1
|
Sepriano A, Ramiro S, Landewé R, van der Heijde D, Ohrndorf S, FitzGerald O, Backhaus M, Larché M, Homik J, Saraux A, Hammer HB, Terslev L, Østergaard M, Burmester G, Combe B, Dougados M, Hitchon C, Boire G, Lambert RG, Dadashova R, Paschke J, Hutchings EJ, Maksymowych WP. Adding ultrasound to treat-to-target shows no benefit in achieving clinical remission nor in slowing radiographic progression in rheumatoid arthritis: results from a multicenter prospective cohort. Clin Rheumatol 2024:10.1007/s10067-024-06978-5. [PMID: 38684600 DOI: 10.1007/s10067-024-06978-5] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 04/11/2024] [Accepted: 04/22/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVE To assess whether using ultrasound (US) in addition to clinical information versus only clinical information in a treat-to-target (T2T) strategy leads to more clinical remission and to less radiographic progression in RA. METHODS Patients with RA from the 2-year prospective BIODAM cohort were included. Clinical and US data (US7-score) were collected every 3 months and hands and feet radiographs every 6 months. At each visit, it was decided whether patients were treated according to the clinical definition of T2T with DAS44 remission as benchmark (T2T-DAS44). T2T-DAS44 was correctly applied if: (i) DAS44 remission had been achieved or (ii) if not, treatment was intensified. A T2T strategy also considering US data (T2T-DAS44-US) was correctly applied if: (i) both DAS44 and US remission (synovitis-score < 2, Doppler-score = 0) were present; or (ii) if not, treatment was intensified. The effect of T2T-DAS44-US on attaining clinical remission and on change in Sharp-van der Heijde score compared to T2T-DAS44 was analysed. RESULTS A total of 1016 visits of 128 patients were included. T2T-DAS44 was correctly followed in 24% of visits and T2T-DAS44-US in 41%. DAS44 < 1.6 was achieved in 39% of visits. Compared to T2T-DAS44, using the T2T-DAS44-US strategy resulted in a 41% lower likelihood of DAS44 remission [OR (95% CI): 0.59 (0.40;0.87)] and had no effect on radiographic progression [β(95% CI): 0.11 (- 0.16;0.39)] assessed at various intervals up to 12 months later. CONCLUSION Our results do not suggest a benefit of using the US7-score in addition to clinical information as a T2T benchmark compared to clinical information alone. Key Points • Ultrasound has a valuable role in diagnostic evaluation of rheumatoid arthritis, but it is unclear whether adding ultrasound to the clinical assessment in a treat-to-target (T2T) strategy leads to more patients achieving remission and reduction in radiographic progression. • Our data from a real-world study demonstrated that adding information from ultrasound to the clinical assessment in a T2T strategy led to a lower rather than a higher likelihood of obtaining clinical remission as compared to using only clinical assessment. • Our data demonstrated that adding ultrasound data to a T2T strategy based only on clinical assessment did not offer additional protection against radiographic progression in patients with RA. • Adding US to a T2T strategy based on clinical assessment led to far more treatment intensifications (with consequences for costs and exposure to adverse events) without yielding a meaningful clinical benefit.
Collapse
Affiliation(s)
- Alexandre Sepriano
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Sofia Ramiro
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Zuyderland Medical Center, Heerlen, The Netherlands
| | - Robert Landewé
- Zuyderland Medical Center, Heerlen, The Netherlands
- Amsterdam University Medical Center (ARC), Amsterdam, The Netherlands
| | | | - Sarah Ohrndorf
- Department of Internal Medicine - Rheumatology and Clinical Immunology, Academic Hospital of Charité - Universitätsmedizin Berlin, Parkklinik Weissensee, Berlin, Germany
| | - Olivier FitzGerald
- Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland
- Conway Institute for Biomolecular Research, University College Dublin, Dublin, Ireland
| | - Marina Backhaus
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Maggie Larché
- Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University, Hamilton, Canada
| | - Joanne Homik
- Department of Medicine, University of Alberta, 568 Heritage Medical Research Building, Edmonton, T6G 2S2, Canada
| | - Alain Saraux
- LBAI, U1227, University of Brest, Inserm; CHRU Brest, F-29200, Brest, France
| | - Hilde B Hammer
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Lene Terslev
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Gerd Burmester
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Bernard Combe
- Departement de Rhumatologie, Univ Montpellier, CHU Montpellier, Montpellier, France
| | - Maxime Dougados
- Rheumatology Department, Paris Descartes University, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France
| | - Carol Hitchon
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Gilles Boire
- Division of Rheumatology, Department of Medicine, Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke (CIUSSS de l'Estrie - CHUS), Université de Sherbrooke, Québec, Canada
| | - Robert G Lambert
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Canada
- Medical Imaging Consultants, Edmonton, Canada
| | | | | | | | - Walter P Maksymowych
- Department of Medicine, University of Alberta, 568 Heritage Medical Research Building, Edmonton, T6G 2S2, Canada.
