Italy
| | - Marco Di Carlo
- Rheumatology Clinic, Department of Clinical and Molecular Science, Università Politecnica delle Marche, Jesi, Ancona, Italy
| | - Gianniantonio Cassisi
- Departmental Unit of Rheumatology, Specialist Outpatients Department, ASL 1 Dolomiti, Belluno, Italy
| | - Alberto Batticciotto
- Rheumatology Unit, Internal Medicine Department, ASST Settelaghi, Ospedale Di Circolo, Fondazione Macchi, Varese, Italy
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Simon LS, Taylor PC, Choy EH, Sebba A, Quebe A, Knopp KL, Porreca F. The Jak/STAT pathway: A focus on pain in rheumatoid arthritis. Semin Arthritis Rheum 2020; 51:278-284. [PMID: 33412435 DOI: 10.1016/j.semarthrit.2020.10.008] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/02/2020] [Accepted: 10/23/2020] [Indexed: 12/16/2022]
Abstract
Pain is a manifestation of rheumatoid arthritis (RA) that is mediated by inflammatory and non-inflammatory mechanisms and negatively affects quality of life. Recent findings from a Phase 3 clinical trial showed that patients with RA who were treated with a Janus kinase 1 (Jak1) and Janus kinase 2 (Jak2) inhibitor achieved significantly greater improvements in pain than those treated with a tumor necrosis factor blocker; both treatments resulted in similar changes in standard clinical measures and markers of inflammation. These findings suggest that Jak1 and Jak2 inhibition may relieve pain in RA caused by inflammatory and non-inflammatory mechanisms and are consistent with the overarching involvement of the Jak-signal transducer and activator of transcription (Jak/STAT) pathway in mediating the action, expression, and regulation of a multitude of pro- and anti-inflammatory cytokines. In this review, we provide an overview of pain in RA, the underlying importance of cytokines regulated directly or indirectly by the Jak/STAT pathway, and therapeutic targeting of the Jak/STAT pathway in RA. As highlighted herein, multiple cytokines directly or indirectly regulated by the Jak/STAT pathway play important roles in mediating various mechanisms underlying pain in RA. Having a better understanding of these mechanisms may help clinicians make treatment decisions that optimize the control of inflammation and pain.
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Affiliation(s)
| | - Peter C Taylor
- Botnar Research Centre, University of Oxford, Oxford, UK
| | - Ernest H Choy
- CREATE Centre, Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK
| | | | | | | | - Frank Porreca
- Department of Pharmacology, College of Medicine, University of Arizona, 1501 N. Campbell Avenue, Tucson, AZ 85718, USA.
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9
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Pope JE, Choy EH. C-reactive protein and implications in rheumatoid arthritis and associated comorbidities. Semin Arthritis Rheum 2020; 51:219-229. [PMID: 33385862 DOI: 10.1016/j.semarthrit.2020.11.005] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 10/19/2020] [Accepted: 11/05/2020] [Indexed: 02/07/2023]
Abstract
C-reactive protein (CRP) is routinely assessed as a marker of systemic inflammation in rheumatoid arthritis (RA). However, it is also an immune regulator that plays an important role in inflammatory pathways associated with RA and promotes atherogenic effects. Comorbidities linked to systemic inflammation are common in RA, and CRP has been associated with the risk for cardiovascular disease, diabetes, metabolic syndrome, pulmonary diseases, and depression. The relationship between systemic inflammation, CRP, and comorbidities in RA is complex, and it is challenging to determine how changing CRP levels may affect the risk or progression of these comorbidities. We review the biological role of CRP in RA and its implications for disease activity and treatment response. We also discuss the impact of treatment on CRP levels and whether reducing systemic inflammation and inhibiting CRP-mediated inflammatory pathways may have an impact on conditions commonly comorbid with RA.
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Affiliation(s)
- Janet E Pope
- Janet E. Pope: Schulich School of Medicine, University of Western Ontario, St. Joseph's Health Care, London, ON, Canada
| | - Ernest H Choy
- Ernest H. Choy: Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, United Kingdom.
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10
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Kostine M, Finckh A, Bingham CO, Visser K, Leipe J, Schulze-Koops H, Choy EH, Benesova K, Radstake TRDJ, Cope AP, Lambotte O, Gottenberg JE, Allenbach Y, Visser M, Rusthoven C, Thomasen L, Jamal S, Marabelle A, Larkin J, Haanen JBAG, Calabrese LH, Mariette X, Schaeverbeke T. EULAR points to consider for the diagnosis and management of rheumatic immune-related adverse events due to cancer immunotherapy with checkpoint inhibitors. Ann Rheum Dis 2020; 80:36-48. [PMID: 32327425 PMCID: PMC7788064 DOI: 10.1136/annrheumdis-2020-217139] [Citation(s) in RCA: 122] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/03/2020] [Accepted: 04/07/2020] [Indexed: 12/13/2022]
Abstract
Background Rheumatic and musculoskeletal immune-related adverse events (irAEs) are observed in about 10% of patients with cancer receiving checkpoint inhibitors (CPIs). Given the recent emergence of these events and the lack of guidance for rheumatologists addressing them, a European League Against Rheumatism task force was convened to harmonise expert opinion regarding their identification and management. Methods First, the group formulated research questions for a systematic literature review. Then, based on literature and using a consensus procedure, 4 overarching principles and 10 points to consider were developed. Results The overarching principles defined the role of rheumatologists in the management of irAEs, highlighting the shared decision-making process between patients, oncologists and rheumatologists. The points to consider inform rheumatologists on the wide spectrum of musculoskeletal irAEs, not fulfilling usual classification criteria of rheumatic diseases, and their differential diagnoses. Early referral and facilitated access to rheumatologist are recommended, to document the target organ inflammation. Regarding therapeutic, three treatment escalations were defined: (1) local/systemic glucocorticoids if symptoms are not controlled by symptomatic treatment, then tapered to the lowest efficient dose, (2) conventional synthetic disease-modifying antirheumatic drugs, in case of inadequate response to glucocorticoids or for steroid sparing and (3) biological disease-modifying antirheumatic drugs, for severe or refractory irAEs. A warning has been made on severe myositis, a life-threatening situation, requiring high dose of glucocorticoids and close monitoring. For patients with pre-existing rheumatic disease, baseline immunosuppressive regimen should be kept at the lowest efficient dose before starting immunotherapies. Conclusion These statements provide guidance on diagnosis and management of rheumatic irAEs and aim to support future international collaborations.
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Affiliation(s)
- Marie Kostine
- Rheumatology, University Hospital of Bordeaux, Bordeaux, France
| | - Axel Finckh
- Division of Rheumatology, University Hospital of Geneva, Geneva, Switzerland
| | | | - Karen Visser
- Rheumatology, Haga Hospital, Den Haag, The Netherlands
| | - Jan Leipe
- Department of Medicine V, Division of Rheumatology, University Hospital Centre, Mannheim, Germany.,Department of Internal Medicine IV, Division of Rheumatology and Clinical Immunology, University of Munich, Munich, Germany
| | - Hendrik Schulze-Koops
- Department of Internal Medicine IV, Division of Rheumatology and Clinical Immunology, University of Munich, Munich, Germany
| | - Ernest H Choy
- Institute of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK
| | | | | | - Andrew P Cope
- Academic Department of Rheumatology, King's College London, London, UK
| | - Olivier Lambotte
- Internal Medicine and Clinical Immunology, Hopital Bicetre, Le Kremlin-Bicetre, France
| | | | - Yves Allenbach
- Internal Medicine and Clinical Immunology, Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France
| | - Marianne Visser
- EULAR PARE Patient Research Partners, Amsterdam, The Netherlands
| | - Cindy Rusthoven
- EULAR PARE Patient Research Partners, Amsterdam, The Netherlands
| | | | - Shahin Jamal
- Rheumatology, The University of British Columbia, Vancouver, British Columbia, Canada
| | | | - James Larkin
- Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - John B A G Haanen
- The Netherlands Cancer Institute, Amsterdam, Noord-Holland, The Netherlands
| | | | - Xavier Mariette
- Rheumatology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux universitaires Paris-Sud - Hôpital Bicêtre, Le Kremlin Bicêtre, France.,3Université Paris-Sud, Center for Immunology of Viral Infections and Auto-immune Diseases (IMVA), Institut pour la Santé et la Recherche Médicale (INSERM) UMR 1184, Université Paris-Saclay, Le Kremlin Bicêtre, France
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11
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Choy EH. Effect of biologics and targeted synthetic disease-modifying anti-rheumatic drugs on fatigue in rheumatoid arthritis. Rheumatology (Oxford) 2020; 58:v51-v55. [PMID: 31682274 PMCID: PMC6827260 DOI: 10.1093/rheumatology/kez389] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 07/11/2019] [Indexed: 11/20/2022] Open
Abstract
Fatigue is a common and debilitating symptom in patients with RA. Since 2007, fatigue has been included as one of the core outcome measures in RA. Clinical trials of biologic DMARDs (bDMARDs) and targeted synthetic DMARDs (tsDMARDs) have included fatigue as a secondary endpoint. A Cochrane review in 2016 concluded that the bDMARDs have a moderate effect on improving fatigue in RA. More recent clinical trials of the new biologic agent sarilumab and the Janus kinase inhibitors tofacitinib and baricitinib showed similar benefits. It remains unclear whether the effect of bDMARDs and tsDMARDs on fatigue is mediated by direct effects or through a reduction in inflammation. As fatigue was a secondary endpoint, many analyses did not adjust for potential confounding factors, including pain, mood and anaemia, which is a significant limitation.
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Affiliation(s)
- Ernest H Choy
- Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK
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12
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Affiliation(s)
- Ernest H Choy
- CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University, Cardiff
| | - Emma Dures
- Centre for Health and Clinical Research, University of the West of England, Bristol and Academic Rheumatology, Bristol Royal Infirmary, Bristol, UK
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13
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Winthrop KL, Wouters A, Choy EH, Chen C, Biswas P, Wang L, Soma K, Needle E, Valdez H, Rigby WF. Long-term effectiveness of live herpes zoster vaccine in patients with rheumatoid arthritis subsequently treated with tofacitinib. Ann Rheum Dis 2020; 79:669-671. [PMID: 32161057 PMCID: PMC7213307 DOI: 10.1136/annrheumdis-2019-216566] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 02/03/2020] [Accepted: 02/04/2020] [Indexed: 11/12/2022]
Affiliation(s)
| | | | - Ernest H Choy
- CREATE Centre, Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK
| | | | | | - Lisy Wang
- Pfizer Inc, Groton, Connecticut, USA
| | | | | | | | - William Fc Rigby
- Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
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14
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Abstract
Cytokines are key drivers of inflammation in RA, and anti-cytokine therapy has improved the outcome of RA. Janus Kinases (JAK) are intracellular tyrosine kinases linked to intracellular domains of many cytokine receptors. There are four JAK isoforms: JAK1, JAK2, JAK3 and TYK2. Different cytokine receptor families utilize specific JAK isoforms for signal transduction. Phosphorylation of JAK when cytokine binds to its cognate receptor leads to phosphorylation of other intracellular molecules that eventually leads to gene transcription. Oral JAK inhibitors (JAKi) have been developed as anti-cytokine therapy in RA. Two JAKi, tofacitinib and baricitinib, have been approved recently for the treatment of RA, and many JAKi are currently in development. JAKi inhibit JAK isoforms with different selectivity. This review discusses the efficacy and safety of JAKi in RA, in particular the potential clinical significance of JAKi selectivity.
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Affiliation(s)
- Ernest H Choy
- CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK
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15
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Monnet E, Choy EH, McInnes I, Kobakhidze T, de Graaf K, Jacqmin P, Lapeyre G, de Min C. Efficacy and safety of NI-0101, an anti-toll-like receptor 4 monoclonal antibody, in patients with rheumatoid arthritis after inadequate response to methotrexate: a phase II study. Ann Rheum Dis 2019; 79:316-323. [PMID: 31892533 DOI: 10.1136/annrheumdis-2019-216487] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 12/03/2019] [Accepted: 12/13/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Anti-citrullinated protein antibodies (ACPAs) form immune complexes with citrullinated proteins binding toll-like receptor (TLR) 4, which has been proposed as a mediator of rheumatoid arthritis (RA). NI-0101 is a first-in-class humanised monoclonal antibody blocking TLR4, as confirmed by inhibition of in vivo lipopolysaccharide-induced cytokine release in healthy volunteers. This study was design to confirm preclinical investigations supporting a biomarker-driven approach for treatment of patients with RA who present positive for these immune complexes. METHODS Placebo-controlled, double-blind, randomised (2:1) trial of the tolerability and efficacy of NI-0101 (5 mg/kg, every 2 weeks for 12 weeks) versus placebo in ACPA-positive RA patients with inadequate response to methotrexate. Efficacy measures included Disease Activity Score (28-joint count) with C reactive protein (DAS28-CRP), European League Against Rheumatism (EULAR) good and moderate responses, and American College of Rheumatology (ACR) 20, ACR50 and ACR70 responses. Subgroup analyses defined on biomarkers were conducted. Pharmacokinetics, pharmacodynamics and safety were reported. RESULTS 90 patients were randomised (NI-0101 (61) and placebo (29)); 86 completed the study. No significant between-group difference was observed for any of the efficacy endpoints. Subgroup analyses using baseline parameters as covariants did not reveal any population responding to NI-0101. Treatment-emergent adverse events occurred in 51.7% of patients who received placebo versus 52.5% for NI-0101. CONCLUSIONS We demonstrate for the first time that in RA, a human immune-mediated inflammatory disease, blocking the TLR4 pathway alone does not improve disease parameters. Successful targeting of innate immune pathways in RA may require broader and/or earlier inhibitory approaches.
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Affiliation(s)
- Emmanuel Monnet
- Clinical Development, NovImmune SA, Plan les Ouates, Geneva, Switzerland
| | - Ernest H Choy
- Institute of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK
| | - Iain McInnes
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Tamta Kobakhidze
- University Clinic, High Technology Medical Center, Tbilisi, Georgia
| | - Kathy de Graaf
- Clinical Development, NovImmune SA, Plan les Ouates, Geneva, Switzerland
| | | | - Geneviève Lapeyre
- Clinical Development, NovImmune SA, Plan les Ouates, Geneva, Switzerland
| | - Cristina de Min
- Clinical Development, NovImmune SA, Plan les Ouates, Geneva, Switzerland
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16
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Lliso-Ribera G, Humby F, Lewis M, Nerviani A, Mauro D, Rivellese F, Kelly S, Hands R, Bene F, Ramamoorthi N, Hackney JA, Cauli A, Choy EH, Filer A, Taylor PC, McInnes I, Townsend MJ, Pitzalis C. Synovial tissue signatures enhance clinical classification and prognostic/treatment response algorithms in early inflammatory arthritis and predict requirement for subsequent biological therapy: results from the pathobiology of early arthritis cohort (PEAC). Ann Rheum Dis 2019; 78. [PMID: 31582377 PMCID: PMC6900253 DOI: 10.1136/annrheumdis-2019-215751+10.1136/annrheumdis-2019-215751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
OBJECTIVE To establish whether synovial pathobiology improves current clinical classification and prognostic algorithms in early inflammatory arthritis and identify predictors of subsequent biological therapy requirement. METHODS 200 treatment-naïve patients with early arthritis were classified as fulfilling RA1987 American College of Rheumatology (ACR) criteria (RA1987) or as undifferentiated arthritis (UA) and patients with UA further classified into those fulfilling RA2010 ACR/European League Against Rheumatism (EULAR) criteria. Treatment requirements at 12 months (Conventional Synthetic Disease Modifying Antirheumatic Drugs (csDMARDs) vs biologics vs no-csDMARDs treatment) were determined. Synovial tissue was retrieved by minimally invasive, ultrasound-guided biopsy and underwent processing for immunohistochemical (IHC) and molecular characterisation. Samples were analysed for macrophage, plasma-cell and B-cells and T-cells markers, pathotype classification (lympho-myeloid, diffuse-myeloid or pauci-immune) by IHC and gene expression profiling by Nanostring. RESULTS 128/200 patients were classified as RA1987, 25 as RA2010 and 47 as UA. Patients classified as RA1987 criteria had significantly higher levels of disease activity, histological synovitis, degree of immune cell infiltration and differential upregulation of genes involved in B and T cell activation/function compared with RA2010 or UA, which shared similar clinical and pathobiological features. At 12-month follow-up, a significantly higher proportion of patients classified as lympho-myeloid pathotype required biological therapy. Performance of a clinical prediction model for biological therapy requirement was improved by the integration of synovial pathobiological markers from 78.8% to 89%-90%. CONCLUSION The capacity to refine early clinical classification criteria through synovial pathobiological markers offers the potential to predict disease outcome and stratify therapeutic intervention to patients most in need.
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Affiliation(s)
- Gloria Lliso-Ribera
- Centre of Experimental Medicine and Rheumatology, William Harvey Research Institute, London, UK
| | - Frances Humby
- Centre for Experimental Medicine and Rheumatology, Barts and the London School of Medicine and Dentistry, London, UK
| | - Myles Lewis
- Queen Mary University of London—Charterhouse Square Campus, London, UK
| | - Alessandra Nerviani
- Centre of Experimental Medicine and Rheumatology, William Harvey Research Institute, London, UK
| | - Daniele Mauro
- Centre of Experimental Medicine and Rheumatology, William Harvey Research Institute, London, UK
| | - Felice Rivellese
- Centre of Experimental Medicine and Rheumatology, William Harvey Research Institute, London, UK
| | | | - Rebecca Hands
- Experimental Medicine and Rheumatology, Queen Marys University of London, London, UK
| | - Fabiola Bene
- Queen Mary University of London—Charterhouse Square Campus, London, UK
| | - Nandhini Ramamoorthi
- Biomarker Discovery OMNI, Genentech Research & Early Development, San Francisco, California, USA
| | - Jason A Hackney
- ITGR Biomarker Discovery Group, Genentech, South San Francisco, California, USA
| | - Alberto Cauli
- Rheumatology and Rheumatology Unit, University of Cagliari and AOU University Clinic of Cagliari, Monserrato, Italy
| | - Ernest H Choy
- Institute of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK
| | - Andrew Filer
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Peter C Taylor
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Iain McInnes
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Michael J Townsend
- ITGR Biomarker Discovery Group, Genentech, South San Francisco, California, USA
| | - Costantino Pitzalis
- Experimental Medicine and Rheumatology, William Harvey Research Institute, London, UK
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17
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Lliso-Ribera G, Humby F, Lewis M, Nerviani A, Mauro D, Rivellese F, Kelly S, Hands R, Bene F, Ramamoorthi N, Hackney JA, Cauli A, Choy EH, Filer A, Taylor PC, McInnes I, Townsend MJ, Pitzalis C. Synovial tissue signatures enhance clinical classification and prognostic/treatment response algorithms in early inflammatory arthritis and predict requirement for subsequent biological therapy: results from the pathobiology of early arthritis cohort (PEAC). Ann Rheum Dis 2019. [PMID: 31582377 DOI: 10.1136/annrheumdis-2019-215751 10.1136/annrheumdis-2019-215751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To establish whether synovial pathobiology improves current clinical classification and prognostic algorithms in early inflammatory arthritis and identify predictors of subsequent biological therapy requirement. METHODS 200 treatment-naïve patients with early arthritis were classified as fulfilling RA1987 American College of Rheumatology (ACR) criteria (RA1987) or as undifferentiated arthritis (UA) and patients with UA further classified into those fulfilling RA2010 ACR/European League Against Rheumatism (EULAR) criteria. Treatment requirements at 12 months (Conventional Synthetic Disease Modifying Antirheumatic Drugs (csDMARDs) vs biologics vs no-csDMARDs treatment) were determined. Synovial tissue was retrieved by minimally invasive, ultrasound-guided biopsy and underwent processing for immunohistochemical (IHC) and molecular characterisation. Samples were analysed for macrophage, plasma-cell and B-cells and T-cells markers, pathotype classification (lympho-myeloid, diffuse-myeloid or pauci-immune) by IHC and gene expression profiling by Nanostring. RESULTS 128/200 patients were classified as RA1987, 25 as RA2010 and 47 as UA. Patients classified as RA1987 criteria had significantly higher levels of disease activity, histological synovitis, degree of immune cell infiltration and differential upregulation of genes involved in B and T cell activation/function compared with RA2010 or UA, which shared similar clinical and pathobiological features. At 12-month follow-up, a significantly higher proportion of patients classified as lympho-myeloid pathotype required biological therapy. Performance of a clinical prediction model for biological therapy requirement was improved by the integration of synovial pathobiological markers from 78.8% to 89%-90%. CONCLUSION The capacity to refine early clinical classification criteria through synovial pathobiological markers offers the potential to predict disease outcome and stratify therapeutic intervention to patients most in need.
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Affiliation(s)
- Gloria Lliso-Ribera
- Centre of Experimental Medicine and Rheumatology, William Harvey Research Institute, London, UK
| | - Frances Humby
- Centre for Experimental Medicine and Rheumatology, Barts and the London School of Medicine and Dentistry, London, UK
| | - Myles Lewis
- Queen Mary University of London-Charterhouse Square Campus, London, UK
| | - Alessandra Nerviani
- Centre of Experimental Medicine and Rheumatology, William Harvey Research Institute, London, UK
| | - Daniele Mauro
- Centre of Experimental Medicine and Rheumatology, William Harvey Research Institute, London, UK
| | - Felice Rivellese
- Centre of Experimental Medicine and Rheumatology, William Harvey Research Institute, London, UK
| | | | - Rebecca Hands
- Experimental Medicine and Rheumatology, Queen Marys University of London, London, UK
| | - Fabiola Bene
- Queen Mary University of London-Charterhouse Square Campus, London, UK
| | - Nandhini Ramamoorthi
- Biomarker Discovery OMNI, Genentech Research & Early Development, San Francisco, California, USA
| | - Jason A Hackney
- ITGR Biomarker Discovery Group, Genentech, South San Francisco, California, USA
| | - Alberto Cauli
- Rheumatology and Rheumatology Unit, University of Cagliari and AOU University Clinic of Cagliari, Monserrato, Italy
| | - Ernest H Choy
- Institute of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK
| | - Andrew Filer
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Peter C Taylor
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Iain McInnes
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Michael J Townsend
- ITGR Biomarker Discovery Group, Genentech, South San Francisco, California, USA
| | - Costantino Pitzalis
- Experimental Medicine and Rheumatology, William Harvey Research Institute, London, UK
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18
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Lliso-Ribera G, Humby F, Lewis M, Nerviani A, Mauro D, Rivellese F, Kelly S, Hands R, Bene F, Ramamoorthi N, Hackney JA, Cauli A, Choy EH, Filer A, Taylor PC, McInnes I, Townsend MJ, Pitzalis C. Synovial tissue signatures enhance clinical classification and prognostic/treatment response algorithms in early inflammatory arthritis and predict requirement for subsequent biological therapy: results from the pathobiology of early arthritis cohort (PEAC). Ann Rheum Dis 2019; 78:1642-1652. [PMID: 31582377 PMCID: PMC6900253 DOI: 10.1136/annrheumdis-2019-215751] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/26/2019] [Accepted: 08/27/2019] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To establish whether synovial pathobiology improves current clinical classification and prognostic algorithms in early inflammatory arthritis and identify predictors of subsequent biological therapy requirement. METHODS 200 treatment-naïve patients with early arthritis were classified as fulfilling RA1987 American College of Rheumatology (ACR) criteria (RA1987) or as undifferentiated arthritis (UA) and patients with UA further classified into those fulfilling RA2010 ACR/European League Against Rheumatism (EULAR) criteria. Treatment requirements at 12 months (Conventional Synthetic Disease Modifying Antirheumatic Drugs (csDMARDs) vs biologics vs no-csDMARDs treatment) were determined. Synovial tissue was retrieved by minimally invasive, ultrasound-guided biopsy and underwent processing for immunohistochemical (IHC) and molecular characterisation. Samples were analysed for macrophage, plasma-cell and B-cells and T-cells markers, pathotype classification (lympho-myeloid, diffuse-myeloid or pauci-immune) by IHC and gene expression profiling by Nanostring. RESULTS 128/200 patients were classified as RA1987, 25 as RA2010 and 47 as UA. Patients classified as RA1987 criteria had significantly higher levels of disease activity, histological synovitis, degree of immune cell infiltration and differential upregulation of genes involved in B and T cell activation/function compared with RA2010 or UA, which shared similar clinical and pathobiological features. At 12-month follow-up, a significantly higher proportion of patients classified as lympho-myeloid pathotype required biological therapy. Performance of a clinical prediction model for biological therapy requirement was improved by the integration of synovial pathobiological markers from 78.8% to 89%-90%. CONCLUSION The capacity to refine early clinical classification criteria through synovial pathobiological markers offers the potential to predict disease outcome and stratify therapeutic intervention to patients most in need.