- CARE ARTHRITIS LTD, Edmonton, Canada.
| |
Collapse
|
2
|
Fleischmann R, Curtis JR, Charles-Schoeman C, Mysler E, Yamaoka K, Richez C, Palac H, Dilley D, Liu J, Strengholt S, Burmester G. Safety profile of upadacitinib in patients at risk of cardiovascular disease: integrated post hoc analysis of the SELECT phase III rheumatoid arthritis clinical programme. Ann Rheum Dis 2023; 82:1130-1141. [PMID: 37308218 PMCID: PMC10423494 DOI: 10.1136/ard-2023-223916] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 05/17/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Increased risk of serious adverse events (AEs) was reported for tofacitinib relative to tumour necrosis factor inhibitor therapy in patients with rheumatoid arthritis (RA) aged ≥50 years enriched for cardiovascular (CV) risk (ORAL Surveillance). We assessed post hoc the potential risk of upadacitinib in a similar RA population. METHODS Pooled safety data from six phase III trials were evaluated post hoc for AEs in patients receiving upadacitinib 15 mg once a day (with or without conventional synthetic disease-modifying antirheumatic drugs), adalimumab 40 mg every other week with concomitant methotrexate (MTX), or MTX monotherapy in the overall trial population and in a subset of patients with higher CV risk (aged ≥50 years, ≥1 CV risk factor). Higher-risk patients from a head-to-head study of upadacitinib 15 mg versus adalimumab (SELECT-COMPARE) were assessed in parallel. Exposure-adjusted incidence rates for treatment-emergent AEs were summarised based on exposure to upadacitinib or comparators. RESULTS A total of 3209 patients received upadacitinib 15 mg, 579 received adalimumab and 314 received MTX monotherapy; ~54% of the patients were included in the overall and SELECT-COMPARE higher-risk populations. Major adverse cardiovascular events (MACE), malignancy (excluding non-melanoma skin cancer (NMSC)) and venous thromboembolism (VTE) were more frequent in the higher-risk cohorts versus the overall population but were generally similar across treatment groups. Rates of serious infections in higher-risk populations and herpes zoster (HZ) and NMSC in all populations were higher with upadacitinib 15 mg than comparators. CONCLUSIONS An increased risk of MACE, malignancy (excluding NMSC) and VTE was observed in higher-risk populations with RA, yet risk was comparable between upadacitinib-treated and adalimumab-treated patients. Higher rates of NMSC and HZ were observed with upadacitinib versus comparators across all populations, and increased rates of serious infections were detected in upadacitinib-treated patients at higher CV risk. TRIAL REGISTRATION NUMBERS NCT02706873, NCT02675426, NCT02629159, NCT02706951, NCT02706847 and NCT03086343.
Collapse
Affiliation(s)
- Roy Fleischmann
- Department of Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jeffrey R Curtis
- Department of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Christina Charles-Schoeman
- Department of Medicine, Division of Rheumatology, University of California Los Angeles, Los Angeles, California, USA
| | - Eduardo Mysler
- Organización Medica de Investigación, Buenos Aires, Argentina
| | - Kunihiro Yamaoka
- Department of Rheumatology and Infectious Diseases, Kitasato University School of Medicine, Sagamihara, Japan
| | - Christophe Richez
- University Bordeaux, CNRS, ImmunoConcEpT, UMR 5164, and CHU of Bordeaux, Department of Rheumatology, Bordeaux, France
| | | | | | | | | | - Gerd Burmester
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
3
|
Curtis JR, Aletaha D, Burmester G, Ford K, van Hoogstraten H, Praestgaard A, Bykerk VP. Improvement or Worsening of Disease Activity After Switch to Sarilumab in Patients With Rheumatoid Arthritis With a Partial Response to Adalimumab. J Clin Rheumatol 2023; 29:196-201. [PMID: 36858816 DOI: 10.1097/rhu.0000000000001946] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
OBJECTIVE The aim of this study was to assess the effect of switching from adalimumab to sarilumab monotherapy in partial responders with rheumatoid arthritis from the MONARCH randomized trial and its open-label extension (OLE). METHODS Partial response was defined as improvement in Clinical Disease Activity Index (CDAI) of 12 or 6 units (baseline score: >22 or >10 and ≤22, respectively). Proportions of adalimumab partial responders with meaningful worsening or improvement at OLE weeks 12 and 24 were evaluated using 2 CDAI thresholds (≥6 and ≥12 points), 28-joint Disease Activity Score using erythrocyte sedimentation rate (≥0.6 and ≥1.2 points), Health Assessment Questionnaire Disability Index (≥0.22 and ≥0.30 points), Simple Disease Activity Index (≥7 and ≥13 points), physician and patient global assessments (≥10 and ≥20), and 28-joint swollen and tender joint counts (≥1 and ≥2 joints). Outcomes were analyzed using mixed-effect models with repeated measures for observed cases. The p values were produced using Wilcoxon tests. RESULTS Of 369 enrolled patients, 320 (87%) entered the OLE and 155 switched from adalimumab to sarilumab; 59% (91/155) were partial responders. At week 24, 4%-17% and 2%-12% of partial responders experienced a worsening using the lower and higher thresholds, respectively, whereas 47%-78% and 27%-66% experienced improvement. CONCLUSIONS Partial responders to adalimumab who switched to sarilumab had a low likelihood of experiencing meaningful worsening, with most patients showing meaningful improvement or no change in disease activity. This may help alleviate patients' fears of worsening when considering switching to a treatment with a different mechanism of action.
Collapse
Affiliation(s)
- Jeffrey R Curtis
- From the Division of Clinical Immunology and Rheumatology at the University of Alabama at Birmingham, Birmingham, AL
| | - Daniel Aletaha
- Division of Rheumatology, Medical University Vienna, Vienna, Austria
| | | | | | | | | | | |
Collapse
|
4
|
Shadick N, Hagino O, Praestgaard A, Fiore S, Weinblatt M, Burmester G. Association of hemoglobin levels with radiographic progression in patients with rheumatoid arthritis: an analysis from the BRASS registry. Arthritis Res Ther 2023; 25:88. [PMID: 37237405 DOI: 10.1186/s13075-023-03068-w] [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] [Received: 09/16/2022] [Accepted: 05/15/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND To evaluate baseline hemoglobin (Hb) and radiographic progression over time in patients enrolled in the Brigham and Women's Rheumatoid Arthritis Sequential Study (BRASS) registry. METHODS The BRASS is a prospective observational registry of patients with rheumatoid arthritis. BRASS Hb data and total sharp score data were matched with the main BRASS patients. Hb at baseline was categorized per the World Health Organization guidelines. Mean Hb, mean total sharp score, and mean changes over time from baseline to month 120 were summarized (overall, by low/normal Hb, and by current medication at baseline). All analyses were descriptive. RESULTS Out of the total (N = 1114) rheumatoid arthritis patients included in the analysis, patients with low Hb at baseline (n = 224 [20%]) had longer disease duration and higher disease activity and reported more pain compared with patients with normal Hb at baseline (n = 890 [80%]). Patients with low Hb at baseline continued to have lower Hb than patients with normal Hb throughout 10 years; although, on average, patients in the low Hb subgroup exhibited a steady increase in Hb levels. A larger increase in total sharp score over time was observed for patients with low Hb than for patients with normal Hb. No meaningful differences potentially attributable to medication at baseline were detected. CONCLUSIONS Patients with low Hb levels at baseline tended to have increased radiographic progression as measured by total sharp score compared with patients with rheumatoid arthritis having normal Hb levels. Patients with low Hb experienced sustained improvements in Hb levels over time, regardless of the class of medication used. TRIAL REGISTRATION ClinicalTrials.gov NCT01793103.
Collapse
Affiliation(s)
- Nancy Shadick
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA.
| | - Owen Hagino
- Sanofi, Research and Development, Bridgewater, NJ, USA
| | | | - Stefano Fiore
- Global Medical Affairs, Biostatistics, Cambridge, MA, USA
| | - Michael Weinblatt
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Gerd Burmester
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin, Berlin, Germany
| |
Collapse
|
5
|
Rubbert-Roth A, Furst DE, Fiore S, Praestgaard A, Bykerk V, Bingham CO, Charles-Schoeman C, Burmester G. Association between low hemoglobin, clinical measures, and patient-reported outcomes in patients with rheumatoid arthritis: results from post hoc analyses of three phase III trials of sarilumab. Arthritis Res Ther 2022; 24:207. [PMID: 36008838 PMCID: PMC9404615 DOI: 10.1186/s13075-022-02891-x] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 08/07/2022] [Indexed: 11/29/2022] Open
Abstract
Background Anemia is common in patients with rheumatoid arthritis (RA). Higher hemoglobin (Hb) levels may be associated with better clinical outcomes and patient-reported outcomes (PROs). To assess this hypothesis, we conducted two post hoc analyses in three sarilumab phase III studies: TARGET, MOBILITY, and MONARCH. Methods Pooled data from combination therapy from placebo-controlled MOBILITY (sarilumab + methotrexate) and TARGET (sarilumab + conventional synthetic disease-modifying antirheumatic drugs [csDMARDs]) and monotherapy data from active-controlled MONARCH (sarilumab vs. adalimumab) studies were included. Associations between Hb levels and clinical measures and PROs were assessed over 24 weeks. The mean changes from baseline in clinical outcomes and PROs (to week 24) and radiographic outcomes (to week 52) were evaluated between low and normal Hb levels (based on the World Health Organization [WHO] criteria). Results From TARGET, MOBILITY, and MONARCH, 546, 1197, and 369 patients, respectively, were stratified according to Hb levels (low vs. normal). Over 24 weeks, higher Hb levels were found to be consistently associated with better clinical outcomes and PROs in combination therapy and monotherapy groups and were more pronounced among the patients treated with sarilumab than those treated with placebo and adalimumab. The mean change from baseline to week 24 in clinical efficacy measures and PROs was similar in patients with low vs. normal Hb at baseline. Differences between sarilumab and/or adalimumab, for all outcomes, were larger for low Hb subgroups. In MOBILITY, by week 52, the inhibition of progression of structural damage (assessed via Modified Total Sharp Score [mTSS]) was 84% (sarilumab 200 mg) and 68% (sarilumab 150 mg) vs. placebo in patients with low Hb and 97% (sarilumab 200 mg) and 68% (sarilumab 150 mg) vs. placebo in patients with normal Hb. Similar results were observed for other radiographic outcomes. Conclusions In these post hoc analyses, a consistent relationship was observed between higher Hb levels and better clinical outcomes and PROs in patients with RA. Irrespective of the baseline Hb levels, sarilumab treatment was associated with improvements in clinical measures and PROs over 24 weeks (improvements were more pronounced than those with adalimumab treatment) and mitigation of joint damage progression over 52 weeks. Trial registration ClinTrials.gov NCT01061736, NCT01709578, and NCT02332590 Supplementary Information The online version contains supplementary material available at 10.1186/s13075-022-02891-x.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Gerd Burmester