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Affiliation(s)
- Gloria Lliso-Ribera
- Centre of Experimental Medicine and Rheumatology, William Harvey Research Institute, London, UK
| | - Frances Humby
- Centre for Experimental Medicine and Rheumatology, Barts and the London School of Medicine and Dentistry, London, UK
| | - Myles Lewis
- Queen Mary University of London-Charterhouse Square Campus, London, UK
| | - Alessandra Nerviani
- Centre of Experimental Medicine and Rheumatology, William Harvey Research Institute, London, UK
| | - Daniele Mauro
- Centre of Experimental Medicine and Rheumatology, William Harvey Research Institute, London, UK
| | - Felice Rivellese
- Centre of Experimental Medicine and Rheumatology, William Harvey Research Institute, London, UK
| | | | - Rebecca Hands
- Experimental Medicine and Rheumatology, Queen Marys University of London, London, UK
| | - Fabiola Bene
- Queen Mary University of London-Charterhouse Square Campus, London, UK
| | - Nandhini Ramamoorthi
- Biomarker Discovery OMNI, Genentech Research & Early Development, San Francisco, California, USA
| | - Jason A Hackney
- ITGR Biomarker Discovery Group, Genentech, South San Francisco, California, USA
| | - Alberto Cauli
- Rheumatology and Rheumatology Unit, University of Cagliari and AOU University Clinic of Cagliari, Monserrato, Italy
| | - Ernest H Choy
- Institute of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK
| | - Andrew Filer
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Peter C Taylor
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Iain McInnes
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Michael J Townsend
- ITGR Biomarker Discovery Group, Genentech, South San Francisco, California, USA
| | - Costantino Pitzalis
- Experimental Medicine and Rheumatology, William Harvey Research Institute, London, UK
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Choy EH. Using biologics safely. Rheumatology (Oxford) 2019; 58:1515-1516. [PMID: 30982882 DOI: 10.1093/rheumatology/kez129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 03/06/2019] [Accepted: 03/07/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ernest H Choy
- CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University, Cardiff, UK
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20
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Jordan LA, Erlandsson MC, Fenner BF, Davies R, Harvey AK, Choy EH, Errington R, Bokarewa MI, Williams AS. Inhibition of CCL3 abrogated precursor cell fusion and bone erosions in human osteoclast cultures and murine collagen-induced arthritis. Rheumatology (Oxford) 2019; 57:2042-2052. [PMID: 30053130 PMCID: PMC6199535 DOI: 10.1093/rheumatology/key196] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Indexed: 12/12/2022] Open
Abstract
Objective Macrophage inflammatory protein 1-alpha (CCL3) is a chemokine that regulates macrophage trafficking to the inflamed joint. The agonistic effect of CCL3 on osteolytic lesions in patients with multiple myeloma is recognized; however, its role in skeletal damage during inflammatory arthritis has not been established. The aim of the study was to explore the role of osteoclast-associated CCL3 upon bone resorption, and to test its pharmacological blockade for protecting against bone pathology during inflammatory arthritis. Methods CCL3 production was studied during osteoclast differentiation from osteoclast precursor cells: human CD14-positive mononuclear cells. Mice with CIA were treated with an anti-CCL3 antibody. The effect of CCL3 blockade through mAb was studied through osteoclast number, cytokine production and bone resorption on ivory disks, and in vivo through CIA progression (clinical score, paw diameter, synovial inflammation and bone damage). Results Over time, CCL3 increased in parallel with the number of osteoclasts in culture. Anti-CCL3 treatment achieved a concentration-dependent inhibition of osteoclast fusion and reduced pit formation on ivory disks (P ⩽ 0.05). In CIA, anti-CCL3 treatment reduced joint damage and significantly decreased multinucleated tartrate-resistant acid phosphatase-positive osteoclasts and erosions in the wrists (P < 0.05) and elbows (P < 0.05), while also reducing joint erosions in the hind (P < 0.01) and fore paws (P < 0.01) as confirmed by X-ray. Conclusion Inhibition of osteoclast-associated CCL3 reduced osteoclast formation and function whilst attenuating arthritis-associated bone loss and controlling development of erosion in murine joints, thus uncoupling bone damage from inflammation. Our findings may help future innovations for the diagnosis and treatment of inflammatory arthritis.
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Affiliation(s)
- Lauren A Jordan
- Division of Infection and Immunity, Cardiff, Wales, UK.,The Cardiff Regional Experimental Arthritis Treatment and Evaluation (CREATE) Centre, Cardiff, Wales, UK
| | - Malin C Erlandsson
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, The University of Gothenburg, Göteborg, Sweden
| | | | - Ruth Davies
- Division of Infection and Immunity, Cardiff, Wales, UK.,The Cardiff Regional Experimental Arthritis Treatment and Evaluation (CREATE) Centre, Cardiff, Wales, UK
| | - Ann K Harvey
- Division of Infection and Immunity, Cardiff, Wales, UK
| | - Ernest H Choy
- Division of Infection and Immunity, Cardiff, Wales, UK.,The Cardiff Regional Experimental Arthritis Treatment and Evaluation (CREATE) Centre, Cardiff, Wales, UK
| | - Rachel Errington
- Division of Cancer and Genetics, Cardiff University, School of Medicine, Cardiff, UK
| | - Maria I Bokarewa
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, The University of Gothenburg, Göteborg, Sweden
| | - Anwen S Williams
- Division of Infection and Immunity, Cardiff, Wales, UK.,The Cardiff Regional Experimental Arthritis Treatment and Evaluation (CREATE) Centre, Cardiff, Wales, UK
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21
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Hewlett S, Almeida C, Ambler N, Blair PS, Choy EH, Dures E, Hammond A, Hollingworth W, Kadir B, Kirwan JR, Plummer Z, Rooke C, Thorn J, Turner N, Pollock J. Reducing arthritis fatigue impact: two-year randomised controlled trial of cognitive behavioural approaches by rheumatology teams (RAFT). Ann Rheum Dis 2019; 78:465-472. [PMID: 30793700 PMCID: PMC6530078 DOI: 10.1136/annrheumdis-2018-214469] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 01/08/2019] [Accepted: 01/11/2019] [Indexed: 12/05/2022]
Abstract
OBJECTIVES To see if a group course delivered by rheumatology teams using cognitive-behavioural approaches, plus usual care, reduced RA fatigue impact more than usual care alone. METHODS Multicentre, 2-year randomised controlled trial in RA adults (fatigue severity>6/10, no recent major medication changes). RAFT (Reducing Arthritis Fatigue: clinical Teams using CB approaches) comprises seven sessions, codelivered by pairs of trained rheumatology occupational therapists/nurses. Usual care was Arthritis Research UK fatigue booklet. Primary 26-week outcome fatigue impact (Bristol RA Fatigue Effect Numerical Rating Scale, BRAF-NRS 0-10). Intention-to-treat regression analysis adjusted for baseline scores and centre. RESULTS 308/333 randomised patients completed 26 week data (156/175 RAFT, 152/158 Control). Mean baseline variables were similar. At 26 weeks, the adjusted difference between arms for fatigue impact change favoured RAFT (BRAF-NRS Effect -0.59, 95% CI -1.11 to -0.06), BRAF Multidimensional Questionnaire (MDQ) Total -3.42 (95% CI -6.44 to -0.39), Living with Fatigue -1.19 (95% CI -2.17 to -0.21), Emotional Fatigue -0.91 (95% CI -1.58 to -0.23); RA Self-Efficacy (RASE, +3.05, 95% CI 0.43 to 5.66) (14 secondary outcomes unchanged). Effects persisted at 2 years: BRAF-NRS Effect -0.49 (95% CI -0.83 to -0.14), BRAF MDQ Total -2.98 (95% CI -5.39 to -0.57), Living with Fatigue -0.93 (95% CI -1.75 to -0.10), Emotional Fatigue -0.90 (95% CI -1.44, to -0.37); BRAF-NRS Coping +0.42 (95% CI 0.08 to 0.77) (relevance of fatigue impact improvement uncertain). RAFT satisfaction: 89% scored > 8/10 vs 54% controls rating usual care booklet (p<0.0001). CONCLUSION Multiple RA fatigue impacts can be improved for 2 years by rheumatology teams delivering a group programme using cognitive behavioural approaches. TRIAL REGISTRATION NUMBER ISRCTN52709998.
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Affiliation(s)
- Sarah Hewlett
- Department of Nursing and Midwifery, University of the West of England Bristol, Bristol, UK
| | - Celia Almeida
- Department of Nursing and Midwifery, University of the West of England Bristol, Bristol, UK
| | | | - Peter S Blair
- Department of Population Health Sciences, University of Bristol, Bristol, UK
| | - Ernest H Choy
- Section of Rheumatology, Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - Emma Dures
- Department of Nursing and Midwifery, University of the West of England Bristol, Bristol, UK
| | - Alison Hammond
- Centre for Health Sciences Research, School of Health Sciences, University of Salford, Salford, UK
| | | | - Bryar Kadir
- Department of Population Health Sciences, University of Bristol, Bristol, UK
| | - John Richard Kirwan
- Department of Translational Health Sciences, Academic Rheumatology, University of Bristol, Bristol, UK
| | - Zoe Plummer
- Department of Nursing and Midwifery, University of the West of England Bristol, Bristol, UK
| | - Clive Rooke
- Patient Research Partner, Academic Rheumatology, Bristol Royal Infirmary, Bristol, UK
| | - Joanna Thorn
- Department of Population Health Sciences, University of Bristol, Bristol, UK
| | - Nicholas Turner
- Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Jon Pollock
- Department of Health and Social Sciences, University of the West of England Bristol, Bristol, UK
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22
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Humby F, Lewis M, Ramamoorthi N, Hackney JA, Barnes MR, Bombardieri M, Setiadi AF, Kelly S, Bene F, DiCicco M, Riahi S, Rocher V, Ng N, Lazarou I, Hands R, van der Heijde D, Landewé RBM, van der Helm-van Mil A, Cauli A, McInnes I, Buckley CD, Choy EH, Taylor PC, Townsend MJ, Pitzalis C. Synovial cellular and molecular signatures stratify clinical response to csDMARD therapy and predict radiographic progression in early rheumatoid arthritis patients. Ann Rheum Dis 2019; 78:761-772. [PMID: 30878974 PMCID: PMC6579551 DOI: 10.1136/annrheumdis-2018-214539] [Citation(s) in RCA: 176] [Impact Index Per Article: 35.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 02/06/2019] [Accepted: 02/14/2019] [Indexed: 12/21/2022]
Abstract
Objectives To unravel the hierarchy of cellular/molecular pathways in the disease tissue of early, treatment-naïve rheumatoid arthritis (RA) patients and determine their relationship with clinical phenotypes and treatment response/outcomes longitudinally. Methods 144 consecutive treatment-naïve early RA patients (<12 months symptoms duration) underwent ultrasound-guided synovial biopsy before and 6 months after disease-modifying antirheumatic drug (DMARD) initiation. Synovial biopsies were analysed for cellular (immunohistology) and molecular (NanoString) characteristics and results compared with clinical and imaging outcomes. Differential gene expression analysis and logistic regression were applied to define variables correlating with treatment response and predicting radiographic progression. Results Cellular and molecular analyses of synovial tissue demonstrated for the first time in early RA the presence of three pathology groups: (1) lympho-myeloid dominated by the presence of B cells in addition to myeloid cells; (2) diffuse-myeloid with myeloid lineage predominance but poor in B cells nd (3) pauci-immune characterised by scanty immune cells and prevalent stromal cells. Longitudinal correlation of molecular signatures demonstrated that elevation of myeloid- and lymphoid-associated gene expression strongly correlated with disease activity, acute phase reactants and DMARD response at 6 months. Furthermore, elevation of synovial lymphoid-associated genes correlated with autoantibody positivity and elevation of osteoclast-targeting genes predicting radiographic joint damage progression at 12 months. Patients with predominant pauci-immune pathology showed less severe disease activity and radiographic progression. Conclusions We demonstrate at disease presentation, prior to pathology modulation by therapy, the presence of specific cellular/molecular synovial signatures that delineate disease severity/progression and therapeutic response and may pave the way to more precise definition of RA taxonomy, therapeutic targeting and improved outcomes.
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Affiliation(s)
- Frances Humby
- Centre for Experimental Medicine & Rheumatology, William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Myles Lewis
- Centre for Experimental Medicine & Rheumatology, William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | | | - Jason A Hackney
- Bioinformatics and Computational Biology, Genentech Inc, South San Francisco, California, USA
| | - Michael R Barnes
- Centre for Experimental Medicine & Rheumatology, William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK.,Centre for Translational Bioinformatics, William Harvey Research Institute, London, UK
| | - Michele Bombardieri
- Centre for Experimental Medicine & Rheumatology, William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - A Francesca Setiadi
- Biomarker Discovery OMNI, Genentech Inc, South San Francisco, California, USA
| | - Stephen Kelly
- Centre for Experimental Medicine & Rheumatology, William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Fabiola Bene
- Centre for Experimental Medicine & Rheumatology, William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Maria DiCicco
- Centre for Experimental Medicine & Rheumatology, William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Sudeh Riahi
- Centre for Experimental Medicine & Rheumatology, William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Vidalba Rocher
- Centre for Experimental Medicine & Rheumatology, William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Nora Ng
- Centre for Experimental Medicine & Rheumatology, William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Ilias Lazarou
- Centre for Experimental Medicine & Rheumatology, William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Rebecca Hands
- Centre for Experimental Medicine & Rheumatology, William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | | | - Robert B M Landewé
- Amsterdam Rheumatology Center, AMC, Amsterdam, Netherlands.,Department of Rheumatology, Zuyderland MC, Heerlen, Netherlands
| | | | | | - Iain McInnes
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | | | - Ernest H Choy
- Institute of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK
| | - Peter C Taylor
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Kennedy Institute of Rheumatology, Oxford, UK
| | - Michael J Townsend
- Biomarker Discovery OMNI, Genentech Inc, South San Francisco, California, USA
| | - Costantino Pitzalis
- Centre for Experimental Medicine & Rheumatology, William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
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23
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Pickles T, Alten R, Boers M, Bykerk V, Christensen J, Christensen R, van Hoogstraten H, Simon LS, Tam LS, Choy EH. Adaptive Trial Designs in Rheumatology: Report from the OMERACT Special Interest Group. J Rheumatol 2019; 46:1406-1408. [PMID: 30770514 DOI: 10.3899/jrheum.181054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Adaptive trial design was developed initially for oncology to improve trial efficiency. If optimized for rheumatology, it may improve trial efficiency by reducing sample size and time. METHODS A systematic review assessed design of phase II clinical trials in rheumatoid arthritis. RESULTS Fifty-six trials were reviewed. Most trials had 4 groups (1 control and 3 intervention), with an average group size of 34 patients. American College of Rheumatology 20 measured at 16 weeks was the most commonly used primary endpoint. CONCLUSION The next step is to undertake a systematic review of adaptive designs used in early-phase trials in nonrheumatic conditions.
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Affiliation(s)
- Tim Pickles
- From the CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University, Cardiff, UK; Schlosspark Klinik, Charité University Medicine, Berlin, Germany; Department of Epidemiology and Biostatistics; Amsterdam Rheumatology and Immunology Center; Amsterdam University Medical Centers, location VUmc, Amsterdam, the Netherlands; Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College; Pfizer, New York, New York; Sanofi, Bridgewater, New Jersey; SDG LLC, Cambridge, Massachusetts, USA; Rebecca McDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital; Department of Rheumatology, Odense University Hospital, Odense, Denmark; Division of Rheumatology, Department of Medicine and Therapeutics, and Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.,T. Pickles, MSc, CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University; R. Alten, MD, PhD, Schlosspark Klinik, Charité University Medicine; M. Boers, MD, PhD, MSc, Department of Epidemiology and Biostatistics, and Amsterdam Rheumatology and Immunology Center, and Amsterdam University Medical Centers VUmc; V. Bykerk, MD, FRCPC, Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College, and Rebecca McDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, University of Toronto; J. Christensen, MD, Pfizer; R. Christensen, PhD, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and Department of Rheumatology, Odense University Hospital; H. van Hoogstraten, MD, PhD, Sanofi; L.S. Simon, MD, SDG LLC; L.S. Tam, MD, Division of Rheumatology, Department of Medicine and Therapeutics, and Faculty of Medicine, The Chinese University of Hong Kong; E.H. Choy, MD, CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University
| | - Rieke Alten
- From the CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University, Cardiff, UK; Schlosspark Klinik, Charité University Medicine, Berlin, Germany; Department of Epidemiology and Biostatistics; Amsterdam Rheumatology and Immunology Center; Amsterdam University Medical Centers, location VUmc, Amsterdam, the Netherlands; Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College; Pfizer, New York, New York; Sanofi, Bridgewater, New Jersey; SDG LLC, Cambridge, Massachusetts, USA; Rebecca McDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital; Department of Rheumatology, Odense University Hospital, Odense, Denmark; Division of Rheumatology, Department of Medicine and Therapeutics, and Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.,T. Pickles, MSc, CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University; R. Alten, MD, PhD, Schlosspark Klinik, Charité University Medicine; M. Boers, MD, PhD, MSc, Department of Epidemiology and Biostatistics, and Amsterdam Rheumatology and Immunology Center, and Amsterdam University Medical Centers VUmc; V. Bykerk, MD, FRCPC, Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College, and Rebecca McDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, University of Toronto; J. Christensen, MD, Pfizer; R. Christensen, PhD, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and Department of Rheumatology, Odense University Hospital; H. van Hoogstraten, MD, PhD, Sanofi; L.S. Simon, MD, SDG LLC; L.S. Tam, MD, Division of Rheumatology, Department of Medicine and Therapeutics, and Faculty of Medicine, The Chinese University of Hong Kong; E.H. Choy, MD, CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University
| | - Maarten Boers
- From the CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University, Cardiff, UK; Schlosspark Klinik, Charité University Medicine, Berlin, Germany; Department of Epidemiology and Biostatistics; Amsterdam Rheumatology and Immunology Center; Amsterdam University Medical Centers, location VUmc, Amsterdam, the Netherlands; Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College; Pfizer, New York, New York; Sanofi, Bridgewater, New Jersey; SDG LLC, Cambridge, Massachusetts, USA; Rebecca McDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital; Department of Rheumatology, Odense University Hospital, Odense, Denmark; Division of Rheumatology, Department of Medicine and Therapeutics, and Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.,T. Pickles, MSc, CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University; R. Alten, MD, PhD, Schlosspark Klinik, Charité University Medicine; M. Boers, MD, PhD, MSc, Department of Epidemiology and Biostatistics, and Amsterdam Rheumatology and Immunology Center, and Amsterdam University Medical Centers VUmc; V. Bykerk, MD, FRCPC, Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College, and Rebecca McDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, University of Toronto; J. Christensen, MD, Pfizer; R. Christensen, PhD, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and Department of Rheumatology, Odense University Hospital; H. van Hoogstraten, MD, PhD, Sanofi; L.S. Simon, MD, SDG LLC; L.S. Tam, MD, Division of Rheumatology, Department of Medicine and Therapeutics, and Faculty of Medicine, The Chinese University of Hong Kong; E.H. Choy, MD, CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University
| | - Vivian Bykerk
- From the CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University, Cardiff, UK; Schlosspark Klinik, Charité University Medicine, Berlin, Germany; Department of Epidemiology and Biostatistics; Amsterdam Rheumatology and Immunology Center; Amsterdam University Medical Centers, location VUmc, Amsterdam, the Netherlands; Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College; Pfizer, New York, New York; Sanofi, Bridgewater, New Jersey; SDG LLC, Cambridge, Massachusetts, USA; Rebecca McDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital; Department of Rheumatology, Odense University Hospital, Odense, Denmark; Division of Rheumatology, Department of Medicine and Therapeutics, and Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.,T. Pickles, MSc, CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University; R. Alten, MD, PhD, Schlosspark Klinik, Charité University Medicine; M. Boers, MD, PhD, MSc, Department of Epidemiology and Biostatistics, and Amsterdam Rheumatology and Immunology Center, and Amsterdam University Medical Centers VUmc; V. Bykerk, MD, FRCPC, Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College, and Rebecca McDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, University of Toronto; J. Christensen, MD, Pfizer; R. Christensen, PhD, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and Department of Rheumatology, Odense University Hospital; H. van Hoogstraten, MD, PhD, Sanofi; L.S. Simon, MD, SDG LLC; L.S. Tam, MD, Division of Rheumatology, Department of Medicine and Therapeutics, and Faculty of Medicine, The Chinese University of Hong Kong; E.H. Choy, MD, CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University
| | - Jared Christensen
- From the CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University, Cardiff, UK; Schlosspark Klinik, Charité University Medicine, Berlin, Germany; Department of Epidemiology and Biostatistics; Amsterdam Rheumatology and Immunology Center; Amsterdam University Medical Centers, location VUmc, Amsterdam, the Netherlands; Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College; Pfizer, New York, New York; Sanofi, Bridgewater, New Jersey; SDG LLC, Cambridge, Massachusetts, USA; Rebecca McDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital; Department of Rheumatology, Odense University Hospital, Odense, Denmark; Division of Rheumatology, Department of Medicine and Therapeutics, and Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.,T. Pickles, MSc, CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University; R. Alten, MD, PhD, Schlosspark Klinik, Charité University Medicine; M. Boers, MD, PhD, MSc, Department of Epidemiology and Biostatistics, and Amsterdam Rheumatology and Immunology Center, and Amsterdam University Medical Centers VUmc; V. Bykerk, MD, FRCPC, Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College, and Rebecca McDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, University of Toronto; J. Christensen, MD, Pfizer; R. Christensen, PhD, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and Department of Rheumatology, Odense University Hospital; H. van Hoogstraten, MD, PhD, Sanofi; L.S. Simon, MD, SDG LLC; L.S. Tam, MD, Division of Rheumatology, Department of Medicine and Therapeutics, and Faculty of Medicine, The Chinese University of Hong Kong; E.H. Choy, MD, CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University
| | - Robin Christensen
- From the CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University, Cardiff, UK; Schlosspark Klinik, Charité University Medicine, Berlin, Germany; Department of Epidemiology and Biostatistics; Amsterdam Rheumatology and Immunology Center; Amsterdam University Medical Centers, location VUmc, Amsterdam, the Netherlands; Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College; Pfizer, New York, New York; Sanofi, Bridgewater, New Jersey; SDG LLC, Cambridge, Massachusetts, USA; Rebecca McDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital; Department of Rheumatology, Odense University Hospital, Odense, Denmark; Division of Rheumatology, Department of Medicine and Therapeutics, and Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.,T. Pickles, MSc, CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University; R. Alten, MD, PhD, Schlosspark Klinik, Charité University Medicine; M. Boers, MD, PhD, MSc, Department of Epidemiology and Biostatistics, and Amsterdam Rheumatology and Immunology Center, and Amsterdam University Medical Centers VUmc; V. Bykerk, MD, FRCPC, Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College, and Rebecca McDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, University of Toronto; J. Christensen, MD, Pfizer; R. Christensen, PhD, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and Department of Rheumatology, Odense University Hospital; H. van Hoogstraten, MD, PhD, Sanofi; L.S. Simon, MD, SDG LLC; L.S. Tam, MD, Division of Rheumatology, Department of Medicine and Therapeutics, and Faculty of Medicine, The Chinese University of Hong Kong; E.H. Choy, MD, CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University
| | - Hubert van Hoogstraten
- From the CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University, Cardiff, UK; Schlosspark Klinik, Charité University Medicine, Berlin, Germany; Department of Epidemiology and Biostatistics; Amsterdam Rheumatology and Immunology Center; Amsterdam University Medical Centers, location VUmc, Amsterdam, the Netherlands; Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College; Pfizer, New York, New York; Sanofi, Bridgewater, New Jersey; SDG LLC, Cambridge, Massachusetts, USA; Rebecca McDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital; Department of Rheumatology, Odense University Hospital, Odense, Denmark; Division of Rheumatology, Department of Medicine and Therapeutics, and Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.,T. Pickles, MSc, CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University; R. Alten, MD, PhD, Schlosspark Klinik, Charité University Medicine; M. Boers, MD, PhD, MSc, Department of Epidemiology and Biostatistics, and Amsterdam Rheumatology and Immunology Center, and Amsterdam University Medical Centers VUmc; V. Bykerk, MD, FRCPC, Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College, and Rebecca McDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, University of Toronto; J. Christensen, MD, Pfizer; R. Christensen, PhD, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and Department of Rheumatology, Odense University Hospital; H. van Hoogstraten, MD, PhD, Sanofi; L.S. Simon, MD, SDG LLC; L.S. Tam, MD, Division of Rheumatology, Department of Medicine and Therapeutics, and Faculty of Medicine, The Chinese University of Hong Kong; E.H. Choy, MD, CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University
| | - Lee S Simon
- From the CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University, Cardiff, UK; Schlosspark Klinik, Charité University Medicine, Berlin, Germany; Department of Epidemiology and Biostatistics; Amsterdam Rheumatology and Immunology Center; Amsterdam University Medical Centers, location VUmc, Amsterdam, the Netherlands; Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College; Pfizer, New York, New York; Sanofi, Bridgewater, New Jersey; SDG LLC, Cambridge, Massachusetts, USA; Rebecca McDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital; Department of Rheumatology, Odense University Hospital, Odense, Denmark; Division of Rheumatology, Department of Medicine and Therapeutics, and Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.,T. Pickles, MSc, CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University; R. Alten, MD, PhD, Schlosspark Klinik, Charité University Medicine; M. Boers, MD, PhD, MSc, Department of Epidemiology and Biostatistics, and Amsterdam Rheumatology and Immunology Center, and Amsterdam University Medical Centers VUmc; V. Bykerk, MD, FRCPC, Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College, and Rebecca McDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, University of Toronto; J. Christensen, MD, Pfizer; R. Christensen, PhD, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and Department of Rheumatology, Odense University Hospital; H. van Hoogstraten, MD, PhD, Sanofi; L.S. Simon, MD, SDG LLC; L.S. Tam, MD, Division of Rheumatology, Department of Medicine and Therapeutics, and Faculty of Medicine, The Chinese University of Hong Kong; E.H. Choy, MD, CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University
| | - Lai-Shan Tam
- From the CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University, Cardiff, UK; Schlosspark Klinik, Charité University Medicine, Berlin, Germany; Department of Epidemiology and Biostatistics; Amsterdam Rheumatology and Immunology Center; Amsterdam University Medical Centers, location VUmc, Amsterdam, the Netherlands; Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College; Pfizer, New York, New York; Sanofi, Bridgewater, New Jersey; SDG LLC, Cambridge, Massachusetts, USA; Rebecca McDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital; Department of Rheumatology, Odense University Hospital, Odense, Denmark; Division of Rheumatology, Department of Medicine and Therapeutics, and Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.,T. Pickles, MSc, CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University; R. Alten, MD, PhD, Schlosspark Klinik, Charité University Medicine; M. Boers, MD, PhD, MSc, Department of Epidemiology and Biostatistics, and Amsterdam Rheumatology and Immunology Center, and Amsterdam University Medical Centers VUmc; V. Bykerk, MD, FRCPC, Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College, and Rebecca McDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, University of Toronto; J. Christensen, MD, Pfizer; R. Christensen, PhD, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and Department of Rheumatology, Odense University Hospital; H. van Hoogstraten, MD, PhD, Sanofi; L.S. Simon, MD, SDG LLC; L.S. Tam, MD, Division of Rheumatology, Department of Medicine and Therapeutics, and Faculty of Medicine, The Chinese University of Hong Kong; E.H. Choy, MD, CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University
| | - Ernest H Choy
- From the CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University, Cardiff, UK; Schlosspark Klinik, Charité University Medicine, Berlin, Germany; Department of Epidemiology and Biostatistics; Amsterdam Rheumatology and Immunology Center; Amsterdam University Medical Centers, location VUmc, Amsterdam, the Netherlands; Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College; Pfizer, New York, New York; Sanofi, Bridgewater, New Jersey; SDG LLC, Cambridge, Massachusetts, USA; Rebecca McDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital; Department of Rheumatology, Odense University Hospital, Odense, Denmark; Division of Rheumatology, Department of Medicine and Therapeutics, and Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong. .,T. Pickles, MSc, CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University; R. Alten, MD, PhD, Schlosspark Klinik, Charité University Medicine; M. Boers, MD, PhD, MSc, Department of Epidemiology and Biostatistics, and Amsterdam Rheumatology and Immunology Center, and Amsterdam University Medical Centers VUmc; V. Bykerk, MD, FRCPC, Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College, and Rebecca McDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, University of Toronto; J. Christensen, MD, Pfizer; R. Christensen, PhD, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and Department of Rheumatology, Odense University Hospital; H. van Hoogstraten, MD, PhD, Sanofi; L.S. Simon, MD, SDG LLC; L.S. Tam, MD, Division of Rheumatology, Department of Medicine and Therapeutics, and Faculty of Medicine, The Chinese University of Hong Kong; E.H. Choy, MD, CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University.