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität Berlin, Berlin, Germany
| |
Collapse
|
6
|
Boyadzhieva Z, Ruffer N, Burmester G, Pankow A, Krusche M. Effectiveness and Safety of JAK Inhibitors in Autoinflammatory Diseases: A Systematic Review. Front Med (Lausanne) 2022; 9:930071. [PMID: 35833101 PMCID: PMC9271622 DOI: 10.3389/fmed.2022.930071] [Citation(s) in RCA: 2] [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: 04/27/2022] [Accepted: 05/24/2022] [Indexed: 01/25/2023] Open
Abstract
Introduction Autoinflammatory diseases (AID) are rare diseases presenting with episodes of sterile inflammation. These involve multiple organs and can cause both acute organ damage and serious long-term effects, like amyloidosis. Disease-specific anti-inflammatory therapeutic strategies are established for some AID. However, their clinical course frequently includes relapsing, uncontrolled conditions. Therefore, new therapeutic approaches are needed. Janus Kinase inhibitors (JAKi) block key cytokines of AID pathogenesis and can be a potential option. Methods A systematic review of the literature in accordance with the PRISMA guidelines was conducted. Three databases (MEDLINE, Embase and Cochrane Central Register of Controlled Trials) were searched for publications regarding the use of JAKi for AID. Data from the included publications was extracted and a narrative synthesis was performed. Criteria for defining treatment response were defined and applied. Results We report data from 38 publications with a total of 101 patients describing the effects of JAKi in AID. Data on Type I Interferonopathies, Adult-Onset Still's Disease (AOSD), Systemic Juvenile Idiopathic Arthritis (sJIA), Familial Mediterranean Fever (FMF), and Behçet's Syndrome (BS) was identified. From a total of 52 patients with type I interferonopathies, in seven patients (7/52, 13.5%) a complete response was achieved, most (35/52, 67.3%) showed a partial response and a minority (10/52, 19.2%) showed no treatment response. For AOSD, a complete or a partial response was achieved by eleven (11/26, 42.3%) patients each. Two sJIA patients achieved complete response (2/4, 50%) and in two cases (2/4, 50%) a partial response was reported. Half of FMF patients showed a complete response and the other half had a partial one (3/6, 50.0%). Amongst BS patients most achieved a partial response (8/13, 61.5%). Five patients showed no response to therapy (5/13, 38.5%). Overall, the most frequent AEs were upper respiratory tract infections (17), pneumonia (10), BK virus viremia (10) and viruria (4), herpes zoster infection (5), viral gastroenteritis (2) and other infections (4). Conclusion The results from this systematic review show that JAKi can be beneficial in certain AID. The risk of AEs, especially viral infections, should be considered. To accurately assess the risk benefit ratio of JAKi for AID, clinical trials should be conducted.
Collapse
Affiliation(s)
- Zhivana Boyadzhieva
- Department of Rheumatology and Clinical Immunology, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Nikolas Ruffer
- Division of Rheumatology and Systemic Inflammatory Diseases, University Hospital Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Gerd Burmester
- Department of Rheumatology and Clinical Immunology, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Anne Pankow
- Department of Rheumatology and Clinical Immunology, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Krusche
- Division of Rheumatology and Systemic Inflammatory Diseases, University Hospital Hamburg-Eppendorf (UKE), Hamburg, Germany
| |
Collapse
|
7
|
Cobb P, Niederwieser D, Cohen S, Hamm C, Burmester G, Seo N, Lehto SG, Hanes V. A review of the totality of evidence in the development of ABP 798, a rituximab biosimilar. Immunotherapy 2022; 14:727-740. [PMID: 35543293 DOI: 10.2217/imt-2022-0024] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABP 798 (RIABNI™) is a biosimilar to rituximab reference product (RP), a monoclonal antibody that targets CD20. Approval of ABP 798 was based on the totality of evidence generated using a stepwise approach which began by showing that it is structurally and functionally similar to rituximab RP. This analytical assessment was followed by a demonstration of pharmacokinetic/pharmacodynamic similarity in patients with rheumatoid arthritis. Comparative clinical efficacy and safety of ABP 798 with rituximab RP was demonstrated as a final step in patients with non-Hodgkin lymphoma and in those with rheumatoid arthritis. Overall, the totality of evidence supported the conclusion that ABP 798 is highly similar to rituximab RP and provided scientific justification for extrapolation to other approved indications of rituximab RP.