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Affiliation(s)
- Ernest H Choy
- CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK
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Abstract
The cytokine interleukin (IL)−6 performs a diverse portfolio of functions in normal physiology and disease. These functions extend beyond the typical role for an inflammatory cytokine, and IL-6 often displays hormone-like properties that affect metabolic processes associated with lipid metabolism, insulin resistance, and the neuroendocrine system. Consequently, the biology of IL-6 is complex. Recent advances in the field have led to novel interpretations of how IL-6 delivers immune homeostasis in health and yet drives disease pathology during infection, autoimmunity, and cancer. Various biological drugs that target IL-6 are in clinical practice or emerging in clinical trials and pre-clinical development programmes. The challenge is knowing how and when to apply these therapies. In this review, we will explore the biology behind IL-6 directed therapies and identify some key hurdles for future investigation.
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Pickles T, Christensen R, Tam LS, Simon LS, Choy EH. Early phase and adaptive design clinical trials in rheumatoid arthritis: a systematic review of early phase trials. Rheumatol Adv Pract 2018; 2:rky045. [PMID: 31431982 PMCID: PMC6649924 DOI: 10.1093/rap/rky045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 09/17/2018] [Indexed: 12/21/2022] Open
Abstract
Objective Adaptive designs can enable highly sophisticated and efficient early phase trials, but the clinical inference from these trials is surrounded by complexity, and currently there is a paucity but steadily increasing amount of use of these designs in all fields of medicine. We aim to review early phase trials in RA to discover those that have used adaptive designs and benchmark trial characteristics. Methods From an OVID search for journal articles reporting the results of early phase trials in rheumatology, 35 studies were found, with 9 subsequently excluded; 11 were added from manual searches and 19 from searching the references. Study characteristics were extracted from the 56 papers (describing 62 trials), including the number of arms, number of patients, the primary outcome and when it was measured. Result One early phase trial using an adaptive design was found. The benchmark early phase trial in RA is a phase II double-blinded randomized trial, with four arms (one control and three intervention), each with 34 patients, and ACR20 measured at 16 weeks as the primary outcome. Conclusion The one adaptive design reviewed here, and a simulation study found in the search, both indicate that adaptive designs can be applied to early phase trials in RA. We have described the benchmark, which the efficiency of early phase trials using an adaptive design needs to exceed. These efficient designs could drive down numbers required, time for data collection and thus cost. Changes have been suggested, but more needs to be done.
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Affiliation(s)
- Tim Pickles
- Cardiff Regional Experimental Arthritis Treatment and Evaluation (CREATE) Centre, Division of Infection and Immunity, School of Medicine, College of Biomedical and Life Sciences, Cardiff University.,Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Robin Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Lai-Shan Tam
- Department of Medicine & Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | | | - Ernest H Choy
- Cardiff Regional Experimental Arthritis Treatment and Evaluation (CREATE) Centre, Division of Infection and Immunity, School of Medicine, College of Biomedical and Life Sciences, Cardiff University
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Tarp S, Jørgensen TS, Furst DE, Dossing A, Taylor PC, Choy EH, Suarez-Almazor ME, Lyddiatt A, Kristensen LE, Bliddal H, Christensen R. Added value of combining methotrexate with a biological agent compared to biological monotherapy in rheumatoid arthritis patients: A systematic review and meta-analysis of randomised trials. Semin Arthritis Rheum 2018; 48:958-966. [PMID: 30396592 DOI: 10.1016/j.semarthrit.2018.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 09/25/2018] [Accepted: 10/01/2018] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To assess the efficacy and safety of methotrexate (MTX) in combination with an approved biological agent compared to biological monotherapy, in the management of patients with rheumatoid arthritis (RA). METHODS MEDLINE, EMBASE, CENTRAL and other sources were searched for randomised trials evaluating a biological agent plus MTX versus the same biological agent in monotherapy. Co-primary outcomes were ACR50 and the number of patients who discontinued due to adverse events (AEs). Random-effects models were applied for meta-analyses with risk ratio and 95% confidence intervals and the GRADE approach was used to assess confidence in the estimates. RESULTS The analysis comprised 16 trials (4965 patients), including all biological agents approved for RA except anakinra and certolizumab. The overall likelihood of responding to therapy (i.e. ACR50) after 6 months was 32% better when MTX was given concomitantly with biological agents (1.32 [1.20-1.45]; P < 0.001) corresponding to 11 more out of 100 patients (7-16 more); Moderate Quality Evidence. Discontinuing due to AEs from concomitant use of MTX was potentially 20% increased (1.21 [0.97-1.50]; P = 0.09) compared to biological monotherapy corresponding to 1 more out of 100 patients (0-3 more); Moderate Quality Evidence. CONCLUSIONS Randomised trials provide Moderate Quality Evidence for a favourable benefit-harm balance supporting concomitant use of MTX rather than monotherapy when prescribing a biological agent in patients with RA although in absolute terms only 7-16 more out of 100 patients will achieve an ACR50 response after 6 months of this combination therapy.
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Affiliation(s)
- Simon Tarp
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, 2000 Copenhagen, Denmark.
| | - Tanja S Jørgensen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, 2000 Copenhagen, Denmark
| | - Daniel E Furst
- Division of Rheumatology, Department of Medicine, David Geffen School of Medicine, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA
| | - Anna Dossing
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, 2000 Copenhagen, Denmark
| | - Peter C Taylor
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Headington, Oxford, UK
| | - Ernest H Choy
- Section of Rheumatology, Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK; CREATE Centre, Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - Maria E Suarez-Almazor
- Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anne Lyddiatt
- Musculoskeletal Group, Cochrane Collaboration, Ottawa, ON K1H 8L6, Canada
| | - Lars E Kristensen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, 2000 Copenhagen, Denmark
| | - Henning Bliddal
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, 2000 Copenhagen, Denmark
| | - Robin Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, 2000 Copenhagen, Denmark
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McInnes IB, Nash P, Ritchlin C, Choy EH, Kanters S, Thom H, Gandhi K, Pricop L, Jugl SM. Secukinumab for psoriatic arthritis: comparative effectiveness versus licensed biologics/apremilast: a network meta-analysis. J Comp Eff Res 2018; 7:1107-1123. [PMID: 30230361 DOI: 10.2217/cer-2018-0075] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
AIM A network meta-analysis using randomized controlled trial data compared psoriatic arthritis (PsA) outcomes (American College of Rheumatology [ACR], Psoriasis Area Severity Index [PASI] and Psoriatic Arthritis Response Criteria [PsARC] response rates) at 12-16 weeks for secukinumab, adalimumab, apremilast, certolizumab, etanercept, golimumab, infliximab and ustekinumab. PATIENTS & METHODS Trials were identified by systematic review. Separate networks were developed for the full-study populations, biologic-naive patients and biologic-experienced patients. RESULTS In the full populations, secukinumab, adalimumab, golimumab and infliximab demonstrated the highest ACR response rates. Secukinumab and infliximab demonstrated the highest PASI response rates, and infliximab and etanercept demonstrated the highest PsARC response rates. CONCLUSION In the full populations, secukinumab demonstrated good efficacy across all outcomes. All treatments for active PsA included in this comprehensive network meta-analysis demonstrated superiority to placebo.
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Affiliation(s)
- Iain B McInnes
- University of Glasgow, Institute of Infection, Immunity & Inflammation, College of Medical, Veterinary & Life Sciences, University of Glasgow, Sir Graeme Davies Building, 120 University Place, Glasgow G12 8TA, UK
| | - Peter Nash
- Department of Medicine, University of Queensland, Brisbane, QLD 4072, Australia
| | - Christopher Ritchlin
- Division of Allergy, Immunology & Rheumatology, University of Rochester, 601 Elmwood Avenue, Box 695, Rochester, NY 1464, USA
| | - Ernest H Choy
- Institute of Infection & Immunity, Cardiff University School of Medicine, Tenovus Building, Heath Park Campus, Cardiff CF14 4XN, UK
| | - Steve Kanters
- Precision Xtract, 1505 West 2nd Avenue, Suite 300, Vancouver, BC V6H 3Y4, Canada
| | - Howard Thom
- Bristol Medical School: Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Kunal Gandhi
- Oncology Global Development Unit, Novartis Pharmaceuticals Corporation, One Health Plaza, Building 337, B04.3B, East Hanover, NJ, USA
| | - Luminita Pricop
- Immunology & Dermatology Franchise, Novartis Pharmaceuticals Corporation, One Health Plaza, Building 337, B04.3B, East Hanover, NJ, USA
| | - Steffen M Jugl
- Global Patient Access Immunology & Dermatology, Novartis Pharma AG, Asklepios 8-1.001.11, Postfach, Basel, CH-4001, Switzerland
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O'Mahony A, John MR, Cho H, Hashizume M, Choy EH. Discriminating phenotypic signatures identified for tocilizumab, adalimumab, and tofacitinib monotherapy and their combinations with methotrexate. J Transl Med 2018; 16:156. [PMID: 29879987 PMCID: PMC5992722 DOI: 10.1186/s12967-018-1532-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 05/30/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Clinical trials have shown combinations of anti-tumor necrosis factor biologicals plus methotrexate (MTX) are more effective treatments for rheumatoid arthritis than biological monotherapies, based, in part, on the assumption that MTX reduces the immunogenicity of biologicals. However, co-treatment with the anti-interleukin-6 receptor-alpha antibody tocilizumab (TCZ) and MTX does not demonstrate the same level of incremental benefit over TCZ monotherapy. Using the human primary cell based BioMAP phenotypic profiling platform, we investigated the impact of TCZ, adalimumab (ADA), and the small molecule drug tofacitinib (TOF), alone and in combination with MTX, on translational biomarkers that could indicate unique pharmacodynamic interactions outside those of reduced immunogenicity. METHODS TCZ, ADA, and TOF, alone and in combination with MTX, were profiled in BioMAP systems at concentrations close to clinical exposure levels: TCZ, 200 μg/ml; TOF1, 1.1 μM; TOF2, 0.12 µM; MTX, 10 μM. Changes in biomarkers were evaluated by statistical methods to determine whether combinations differed from the individual agents. RESULTS Although the BioMAP activity profile for TCZ + MTX was not significantly different from that for TCZ alone, profiles for ADA + MTX and TOF1 + MTX or TOF2 + MTX had a greater number of statistically significant different activities (P < 0.01) than did agents profiled individually. CONCLUSIONS These data support the comparable efficacy of TCZ as monotherapy and as combination therapy and suggest that TOF, like ADA, may be more beneficial in combination with MTX. Taking an orthogonal approach to directly compare monotherapy and combination therapies indicates that MTX contributes to the efficacy of some, but not all, RA therapies and can be affected by factors additional to reduced immunogenicity.
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Affiliation(s)
- Alison O'Mahony
- BioMAP Division, Eurofins DiscoverX, 310 Utah Avenue, South San Francisco, CA, 94080, USA.
| | | | - Hannah Cho
- BioMAP Division, Eurofins DiscoverX, 310 Utah Avenue, South San Francisco, CA, 94080, USA
| | | | - Ernest H Choy
- Division of Infection and Immunity, CREATE Centre, Cardiff University, Cardiff, CF10 3AT, UK
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Winthrop KL, Wouters AG, Choy EH, Soma K, Hodge JA, Nduaka CI, Biswas P, Needle E, Passador S, Mojcik CF, Rigby WF. The Safety and Immunogenicity of Live Zoster Vaccination in Patients With Rheumatoid Arthritis Before Starting Tofacitinib: A Randomized Phase II Trial. Arthritis Rheumatol 2017; 69:1969-1977. [PMID: 28845577 PMCID: PMC5656925 DOI: 10.1002/art.40187] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 06/20/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Patients with rheumatoid arthritis (RA) are at increased risk of herpes zoster, and vaccination is recommended for patients ages 50 years and older, prior to starting treatment with biologic agents or tofacitinib. Tofacitinib is an oral JAK inhibitor for the treatment of RA. We evaluated its effect on the immune response and safety of live zoster vaccine (LZV). METHODS In this phase II, 14-week, placebo-controlled trial, patients ages 50 years and older who had active RA and were receiving background methotrexate were given LZV and randomized to receive tofacitinib 5 mg twice daily or placebo 2-3 weeks postvaccination. We measured humoral responses (varicella zoster virus [VZV]-specific IgG level as determined by glycoprotein enzyme-linked immunosorbent assay) and cell-mediated responses (VZV-specific T cell enumeration, as determined by enzyme-linked immunospot assay) at baseline and 2 weeks, 6 weeks, and 14 weeks postvaccination. End points included the geometric mean fold rise (GMFR) in VZV-specific IgG levels (primary end point) and T cells (number of spot-forming cells/106 peripheral blood mononuclear cells) at 6 weeks postvaccination. RESULTS One hundred twelve patients were randomized to receive tofacitinib (n = 55) or placebo (n = 57). Six weeks postvaccination, the GMFR in VZV-specific IgG levels was 2.11 in the tofacitinib group and 1.74 in the placebo group, and the VZV-specific T cell GMFR was similar in the tofacitinib group and the placebo group (1.50 and 1.29, respectively). Serious adverse events occurred in 3 patients in the tofacitinib group (5.5%) and 0 patients (0.0%) in the placebo group. One patient, who lacked preexisting VZV immunity, developed cutaneous vaccine dissemination 2 days after starting tofacitinib (16 days postvaccination). This resolved after tofacitinib was discontinued and the patient received antiviral treatment. CONCLUSION Patients who began treatment with tofacitinib 2-3 weeks after receiving LZV had VZV-specific humoral and cell-mediated immune responses to LZV similar to those in placebo-treated patients. Vaccination appeared to be safe in all of the patients except 1 patient who lacked preexisting VZV immunity.
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Affiliation(s)
| | | | | | | | | | - Chudy I. Nduaka
- Chudy I. Nduaka, DVM, PhD: Pfizer IncCollegevillePennsylvania
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Choy EH, Bernasconi C, Aassi M, Molina JF, Epis OM. Treatment of Rheumatoid Arthritis With Anti-Tumor Necrosis Factor or Tocilizumab Therapy as First Biologic Agent in a Global Comparative Observational Study. Arthritis Care Res (Hoboken) 2017. [PMID: 28622454 PMCID: PMC5656814 DOI: 10.1002/acr.23303] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Objective To compare clinical effectiveness between tocilizumab and tumor necrosis factor inhibitors (TNFi) in patients with rheumatoid arthritis (RA) and inadequate response to conventional synthetic disease‐modifying antirheumatic drugs initiating biologic therapy. Methods Patients prescribed tocilizumab (intravenous) or TNFi were prospectively observed in routine clinical practice for 52 weeks across 158 sites in 26 countries. The primary observation was the change from baseline in Disease Activity Score based on 28 joints using the erythrocyte sedimentation rate (DAS28‐ESR) at week 24 using analysis of covariance for between‐groups comparison. Secondary end points included Clinical Disease Activity Index (CDAI) and patient‐reported outcomes at weeks 24 and 52. Results Of 1,216 patients, 35% initiated tocilizumab and 65% initiated TNFi. RA duration was shorter, and disease activity and corticosteroid use were higher in tocilizumab patients. Tocilizumab‐treated patients had greater improvement in DAS28‐ESR at weeks 24 and 52 (week 24 difference [95% confidence interval] in adjusted means: −0.831 [−1.086, −0.576]; P < 0.001). Change from baseline in CDAI was also greater with tocilizumab (adjusted means difference: week 24, −3.48; week 52, −4.60; both P < 0.001). Tocilizumab‐treated patients had more improvement in the Health Assessment Questionnaire disability index than TNFi‐treated patients (P < 0.05). The cumulative probability of drug discontinuation at week 52 was lower with tocilizumab (15%) than TNFi (27%; P < 0.001, unadjusted analysis). Unadjusted frequencies (events per 100 patient‐years) for tocilizumab and TNFi were 6.44 and 11.99 for serious adverse events, 1.98 and 5.03 for serious infections, and 0.74 and 0.77 for deaths, respectively. Conclusion Patients initiating tocilizumab experienced greater effectiveness and drug survival than those initiating TNFi in an observational setting.
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Bartlett SJ, Barbic SP, Bykerk VP, Choy EH, Alten R, Christensen R, den Broeder A, Fautrel B, Furst DE, Guillemin F, Hewlett S, Leong AL, Lyddiatt A, March L, Montie P, Pohl C, Scholte Voshaar M, Woodworth TG, Bingham CO. Content and Construct Validity, Reliability, and Responsiveness of the Rheumatoid Arthritis Flare Questionnaire: OMERACT 2016 Workshop Report. J Rheumatol 2017; 44:1536-1543. [PMID: 28811351 DOI: 10.3899/jrheum.161145] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2017] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The Outcome Measures in Rheumatology (OMERACT) Rheumatoid Arthritis (RA) Flare Group was established to develop a reliable way to identify and measure RA flares in randomized controlled trials (RCT). Here, we summarized the development and field testing of the RA Flare Questionnaire (RA-FQ), and the voting results at OMERACT 2016. METHODS Classic and modern psychometric methods were used to assess reliability, validity, sensitivity, factor structure, scoring, and thresholds. Interviews with patients and clinicians also assessed content validity, utility, and meaningfulness of RA-FQ scores. RESULTS People with RA in observational trials in Canada (n = 896) and France (n = 138), and an RCT in the Netherlands (n = 178) completed 5 items (11-point numerical rating scale) representing RA Flare core domains. There was moderate to high evidence of reliability, content and construct validity, and responsiveness. Factor analysis supported unidimensionality. Rasch analysis showed acceptable fit to the Rasch model, with items and people covering a broad measurement continuum and evidence of appropriate targeting of items to people, ordered thresholds, minimal differential item functioning by language, sex, or age. A summative score across items is defensible, yielding an interval score (0-50) where higher scores reflect worsening flare. The RA-FQ received endorsement from 88% of attendees that it passed the OMERACT Filter 2.0 "Eyeball Test" for instrument selection. CONCLUSION The RA-FQ has been developed to identify and measure RA flares. Its review through OMERACT Filter 2.0 shows evidence of reliability, content and construct validity, and responsiveness. These properties merit its further validation as an outcome for clinical trials.