Collapse
Affiliation(s)
- Patrick Cobb
- St Vincent Frontier Cancer Center, Billings, MT 59102, USA
| | - Dietger Niederwieser
- Division of Hematology and Oncology, University of Leipzig, Leipzig, Liebigstr. 19, 04106, Germany
| | - Stanley Cohen
- Metroplex Clinical Research Center, Dallas, TX 75231, USA
| | - Caroline Hamm
- Windsor Oncology; Western University; Windsor, ON N8W2X3, Canada
| | - Gerd Burmester
- Department of Rheumatology & Clinical Immunology, Free University & Humboldt University Berlin, Charité-University Medicine Berlin, Charitéplatz 1, Berlin, 10117, Germany
| | - Neungseon Seo
- Amgen Inc., One Amgen Center Drive, Thousand Oaks, CA 91320-1799, USA
| | - Sonya G Lehto
- Amgen Inc., One Amgen Center Drive, Thousand Oaks, CA 91320-1799, USA
| | - Vladimir Hanes
- Amgen Inc., One Amgen Center Drive, Thousand Oaks, CA 91320-1799, USA
| |
Collapse
|
8
|
Taylor PC, Takeuchi T, Burmester G, Durez P, Smolen J, Deberdt W, Zhong J, Terres JR, Bello N, Winthrop K. P196 Safety profile of baricitinib for the treatment of rheumatoid arthritis up to 9.3 years: an updated integrated safety analysis. Rheumatology (Oxford) 2022. [DOI: 10.1093/rheumatology/keac133.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Aims
Baricitinib (BARI) is an oral selective Janus kinase (JAK)1/JAK2 inhibitor approved for the treatment of adult patients with moderate-to-severe rheumatoid arthritis (RA).
Objective
Reporting BARI’s safety profile with data up to 9.3 years of treatment.
Methods
Pooled data from nine randomized (five Phase 3, three Phase 2, one Phase 1b) and one long-term-extension (LTE) study were assessed. Incidence rates (IR)/100 patient-years at risk (PYR) were calculated for all patients treated with ≥1 dose of BARI (All-BARI-RA). Adverse events (AEs) of interest were assessed in 48-month intervals. Major adverse cardiovascular events (MACE) were adjudicated in five Phase 3 studies and the LTE, and incidence rates evaluated in subgroups of patients aged ≥50 years and presenting with ≥1 cardiovascular risk factor (current smoker, hypertension, high-density lipoprotein cholesterol <40 mg/dL, diabetes, or arteriosclerotic cardiovascular disease). To account for aging of the cohort, a standardized incidence ratio (SIR) for malignancy (excluding non-melanoma skin cancer [NMSC]) was estimated using SEER17, 2013-2017 US population cancer rates, and a standardized mortality ratio (SMR) was estimated using 2019 US population mortality calculated compared to the general US population with the same age distribution. Exposure-adjusted IRs (EAIRs) for deep vein thrombosis (DVT), pulmonary embolism (PE), and DVT and/or PE (DVT/PE) were also calculated for patient groups while receiving BARI 2-mg/4-mg within All-BARI-RA.
Results
A total of 3770 patients received BARI for 14,744.4 PYE with a median exposure of 4.6 years and a maximum exposure of 9.3 years; 80.5% of PYE were BARI 4-mg and 18.1% of PYE were BARI 2-mg. Overall, EAIRs/100 PYE for any treatment-emergent AE and serious AE (including death) were 22.6 and 7.4. Overall IRs/100 PYR were 2.58 for serious infections; 0.35 for DVT, 0.26 for PE, 0.49 for DVT/PE, 0.51 for MACE, and 0.92 for malignancy; IRs remained stable over time. The IR (95%CI) of MACE for patients aged ≥50 years was 0.68 (0.52, 0.88). In patients aged ≥50 with ≥1 of the cardiovascular risk factors, IR (95%CI) of MACE was 0.77 (0.56, 1.04). The SIR (95%CI) for malignancies excluding NMSC based on the SEER17 standard was 1.07 (0.90, 1.26); the SMR (95%CI) was 0.74 (0.59, 0.92) showing that the incidence of malignancy and death in patients treated with BARI appear similar to the general US population. EAIRs (95%CI) for patients while receiving BARI 2-mg (PYE=2678) and BARI 4-g (PYE=11,872) were DVT 2-mg 0.41 (0.21, 0.73) and 4-mg 0.35 (0.25, 0.48); PE 2-mg 0.26 (0.11, 0.54) and 4-mg 0.27 (0.18, 0.38); and DVT/PE 2-mg 0.49 (0.26, 0.83) and 4-mg 0.51 (0.39, 0.66).