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Affiliation(s)
- Susan J Bartlett
- From McGill University, Montreal, Quebec; University of British Columbia, Vancouver, British Columbia, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York; University of California, Los Angeles; Healthy Motivation, Santa Barbara, California, USA; Cardiff University, Cardiff; University of the West of England, Bristol, UK; Schlosspark-Klinik University Medicine, Berlin, Germany; Parker Institute, Copenhagen University, Copenhagen, Denmark; Sint Maartenskliniek, Nijmege; Vrije Universiteit (VU), Amsterdam, the Netherlands; Pierre et Marie Curie University, Paris; University of Lorraine, Lorraine, France; University of Sydney, Sydney, Australia. .,S.J. Bartlett, PhD, McGill University, and Johns Hopkins University; S.P. Barbic, PhD, University of British Columbia; V.P. Bykerk, MD, Hospital for Special Surgery; E.H. Choy, MD, Cardiff University; R. Alten, MD, Schlosspark-Klinik University Medicine; R. Christensen, PhD, Parker Institute, Copenhagen University; A. den Broeder, MD, PhD, Sint Maartenskliniek; B. Fautrel, MD, PhD, Pierre et Marie Curie University; D.E. Furst, MD, University of California; F. Guillemin, MD, PhD, University of Lorraine; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, MBA, Healthy Motivation; A. Lyddiatt, Patient Research Partner; L. March, MD, PhD, University of Sydney; P. Montie, Patient Research Partner; C. Pohl, MD, Schlosspark-Klinik University Medicine; M. Scholte Voshaar, MSc, VU; T.G. Woodworth, MD, University of California; C.O. Bingham III, MD, Johns Hopkins University.
| | - Skye P Barbic
- From McGill University, Montreal, Quebec; University of British Columbia, Vancouver, British Columbia, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York; University of California, Los Angeles; Healthy Motivation, Santa Barbara, California, USA; Cardiff University, Cardiff; University of the West of England, Bristol, UK; Schlosspark-Klinik University Medicine, Berlin, Germany; Parker Institute, Copenhagen University, Copenhagen, Denmark; Sint Maartenskliniek, Nijmege; Vrije Universiteit (VU), Amsterdam, the Netherlands; Pierre et Marie Curie University, Paris; University of Lorraine, Lorraine, France; University of Sydney, Sydney, Australia.,S.J. Bartlett, PhD, McGill University, and Johns Hopkins University; S.P. Barbic, PhD, University of British Columbia; V.P. Bykerk, MD, Hospital for Special Surgery; E.H. Choy, MD, Cardiff University; R. Alten, MD, Schlosspark-Klinik University Medicine; R. Christensen, PhD, Parker Institute, Copenhagen University; A. den Broeder, MD, PhD, Sint Maartenskliniek; B. Fautrel, MD, PhD, Pierre et Marie Curie University; D.E. Furst, MD, University of California; F. Guillemin, MD, PhD, University of Lorraine; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, MBA, Healthy Motivation; A. Lyddiatt, Patient Research Partner; L. March, MD, PhD, University of Sydney; P. Montie, Patient Research Partner; C. Pohl, MD, Schlosspark-Klinik University Medicine; M. Scholte Voshaar, MSc, VU; T.G. Woodworth, MD, University of California; C.O. Bingham III, MD, Johns Hopkins University
| | - Vivian P Bykerk
- From McGill University, Montreal, Quebec; University of British Columbia, Vancouver, British Columbia, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York; University of California, Los Angeles; Healthy Motivation, Santa Barbara, California, USA; Cardiff University, Cardiff; University of the West of England, Bristol, UK; Schlosspark-Klinik University Medicine, Berlin, Germany; Parker Institute, Copenhagen University, Copenhagen, Denmark; Sint Maartenskliniek, Nijmege; Vrije Universiteit (VU), Amsterdam, the Netherlands; Pierre et Marie Curie University, Paris; University of Lorraine, Lorraine, France; University of Sydney, Sydney, Australia.,S.J. Bartlett, PhD, McGill University, and Johns Hopkins University; S.P. Barbic, PhD, University of British Columbia; V.P. Bykerk, MD, Hospital for Special Surgery; E.H. Choy, MD, Cardiff University; R. Alten, MD, Schlosspark-Klinik University Medicine; R. Christensen, PhD, Parker Institute, Copenhagen University; A. den Broeder, MD, PhD, Sint Maartenskliniek; B. Fautrel, MD, PhD, Pierre et Marie Curie University; D.E. Furst, MD, University of California; F. Guillemin, MD, PhD, University of Lorraine; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, MBA, Healthy Motivation; A. Lyddiatt, Patient Research Partner; L. March, MD, PhD, University of Sydney; P. Montie, Patient Research Partner; C. Pohl, MD, Schlosspark-Klinik University Medicine; M. Scholte Voshaar, MSc, VU; T.G. Woodworth, MD, University of California; C.O. Bingham III, MD, Johns Hopkins University
| | - Ernest H Choy
- From McGill University, Montreal, Quebec; University of British Columbia, Vancouver, British Columbia, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York; University of California, Los Angeles; Healthy Motivation, Santa Barbara, California, USA; Cardiff University, Cardiff; University of the West of England, Bristol, UK; Schlosspark-Klinik University Medicine, Berlin, Germany; Parker Institute, Copenhagen University, Copenhagen, Denmark; Sint Maartenskliniek, Nijmege; Vrije Universiteit (VU), Amsterdam, the Netherlands; Pierre et Marie Curie University, Paris; University of Lorraine, Lorraine, France; University of Sydney, Sydney, Australia.,S.J. Bartlett, PhD, McGill University, and Johns Hopkins University; S.P. Barbic, PhD, University of British Columbia; V.P. Bykerk, MD, Hospital for Special Surgery; E.H. Choy, MD, Cardiff University; R. Alten, MD, Schlosspark-Klinik University Medicine; R. Christensen, PhD, Parker Institute, Copenhagen University; A. den Broeder, MD, PhD, Sint Maartenskliniek; B. Fautrel, MD, PhD, Pierre et Marie Curie University; D.E. Furst, MD, University of California; F. Guillemin, MD, PhD, University of Lorraine; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, MBA, Healthy Motivation; A. Lyddiatt, Patient Research Partner; L. March, MD, PhD, University of Sydney; P. Montie, Patient Research Partner; C. Pohl, MD, Schlosspark-Klinik University Medicine; M. Scholte Voshaar, MSc, VU; T.G. Woodworth, MD, University of California; C.O. Bingham III, MD, Johns Hopkins University
| | - Rieke Alten
- From McGill University, Montreal, Quebec; University of British Columbia, Vancouver, British Columbia, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York; University of California, Los Angeles; Healthy Motivation, Santa Barbara, California, USA; Cardiff University, Cardiff; University of the West of England, Bristol, UK; Schlosspark-Klinik University Medicine, Berlin, Germany; Parker Institute, Copenhagen University, Copenhagen, Denmark; Sint Maartenskliniek, Nijmege; Vrije Universiteit (VU), Amsterdam, the Netherlands; Pierre et Marie Curie University, Paris; University of Lorraine, Lorraine, France; University of Sydney, Sydney, Australia.,S.J. Bartlett, PhD, McGill University, and Johns Hopkins University; S.P. Barbic, PhD, University of British Columbia; V.P. Bykerk, MD, Hospital for Special Surgery; E.H. Choy, MD, Cardiff University; R. Alten, MD, Schlosspark-Klinik University Medicine; R. Christensen, PhD, Parker Institute, Copenhagen University; A. den Broeder, MD, PhD, Sint Maartenskliniek; B. Fautrel, MD, PhD, Pierre et Marie Curie University; D.E. Furst, MD, University of California; F. Guillemin, MD, PhD, University of Lorraine; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, MBA, Healthy Motivation; A. Lyddiatt, Patient Research Partner; L. March, MD, PhD, University of Sydney; P. Montie, Patient Research Partner; C. Pohl, MD, Schlosspark-Klinik University Medicine; M. Scholte Voshaar, MSc, VU; T.G. Woodworth, MD, University of California; C.O. Bingham III, MD, Johns Hopkins University
| | - Robin Christensen
- From McGill University, Montreal, Quebec; University of British Columbia, Vancouver, British Columbia, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York; University of California, Los Angeles; Healthy Motivation, Santa Barbara, California, USA; Cardiff University, Cardiff; University of the West of England, Bristol, UK; Schlosspark-Klinik University Medicine, Berlin, Germany; Parker Institute, Copenhagen University, Copenhagen, Denmark; Sint Maartenskliniek, Nijmege; Vrije Universiteit (VU), Amsterdam, the Netherlands; Pierre et Marie Curie University, Paris; University of Lorraine, Lorraine, France; University of Sydney, Sydney, Australia.,S.J. Bartlett, PhD, McGill University, and Johns Hopkins University; S.P. Barbic, PhD, University of British Columbia; V.P. Bykerk, MD, Hospital for Special Surgery; E.H. Choy, MD, Cardiff University; R. Alten, MD, Schlosspark-Klinik University Medicine; R. Christensen, PhD, Parker Institute, Copenhagen University; A. den Broeder, MD, PhD, Sint Maartenskliniek; B. Fautrel, MD, PhD, Pierre et Marie Curie University; D.E. Furst, MD, University of California; F. Guillemin, MD, PhD, University of Lorraine; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, MBA, Healthy Motivation; A. Lyddiatt, Patient Research Partner; L. March, MD, PhD, University of Sydney; P. Montie, Patient Research Partner; C. Pohl, MD, Schlosspark-Klinik University Medicine; M. Scholte Voshaar, MSc, VU; T.G. Woodworth, MD, University of California; C.O. Bingham III, MD, Johns Hopkins University
| | - Alfons den Broeder
- From McGill University, Montreal, Quebec; University of British Columbia, Vancouver, British Columbia, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York; University of California, Los Angeles; Healthy Motivation, Santa Barbara, California, USA; Cardiff University, Cardiff; University of the West of England, Bristol, UK; Schlosspark-Klinik University Medicine, Berlin, Germany; Parker Institute, Copenhagen University, Copenhagen, Denmark; Sint Maartenskliniek, Nijmege; Vrije Universiteit (VU), Amsterdam, the Netherlands; Pierre et Marie Curie University, Paris; University of Lorraine, Lorraine, France; University of Sydney, Sydney, Australia.,S.J. Bartlett, PhD, McGill University, and Johns Hopkins University; S.P. Barbic, PhD, University of British Columbia; V.P. Bykerk, MD, Hospital for Special Surgery; E.H. Choy, MD, Cardiff University; R. Alten, MD, Schlosspark-Klinik University Medicine; R. Christensen, PhD, Parker Institute, Copenhagen University; A. den Broeder, MD, PhD, Sint Maartenskliniek; B. Fautrel, MD, PhD, Pierre et Marie Curie University; D.E. Furst, MD, University of California; F. Guillemin, MD, PhD, University of Lorraine; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, MBA, Healthy Motivation; A. Lyddiatt, Patient Research Partner; L. March, MD, PhD, University of Sydney; P. Montie, Patient Research Partner; C. Pohl, MD, Schlosspark-Klinik University Medicine; M. Scholte Voshaar, MSc, VU; T.G. Woodworth, MD, University of California; C.O. Bingham III, MD, Johns Hopkins University
| | - Bruno Fautrel
- From McGill University, Montreal, Quebec; University of British Columbia, Vancouver, British Columbia, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York; University of California, Los Angeles; Healthy Motivation, Santa Barbara, California, USA; Cardiff University, Cardiff; University of the West of England, Bristol, UK; Schlosspark-Klinik University Medicine, Berlin, Germany; Parker Institute, Copenhagen University, Copenhagen, Denmark; Sint Maartenskliniek, Nijmege; Vrije Universiteit (VU), Amsterdam, the Netherlands; Pierre et Marie Curie University, Paris; University of Lorraine, Lorraine, France; University of Sydney, Sydney, Australia.,S.J. Bartlett, PhD, McGill University, and Johns Hopkins University; S.P. Barbic, PhD, University of British Columbia; V.P. Bykerk, MD, Hospital for Special Surgery; E.H. Choy, MD, Cardiff University; R. Alten, MD, Schlosspark-Klinik University Medicine; R. Christensen, PhD, Parker Institute, Copenhagen University; A. den Broeder, MD, PhD, Sint Maartenskliniek; B. Fautrel, MD, PhD, Pierre et Marie Curie University; D.E. Furst, MD, University of California; F. Guillemin, MD, PhD, University of Lorraine; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, MBA, Healthy Motivation; A. Lyddiatt, Patient Research Partner; L. March, MD, PhD, University of Sydney; P. Montie, Patient Research Partner; C. Pohl, MD, Schlosspark-Klinik University Medicine; M. Scholte Voshaar, MSc, VU; T.G. Woodworth, MD, University of California; C.O. Bingham III, MD, Johns Hopkins University
| | - Daniel E Furst
- From McGill University, Montreal, Quebec; University of British Columbia, Vancouver, British Columbia, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York; University of California, Los Angeles; Healthy Motivation, Santa Barbara, California, USA; Cardiff University, Cardiff; University of the West of England, Bristol, UK; Schlosspark-Klinik University Medicine, Berlin, Germany; Parker Institute, Copenhagen University, Copenhagen, Denmark; Sint Maartenskliniek, Nijmege; Vrije Universiteit (VU), Amsterdam, the Netherlands; Pierre et Marie Curie University, Paris; University of Lorraine, Lorraine, France; University of Sydney, Sydney, Australia.,S.J. Bartlett, PhD, McGill University, and Johns Hopkins University; S.P. Barbic, PhD, University of British Columbia; V.P. Bykerk, MD, Hospital for Special Surgery; E.H. Choy, MD, Cardiff University; R. Alten, MD, Schlosspark-Klinik University Medicine; R. Christensen, PhD, Parker Institute, Copenhagen University; A. den Broeder, MD, PhD, Sint Maartenskliniek; B. Fautrel, MD, PhD, Pierre et Marie Curie University; D.E. Furst, MD, University of California; F. Guillemin, MD, PhD, University of Lorraine; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, MBA, Healthy Motivation; A. Lyddiatt, Patient Research Partner; L. March, MD, PhD, University of Sydney; P. Montie, Patient Research Partner; C. Pohl, MD, Schlosspark-Klinik University Medicine; M. Scholte Voshaar, MSc, VU; T.G. Woodworth, MD, University of California; C.O. Bingham III, MD, Johns Hopkins University
| | - Francis Guillemin
- From McGill University, Montreal, Quebec; University of British Columbia, Vancouver, British Columbia, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York; University of California, Los Angeles; Healthy Motivation, Santa Barbara, California, USA; Cardiff University, Cardiff; University of the West of England, Bristol, UK; Schlosspark-Klinik University Medicine, Berlin, Germany; Parker Institute, Copenhagen University, Copenhagen, Denmark; Sint Maartenskliniek, Nijmege; Vrije Universiteit (VU), Amsterdam, the Netherlands; Pierre et Marie Curie University, Paris; University of Lorraine, Lorraine, France; University of Sydney, Sydney, Australia.,S.J. Bartlett, PhD, McGill University, and Johns Hopkins University; S.P. Barbic, PhD, University of British Columbia; V.P. Bykerk, MD, Hospital for Special Surgery; E.H. Choy, MD, Cardiff University; R. Alten, MD, Schlosspark-Klinik University Medicine; R. Christensen, PhD, Parker Institute, Copenhagen University; A. den Broeder, MD, PhD, Sint Maartenskliniek; B. Fautrel, MD, PhD, Pierre et Marie Curie University; D.E. Furst, MD, University of California; F. Guillemin, MD, PhD, University of Lorraine; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, MBA, Healthy Motivation; A. Lyddiatt, Patient Research Partner; L. March, MD, PhD, University of Sydney; P. Montie, Patient Research Partner; C. Pohl, MD, Schlosspark-Klinik University Medicine; M. Scholte Voshaar, MSc, VU; T.G. Woodworth, MD, University of California; C.O. Bingham III, MD, Johns Hopkins University
| | - Sarah Hewlett
- From McGill University, Montreal, Quebec; University of British Columbia, Vancouver, British Columbia, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York; University of California, Los Angeles; Healthy Motivation, Santa Barbara, California, USA; Cardiff University, Cardiff; University of the West of England, Bristol, UK; Schlosspark-Klinik University Medicine, Berlin, Germany; Parker Institute, Copenhagen University, Copenhagen, Denmark; Sint Maartenskliniek, Nijmege; Vrije Universiteit (VU), Amsterdam, the Netherlands; Pierre et Marie Curie University, Paris; University of Lorraine, Lorraine, France; University of Sydney, Sydney, Australia.,S.J. Bartlett, PhD, McGill University, and Johns Hopkins University; S.P. Barbic, PhD, University of British Columbia; V.P. Bykerk, MD, Hospital for Special Surgery; E.H. Choy, MD, Cardiff University; R. Alten, MD, Schlosspark-Klinik University Medicine; R. Christensen, PhD, Parker Institute, Copenhagen University; A. den Broeder, MD, PhD, Sint Maartenskliniek; B. Fautrel, MD, PhD, Pierre et Marie Curie University; D.E. Furst, MD, University of California; F. Guillemin, MD, PhD, University of Lorraine; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, MBA, Healthy Motivation; A. Lyddiatt, Patient Research Partner; L. March, MD, PhD, University of Sydney; P. Montie, Patient Research Partner; C. Pohl, MD, Schlosspark-Klinik University Medicine; M. Scholte Voshaar, MSc, VU; T.G. Woodworth, MD, University of California; C.O. Bingham III, MD, Johns Hopkins University
| | - Amye L Leong
- From McGill University, Montreal, Quebec; University of British Columbia, Vancouver, British Columbia, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York; University of California, Los Angeles; Healthy Motivation, Santa Barbara, California, USA; Cardiff University, Cardiff; University of the West of England, Bristol, UK; Schlosspark-Klinik University Medicine, Berlin, Germany; Parker Institute, Copenhagen University, Copenhagen, Denmark; Sint Maartenskliniek, Nijmege; Vrije Universiteit (VU), Amsterdam, the Netherlands; Pierre et Marie Curie University, Paris; University of Lorraine, Lorraine, France; University of Sydney, Sydney, Australia.,S.J. Bartlett, PhD, McGill University, and Johns Hopkins University; S.P. Barbic, PhD, University of British Columbia; V.P. Bykerk, MD, Hospital for Special Surgery; E.H. Choy, MD, Cardiff University; R. Alten, MD, Schlosspark-Klinik University Medicine; R. Christensen, PhD, Parker Institute, Copenhagen University; A. den Broeder, MD, PhD, Sint Maartenskliniek; B. Fautrel, MD, PhD, Pierre et Marie Curie University; D.E. Furst, MD, University of California; F. Guillemin, MD, PhD, University of Lorraine; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, MBA, Healthy Motivation; A. Lyddiatt, Patient Research Partner; L. March, MD, PhD, University of Sydney; P. Montie, Patient Research Partner; C. Pohl, MD, Schlosspark-Klinik University Medicine; M. Scholte Voshaar, MSc, VU; T.G. Woodworth, MD, University of California; C.O. Bingham III, MD, Johns Hopkins University
| | - Anne Lyddiatt
- From McGill University, Montreal, Quebec; University of British Columbia, Vancouver, British Columbia, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York; University of California, Los Angeles; Healthy Motivation, Santa Barbara, California, USA; Cardiff University, Cardiff; University of the West of England, Bristol, UK; Schlosspark-Klinik University Medicine, Berlin, Germany; Parker Institute, Copenhagen University, Copenhagen, Denmark; Sint Maartenskliniek, Nijmege; Vrije Universiteit (VU), Amsterdam, the Netherlands; Pierre et Marie Curie University, Paris; University of Lorraine, Lorraine, France; University of Sydney, Sydney, Australia.,S.J. Bartlett, PhD, McGill University, and Johns Hopkins University; S.P. Barbic, PhD, University of British Columbia; V.P. Bykerk, MD, Hospital for Special Surgery; E.H. Choy, MD, Cardiff University; R. Alten, MD, Schlosspark-Klinik University Medicine; R. Christensen, PhD, Parker Institute, Copenhagen University; A. den Broeder, MD, PhD, Sint Maartenskliniek; B. Fautrel, MD, PhD, Pierre et Marie Curie University; D.E. Furst, MD, University of California; F. Guillemin, MD, PhD, University of Lorraine; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, MBA, Healthy Motivation; A. Lyddiatt, Patient Research Partner; L. March, MD, PhD, University of Sydney; P. Montie, Patient Research Partner; C. Pohl, MD, Schlosspark-Klinik University Medicine; M. Scholte Voshaar, MSc, VU; T.G. Woodworth, MD, University of California; C.O. Bingham III, MD, Johns Hopkins University
| | - Lyn March
- From McGill University, Montreal, Quebec; University of British Columbia, Vancouver, British Columbia, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York; University of California, Los Angeles; Healthy Motivation, Santa Barbara, California, USA; Cardiff University, Cardiff; University of the West of England, Bristol, UK; Schlosspark-Klinik University Medicine, Berlin, Germany; Parker Institute, Copenhagen University, Copenhagen, Denmark; Sint Maartenskliniek, Nijmege; Vrije Universiteit (VU), Amsterdam, the Netherlands; Pierre et Marie Curie University, Paris; University of Lorraine, Lorraine, France; University of Sydney, Sydney, Australia.,S.J. Bartlett, PhD, McGill University, and Johns Hopkins University; S.P. Barbic, PhD, University of British Columbia; V.P. Bykerk, MD, Hospital for Special Surgery; E.H. Choy, MD, Cardiff University; R. Alten, MD, Schlosspark-Klinik University Medicine; R. Christensen, PhD, Parker Institute, Copenhagen University; A. den Broeder, MD, PhD, Sint Maartenskliniek; B. Fautrel, MD, PhD, Pierre et Marie Curie University; D.E. Furst, MD, University of California; F. Guillemin, MD, PhD, University of Lorraine; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, MBA, Healthy Motivation; A. Lyddiatt, Patient Research Partner; L. March, MD, PhD, University of Sydney; P. Montie, Patient Research Partner; C. Pohl, MD, Schlosspark-Klinik University Medicine; M. Scholte Voshaar, MSc, VU; T.G. Woodworth, MD, University of California; C.O. Bingham III, MD, Johns Hopkins University
| | - Pamela Montie
- From McGill University, Montreal, Quebec; University of British Columbia, Vancouver, British Columbia, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York; University of California, Los Angeles; Healthy Motivation, Santa Barbara, California, USA; Cardiff University, Cardiff; University of the West of England, Bristol, UK; Schlosspark-Klinik University Medicine, Berlin, Germany; Parker Institute, Copenhagen University, Copenhagen, Denmark; Sint Maartenskliniek, Nijmege; Vrije Universiteit (VU), Amsterdam, the Netherlands; Pierre et Marie Curie University, Paris; University of Lorraine, Lorraine, France; University of Sydney, Sydney, Australia.,S.J. Bartlett, PhD, McGill University, and Johns Hopkins University; S.P. Barbic, PhD, University of British Columbia; V.P. Bykerk, MD, Hospital for Special Surgery; E.H. Choy, MD, Cardiff University; R. Alten, MD, Schlosspark-Klinik University Medicine; R. Christensen, PhD, Parker Institute, Copenhagen University; A. den Broeder, MD, PhD, Sint Maartenskliniek; B. Fautrel, MD, PhD, Pierre et Marie Curie University; D.E. Furst, MD, University of California; F. Guillemin, MD, PhD, University of Lorraine; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, MBA, Healthy Motivation; A. Lyddiatt, Patient Research Partner; L. March, MD, PhD, University of Sydney; P. Montie, Patient Research Partner; C. Pohl, MD, Schlosspark-Klinik University Medicine; M. Scholte Voshaar, MSc, VU; T.G. Woodworth, MD, University of California; C.O. Bingham III, MD, Johns Hopkins University
| | - Christoph Pohl
- From McGill University, Montreal, Quebec; University of British Columbia, Vancouver, British Columbia, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York; University of California, Los Angeles; Healthy Motivation, Santa Barbara, California, USA; Cardiff University, Cardiff; University of the West of England, Bristol, UK; Schlosspark-Klinik University Medicine, Berlin, Germany; Parker Institute, Copenhagen University, Copenhagen, Denmark; Sint Maartenskliniek, Nijmege; Vrije Universiteit (VU), Amsterdam, the Netherlands; Pierre et Marie Curie University, Paris; University of Lorraine, Lorraine, France; University of Sydney, Sydney, Australia.,S.J. Bartlett, PhD, McGill University, and Johns Hopkins University; S.P. Barbic, PhD, University of British Columbia; V.P. Bykerk, MD, Hospital for Special Surgery; E.H. Choy, MD, Cardiff University; R. Alten, MD, Schlosspark-Klinik University Medicine; R. Christensen, PhD, Parker Institute, Copenhagen University; A. den Broeder, MD, PhD, Sint Maartenskliniek; B. Fautrel, MD, PhD, Pierre et Marie Curie University; D.E. Furst, MD, University of California; F. Guillemin, MD, PhD, University of Lorraine; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, MBA, Healthy Motivation; A. Lyddiatt, Patient Research Partner; L. March, MD, PhD, University of Sydney; P. Montie, Patient Research Partner; C. Pohl, MD, Schlosspark-Klinik University Medicine; M. Scholte Voshaar, MSc, VU; T.G. Woodworth, MD, University of California; C.O. Bingham III, MD, Johns Hopkins University
| | - Marieke Scholte Voshaar
- From McGill University, Montreal, Quebec; University of British Columbia, Vancouver, British Columbia, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York; University of California, Los Angeles; Healthy Motivation, Santa Barbara, California, USA; Cardiff University, Cardiff; University of the West of England, Bristol, UK; Schlosspark-Klinik University Medicine, Berlin, Germany; Parker Institute, Copenhagen University, Copenhagen, Denmark; Sint Maartenskliniek, Nijmege; Vrije Universiteit (VU), Amsterdam, the Netherlands; Pierre et Marie Curie University, Paris; University of Lorraine, Lorraine, France; University of Sydney, Sydney, Australia.,S.J. Bartlett, PhD, McGill University, and Johns Hopkins University; S.P. Barbic, PhD, University of British Columbia; V.P. Bykerk, MD, Hospital for Special Surgery; E.H. Choy, MD, Cardiff University; R. Alten, MD, Schlosspark-Klinik University Medicine; R. Christensen, PhD, Parker Institute, Copenhagen University; A. den Broeder, MD, PhD, Sint Maartenskliniek; B. Fautrel, MD, PhD, Pierre et Marie Curie University; D.E. Furst, MD, University of California; F. Guillemin, MD, PhD, University of Lorraine; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, MBA, Healthy Motivation; A. Lyddiatt, Patient Research Partner; L. March, MD, PhD, University of Sydney; P. Montie, Patient Research Partner; C. Pohl, MD, Schlosspark-Klinik University Medicine; M. Scholte Voshaar, MSc, VU; T.G. Woodworth, MD, University of California; C.O. Bingham III, MD, Johns Hopkins University
| | - Thasia G Woodworth
- From McGill University, Montreal, Quebec; University of British Columbia, Vancouver, British Columbia, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York; University of California, Los Angeles; Healthy Motivation, Santa Barbara, California, USA; Cardiff University, Cardiff; University of the West of England, Bristol, UK; Schlosspark-Klinik University Medicine, Berlin, Germany; Parker Institute, Copenhagen University, Copenhagen, Denmark; Sint Maartenskliniek, Nijmege; Vrije Universiteit (VU), Amsterdam, the Netherlands; Pierre et Marie Curie University, Paris; University of Lorraine, Lorraine, France; University of Sydney, Sydney, Australia.,S.J. Bartlett, PhD, McGill University, and Johns Hopkins University; S.P. Barbic, PhD, University of British Columbia; V.P. Bykerk, MD, Hospital for Special Surgery; E.H. Choy, MD, Cardiff University; R. Alten, MD, Schlosspark-Klinik University Medicine; R. Christensen, PhD, Parker Institute, Copenhagen University; A. den Broeder, MD, PhD, Sint Maartenskliniek; B. Fautrel, MD, PhD, Pierre et Marie Curie University; D.E. Furst, MD, University of California; F. Guillemin, MD, PhD, University of Lorraine; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, MBA, Healthy Motivation; A. Lyddiatt, Patient Research Partner; L. March, MD, PhD, University of Sydney; P. Montie, Patient Research Partner; C. Pohl, MD, Schlosspark-Klinik University Medicine; M. Scholte Voshaar, MSc, VU; T.G. Woodworth, MD, University of California; C.O. Bingham III, MD, Johns Hopkins University
| | - Clifton O Bingham
- From McGill University, Montreal, Quebec; University of British Columbia, Vancouver, British Columbia, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York; University of California, Los Angeles; Healthy Motivation, Santa Barbara, California, USA; Cardiff University, Cardiff; University of the West of England, Bristol, UK; Schlosspark-Klinik University Medicine, Berlin, Germany; Parker Institute, Copenhagen University, Copenhagen, Denmark; Sint Maartenskliniek, Nijmege; Vrije Universiteit (VU), Amsterdam, the Netherlands; Pierre et Marie Curie University, Paris; University of Lorraine, Lorraine, France; University of Sydney, Sydney, Australia.,S.J. Bartlett, PhD, McGill University, and Johns Hopkins University; S.P. Barbic, PhD, University of British Columbia; V.P. Bykerk, MD, Hospital for Special Surgery; E.H. Choy, MD, Cardiff University; R. Alten, MD, Schlosspark-Klinik University Medicine; R. Christensen, PhD, Parker Institute, Copenhagen University; A. den Broeder, MD, PhD, Sint Maartenskliniek; B. Fautrel, MD, PhD, Pierre et Marie Curie University; D.E. Furst, MD, University of California; F. Guillemin, MD, PhD, University of Lorraine; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, MBA, Healthy Motivation; A. Lyddiatt, Patient Research Partner; L. March, MD, PhD, University of Sydney; P. Montie, Patient Research Partner; C. Pohl, MD, Schlosspark-Klinik University Medicine; M. Scholte Voshaar, MSc, VU; T.G. Woodworth, MD, University of California; C.O. Bingham III, MD, Johns Hopkins University
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Macfarlane GJ, Kronisch C, Atzeni F, Häuser W, Choy EH, Amris K, Branco J, Dincer F, Leino-Arjas P, Longley K, McCarthy G, Makri S, Perrot S, Sarzi Puttini P, Taylor A, Jones GT. EULAR recommendations for management of fibromyalgia. Ann Rheum Dis 2017; 76:e54. [DOI: 10.1136/annrheumdis-2017-211587] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 04/08/2017] [Indexed: 11/03/2022]
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Abstract
The physiologic function of adipose tissue is altered by the host's inflammatory response; the implications for maintaining human health and regulating inflammation-associated disease progression are ill defined. However, this cannot be investigated in humans, therefore the use of animal models is required. With the aim to determine morphological and molecular alterations to perivascular and organ-associated adipose tissues during inflammatory arthritis, collagen-induced arthritis (CIA) was established in male DBA/1 mice. Emerging evidence from this study signposts CIA in the DBA/1 mouse as a model that is relevant to study the development and treatment of early cardiovascular pathology associated with inflammatory arthritis. Here, we show global morphological changes in adipose tissue and the thoracic aorta in animals induced with CIA compared with the non-immunized controls. In CIA, we concluded that the increased cell count in PVAT was, at least in part, caused by an ingress and/or expansion of macrophages that had a mixed phenotype. A substantial increase of galectin-3 was expressed in PVAT from mice with CIA. Galectin-3 is elevated in the blood of patients with CVDs, however, it has never before been measured in PVAT in rodents or humans. Here, PVAT-associated galectin-3 is identified as a potential biomarker for detecting early vascular pathology in CIA and a promising candidate for translation to RA.
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Affiliation(s)
- Katie Sime
- Division of Infection and Immunity, Department of Rheumatology, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Ernest H. Choy
- Division of Infection and Immunity, Department of Rheumatology, Cardiff University School of Medicine, Cardiff, United Kingdom
- The Cardiff Regional Experimental Arthritis Treatment and Evaluation Centre (CREATE Centre), Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Anwen S. Williams
- Division of Infection and Immunity, Department of Rheumatology, Cardiff University School of Medicine, Cardiff, United Kingdom
- The Cardiff Regional Experimental Arthritis Treatment and Evaluation Centre (CREATE Centre), Cardiff University School of Medicine, Cardiff, United Kingdom
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Tarp S, Furst DE, Dossing A, Østergaard M, Lorenzen T, Hansen MS, Singh JA, Choy EH, Boers M, Suarez-Almazor ME, Kristensen LE, Bliddal H, Christensen R. Defining the optimal biological monotherapy in rheumatoid arthritis: A systematic review and meta-analysis of randomised trials. Semin Arthritis Rheum 2016; 46:699-708. [PMID: 27769592 DOI: 10.1016/j.semarthrit.2016.09.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 08/23/2016] [Accepted: 09/08/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To summarize and compare the benefits and harms of biological agents used as monotherapy for rheumatoid arthritis (RA) in order to inform decisions for patients who are intolerant to conventional DMARD therapy. METHODS We searched MEDLINE, EMBASE, CENTRAL, and other sources for randomised trials that compared biological monotherapy with methotrexate, placebo, or other biological monotherapies. Primary outcomes were ACR50 and the number of patients who discontinued due to adverse events. Our network meta-analysis was based on mixed-effects logistic regression, including both direct and indirect comparisons of the treatment effects, while preserving the randomised comparisons within each trial. PROSPERO identifier: CRD42012002800. RESULTS The analysis comprises 28 trials (8602 patients), including all nine biological agents approved for RA. Eight trials included "DMARD-naïve", and 20 "DMARD-Inadequate responder" (DMARD-IR) patients. All agents except anakinra and infliximab were superior (p < 0.05) to placebo (i.e., no DMARD treatment) with regard to ACR50. Etanercept and rituximab were superior to anakinra (p = 0.018 and p = 0.049, respectively). Tocilizumab was superior to adalimumab (p = 0.0082), anakinra (p = 0.0083), certolizumab (p = 0.037), and golimumab (p = 0.049). No differences among etanercept, tocilizumab, and rituximab were found (p > 0.52). However, because rituximab was evaluated in just 40 patients, our confidence in the estimates is limited. When including only DMARD-IR trials, the same statistical pattern emerged; in addition etanercept and tocilizumab were superior to abatacept. At recommended doses, both etanercept and tocilizumab were superior to adalimumab and certolizumab. No statistically significant differences among biological agents were found with respect to discontinuation due to adverse events (p > 0.068). CONCLUSIONS Evidence from randomised trials suggests that most biological agents are effective as monotherapy. Although our confidence in the estimates is limited, etanercept or tocilizumab may be the optimal choice for most patients who need treatment with biological monotherapy. However, given our limited confidence in the estimates including possibility of bias, it is appropriate to strongly weight patients׳ preferences and values in the final treatment choice.
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Affiliation(s)
- Simon Tarp
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg og Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark.
| | - Daniel E Furst
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Anna Dossing
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg og Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Tove Lorenzen
- Department of Rheumatology, Diagnostic Centre, Silkeborg Regional Hospital, Copenhagen, Denmark
| | - Michael S Hansen
- ReumaKlinik Roskilde, Roskilde, Denmark; Gildhøj Privathospital, Brøndby, Denmark
| | - Jasvinder A Singh
- Medicine Service and Center for Surgical Medical Acute care Research and Transitions, VA Medical Center, Birmingham, AL; Department of Medicine at School of Medicine, Division of Epidemiology at School of Public Health, University of Alabama, Birmingham, AL; Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, MN
| | - Ernest H Choy
- Section of Rheumatology, Arthritis Research UK and Health and Care Research Wales CREATE Centre, Cardiff University School of Medicine, Cardiff, UK
| | - Maarten Boers
- Department of Epidemiology & Biostatistics, VU University Medical Center, Amsterdam, The Netherlands; Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, The Netherlands
| | - Maria E Suarez-Almazor
- Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lars E Kristensen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg og Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark
| | - Henning Bliddal
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg og Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark
| | - Robin Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg og Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark
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Abstract
Fibromyalgia is characterized by chronic widespread pain, fatigue and nonrestorative sleep. Polysomnography showed reduced short-wave sleep and abnormal alpha rhythms during nonrapid eye movement sleep in patients with fibromyalgia. However, sleep dysfunction might be pathogenic in fibromyalgia since myalgia and fatigue could be induced in healthy individuals by disrupting sleep. Poor sleep quality was a major risk factor for the subsequent development of chronic widespread pain in healthy pain-free individuals. Sleep disruption leads to impairment of the descending pain inhibition pathways. Aside from good sleep, hygiene, exercise can promote sleep. Among currently available pharmacological treatments, evidence suggests amitriptyline and pregabalin can improve sleep in fibromyalgia.
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Affiliation(s)
- Ernest H Choy
- Section of Rheumatology, Institute of Infection & Immunity, Cardiff University School of Medicine, Cardiff University, Cardiff, UK
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Bykerk VP, Bingham CO, Choy EH, Lin D, Alten R, Christensen R, Furst DE, Hewlett S, Leong A, March L, Woodworth T, Boire G, Haraoui B, Hitchon C, Jamal S, Keystone EC, Pope J, Tin D, Thorne JC, Bartlett SJ. Identifying flares in rheumatoid arthritis: reliability and construct validation of the OMERACT RA Flare Core Domain Set. RMD Open 2016; 2:e000225. [PMID: 27252895 PMCID: PMC4885442 DOI: 10.1136/rmdopen-2015-000225] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 04/21/2016] [Accepted: 04/22/2016] [Indexed: 12/13/2022] Open
Abstract
Objective To evaluate the reliability of concurrent flare identification using 3 methods (patient, rheumatologist and Disease Activity Score (DAS)28 criteria), and construct validity of candidate items representing the Outcome Measures in Rheumatology Clinical Trials (OMERACT) RA Flare Core Domain Set. Methods Candidate flare questions and legacy measures were administered at consecutive visits to Canadian Early Arthritis Cohort (CATCH) patients between November 2011 and November 2014. The American College of Rheumatology (ACR) core set indicators were recorded. Concordance to identify flares was assessed using the agreement coefficient. Construct validity of flare questions was examined: convergent (Spearman's r); discriminant (mean differences between flaring/non-flaring patients); and consequential (proportions with prior treatment reductions and intended therapeutic change postflare). Results The 849 patients were 75% female, 81% white, 42% were in remission/low disease activity (R/LDA), and 16–32% were flaring at the second visit. Agreement of flare status was low–strong (κ's 0.17–0.88) and inversely related to RA disease activity level. Flare domains correlated highly (r's≥0.70) with each other, patient global (r's≥0.66) and corresponding measures (r's 0.49–0.92); and moderately highly with MD and patient-reported joint counts (r's 0.29–0.62). When MD/patients agreed the patient was flaring, mean flare domain between-group differences were 2.1–3.0; 36% had treatment reductions prior to flare, with escalation planned in 61%. Conclusions Flares are common in rheumatoid arthritis (RA) and are often preceded by treatment reductions. Patient/MD/DAS agreement of flare status is highest in patients worsening from R/LDA. OMERACT RA flare questions can discriminate between patients with/without flare and have strong evidence of construct and consequential validity. Ongoing work will identify optimal scoring and cut points to identify RA flares.
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Affiliation(s)
- Vivian P Bykerk
- Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York, USA; Rebecca McDonald Center for Arthritis & Autoimmune Disease, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Clifton O Bingham
- Division of Rheumatology , Johns Hopkins School of Medicine , Baltimore, Maryland , USA
| | - Ernest H Choy
- Section of Rheumatology , Arthritis Research UK & Health and Care Research Wales CREATE Centre, Cardiff University , Cardiff , UK
| | - Daming Lin
- Rebecca McDonald Center for Arthritis & Autoimmune Disease, Mount Sinai Hospital, University of Toronto , Toronto, Ontario , Canada
| | - Rieke Alten
- Schlosspark Klinik, Charité University Medicine , Berlin , Germany
| | - Robin Christensen
- Musculoskeletal Statistics Unit, Department of Rheumatology , The Parker Institute , Copenhagen University Hospital, Bispebjerg and Frederiksberg , Denmark
| | - Daniel E Furst
- Division of Rheumatology, University of California, Los Angeles, Los Angeles, California, USA (Emeritus); University of Washington, Seattle Wash; University of Florence, Florence, Italy
| | | | - Amye Leong
- Bone and Joint Decade, Healthy Motivation , Santa Barbara, California , USA
| | - Lyn March
- Department of Rheumatology , University of Sydney, Institute of Bone and Joint Research, Royal North Shore Hospital , St Leonards, New South Wales , Australia
| | - Thasia Woodworth
- Division of Rheumatology , University of California, Los Angeles , Los Angeles, California , USA
| | - Gilles Boire
- Division of Rheumatology , Université de Sherbrooke , Sherbrooke, Québec , Canada
| | - Boulos Haraoui
- Rheumatic Disease Unit , Institut de Rheumatologie , Montreal, Québec , Canada
| | - Carol Hitchon
- Arthritis Center, University of Manitoba , Winnipeg, Manitoba , Canada
| | - Shahin Jamal
- Vancouver Coastal Health Institute , Vancouver, British Columbia , Canada
| | - Edward C Keystone
- Rebecca McDonald Center for Arthritis & Autoimmune Disease, Mount Sinai Hospital, University of Toronto , Toronto, Ontario , Canada
| | - Janet Pope
- Division of Rheumatology , St. Joseph's Health Care London, University of Western Ontario , London, Ontario , Canada
| | - Diane Tin
- Southlake Regional Health Centre , Newmarket, Ontario , Canada
| | - J Carter Thorne
- Southlake Regional Health Centre , Newmarket, Ontario , Canada
| | - Susan J Bartlett
- Division of Rheumatology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA; Divisions of Clinical Epidemiology, Rheumatology, and Respiratory Clinical Trials Unit, McGill University, Montreal, Québec, Canada
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Taylor AM, Taylor JO, Singh JA, Conaghan PG, Choy EH, Tugwell PS, Kaiser U, Strand V, Simon LS, Mease PJ. Ms. A.M. Taylor, et al reply. J Rheumatol 2016; 43:826. [PMID: 27037244 DOI: 10.3899/jrheum.151456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
| | | | - Jasvinder A Singh
- Medicine Service, VA Medical Center, Department of Medicine at the School of Medicine, and Division of Epidemiology at the School of Public Health, University of Alabama at Birmingham, and Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Birmingham, Alabama, USA
| | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and UK National Institute for Health Research Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | | | - Peter S Tugwell
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Ulrike Kaiser
- University Hospital Carl Gustav Carus, Dresden, Germany
| | - Vibeke Strand
- Division of Immunology/Rheumatology, Stanford University, Palo Alto, California, USA
| | | | - Philip J Mease
- Swedish Medical Center and University of Washington, Seattle, Washington, USA
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Dougados M, Huizinga TWJ, Choy EH, Bingham CO, Aassi M, Bernasconi C. Evaluation of the Disease Activity Score in Twenty-Eight Joints-Based Flare Definitions in Rheumatoid Arthritis: Data From a Three-Year Clinical Trial. Arthritis Care Res (Hoboken) 2015; 67:1762-6. [PMID: 26037777 PMCID: PMC5132117 DOI: 10.1002/acr.22633] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 04/20/2015] [Accepted: 05/26/2015] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To assess the flare rate using published criteria (Disease Activity Score in 28 joints [DAS28-2] increase between visits of >1.2 or >0.6 if current DAS28 ≥3.2) in patients receiving constant treatment, and to compare published flare criteria to criteria used by study investigators after biologic treatment discontinuation in the ACT-RAY study. METHODS Patients with rheumatoid arthritis (n = 553) were randomized to add tocilizumab to ongoing methotrexate, or switch to tocilizumab plus placebo. If DAS28 ≤3.2 occurred at week 24, treatment remained constant until week 52; here we assessed the DAS28-2 flare rate. Between weeks 52 and 104, patients in sustained remission (DAS28 <2.6 at 2 consecutive visits 12 weeks apart) discontinued tocilizumab and were assessed every 4 weeks. Per protocol, flare was defined as a worsening of disease activity that required treatment beyond the permitted therapy based on investigator opinions (investigator flare) and was compared with the DAS28-2 definition. RESULTS After tocilizumab discontinuation, DAS28-2 was sensitive (88-100%), but not specific (57-65%), for detecting investigator flare. Under constant treatment, DAS28-2 criteria were met in 136 cases per 100 patient-years despite stable disease activity. Sustained flares were infrequent. Other DAS28-based criteria led to similar conclusions. CONCLUSION DAS28-based flare occurred more often than investigator-defined flares after biologic agent discontinuation. More stringent criteria may be more appropriate for clinical practice.
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Phillips K, Taylor A, Mease PJ, Simon LS, Conaghan PG, Choy EH, Singh JA, Strand V, Gossec L, Kaiser U, de Wit M, Ostelo R, Maxwell L, Tugwell PS. Harmonizing Pain Outcome Measures: Results of the Pre-OMERACT Meeting on Partnerships for Consensus on Patient-important Pain Outcome Domains Between the Cochrane Musculoskeletal Group and OMERACT. J Rheumatol 2015; 42:1943-1946. [DOI: 10.3899/jrheum.141386] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objective.A variety of authorities in pain measurement and outcome methodology met prior to the Outcome Measures in Rheumatology (OMERACT) 12 meeting in May 2014 to develop partnerships for consensus on pain outcomes.Methods.Following overview presentations, discussion centered on pain-specific and global constructs in the domain of chronic pain. Practical issues for clinical trial implementation were also discussed. Breakout sessions were completed regarding additional details of domain constructs. A nominal group process involving all workshop participants confirmed that chronic pain outcome measures encompass a broad range of constructs and that existing scales may be inadequate for assessment in clinical trials.Results.Participants endorsed that both pain intensity and pain interference are important constructs to be measured in clinical trials of chronic pain as it pertains to rheumatologic diagnoses.Conclusion.Further work is needed on inclusion of the patient perspective in the development of pain domains as well as Cochrane Collaboration summary of findings tables.
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Taylor AM, Phillips K, Taylor JO, Singh JA, Conaghan PG, Choy EH, Tugwell PS, Kaiser U, Strand V, Simon LS, Mease PJ. Is Chronic Pain a Disease in Its Own Right? Discussions from a Pre-OMERACT 2014 Workshop on Chronic Pain. J Rheumatol 2015; 42:1947-1953. [DOI: 10.3899/jrheum.141328] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
At the pain workshop held prior to the Outcome Measures in Rheumatology (OMERACT) 12 conference, chronic nonmalignant pain (CP) as a “disease” was discussed, in response to growing interest in this concept and in terms of the effect on the OMERACT Filter 2.0 framework. CP is often assessed as a unidimensional outcome measure; however, if CP is a disease, then outcome measures need to define the disease state and identify all its manifestations as well as its effects, as specified by Filter 2.0. The aim was to write a discussion piece, reflecting the workshop contributions and debate, as an important step in opening a dialogue around future OMERACT Filter 2.0 Framework developments.