Conclusion
In this report with 14,744 PYE, BARI maintained a safety profile similar to that previously reported, with no increase of IRs across safety events through exposures up to 9.3 years.
Disclosure
P.C. Taylor: Consultancies; AbbVie, Biogen, Bristol Myers Squibb, Celgene, Eli Lilly and Company, Fresenius Medical Care, Galapagos NV, Gilead Sciences, GlaxoSmithKline, Janssen, Nordic Pharma, Pfizer, Roche, Sanofi, UCB Pharma. Grants/research support; AbbVie, Biogen, Bristol Myers Squibb, Celgene, Eli Lilly and Company, Fresenius Medical Care, Galapagos NV, Gilead Sciences, GlaxoSmithKline, Janssen, Nordic Pharma, Pfizer, Roche, Sanofi, UCB Pharma. T. Takeuchi: Consultancies; AbbVie, Asahi Kasei Pharma, Astellas, AstraZeneca, Bristol Myers Squibb, Chugai Pharmaceutical, Daiichi Sankyo, Eisai, Eli Lilly and Company, GlaxoSmithKline, Janssen, Mitsubishi Tanabe Pharma, Nippon Kayaku, Novartis, Pfizer Japan, Taiho Pharmaceutical, Taisho Toyama Pharmaceutical, Takeda, and UCB Japan. Member of speakers’ bureau; AbbVie, Asahi Kasei Pharma, Astellas, AstraZeneca, Bristol Myers Squibb, Chugai Pharmaceutical, Daiichi Sankyo, Eisai, Eli Lilly and Company, GlaxoSmithKline, Janssen, Mitsubishi Tanabe Pharma, Nippon Kayaku, Novartis, Pfizer Japan, Taiho Pharmaceutical, Taisho Toyama Pharmaceutical, Takeda, and UCB Japan. G. Burmester: Consultancies; Eli Lilly and Company, Janssen, Novartis, and Pfizer. Grants/research support; Eli Lilly and Company. P. Durez: Member of speakers’ bureau; Bristol Myers Squibb, Celltrion, Eli Lilly and Company, and Sanofi. J. Smolen: Consultancies; AbbVie, Amgen, AstraZeneca, Astro Pharma, Bristol Myers Squibb, Celgene, Celltrion, Chugai Pharmaceutical, Eli Lilly and Company, Gilead Sciences, GlaxoSmithKline, ILTOO Pharma, Janssen, MedImmune, Merck Sharp & Dohme, Novartis-Sandoz, Pfizer, Roche, Samsung, Sanofi, and UCB Pharma. Member of speakers’ bureau; AbbVie, Amgen, AstraZeneca, Astro Pharma, Bristol Myers Squibb, Celgene, Celltrion, Chugai Pharmaceutical, Eli Lilly and Company, Gilead Sciences, GlaxoSmithKline, ILTOO Pharma, Janssen, MedImmune, Merck Sharp & Dohme, Novartis-Sandoz, Pfizer, Roche, Samsung, Sanofi, and UCB Pharma. Grants/research support; AbbVie, Amgen, AstraZeneca, Astro Pharma, Bristol Myers Squibb, Celgene, Celltrion, Chugai Pharmaceutical, Eli Lilly and Company, Gilead Sciences, GlaxoSmithKline, ILTOO Pharma, Janssen, MedImmune, Merck Sharp & Dohme, Novartis-Sandoz, Pfizer, Roche, Samsung, Sanofi, and UCB Pharma. W. Deberdt: Shareholder/stock ownership; Eli Lilly and Company. J. Zhong: Other; current employee of: IQVIA. J. Ross Terres: Shareholder/stock ownership; Eli Lilly and Company. N. Bello: Shareholder/stock ownership; Eli Lilly and Company. K. Winthrop: Consultancies; AbbVie, Amgen, Bristol Myers Squibb, Eli Lilly and Company, Pfizer, and UCB Pharma. Grants/research support; Bristol Myers Squibb and Pfizer.