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Humby F, Kelly S, Bugatti S, Manzo A, Filer A, Mahto A, Fonseca JE, Lauwerys B, D'Agostino MA, Naredo E, Lories R, Montecucco C, Tak PP, Fitzgerald O, Smith MD, Veale DJ, Choy EH, Strand V, Pitzalis C. Evaluation of Minimally Invasive, Ultrasound-guided Synovial Biopsy Techniques by the OMERACT Filter--Determining Validation Requirements. J Rheumatol 2015; 43:208-13. [PMID: 26034155 DOI: 10.3899/jrheum.141199] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Because limited data currently support the clinical utility of peripherally expressed biomarkers in guiding treatment decisions for patients with rheumatoid arthritis, the search has turned to the disease tissue. The strategic aim of the Outcome Measures in Rheumatology (OMERACT) synovitis working group over the years has been to develop novel diagnostic and prognostic synovial biomarkers. A critical step in this process is to refine and validate minimally invasive, technically simple, robust techniques to sample synovial tissue, for use both in clinical trials and routine clinical practice. The objective of the synovitis working group (SWG) at OMERACT 12 (2014) was to examine whether recently developed ultrasound (US)-guided synovial biopsy techniques could be validated according to the OMERACT filter for future clinical use recommendation. METHODS The SWG examined whether current data reporting US-guided synovial biopsy of both large and small joints addressed the OMERACT filters of truth, discrimination, and feasibility. RESULTS There are currently limited data examining the performance of US-guided synovial biopsy, mainly from observational studies. Thus, it remains critical to evaluate its performance, within the clinical trials context, against the current gold standard of arthroscopic biopsy, with particular reference to: (1) synovial tissue yield, (2) capacity to determine treatment response as measured by a validated synovial biomarker, and (3) tolerability of the procedure. CONCLUSION We summarize the discrete work packages agreed to as requirements to validate US-guided synovial biopsy and therefore lead to a global consensus on the use of synovial biopsy for research and clinical practice.
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Affiliation(s)
- Frances Humby
- From the Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute at Barts, and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Rheumatology and Translational Immunology Research Laboratories (LaRIT), Division of Rheumatology, IRCCS Policlinico San Matteo Foundation/University of Pavia, Pavia, Italy; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK; Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, and Rheumatology Department, Lisbon Academic Medical Centre, Lisbon, Portugal; Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain and Department of Rheumatology, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Rheumatology Department, Ambroise Paré Hospital, APHP, Université Versailles Saint Quentin en Yvelines, Inserm U987, Boulogne-Billancourt, France; Rheumatology Department, Hospital Universitario Severo Ochoa, Madrid, Spain; Laboratory for Skeletal Development and Joint Disorders, Department of Development and Regeneration, KU Leuven, Leuven, Belgium; University of Cambridge, Cambridge, UK; GlaxoSmithKline Research and Development, Stevenage, UK; School of Medicine and Medical Science, St. Vincent's University Hospital, Dublin, Ireland; Rheumatology Research Unit, Repatriation General Hospital, Daw Park, South Australia; Dublin Academic Medical Centre, The Conway Institute of Biomedical and Biomolecular Research, University College Dublin, Dublin, Ireland; Cardiff Institute of Infection and Immunity, Cardiff Regional Experimental Arthritis Treatment and Evaluation Centre, Cardiff, UK; Division of Immunology/Rheumatology, Stanford University School of Medicine, Stanford, California, USA.F. Humby, MRCP; S. Kelly, MRCP, Centre for Experimental Medicine and Rheumatology, William Harvey Research Ins
| | - Stephen Kelly
- From the Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute at Barts, and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Rheumatology and Translational Immunology Research Laboratories (LaRIT), Division of Rheumatology, IRCCS Policlinico San Matteo Foundation/University of Pavia, Pavia, Italy; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK; Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, and Rheumatology Department, Lisbon Academic Medical Centre, Lisbon, Portugal; Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain and Department of Rheumatology, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Rheumatology Department, Ambroise Paré Hospital, APHP, Université Versailles Saint Quentin en Yvelines, Inserm U987, Boulogne-Billancourt, France; Rheumatology Department, Hospital Universitario Severo Ochoa, Madrid, Spain; Laboratory for Skeletal Development and Joint Disorders, Department of Development and Regeneration, KU Leuven, Leuven, Belgium; University of Cambridge, Cambridge, UK; GlaxoSmithKline Research and Development, Stevenage, UK; School of Medicine and Medical Science, St. Vincent's University Hospital, Dublin, Ireland; Rheumatology Research Unit, Repatriation General Hospital, Daw Park, South Australia; Dublin Academic Medical Centre, The Conway Institute of Biomedical and Biomolecular Research, University College Dublin, Dublin, Ireland; Cardiff Institute of Infection and Immunity, Cardiff Regional Experimental Arthritis Treatment and Evaluation Centre, Cardiff, UK; Division of Immunology/Rheumatology, Stanford University School of Medicine, Stanford, California, USA.F. Humby, MRCP; S. Kelly, MRCP, Centre for Experimental Medicine and Rheumatology, William Harvey Research Ins
| | - Serena Bugatti
- From the Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute at Barts, and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Rheumatology and Translational Immunology Research Laboratories (LaRIT), Division of Rheumatology, IRCCS Policlinico San Matteo Foundation/University of Pavia, Pavia, Italy; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK; Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, and Rheumatology Department, Lisbon Academic Medical Centre, Lisbon, Portugal; Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain and Department of Rheumatology, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Rheumatology Department, Ambroise Paré Hospital, APHP, Université Versailles Saint Quentin en Yvelines, Inserm U987, Boulogne-Billancourt, France; Rheumatology Department, Hospital Universitario Severo Ochoa, Madrid, Spain; Laboratory for Skeletal Development and Joint Disorders, Department of Development and Regeneration, KU Leuven, Leuven, Belgium; University of Cambridge, Cambridge, UK; GlaxoSmithKline Research and Development, Stevenage, UK; School of Medicine and Medical Science, St. Vincent's University Hospital, Dublin, Ireland; Rheumatology Research Unit, Repatriation General Hospital, Daw Park, South Australia; Dublin Academic Medical Centre, The Conway Institute of Biomedical and Biomolecular Research, University College Dublin, Dublin, Ireland; Cardiff Institute of Infection and Immunity, Cardiff Regional Experimental Arthritis Treatment and Evaluation Centre, Cardiff, UK; Division of Immunology/Rheumatology, Stanford University School of Medicine, Stanford, California, USA.F. Humby, MRCP; S. Kelly, MRCP, Centre for Experimental Medicine and Rheumatology, William Harvey Research Ins
| | - Antonio Manzo
- From the Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute at Barts, and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Rheumatology and Translational Immunology Research Laboratories (LaRIT), Division of Rheumatology, IRCCS Policlinico San Matteo Foundation/University of Pavia, Pavia, Italy; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK; Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, and Rheumatology Department, Lisbon Academic Medical Centre, Lisbon, Portugal; Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain and Department of Rheumatology, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Rheumatology Department, Ambroise Paré Hospital, APHP, Université Versailles Saint Quentin en Yvelines, Inserm U987, Boulogne-Billancourt, France; Rheumatology Department, Hospital Universitario Severo Ochoa, Madrid, Spain; Laboratory for Skeletal Development and Joint Disorders, Department of Development and Regeneration, KU Leuven, Leuven, Belgium; University of Cambridge, Cambridge, UK; GlaxoSmithKline Research and Development, Stevenage, UK; School of Medicine and Medical Science, St. Vincent's University Hospital, Dublin, Ireland; Rheumatology Research Unit, Repatriation General Hospital, Daw Park, South Australia; Dublin Academic Medical Centre, The Conway Institute of Biomedical and Biomolecular Research, University College Dublin, Dublin, Ireland; Cardiff Institute of Infection and Immunity, Cardiff Regional Experimental Arthritis Treatment and Evaluation Centre, Cardiff, UK; Division of Immunology/Rheumatology, Stanford University School of Medicine, Stanford, California, USA.F. Humby, MRCP; S. Kelly, MRCP, Centre for Experimental Medicine and Rheumatology, William Harvey Research Ins
| | - Andrew Filer
- From the Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute at Barts, and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Rheumatology and Translational Immunology Research Laboratories (LaRIT), Division of Rheumatology, IRCCS Policlinico San Matteo Foundation/University of Pavia, Pavia, Italy; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK; Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, and Rheumatology Department, Lisbon Academic Medical Centre, Lisbon, Portugal; Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain and Department of Rheumatology, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Rheumatology Department, Ambroise Paré Hospital, APHP, Université Versailles Saint Quentin en Yvelines, Inserm U987, Boulogne-Billancourt, France; Rheumatology Department, Hospital Universitario Severo Ochoa, Madrid, Spain; Laboratory for Skeletal Development and Joint Disorders, Department of Development and Regeneration, KU Leuven, Leuven, Belgium; University of Cambridge, Cambridge, UK; GlaxoSmithKline Research and Development, Stevenage, UK; School of Medicine and Medical Science, St. Vincent's University Hospital, Dublin, Ireland; Rheumatology Research Unit, Repatriation General Hospital, Daw Park, South Australia; Dublin Academic Medical Centre, The Conway Institute of Biomedical and Biomolecular Research, University College Dublin, Dublin, Ireland; Cardiff Institute of Infection and Immunity, Cardiff Regional Experimental Arthritis Treatment and Evaluation Centre, Cardiff, UK; Division of Immunology/Rheumatology, Stanford University School of Medicine, Stanford, California, USA.F. Humby, MRCP; S. Kelly, MRCP, Centre for Experimental Medicine and Rheumatology, William Harvey Research Ins
| | - Arti Mahto
- From the Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute at Barts, and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Rheumatology and Translational Immunology Research Laboratories (LaRIT), Division of Rheumatology, IRCCS Policlinico San Matteo Foundation/University of Pavia, Pavia, Italy; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK; Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, and Rheumatology Department, Lisbon Academic Medical Centre, Lisbon, Portugal; Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain and Department of Rheumatology, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Rheumatology Department, Ambroise Paré Hospital, APHP, Université Versailles Saint Quentin en Yvelines, Inserm U987, Boulogne-Billancourt, France; Rheumatology Department, Hospital Universitario Severo Ochoa, Madrid, Spain; Laboratory for Skeletal Development and Joint Disorders, Department of Development and Regeneration, KU Leuven, Leuven, Belgium; University of Cambridge, Cambridge, UK; GlaxoSmithKline Research and Development, Stevenage, UK; School of Medicine and Medical Science, St. Vincent's University Hospital, Dublin, Ireland; Rheumatology Research Unit, Repatriation General Hospital, Daw Park, South Australia; Dublin Academic Medical Centre, The Conway Institute of Biomedical and Biomolecular Research, University College Dublin, Dublin, Ireland; Cardiff Institute of Infection and Immunity, Cardiff Regional Experimental Arthritis Treatment and Evaluation Centre, Cardiff, UK; Division of Immunology/Rheumatology, Stanford University School of Medicine, Stanford, California, USA.F. Humby, MRCP; S. Kelly, MRCP, Centre for Experimental Medicine and Rheumatology, William Harvey Research Ins
| | - Joao Eurico Fonseca
- From the Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute at Barts, and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Rheumatology and Translational Immunology Research Laboratories (LaRIT), Division of Rheumatology, IRCCS Policlinico San Matteo Foundation/University of Pavia, Pavia, Italy; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK; Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, and Rheumatology Department, Lisbon Academic Medical Centre, Lisbon, Portugal; Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain and Department of Rheumatology, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Rheumatology Department, Ambroise Paré Hospital, APHP, Université Versailles Saint Quentin en Yvelines, Inserm U987, Boulogne-Billancourt, France; Rheumatology Department, Hospital Universitario Severo Ochoa, Madrid, Spain; Laboratory for Skeletal Development and Joint Disorders, Department of Development and Regeneration, KU Leuven, Leuven, Belgium; University of Cambridge, Cambridge, UK; GlaxoSmithKline Research and Development, Stevenage, UK; School of Medicine and Medical Science, St. Vincent's University Hospital, Dublin, Ireland; Rheumatology Research Unit, Repatriation General Hospital, Daw Park, South Australia; Dublin Academic Medical Centre, The Conway Institute of Biomedical and Biomolecular Research, University College Dublin, Dublin, Ireland; Cardiff Institute of Infection and Immunity, Cardiff Regional Experimental Arthritis Treatment and Evaluation Centre, Cardiff, UK; Division of Immunology/Rheumatology, Stanford University School of Medicine, Stanford, California, USA.F. Humby, MRCP; S. Kelly, MRCP, Centre for Experimental Medicine and Rheumatology, William Harvey Research Ins
| | - Bernard Lauwerys
- From the Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute at Barts, and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Rheumatology and Translational Immunology Research Laboratories (LaRIT), Division of Rheumatology, IRCCS Policlinico San Matteo Foundation/University of Pavia, Pavia, Italy; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK; Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, and Rheumatology Department, Lisbon Academic Medical Centre, Lisbon, Portugal; Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain and Department of Rheumatology, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Rheumatology Department, Ambroise Paré Hospital, APHP, Université Versailles Saint Quentin en Yvelines, Inserm U987, Boulogne-Billancourt, France; Rheumatology Department, Hospital Universitario Severo Ochoa, Madrid, Spain; Laboratory for Skeletal Development and Joint Disorders, Department of Development and Regeneration, KU Leuven, Leuven, Belgium; University of Cambridge, Cambridge, UK; GlaxoSmithKline Research and Development, Stevenage, UK; School of Medicine and Medical Science, St. Vincent's University Hospital, Dublin, Ireland; Rheumatology Research Unit, Repatriation General Hospital, Daw Park, South Australia; Dublin Academic Medical Centre, The Conway Institute of Biomedical and Biomolecular Research, University College Dublin, Dublin, Ireland; Cardiff Institute of Infection and Immunity, Cardiff Regional Experimental Arthritis Treatment and Evaluation Centre, Cardiff, UK; Division of Immunology/Rheumatology, Stanford University School of Medicine, Stanford, California, USA.F. Humby, MRCP; S. Kelly, MRCP, Centre for Experimental Medicine and Rheumatology, William Harvey Research Ins
| | - Maria-Antonietta D'Agostino
- From the Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute at Barts, and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Rheumatology and Translational Immunology Research Laboratories (LaRIT), Division of Rheumatology, IRCCS Policlinico San Matteo Foundation/University of Pavia, Pavia, Italy; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK; Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, and Rheumatology Department, Lisbon Academic Medical Centre, Lisbon, Portugal; Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain and Department of Rheumatology, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Rheumatology Department, Ambroise Paré Hospital, APHP, Université Versailles Saint Quentin en Yvelines, Inserm U987, Boulogne-Billancourt, France; Rheumatology Department, Hospital Universitario Severo Ochoa, Madrid, Spain; Laboratory for Skeletal Development and Joint Disorders, Department of Development and Regeneration, KU Leuven, Leuven, Belgium; University of Cambridge, Cambridge, UK; GlaxoSmithKline Research and Development, Stevenage, UK; School of Medicine and Medical Science, St. Vincent's University Hospital, Dublin, Ireland; Rheumatology Research Unit, Repatriation General Hospital, Daw Park, South Australia; Dublin Academic Medical Centre, The Conway Institute of Biomedical and Biomolecular Research, University College Dublin, Dublin, Ireland; Cardiff Institute of Infection and Immunity, Cardiff Regional Experimental Arthritis Treatment and Evaluation Centre, Cardiff, UK; Division of Immunology/Rheumatology, Stanford University School of Medicine, Stanford, California, USA.F. Humby, MRCP; S. Kelly, MRCP, Centre for Experimental Medicine and Rheumatology, William Harvey Research Ins
| | - Esperanza Naredo
- From the Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute at Barts, and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Rheumatology and Translational Immunology Research Laboratories (LaRIT), Division of Rheumatology, IRCCS Policlinico San Matteo Foundation/University of Pavia, Pavia, Italy; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK; Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, and Rheumatology Department, Lisbon Academic Medical Centre, Lisbon, Portugal; Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain and Department of Rheumatology, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Rheumatology Department, Ambroise Paré Hospital, APHP, Université Versailles Saint Quentin en Yvelines, Inserm U987, Boulogne-Billancourt, France; Rheumatology Department, Hospital Universitario Severo Ochoa, Madrid, Spain; Laboratory for Skeletal Development and Joint Disorders, Department of Development and Regeneration, KU Leuven, Leuven, Belgium; University of Cambridge, Cambridge, UK; GlaxoSmithKline Research and Development, Stevenage, UK; School of Medicine and Medical Science, St. Vincent's University Hospital, Dublin, Ireland; Rheumatology Research Unit, Repatriation General Hospital, Daw Park, South Australia; Dublin Academic Medical Centre, The Conway Institute of Biomedical and Biomolecular Research, University College Dublin, Dublin, Ireland; Cardiff Institute of Infection and Immunity, Cardiff Regional Experimental Arthritis Treatment and Evaluation Centre, Cardiff, UK; Division of Immunology/Rheumatology, Stanford University School of Medicine, Stanford, California, USA.F. Humby, MRCP; S. Kelly, MRCP, Centre for Experimental Medicine and Rheumatology, William Harvey Research Ins
| | - Rik Lories
- From the Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute at Barts, and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Rheumatology and Translational Immunology Research Laboratories (LaRIT), Division of Rheumatology, IRCCS Policlinico San Matteo Foundation/University of Pavia, Pavia, Italy; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK; Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, and Rheumatology Department, Lisbon Academic Medical Centre, Lisbon, Portugal; Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain and Department of Rheumatology, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Rheumatology Department, Ambroise Paré Hospital, APHP, Université Versailles Saint Quentin en Yvelines, Inserm U987, Boulogne-Billancourt, France; Rheumatology Department, Hospital Universitario Severo Ochoa, Madrid, Spain; Laboratory for Skeletal Development and Joint Disorders, Department of Development and Regeneration, KU Leuven, Leuven, Belgium; University of Cambridge, Cambridge, UK; GlaxoSmithKline Research and Development, Stevenage, UK; School of Medicine and Medical Science, St. Vincent's University Hospital, Dublin, Ireland; Rheumatology Research Unit, Repatriation General Hospital, Daw Park, South Australia; Dublin Academic Medical Centre, The Conway Institute of Biomedical and Biomolecular Research, University College Dublin, Dublin, Ireland; Cardiff Institute of Infection and Immunity, Cardiff Regional Experimental Arthritis Treatment and Evaluation Centre, Cardiff, UK; Division of Immunology/Rheumatology, Stanford University School of Medicine, Stanford, California, USA.F. Humby, MRCP; S. Kelly, MRCP, Centre for Experimental Medicine and Rheumatology, William Harvey Research Ins
| | - Carlomaurizio Montecucco
- From the Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute at Barts, and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Rheumatology and Translational Immunology Research Laboratories (LaRIT), Division of Rheumatology, IRCCS Policlinico San Matteo Foundation/University of Pavia, Pavia, Italy; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK; Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, and Rheumatology Department, Lisbon Academic Medical Centre, Lisbon, Portugal; Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain and Department of Rheumatology, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Rheumatology Department, Ambroise Paré Hospital, APHP, Université Versailles Saint Quentin en Yvelines, Inserm U987, Boulogne-Billancourt, France; Rheumatology Department, Hospital Universitario Severo Ochoa, Madrid, Spain; Laboratory for Skeletal Development and Joint Disorders, Department of Development and Regeneration, KU Leuven, Leuven, Belgium; University of Cambridge, Cambridge, UK; GlaxoSmithKline Research and Development, Stevenage, UK; School of Medicine and Medical Science, St. Vincent's University Hospital, Dublin, Ireland; Rheumatology Research Unit, Repatriation General Hospital, Daw Park, South Australia; Dublin Academic Medical Centre, The Conway Institute of Biomedical and Biomolecular Research, University College Dublin, Dublin, Ireland; Cardiff Institute of Infection and Immunity, Cardiff Regional Experimental Arthritis Treatment and Evaluation Centre, Cardiff, UK; Division of Immunology/Rheumatology, Stanford University School of Medicine, Stanford, California, USA.F. Humby, MRCP; S. Kelly, MRCP, Centre for Experimental Medicine and Rheumatology, William Harvey Research Ins
| | - Paul Peter Tak
- From the Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute at Barts, and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Rheumatology and Translational Immunology Research Laboratories (LaRIT), Division of Rheumatology, IRCCS Policlinico San Matteo Foundation/University of Pavia, Pavia, Italy; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK; Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, and Rheumatology Department, Lisbon Academic Medical Centre, Lisbon, Portugal; Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain and Department of Rheumatology, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Rheumatology Department, Ambroise Paré Hospital, APHP, Université Versailles Saint Quentin en Yvelines, Inserm U987, Boulogne-Billancourt, France; Rheumatology Department, Hospital Universitario Severo Ochoa, Madrid, Spain; Laboratory for Skeletal Development and Joint Disorders, Department of Development and Regeneration, KU Leuven, Leuven, Belgium; University of Cambridge, Cambridge, UK; GlaxoSmithKline Research and Development, Stevenage, UK; School of Medicine and Medical Science, St. Vincent's University Hospital, Dublin, Ireland; Rheumatology Research Unit, Repatriation General Hospital, Daw Park, South Australia; Dublin Academic Medical Centre, The Conway Institute of Biomedical and Biomolecular Research, University College Dublin, Dublin, Ireland; Cardiff Institute of Infection and Immunity, Cardiff Regional Experimental Arthritis Treatment and Evaluation Centre, Cardiff, UK; Division of Immunology/Rheumatology, Stanford University School of Medicine, Stanford, California, USA.F. Humby, MRCP; S. Kelly, MRCP, Centre for Experimental Medicine and Rheumatology, William Harvey Research Ins
| | - Oliver Fitzgerald
- From the Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute at Barts, and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Rheumatology and Translational Immunology Research Laboratories (LaRIT), Division of Rheumatology, IRCCS Policlinico San Matteo Foundation/University of Pavia, Pavia, Italy; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK; Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, and Rheumatology Department, Lisbon Academic Medical Centre, Lisbon, Portugal; Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain and Department of Rheumatology, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Rheumatology Department, Ambroise Paré Hospital, APHP, Université Versailles Saint Quentin en Yvelines, Inserm U987, Boulogne-Billancourt, France; Rheumatology Department, Hospital Universitario Severo Ochoa, Madrid, Spain; Laboratory for Skeletal Development and Joint Disorders, Department of Development and Regeneration, KU Leuven, Leuven, Belgium; University of Cambridge, Cambridge, UK; GlaxoSmithKline Research and Development, Stevenage, UK; School of Medicine and Medical Science, St. Vincent's University Hospital, Dublin, Ireland; Rheumatology Research Unit, Repatriation General Hospital, Daw Park, South Australia; Dublin Academic Medical Centre, The Conway Institute of Biomedical and Biomolecular Research, University College Dublin, Dublin, Ireland; Cardiff Institute of Infection and Immunity, Cardiff Regional Experimental Arthritis Treatment and Evaluation Centre, Cardiff, UK; Division of Immunology/Rheumatology, Stanford University School of Medicine, Stanford, California, USA.F. Humby, MRCP; S. Kelly, MRCP, Centre for Experimental Medicine and Rheumatology, William Harvey Research Ins
| | - Malcolm D Smith
- From the Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute at Barts, and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Rheumatology and Translational Immunology Research Laboratories (LaRIT), Division of Rheumatology, IRCCS Policlinico San Matteo Foundation/University of Pavia, Pavia, Italy; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK; Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, and Rheumatology Department, Lisbon Academic Medical Centre, Lisbon, Portugal; Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain and Department of Rheumatology, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Rheumatology Department, Ambroise Paré Hospital, APHP, Université Versailles Saint Quentin en Yvelines, Inserm U987, Boulogne-Billancourt, France; Rheumatology Department, Hospital Universitario Severo Ochoa, Madrid, Spain; Laboratory for Skeletal Development and Joint Disorders, Department of Development and Regeneration, KU Leuven, Leuven, Belgium; University of Cambridge, Cambridge, UK; GlaxoSmithKline Research and Development, Stevenage, UK; School of Medicine and Medical Science, St. Vincent's University Hospital, Dublin, Ireland; Rheumatology Research Unit, Repatriation General Hospital, Daw Park, South Australia; Dublin Academic Medical Centre, The Conway Institute of Biomedical and Biomolecular Research, University College Dublin, Dublin, Ireland; Cardiff Institute of Infection and Immunity, Cardiff Regional Experimental Arthritis Treatment and Evaluation Centre, Cardiff, UK; Division of Immunology/Rheumatology, Stanford University School of Medicine, Stanford, California, USA.F. Humby, MRCP; S. Kelly, MRCP, Centre for Experimental Medicine and Rheumatology, William Harvey Research Ins
| | - Douglas J Veale
- From the Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute at Barts, and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Rheumatology and Translational Immunology Research Laboratories (LaRIT), Division of Rheumatology, IRCCS Policlinico San Matteo Foundation/University of Pavia, Pavia, Italy; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK; Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, and Rheumatology Department, Lisbon Academic Medical Centre, Lisbon, Portugal; Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain and Department of Rheumatology, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Rheumatology Department, Ambroise Paré Hospital, APHP, Université Versailles Saint Quentin en Yvelines, Inserm U987, Boulogne-Billancourt, France; Rheumatology Department, Hospital Universitario Severo Ochoa, Madrid, Spain; Laboratory for Skeletal Development and Joint Disorders, Department of Development and Regeneration, KU Leuven, Leuven, Belgium; University of Cambridge, Cambridge, UK; GlaxoSmithKline Research and Development, Stevenage, UK; School of Medicine and Medical Science, St. Vincent's University Hospital, Dublin, Ireland; Rheumatology Research Unit, Repatriation General Hospital, Daw Park, South Australia; Dublin Academic Medical Centre, The Conway Institute of Biomedical and Biomolecular Research, University College Dublin, Dublin, Ireland; Cardiff Institute of Infection and Immunity, Cardiff Regional Experimental Arthritis Treatment and Evaluation Centre, Cardiff, UK; Division of Immunology/Rheumatology, Stanford University School of Medicine, Stanford, California, USA.F. Humby, MRCP; S. Kelly, MRCP, Centre for Experimental Medicine and Rheumatology, William Harvey Research Ins
| | - Ernest H Choy
- From the Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute at Barts, and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Rheumatology and Translational Immunology Research Laboratories (LaRIT), Division of Rheumatology, IRCCS Policlinico San Matteo Foundation/University of Pavia, Pavia, Italy; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK; Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, and Rheumatology Department, Lisbon Academic Medical Centre, Lisbon, Portugal; Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain and Department of Rheumatology, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Rheumatology Department, Ambroise Paré Hospital, APHP, Université Versailles Saint Quentin en Yvelines, Inserm U987, Boulogne-Billancourt, France; Rheumatology Department, Hospital Universitario Severo Ochoa, Madrid, Spain; Laboratory for Skeletal Development and Joint Disorders, Department of Development and Regeneration, KU Leuven, Leuven, Belgium; University of Cambridge, Cambridge, UK; GlaxoSmithKline Research and Development, Stevenage, UK; School of Medicine and Medical Science, St. Vincent's University Hospital, Dublin, Ireland; Rheumatology Research Unit, Repatriation General Hospital, Daw Park, South Australia; Dublin Academic Medical Centre, The Conway Institute of Biomedical and Biomolecular Research, University College Dublin, Dublin, Ireland; Cardiff Institute of Infection and Immunity, Cardiff Regional Experimental Arthritis Treatment and Evaluation Centre, Cardiff, UK; Division of Immunology/Rheumatology, Stanford University School of Medicine, Stanford, California, USA.F. Humby, MRCP; S. Kelly, MRCP, Centre for Experimental Medicine and Rheumatology, William Harvey Research Ins
| | - Vibeke Strand
- From the Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute at Barts, and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Rheumatology and Translational Immunology Research Laboratories (LaRIT), Division of Rheumatology, IRCCS Policlinico San Matteo Foundation/University of Pavia, Pavia, Italy; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK; Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, and Rheumatology Department, Lisbon Academic Medical Centre, Lisbon, Portugal; Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain and Department of Rheumatology, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Rheumatology Department, Ambroise Paré Hospital, APHP, Université Versailles Saint Quentin en Yvelines, Inserm U987, Boulogne-Billancourt, France; Rheumatology Department, Hospital Universitario Severo Ochoa, Madrid, Spain; Laboratory for Skeletal Development and Joint Disorders, Department of Development and Regeneration, KU Leuven, Leuven, Belgium; University of Cambridge, Cambridge, UK; GlaxoSmithKline Research and Development, Stevenage, UK; School of Medicine and Medical Science, St. Vincent's University Hospital, Dublin, Ireland; Rheumatology Research Unit, Repatriation General Hospital, Daw Park, South Australia; Dublin Academic Medical Centre, The Conway Institute of Biomedical and Biomolecular Research, University College Dublin, Dublin, Ireland; Cardiff Institute of Infection and Immunity, Cardiff Regional Experimental Arthritis Treatment and Evaluation Centre, Cardiff, UK; Division of Immunology/Rheumatology, Stanford University School of Medicine, Stanford, California, USA.F. Humby, MRCP; S. Kelly, MRCP, Centre for Experimental Medicine and Rheumatology, William Harvey Research Ins
| | - Costantino Pitzalis
- From the Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute at Barts, and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Rheumatology and Translational Immunology Research Laboratories (LaRIT), Division of Rheumatology, IRCCS Policlinico San Matteo Foundation/University of Pavia, Pavia, Italy; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK; Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, and Rheumatology Department, Lisbon Academic Medical Centre, Lisbon, Portugal; Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain and Department of Rheumatology, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Rheumatology Department, Ambroise Paré Hospital, APHP, Université Versailles Saint Quentin en Yvelines, Inserm U987, Boulogne-Billancourt, France; Rheumatology Department, Hospital Universitario Severo Ochoa, Madrid, Spain; Laboratory for Skeletal Development and Joint Disorders, Department of Development and Regeneration, KU Leuven, Leuven, Belgium; University of Cambridge, Cambridge, UK; GlaxoSmithKline Research and Development, Stevenage, UK; School of Medicine and Medical Science, St. Vincent's University Hospital, Dublin, Ireland; Rheumatology Research Unit, Repatriation General Hospital, Daw Park, South Australia; Dublin Academic Medical Centre, The Conway Institute of Biomedical and Biomolecular Research, University College Dublin, Dublin, Ireland; Cardiff Institute of Infection and Immunity, Cardiff Regional Experimental Arthritis Treatment and Evaluation Centre, Cardiff, UK; Division of Immunology/Rheumatology, Stanford University School of Medicine, Stanford, California, USA.F. Humby, MRCP; S. Kelly, MRCP, Centre for Experimental Medicine and Rheumatology, William Harvey Research Ins
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Bartlett SJ, Bykerk VP, Cooksey R, Choy EH, Alten R, Christensen R, Furst DE, Guillemin F, Halls S, Hewlett S, Leong AL, Lyddiatt A, March L, Montie P, Orbai AM, Pohl C, Voshaar MS, Woodworth TG, Bingham CO. Feasibility and Domain Validation of Rheumatoid Arthritis (RA) Flare Core Domain Set: Report of the OMERACT 2014 RA Flare Group Plenary. J Rheumatol 2015; 42:2185-9. [PMID: 25684764 DOI: 10.3899/jrheum.141169] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The Outcome Measures in Rheumatology (OMERACT) Rheumatoid Arthritis (RA) Flare Group was established to develop an approach to identify and measure RA flares. An overview of our OMERACT 2014 plenary is provided. METHODS Feasibility and validity of flare domains endorsed at OMERACT 11 (2012) were described based on initial data from 3 international studies collected using a common set of questions specific to RA flare. Mean flare frequency, severity, and duration data were presented, and domain scores were compared by flare status to examine known-groups validity. Breakout groups provided input for stiffness, self-management, contextual factors, and measurement considerations. RESULTS Flare data from 501 patients in an observational study indicated 39% were in flare, with mean (SD) severity of 6.0 (2.6) and 55% lasting > 14 days. Pain, physical function, fatigue, participation, and stiffness scores averaged ≥ 2 times higher (2 of 11 points) in flaring individuals. Correlations between flare domains and corresponding legacy instruments were obtained: r = 0.46 to 0.93. A combined definition (patient report of flare and 28-joint Disease Activity Score increase) was evaluated in 2 other trials, with similar results. Breakout groups debated specific measurement issues. CONCLUSION These data contribute initial evidence of feasibility and content validation of the OMERACT RA Flare Core Domain Set. Our research agenda for OMERACT 2016 includes establishing duration/intensity criteria and developing criteria to identify RA flares using existing disease activity measures. Ongoing work will also address discordance between patient and physician ratings, facilitate application of flare criteria to clinical care, elucidate the role of self-management, and finalize recommendations for RA flare measurement.
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Affiliation(s)
- Susan J Bartlett
- From McGill University, Montreal, Quebec, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York, USA; Swansea University, Swansea; Cardiff University, Cardiff, UK; Schlosspark-Klinik, University Medicine Berlin, Berlin, Germany; The Parker Institute, Copenhagen University Hospital at Frederiksberg, Copenhagen, Denmark; University of California, Los Angeles, California, USA; University of Lorraine, Nancy, France; University of the West of England, Bristol, UK; Healthy Motivation, Santa Barbara, California, USA; University of Sydney, Sydney, Australia; and University of Twente, Enschede, The Netherlands.S.J. Bartlett, PhD, McGill University; and Johns Hopkins University; V.P. Bykerk, MD, Hospital for Special Surgery; R. Cooksey, MSc, Swansea University; E.H. Choy, MD, Cardiff University; R. Alten, Schlosspark-Klinik, University Medicine Berlin; R. Christensen, PhD, Parker Institute, Copenhagen University Hospital at Frederiksberg; D.E. Furst, MD, University of California, Los Angeles; F. Guillemin, MD, PhD, University of Lorraine; S. Halls, MSc; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, Healthy Motivation; A. Lyddiatt; University of Sydney; L. March, MD, PhD; P. Montie; A.M. Orbai, MD, MHS, Johns Hopkins University; C. Pohl, MD, Schlosspark-Klinik, University Medicine; M. Scholte Voshaar, University of Twente; T.G. Woodworth, MD, University of California, Los Angeles; and C.O. Bingham 3rd, MD, Johns Hopkins University.
| | - Vivian P Bykerk
- From McGill University, Montreal, Quebec, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York, USA; Swansea University, Swansea; Cardiff University, Cardiff, UK; Schlosspark-Klinik, University Medicine Berlin, Berlin, Germany; The Parker Institute, Copenhagen University Hospital at Frederiksberg, Copenhagen, Denmark; University of California, Los Angeles, California, USA; University of Lorraine, Nancy, France; University of the West of England, Bristol, UK; Healthy Motivation, Santa Barbara, California, USA; University of Sydney, Sydney, Australia; and University of Twente, Enschede, The Netherlands.S.J. Bartlett, PhD, McGill University; and Johns Hopkins University; V.P. Bykerk, MD, Hospital for Special Surgery; R. Cooksey, MSc, Swansea University; E.H. Choy, MD, Cardiff University; R. Alten, Schlosspark-Klinik, University Medicine Berlin; R. Christensen, PhD, Parker Institute, Copenhagen University Hospital at Frederiksberg; D.E. Furst, MD, University of California, Los Angeles; F. Guillemin, MD, PhD, University of Lorraine; S. Halls, MSc; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, Healthy Motivation; A. Lyddiatt; University of Sydney; L. March, MD, PhD; P. Montie; A.M. Orbai, MD, MHS, Johns Hopkins University; C. Pohl, MD, Schlosspark-Klinik, University Medicine; M. Scholte Voshaar, University of Twente; T.G. Woodworth, MD, University of California, Los Angeles; and C.O. Bingham 3rd, MD, Johns Hopkins University
| | - Roxanne Cooksey
- From McGill University, Montreal, Quebec, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York, USA; Swansea University, Swansea; Cardiff University, Cardiff, UK; Schlosspark-Klinik, University Medicine Berlin, Berlin, Germany; The Parker Institute, Copenhagen University Hospital at Frederiksberg, Copenhagen, Denmark; University of California, Los Angeles, California, USA; University of Lorraine, Nancy, France; University of the West of England, Bristol, UK; Healthy Motivation, Santa Barbara, California, USA; University of Sydney, Sydney, Australia; and University of Twente, Enschede, The Netherlands.S.J. Bartlett, PhD, McGill University; and Johns Hopkins University; V.P. Bykerk, MD, Hospital for Special Surgery; R. Cooksey, MSc, Swansea University; E.H. Choy, MD, Cardiff University; R. Alten, Schlosspark-Klinik, University Medicine Berlin; R. Christensen, PhD, Parker Institute, Copenhagen University Hospital at Frederiksberg; D.E. Furst, MD, University of California, Los Angeles; F. Guillemin, MD, PhD, University of Lorraine; S. Halls, MSc; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, Healthy Motivation; A. Lyddiatt; University of Sydney; L. March, MD, PhD; P. Montie; A.M. Orbai, MD, MHS, Johns Hopkins University; C. Pohl, MD, Schlosspark-Klinik, University Medicine; M. Scholte Voshaar, University of Twente; T.G. Woodworth, MD, University of California, Los Angeles; and C.O. Bingham 3rd, MD, Johns Hopkins University
| | - Ernest H Choy
- From McGill University, Montreal, Quebec, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York, USA; Swansea University, Swansea; Cardiff University, Cardiff, UK; Schlosspark-Klinik, University Medicine Berlin, Berlin, Germany; The Parker Institute, Copenhagen University Hospital at Frederiksberg, Copenhagen, Denmark; University of California, Los Angeles, California, USA; University of Lorraine, Nancy, France; University of the West of England, Bristol, UK; Healthy Motivation, Santa Barbara, California, USA; University of Sydney, Sydney, Australia; and University of Twente, Enschede, The Netherlands.S.J. Bartlett, PhD, McGill University; and Johns Hopkins University; V.P. Bykerk, MD, Hospital for Special Surgery; R. Cooksey, MSc, Swansea University; E.H. Choy, MD, Cardiff University; R. Alten, Schlosspark-Klinik, University Medicine Berlin; R. Christensen, PhD, Parker Institute, Copenhagen University Hospital at Frederiksberg; D.E. Furst, MD, University of California, Los Angeles; F. Guillemin, MD, PhD, University of Lorraine; S. Halls, MSc; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, Healthy Motivation; A. Lyddiatt; University of Sydney; L. March, MD, PhD; P. Montie; A.M. Orbai, MD, MHS, Johns Hopkins University; C. Pohl, MD, Schlosspark-Klinik, University Medicine; M. Scholte Voshaar, University of Twente; T.G. Woodworth, MD, University of California, Los Angeles; and C.O. Bingham 3rd, MD, Johns Hopkins University
| | - Rieke Alten
- From McGill University, Montreal, Quebec, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York, USA; Swansea University, Swansea; Cardiff University, Cardiff, UK; Schlosspark-Klinik, University Medicine Berlin, Berlin, Germany; The Parker Institute, Copenhagen University Hospital at Frederiksberg, Copenhagen, Denmark; University of California, Los Angeles, California, USA; University of Lorraine, Nancy, France; University of the West of England, Bristol, UK; Healthy Motivation, Santa Barbara, California, USA; University of Sydney, Sydney, Australia; and University of Twente, Enschede, The Netherlands.S.J. Bartlett, PhD, McGill University; and Johns Hopkins University; V.P. Bykerk, MD, Hospital for Special Surgery; R. Cooksey, MSc, Swansea University; E.H. Choy, MD, Cardiff University; R. Alten, Schlosspark-Klinik, University Medicine Berlin; R. Christensen, PhD, Parker Institute, Copenhagen University Hospital at Frederiksberg; D.E. Furst, MD, University of California, Los Angeles; F. Guillemin, MD, PhD, University of Lorraine; S. Halls, MSc; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, Healthy Motivation; A. Lyddiatt; University of Sydney; L. March, MD, PhD; P. Montie; A.M. Orbai, MD, MHS, Johns Hopkins University; C. Pohl, MD, Schlosspark-Klinik, University Medicine; M. Scholte Voshaar, University of Twente; T.G. Woodworth, MD, University of California, Los Angeles; and C.O. Bingham 3rd, MD, Johns Hopkins University
| | - Robin Christensen
- From McGill University, Montreal, Quebec, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York, USA; Swansea University, Swansea; Cardiff University, Cardiff, UK; Schlosspark-Klinik, University Medicine Berlin, Berlin, Germany; The Parker Institute, Copenhagen University Hospital at Frederiksberg, Copenhagen, Denmark; University of California, Los Angeles, California, USA; University of Lorraine, Nancy, France; University of the West of England, Bristol, UK; Healthy Motivation, Santa Barbara, California, USA; University of Sydney, Sydney, Australia; and University of Twente, Enschede, The Netherlands.S.J. Bartlett, PhD, McGill University; and Johns Hopkins University; V.P. Bykerk, MD, Hospital for Special Surgery; R. Cooksey, MSc, Swansea University; E.H. Choy, MD, Cardiff University; R. Alten, Schlosspark-Klinik, University Medicine Berlin; R. Christensen, PhD, Parker Institute, Copenhagen University Hospital at Frederiksberg; D.E. Furst, MD, University of California, Los Angeles; F. Guillemin, MD, PhD, University of Lorraine; S. Halls, MSc; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, Healthy Motivation; A. Lyddiatt; University of Sydney; L. March, MD, PhD; P. Montie; A.M. Orbai, MD, MHS, Johns Hopkins University; C. Pohl, MD, Schlosspark-Klinik, University Medicine; M. Scholte Voshaar, University of Twente; T.G. Woodworth, MD, University of California, Los Angeles; and C.O. Bingham 3rd, MD, Johns Hopkins University
| | - Daniel E Furst
- From McGill University, Montreal, Quebec, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York, USA; Swansea University, Swansea; Cardiff University, Cardiff, UK; Schlosspark-Klinik, University Medicine Berlin, Berlin, Germany; The Parker Institute, Copenhagen University Hospital at Frederiksberg, Copenhagen, Denmark; University of California, Los Angeles, California, USA; University of Lorraine, Nancy, France; University of the West of England, Bristol, UK; Healthy Motivation, Santa Barbara, California, USA; University of Sydney, Sydney, Australia; and University of Twente, Enschede, The Netherlands.S.J. Bartlett, PhD, McGill University; and Johns Hopkins University; V.P. Bykerk, MD, Hospital for Special Surgery; R. Cooksey, MSc, Swansea University; E.H. Choy, MD, Cardiff University; R. Alten, Schlosspark-Klinik, University Medicine Berlin; R. Christensen, PhD, Parker Institute, Copenhagen University Hospital at Frederiksberg; D.E. Furst, MD, University of California, Los Angeles; F. Guillemin, MD, PhD, University of Lorraine; S. Halls, MSc; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, Healthy Motivation; A. Lyddiatt; University of Sydney; L. March, MD, PhD; P. Montie; A.M. Orbai, MD, MHS, Johns Hopkins University; C. Pohl, MD, Schlosspark-Klinik, University Medicine; M. Scholte Voshaar, University of Twente; T.G. Woodworth, MD, University of California, Los Angeles; and C.O. Bingham 3rd, MD, Johns Hopkins University
| | - Francis Guillemin
- From McGill University, Montreal, Quebec, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York, USA; Swansea University, Swansea; Cardiff University, Cardiff, UK; Schlosspark-Klinik, University Medicine Berlin, Berlin, Germany; The Parker Institute, Copenhagen University Hospital at Frederiksberg, Copenhagen, Denmark; University of California, Los Angeles, California, USA; University of Lorraine, Nancy, France; University of the West of England, Bristol, UK; Healthy Motivation, Santa Barbara, California, USA; University of Sydney, Sydney, Australia; and University of Twente, Enschede, The Netherlands.S.J. Bartlett, PhD, McGill University; and Johns Hopkins University; V.P. Bykerk, MD, Hospital for Special Surgery; R. Cooksey, MSc, Swansea University; E.H. Choy, MD, Cardiff University; R. Alten, Schlosspark-Klinik, University Medicine Berlin; R. Christensen, PhD, Parker Institute, Copenhagen University Hospital at Frederiksberg; D.E. Furst, MD, University of California, Los Angeles; F. Guillemin, MD, PhD, University of Lorraine; S. Halls, MSc; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, Healthy Motivation; A. Lyddiatt; University of Sydney; L. March, MD, PhD; P. Montie; A.M. Orbai, MD, MHS, Johns Hopkins University; C. Pohl, MD, Schlosspark-Klinik, University Medicine; M. Scholte Voshaar, University of Twente; T.G. Woodworth, MD, University of California, Los Angeles; and C.O. Bingham 3rd, MD, Johns Hopkins University
| | - Serena Halls
- From McGill University, Montreal, Quebec, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York, USA; Swansea University, Swansea; Cardiff University, Cardiff, UK; Schlosspark-Klinik, University Medicine Berlin, Berlin, Germany; The Parker Institute, Copenhagen University Hospital at Frederiksberg, Copenhagen, Denmark; University of California, Los Angeles, California, USA; University of Lorraine, Nancy, France; University of the West of England, Bristol, UK; Healthy Motivation, Santa Barbara, California, USA; University of Sydney, Sydney, Australia; and University of Twente, Enschede, The Netherlands.S.J. Bartlett, PhD, McGill University; and Johns Hopkins University; V.P. Bykerk, MD, Hospital for Special Surgery; R. Cooksey, MSc, Swansea University; E.H. Choy, MD, Cardiff University; R. Alten, Schlosspark-Klinik, University Medicine Berlin; R. Christensen, PhD, Parker Institute, Copenhagen University Hospital at Frederiksberg; D.E. Furst, MD, University of California, Los Angeles; F. Guillemin, MD, PhD, University of Lorraine; S. Halls, MSc; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, Healthy Motivation; A. Lyddiatt; University of Sydney; L. March, MD, PhD; P. Montie; A.M. Orbai, MD, MHS, Johns Hopkins University; C. Pohl, MD, Schlosspark-Klinik, University Medicine; M. Scholte Voshaar, University of Twente; T.G. Woodworth, MD, University of California, Los Angeles; and C.O. Bingham 3rd, MD, Johns Hopkins University
| | - Sarah Hewlett