Collapse
Affiliation(s)
- Peter C Taylor
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UNITED KINGDOM
| | - Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, JAPAN
| | - Gerd Burmester
- Department of Rheumatology and Clinical Immunology, Charité-University Medicine Berlin, Free University, and Humboldt University Berlin, Berlin, GERMANY
| | - Patrick Durez
- Division of Rheumatology, Cliniques Universitaires Saint-Luc, Brussels, BELGIUM
| | - Josef Smolen
- Division of Rheumatology, Department of Medicine, Medical University of Vienna, Vienna, AUSTRIA
| | - Walter Deberdt
- Department of Rheumatology, Eli Lilly and Company, Indianapolis, IN
| | | | | | - Natalia Bello
- Department of Rheumatology, Eli Lilly and Company, Indianapolis, IN
| | - Kevin Winthrop
- Department of Rheumatology, Oregon Health Sciences University, Portland, OR, USA
| |
Collapse
|
9
|
Dörner T, Vital EM, Ohrndorf S, Alten R, Bello N, Haladyj E, Burmester G. A Narrative Literature Review Comparing the Key Features of Musculoskeletal Involvement in Rheumatoid Arthritis and Systemic Lupus Erythematosus. Rheumatol Ther 2022; 9:781-802. [PMID: 35359260 PMCID: PMC9127025 DOI: 10.1007/s40744-022-00442-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 12/16/2021] [Accepted: 03/08/2022] [Indexed: 12/14/2022] Open
Abstract
Although the clinical approach to the management of musculoskeletal manifestations in systemic lupus erythematosus (SLE) is often similar to that of rheumatoid arthritis (RA), there are distinct differences in immunopathogenesis, structural and imaging phenotypes and therapeutic evidence. Additionally, there are few published comparisons of these diseases. The objective of this narrative literature review is to compare the immunopathogenesis, structural features, magnetic resonance imaging (MRI) and musculoskeletal ultrasound (MSUS) studies and management of joint manifestations in RA and SLE. We highlight the key similarities and differences between the two diseases. Overall, the literature evaluated indicates that synovitis and radiographical progression are the key features in RA, while inflammation without swelling, tendinitis and tenosynovitis are more prominent features in SLE. In addition, the importance of defining patients with RA by the presence or absence of autoantibodies and categorizing patients with SLE by synovitis detected by musculoskeletal ultrasound and by structural phenotype (non-deforming, non-erosive arthritis, Jaccoud’s arthropathy and ‘Rhupus’) with respect to joint manifestations will also be discussed. An increased understanding of the joint manifestations in RA and SLE may inform evidence-based clinical decisions for both diseases.
Collapse
Affiliation(s)
- Thomas Dörner
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
- Deutsches Rheuma-Forschungszentrum Berlin, Berlin, Germany.
| | - Edward M Vital
- Faculty of Medicine and Health, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- Leeds Biomedical Research Centre, National Institute for Health Research, Leeds Teaching Hospitals, Leeds, UK
| | - Sarah Ohrndorf
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Rieke Alten
- Department of Internal Medicine and Rheumatology, Schlosspark-Klinik, Teaching Hospital of the Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Ewa Haladyj
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Gerd Burmester
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Deutsches Rheuma-Forschungszentrum Berlin, Berlin, Germany
| |
Collapse
|
10
|
Conaghan P, Cohen S, Burmester G, Mysler E, Nash P, Tanaka Y, Rigby W, Patel J, Shaw T, Betts KA, Patel P, Liu J, Sun R, Fleischmann R. Benefit-Risk Analysis of Upadacitinib Compared with Adalimumab in the Treatment of Patients with Moderate-to-Severe Rheumatoid Arthritis. Rheumatol Ther 2022; 9:191-206. [PMID: 34816388 PMCID: PMC8814262 DOI: 10.1007/s40744-021-00399-5] [Citation(s) in RCA: 2] [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: 10/04/2021] [Accepted: 11/08/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Rheumatoid arthritis (RA) is a chronic autoimmune disease requiring long-term treatment. Upadacitinib (UPA), a Janus kinase (JAK) inhibitor, is a new treatment for RA. The benefit-risk profile of a medication is best understood by evaluating the number needed to treat (NNT) and the number needed to harm (NNH). This analysis evaluated the comparative risk-benefit of UPA versus adalimumab (ADA). METHODS Post-hoc analyses were performed using data from the SELECT-COMPARE trial of UPA versus placebo (PBO) and UPA versus ADA among patients with active RA who remained on stable methotrexate (MTX) treatment and had an inadequate response; patients who failed to achieve response were rescued by predefined criteria-PBO or ADA switch to UPA, and UPA switch to ADA (all patients on PBO were switched to UPA at week 26). This analysis assessed efficacy and adverse events of special interest (AESIs) at week 26, 48, and 156 (3 years). NNT and NNH (95% confidence intervals) values were calculated between UPA versus ADA for all time points, and between UPA versus PBO for week 26. NNT and NNH values were applied to a hypothetical cohort of 100 patients to estimate the comparative efficacy and safety profiles. RESULTS UPA consistently showed greater efficacy than ADA, as evidenced by NNT values < 10 for achievement of Disease Activity Score in 28 joints based on C-reactive protein (DAS28-CRP) of < 2.6 and ≤ 3.2, respectively, and functional improvement. Based on indices for disease assessment other than the DAS28-CRP, remission outcomes were higher with UPA versus ADA over 26 weeks (NNTs: 7-12), 48 weeks (NNTs: 9-16), and 156 weeks (NNTs: 9-15). With the exception of herpes zoster, other AESIs demonstrated a similar risk with UPA versus ADA. CONCLUSION In patients with active RA despite MTX use, UPA demonstrated an incremental achievement of clinical outcomes compared to ADA together with a similar profile of AESIs with ADA (with the exception of herpes zoster).