- From McGill University, Montreal, Quebec, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York, USA; Swansea University, Swansea; Cardiff University, Cardiff, UK; Schlosspark-Klinik, University Medicine Berlin, Berlin, Germany; The Parker Institute, Copenhagen University Hospital at Frederiksberg, Copenhagen, Denmark; University of California, Los Angeles, California, USA; University of Lorraine, Nancy, France; University of the West of England, Bristol, UK; Healthy Motivation, Santa Barbara, California, USA; University of Sydney, Sydney, Australia; and University of Twente, Enschede, The Netherlands.S.J. Bartlett, PhD, McGill University; and Johns Hopkins University; V.P. Bykerk, MD, Hospital for Special Surgery; R. Cooksey, MSc, Swansea University; E.H. Choy, MD, Cardiff University; R. Alten, Schlosspark-Klinik, University Medicine Berlin; R. Christensen, PhD, Parker Institute, Copenhagen University Hospital at Frederiksberg; D.E. Furst, MD, University of California, Los Angeles; F. Guillemin, MD, PhD, University of Lorraine; S. Halls, MSc; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, Healthy Motivation; A. Lyddiatt; University of Sydney; L. March, MD, PhD; P. Montie; A.M. Orbai, MD, MHS, Johns Hopkins University; C. Pohl, MD, Schlosspark-Klinik, University Medicine; M. Scholte Voshaar, University of Twente; T.G. Woodworth, MD, University of California, Los Angeles; and C.O. Bingham 3rd, MD, Johns Hopkins University
| | - Amye L Leong
- From McGill University, Montreal, Quebec, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York, USA; Swansea University, Swansea; Cardiff University, Cardiff, UK; Schlosspark-Klinik, University Medicine Berlin, Berlin, Germany; The Parker Institute, Copenhagen University Hospital at Frederiksberg, Copenhagen, Denmark; University of California, Los Angeles, California, USA; University of Lorraine, Nancy, France; University of the West of England, Bristol, UK; Healthy Motivation, Santa Barbara, California, USA; University of Sydney, Sydney, Australia; and University of Twente, Enschede, The Netherlands.S.J. Bartlett, PhD, McGill University; and Johns Hopkins University; V.P. Bykerk, MD, Hospital for Special Surgery; R. Cooksey, MSc, Swansea University; E.H. Choy, MD, Cardiff University; R. Alten, Schlosspark-Klinik, University Medicine Berlin; R. Christensen, PhD, Parker Institute, Copenhagen University Hospital at Frederiksberg; D.E. Furst, MD, University of California, Los Angeles; F. Guillemin, MD, PhD, University of Lorraine; S. Halls, MSc; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, Healthy Motivation; A. Lyddiatt; University of Sydney; L. March, MD, PhD; P. Montie; A.M. Orbai, MD, MHS, Johns Hopkins University; C. Pohl, MD, Schlosspark-Klinik, University Medicine; M. Scholte Voshaar, University of Twente; T.G. Woodworth, MD, University of California, Los Angeles; and C.O. Bingham 3rd, MD, Johns Hopkins University
| | - Anne Lyddiatt
- From McGill University, Montreal, Quebec, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York, USA; Swansea University, Swansea; Cardiff University, Cardiff, UK; Schlosspark-Klinik, University Medicine Berlin, Berlin, Germany; The Parker Institute, Copenhagen University Hospital at Frederiksberg, Copenhagen, Denmark; University of California, Los Angeles, California, USA; University of Lorraine, Nancy, France; University of the West of England, Bristol, UK; Healthy Motivation, Santa Barbara, California, USA; University of Sydney, Sydney, Australia; and University of Twente, Enschede, The Netherlands.S.J. Bartlett, PhD, McGill University; and Johns Hopkins University; V.P. Bykerk, MD, Hospital for Special Surgery; R. Cooksey, MSc, Swansea University; E.H. Choy, MD, Cardiff University; R. Alten, Schlosspark-Klinik, University Medicine Berlin; R. Christensen, PhD, Parker Institute, Copenhagen University Hospital at Frederiksberg; D.E. Furst, MD, University of California, Los Angeles; F. Guillemin, MD, PhD, University of Lorraine; S. Halls, MSc; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, Healthy Motivation; A. Lyddiatt; University of Sydney; L. March, MD, PhD; P. Montie; A.M. Orbai, MD, MHS, Johns Hopkins University; C. Pohl, MD, Schlosspark-Klinik, University Medicine; M. Scholte Voshaar, University of Twente; T.G. Woodworth, MD, University of California, Los Angeles; and C.O. Bingham 3rd, MD, Johns Hopkins University
| | - Lyn March
- From McGill University, Montreal, Quebec, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York, USA; Swansea University, Swansea; Cardiff University, Cardiff, UK; Schlosspark-Klinik, University Medicine Berlin, Berlin, Germany; The Parker Institute, Copenhagen University Hospital at Frederiksberg, Copenhagen, Denmark; University of California, Los Angeles, California, USA; University of Lorraine, Nancy, France; University of the West of England, Bristol, UK; Healthy Motivation, Santa Barbara, California, USA; University of Sydney, Sydney, Australia; and University of Twente, Enschede, The Netherlands.S.J. Bartlett, PhD, McGill University; and Johns Hopkins University; V.P. Bykerk, MD, Hospital for Special Surgery; R. Cooksey, MSc, Swansea University; E.H. Choy, MD, Cardiff University; R. Alten, Schlosspark-Klinik, University Medicine Berlin; R. Christensen, PhD, Parker Institute, Copenhagen University Hospital at Frederiksberg; D.E. Furst, MD, University of California, Los Angeles; F. Guillemin, MD, PhD, University of Lorraine; S. Halls, MSc; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, Healthy Motivation; A. Lyddiatt; University of Sydney; L. March, MD, PhD; P. Montie; A.M. Orbai, MD, MHS, Johns Hopkins University; C. Pohl, MD, Schlosspark-Klinik, University Medicine; M. Scholte Voshaar, University of Twente; T.G. Woodworth, MD, University of California, Los Angeles; and C.O. Bingham 3rd, MD, Johns Hopkins University
| | - Pamela Montie
- From McGill University, Montreal, Quebec, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York, USA; Swansea University, Swansea; Cardiff University, Cardiff, UK; Schlosspark-Klinik, University Medicine Berlin, Berlin, Germany; The Parker Institute, Copenhagen University Hospital at Frederiksberg, Copenhagen, Denmark; University of California, Los Angeles, California, USA; University of Lorraine, Nancy, France; University of the West of England, Bristol, UK; Healthy Motivation, Santa Barbara, California, USA; University of Sydney, Sydney, Australia; and University of Twente, Enschede, The Netherlands.S.J. Bartlett, PhD, McGill University; and Johns Hopkins University; V.P. Bykerk, MD, Hospital for Special Surgery; R. Cooksey, MSc, Swansea University; E.H. Choy, MD, Cardiff University; R. Alten, Schlosspark-Klinik, University Medicine Berlin; R. Christensen, PhD, Parker Institute, Copenhagen University Hospital at Frederiksberg; D.E. Furst, MD, University of California, Los Angeles; F. Guillemin, MD, PhD, University of Lorraine; S. Halls, MSc; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, Healthy Motivation; A. Lyddiatt; University of Sydney; L. March, MD, PhD; P. Montie; A.M. Orbai, MD, MHS, Johns Hopkins University; C. Pohl, MD, Schlosspark-Klinik, University Medicine; M. Scholte Voshaar, University of Twente; T.G. Woodworth, MD, University of California, Los Angeles; and C.O. Bingham 3rd, MD, Johns Hopkins University
| | - Ana Maria Orbai
- From McGill University, Montreal, Quebec, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York, USA; Swansea University, Swansea; Cardiff University, Cardiff, UK; Schlosspark-Klinik, University Medicine Berlin, Berlin, Germany; The Parker Institute, Copenhagen University Hospital at Frederiksberg, Copenhagen, Denmark; University of California, Los Angeles, California, USA; University of Lorraine, Nancy, France; University of the West of England, Bristol, UK; Healthy Motivation, Santa Barbara, California, USA; University of Sydney, Sydney, Australia; and University of Twente, Enschede, The Netherlands.S.J. Bartlett, PhD, McGill University; and Johns Hopkins University; V.P. Bykerk, MD, Hospital for Special Surgery; R. Cooksey, MSc, Swansea University; E.H. Choy, MD, Cardiff University; R. Alten, Schlosspark-Klinik, University Medicine Berlin; R. Christensen, PhD, Parker Institute, Copenhagen University Hospital at Frederiksberg; D.E. Furst, MD, University of California, Los Angeles; F. Guillemin, MD, PhD, University of Lorraine; S. Halls, MSc; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, Healthy Motivation; A. Lyddiatt; University of Sydney; L. March, MD, PhD; P. Montie; A.M. Orbai, MD, MHS, Johns Hopkins University; C. Pohl, MD, Schlosspark-Klinik, University Medicine; M. Scholte Voshaar, University of Twente; T.G. Woodworth, MD, University of California, Los Angeles; and C.O. Bingham 3rd, MD, Johns Hopkins University
| | - Christoph Pohl
- From McGill University, Montreal, Quebec, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York, USA; Swansea University, Swansea; Cardiff University, Cardiff, UK; Schlosspark-Klinik, University Medicine Berlin, Berlin, Germany; The Parker Institute, Copenhagen University Hospital at Frederiksberg, Copenhagen, Denmark; University of California, Los Angeles, California, USA; University of Lorraine, Nancy, France; University of the West of England, Bristol, UK; Healthy Motivation, Santa Barbara, California, USA; University of Sydney, Sydney, Australia; and University of Twente, Enschede, The Netherlands.S.J. Bartlett, PhD, McGill University; and Johns Hopkins University; V.P. Bykerk, MD, Hospital for Special Surgery; R. Cooksey, MSc, Swansea University; E.H. Choy, MD, Cardiff University; R. Alten, Schlosspark-Klinik, University Medicine Berlin; R. Christensen, PhD, Parker Institute, Copenhagen University Hospital at Frederiksberg; D.E. Furst, MD, University of California, Los Angeles; F. Guillemin, MD, PhD, University of Lorraine; S. Halls, MSc; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, Healthy Motivation; A. Lyddiatt; University of Sydney; L. March, MD, PhD; P. Montie; A.M. Orbai, MD, MHS, Johns Hopkins University; C. Pohl, MD, Schlosspark-Klinik, University Medicine; M. Scholte Voshaar, University of Twente; T.G. Woodworth, MD, University of California, Los Angeles; and C.O. Bingham 3rd, MD, Johns Hopkins University
| | - Marieke Scholte Voshaar
- From McGill University, Montreal, Quebec, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York, USA; Swansea University, Swansea; Cardiff University, Cardiff, UK; Schlosspark-Klinik, University Medicine Berlin, Berlin, Germany; The Parker Institute, Copenhagen University Hospital at Frederiksberg, Copenhagen, Denmark; University of California, Los Angeles, California, USA; University of Lorraine, Nancy, France; University of the West of England, Bristol, UK; Healthy Motivation, Santa Barbara, California, USA; University of Sydney, Sydney, Australia; and University of Twente, Enschede, The Netherlands.S.J. Bartlett, PhD, McGill University; and Johns Hopkins University; V.P. Bykerk, MD, Hospital for Special Surgery; R. Cooksey, MSc, Swansea University; E.H. Choy, MD, Cardiff University; R. Alten, Schlosspark-Klinik, University Medicine Berlin; R. Christensen, PhD, Parker Institute, Copenhagen University Hospital at Frederiksberg; D.E. Furst, MD, University of California, Los Angeles; F. Guillemin, MD, PhD, University of Lorraine; S. Halls, MSc; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, Healthy Motivation; A. Lyddiatt; University of Sydney; L. March, MD, PhD; P. Montie; A.M. Orbai, MD, MHS, Johns Hopkins University; C. Pohl, MD, Schlosspark-Klinik, University Medicine; M. Scholte Voshaar, University of Twente; T.G. Woodworth, MD, University of California, Los Angeles; and C.O. Bingham 3rd, MD, Johns Hopkins University
| | - Thasia G Woodworth
- From McGill University, Montreal, Quebec, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York, USA; Swansea University, Swansea; Cardiff University, Cardiff, UK; Schlosspark-Klinik, University Medicine Berlin, Berlin, Germany; The Parker Institute, Copenhagen University Hospital at Frederiksberg, Copenhagen, Denmark; University of California, Los Angeles, California, USA; University of Lorraine, Nancy, France; University of the West of England, Bristol, UK; Healthy Motivation, Santa Barbara, California, USA; University of Sydney, Sydney, Australia; and University of Twente, Enschede, The Netherlands.S.J. Bartlett, PhD, McGill University; and Johns Hopkins University; V.P. Bykerk, MD, Hospital for Special Surgery; R. Cooksey, MSc, Swansea University; E.H. Choy, MD, Cardiff University; R. Alten, Schlosspark-Klinik, University Medicine Berlin; R. Christensen, PhD, Parker Institute, Copenhagen University Hospital at Frederiksberg; D.E. Furst, MD, University of California, Los Angeles; F. Guillemin, MD, PhD, University of Lorraine; S. Halls, MSc; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, Healthy Motivation; A. Lyddiatt; University of Sydney; L. March, MD, PhD; P. Montie; A.M. Orbai, MD, MHS, Johns Hopkins University; C. Pohl, MD, Schlosspark-Klinik, University Medicine; M. Scholte Voshaar, University of Twente; T.G. Woodworth, MD, University of California, Los Angeles; and C.O. Bingham 3rd, MD, Johns Hopkins University
| | - Clifton O Bingham
- From McGill University, Montreal, Quebec, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York, USA; Swansea University, Swansea; Cardiff University, Cardiff, UK; Schlosspark-Klinik, University Medicine Berlin, Berlin, Germany; The Parker Institute, Copenhagen University Hospital at Frederiksberg, Copenhagen, Denmark; University of California, Los Angeles, California, USA; University of Lorraine, Nancy, France; University of the West of England, Bristol, UK; Healthy Motivation, Santa Barbara, California, USA; University of Sydney, Sydney, Australia; and University of Twente, Enschede, The Netherlands.S.J. Bartlett, PhD, McGill University; and Johns Hopkins University; V.P. Bykerk, MD, Hospital for Special Surgery; R. Cooksey, MSc, Swansea University; E.H. Choy, MD, Cardiff University; R. Alten, Schlosspark-Klinik, University Medicine Berlin; R. Christensen, PhD, Parker Institute, Copenhagen University Hospital at Frederiksberg; D.E. Furst, MD, University of California, Los Angeles; F. Guillemin, MD, PhD, University of Lorraine; S. Halls, MSc; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, Healthy Motivation; A. Lyddiatt; University of Sydney; L. March, MD, PhD; P. Montie; A.M. Orbai, MD, MHS, Johns Hopkins University; C. Pohl, MD, Schlosspark-Klinik, University Medicine; M. Scholte Voshaar, University of Twente; T.G. Woodworth, MD, University of California, Los Angeles; and C.O. Bingham 3rd, MD, Johns Hopkins University
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Lipkovich IA, Choy EH, Van Wambeke P, Deberdt W, Sagman D. Typology of patients with fibromyalgia: cluster analysis of duloxetine study patients. BMC Musculoskelet Disord 2014; 15:450. [PMID: 25532971 PMCID: PMC4364643 DOI: 10.1186/1471-2474-15-450] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 12/17/2014] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND To identify distinct groups of patients with fibromyalgia (FM) with respect to multiple outcome measures. METHODS Data from 631 duloxetine-treated women in 4 randomized, placebo-controlled trials were included in a cluster analysis based on outcomes after up to 12 weeks of treatment. Corresponding classification rules were constructed using a classification tree method. Probabilities for transitioning from baseline to Week 12 category were estimated for placebo and duloxetine patients (Ntotal = 1188) using logistic regression. RESULTS Five clusters were identified, from "worst" (high pain levels and severe mental/physical impairment) to "best" (low pain levels and nearly normal mental/physical function). For patients with moderate overall severity, mental and physical symptoms were less correlated, resulting in 2 distinct clusters based on these 2 symptom domains. Three key variables with threshold values were identified for classification of patients: Brief Pain Inventory (BPI) pain interference overall scores of <3.29 and <7.14, respectively, a Fibromyalgia Impact Questionnaire (FIQ) interference with work score of <2, and an FIQ depression score of ≥5. Patient characteristics and frequencies per baseline category were similar between treatments; >80% of patients were in the 3 worst categories. Duloxetine patients were significantly more likely to improve after 12 weeks than placebo patients. A sustained effect was seen with continued duloxetine treatment. CONCLUSIONS FM patients are heterogeneous and can be classified into distinct subgroups by simple descriptive rules derived from only 3 variables, which may guide individual patient management. Duloxetine showed higher improvement rates than placebo and had a sustained effect beyond 12 weeks.
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Affiliation(s)
| | | | | | | | - Doron Sagman
- Eli Lilly and Company, 3650 Danforth Avenue, Toronto, Ontario M1N 2E8, Canada.
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Grange S, Schmitt C, Ganeshalingam K, Choy EH. 102. Tocilizumb did not Significantly Increase Serum Cholesterol Levels in Healthy Subjects. Rheumatology (Oxford) 2014. [DOI: 10.1093/rheumatology/keu101.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bykerk VP, Lie E, Bartlett SJ, Alten R, Boonen A, Christensen R, Furst DE, Hewlett S, Leong AL, Lyddiatt A, March L, May JE, Montie P, Orbai AM, Pohl C, Scholte Voshaar M, Woodworth T, Bingham CO, Choy EH. Establishing a core domain set to measure rheumatoid arthritis flares: report of the OMERACT 11 RA flare Workshop. J Rheumatol 2014; 41:799-809. [PMID: 24584927 DOI: 10.3899/jrheum.131252] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The OMERACT Rheumatoid Arthritis (RA) Flare Group (FG) is developing a data-driven, patient-inclusive, consensus-based RA flare definition for use in clinical trials, longterm observational studies, and clinical practice. At OMERACT 11, we sought endorsement of a proposed core domain set to measure RA flare. METHODS Patient and healthcare professional (HCP) qualitative studies, focus groups, and literature review, followed by patient and HCP Delphi exercises including combined Delphi consensus at Outcome Measures in Rheumatology 10 (OMERACT 10), identified potential domains to measure flare. At OMERACT 11, breakout groups discussed key domains and instruments to measure them, and proposed a research agenda. Patients were active research partners in all focus groups and domain identification activities. Processes for domain selection and patient partner involvement were case studies for OMERACT Filter 2.0 methodology. RESULTS A pre-meeting combined Delphi exercise for defining flare identified 9 domains as important (>70% consensus from patients or HCP). Four new patient-reported domains beyond those included in the RA disease activity core set were proposed for inclusion (fatigue, participation, stiffness, and self-management). The RA FG developed preliminary flare questions (PFQ) to measure domains. In combined plenary voting sessions, OMERACT 11 attendees endorsed the proposed RA core set to measure flare with ≥78% consensus and the addition of 3 additional domains to the research agenda for OMERACT 12. CONCLUSION At OMERACT 11, a core domain set to measure RA flare was ratified and endorsed by attendees. Domain validation aligning with Filter 2.0 is ongoing in new randomized controlled clinical trials and longitudinal observational studies using existing and new instruments including a set of PFQ.
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Affiliation(s)
- Vivian P Bykerk
- From the Department of Rheumatology, Hospital for Special Surgery, New York, New York, USA; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Johns Hopkins University, Baltimore, Maryland, USA; McGill University, Montreal, Quebec, Canada; Schlosspark Klinik, Charité University Medicine, Berlin, Germany; Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center and Caphri Research Institute, Maastricht, The Netherlands; Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark; David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA; University of the West of England, Bristol, UK; Healthy Motivation, Bone and Joint Decade, Santa Barbara, California, USA; Musculoskeletal Group, Cochrane Collaboration; University of Sydney Department of Rheumatology, Royal North Shore Hospital, St. Leonards, Australia; National Fathers' Network, Seattle, Washington, USA; Arthritis Research Center, Vancouver, British Columbia, Canada; Tools2use.eu, Bussum, The Netherlands; and the Department of Rheumatology, Cardiff University, Cardiff, UK
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Gullick NJ, Abozaid HS, Jayaraj DM, Evans HG, Scott DL, Choy EH, Taams LS. Enhanced and persistent levels of interleukin (IL)-17⁺ CD4⁺ T cells and serum IL-17 in patients with early inflammatory arthritis. Clin Exp Immunol 2013; 174:292-301. [PMID: 23815507 DOI: 10.1111/cei.12167] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2013] [Indexed: 12/14/2022] Open
Abstract
Prognosis of patients with early inflammatory arthritis (EIA) is highly variable. The aim of this study was to compare, longitudinally and cross-sectionally, the levels of cytokine-expressing cells in peripheral blood (PB) from patients with EIA to those in established rheumatoid arthritis (RA) and healthy controls (HC). PB mononuclear cells from HC (n = 30), patients with EIA (n = 20) or RA (n = 38) were stimulated with phorbol myristate acetate (PMA)/ionomycin for 3 h, and stained for cell markers and cytokines. Serum cytokines and chemokines were measured by Luminex. Patients with EIA were reassessed at 6 and 12 months. The percentage of interleukin (IL)-17⁺ interferon (IFN)-γ⁻ CD4⁺ T cells [T helper type 17 (Th17)] was increased in RA and EIA versus HC. Serum IL-1β, IL-2, IL-4 IL-17 and macrophage inflammatory protein (MIP)-1α were increased in RA and EIA versus HC. IL-1Ra, IL-15 and IFN-α were increased in EIA versus HC. IL-6 and tumour necrosis factor (TNF)-α was increased in RA but not EIA versus HC. Disease activity scores in EIA patients improved over 12 months' treatment. Th17 percentage at baseline was correlated with both rheumatoid factor (RF) titre and functional deficit at 12 months. Baseline levels of serum granulocyte-macrophage colony-stimulating factor (GM-CSF), IL-6 and IL-8 were correlated with Larsen score at 12 months. There were no significant changes in cytokine-expressing CD4⁺ T cells over time, although the percentage of IL-6⁺monocytes increased. IL-17⁺ CD4⁺ T cells and serum IL-17 levels are increased in EIA. IL-6-expressing monocytes increase during the first year of disease, irrespective of disease-modifying anti-rheumatic drug (DMARD) therapy. We observed incomplete clinical responses, suggesting EIA patients need more intensive early therapy.
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Affiliation(s)
- N J Gullick
- Academic Department of Rheumatology, King's College London, London, UK; NIHR Comprehensive Biomedical Research Centre, Guy's and St Thomas' Hospital and King's College London, London, UK
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Ceeraz S, Hall C, Choy EH, Spencer J, Corrigall VM. Defective CD8+CD28+ regulatory T cell suppressor function in rheumatoid arthritis is restored by tumour necrosis factor inhibitor therapy. Clin Exp Immunol 2013; 174:18-26. [PMID: 23786396 DOI: 10.1111/cei.12161] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2013] [Indexed: 11/28/2022] Open
Abstract
Balanced immunoregulatory networks are essential for maintenance of systemic tolerance. Disturbances in the homeostatic equilibrium between inflammatory mediators, immune regulators and immune effector cells are implicated directly in the pathogenesis of autoimmune diseases, including rheumatoid arthritis (RA). In this study we characterize the peripheral blood CD8(+) CD28(-) regulatory T cells (Treg) contribution to the immunoregulatory network in health and in RA. In health, CD8(+) CD28(-) Treg are suppressive but, unlike CD4(+) Treg , they function predominantly through the action of soluble mediators such as interleukin (IL)-10 and transforming growth factor (TGF)-β. Neutralization of TGF-β consistently reduced CD8(+) CD28(-) Treg suppressor function in vitro. RA, CD8(+) CD28(-) Treg are increased numerically, but have reduced expression of inducible co-stimulator (ICOS) and programmed death 1 (PD-1) compared to healthy or disease controls. They produce more IL-10 but autologous T cells express less IL-10R. This expression was found to be restored following in-vitro addition of a tumour necrosis factor inhibitor (TNFi). Deficiencies in both the CD8(+) CD28(-) Treg population and reduced sensitivity of the T responder cells impact upon their regulatory function in RA. TNFi therapy partially restores CD8(+) CD28(-) Treg ability in vivo and in vitro, despite the defects in expression of functionally relevant molecules by RA CD8(+) CD28(-) Treg compared to healthy controls. This study places CD8(+) CD28(-) Treg cells in the scheme of immune regulation alongside CD4(+) Treg cells, and highlights the importance of understanding impaired responsiveness to regulation that is common to these suppressor subsets and their restored function in response to TNFi therapy.
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Affiliation(s)
- S Ceeraz
- Academic Department of Rheumatology, Centre for Molecular and Cellular Biology of Inflammation, King's College London School of Medicine, London, UK
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