Collapse
Affiliation(s)
- Philip Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, National Institute for Health Research, Leeds Biomedical Research Centre-University of Leeds, Leeds, UK
| | | | | | - Eduardo Mysler
- Organización Médica de Investigación, Buenos Aires, Argentina
| | - Peter Nash
- Griffith University, Brisbane, Queensland, Australia
| | - Yoshiya Tanaka
- The First Department of Internal Medicine, University of Occupational and Environmental Health Japan, Kitakyushu, Japan
| | - William Rigby
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Jayeshkumar Patel
- AbbVie, Inc, 26525 N Riverwoods Blvd, Mettawa, North Chicago, IL, 60045, USA.
| | | | | | - Pankaj Patel
- AbbVie, Inc, 26525 N Riverwoods Blvd, Mettawa, North Chicago, IL, 60045, USA
| | - Jianzhong Liu
- AbbVie, Inc, 26525 N Riverwoods Blvd, Mettawa, North Chicago, IL, 60045, USA
| | | | - Roy Fleischmann
- Metroplex Clinical Research Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| |
Collapse
|
11
|
Specker C, Aries P, Braun J, Burmester G, Fischer-Betz R, Hasseli R, Holle J, Hoyer BF, Iking-Konert C, Krause A, Krüger K, Krusche M, Leipe J, Lorenz HM, Moosig F, Schmale-Grede R, Schneider M, Strangfeld A, Voll R, Voormann A, Wagner U, Schulze-Koops H. Updated recommendations of the German Society for Rheumatology for the care of patients with inflammatory rheumatic diseases in the context of the SARS-CoV-2/COVID-19 pandemic, including recommendations for COVID-19 vaccination. Z Rheumatol 2021; 80:33-48. [PMID: 34491403 PMCID: PMC8422376 DOI: 10.1007/s00393-021-01055-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2021] [Indexed: 01/13/2023]
Affiliation(s)
- Christof Specker
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany.
- Klinik für Rheumatologie & Klinische Immunologie, Kliniken Essen-Mitte, Pattbergstr. 2, 45239, Essen, Germany.
| | - Peer Aries
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Rheumatologie im Struenseehaus, Hamburg, Germany
| | - Jürgen Braun
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Rheumazentrum Ruhrgebiet, Ruhr Universität Bochum, Bochum, Germany
| | - Gerd Burmester
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité - Universitätsmedizin Berlin, Freie Universität und Humboldt Universität zu Berlin, Berlin, Germany
| | - Rebecca Fischer-Betz
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Poliklinik, Funktionsbereich und Hiller Forschungszentrum für Rheumatologie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - Rebecca Hasseli
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Abteilung für Rheumatologie und Klinische Immunologie, Justus-Liebig-Universität Gießen, Campus Kerckhoff, Bad Nauheim, Germany
| | - Julia Holle
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Rheumazentrum Schleswig-Holstein Mitte, Neumünster, Germany
| | - Bimba Franziska Hoyer
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Abteilung für Rheumatologie, 1. Medizinische Klinik, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Christof Iking-Konert
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- III. Medizinische Klinik und Poliklinik Sektion Rheumatologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg-Eppendorf, Germany
| | - Andreas Krause
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Abteilung für Rheumatologie, Osteologie und Klinische Immunologie, Immanuel Krankenhaus Berlin, Berlin, Germany
| | - Klaus Krüger
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Rheumatologisches Praxiszentrum München, Munich, Germany
| | - Martin Krusche
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité - Universitätsmedizin Berlin, Freie Universität und Humboldt Universität zu Berlin, Berlin, Germany
| | - Jan Leipe
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Abteilung für Rheumatologie, Medizinische Klinik V, Universitätskrankenhaus Mannheim, Mannheim, Germany
| | - Hanns-Martin Lorenz
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Sektion Rheumatologie, Medizinische Klinik V, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Frank Moosig
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Rheumazentrum Schleswig-Holstein Mitte, Neumünster, Germany
| | | | - Matthias Schneider
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Poliklinik, Funktionsbereich und Hiller Forschungszentrum für Rheumatologie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - Anja Strangfeld
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Programmbereich Epidemiologie und Versorgungsforschung, Deutsches Rheumaforschungszentrum Berlin, Berlin, Germany
| | - Reinhard Voll
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Klinik für Rheumatologie und Klinische Immunologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Universität Freiburg, Freiburg, Germany
| | - Anna Voormann
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
| | - Ulf Wagner
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Abteilung für Rheumatologie, Klinik und Poliklinik für Endokrinologie, Nephrologie, Rheumatologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Hendrik Schulze-Koops
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany.
- Sektion Rheumatologie und Klinische Immunologie, Medizinische Klinik IV, Ludwig-Maximilians-Universität München, Pettenkoferstraße 8a, Munich, Germany.
| |
Collapse
|
12
|
Zorn-Pauly L, von Stuckrad ASL, Klotsche J, Rose T, Kallinich T, Enghard P, Ostendorf L, Burns M, Doerner T, Meisel C, Schneider U, Unterwalder N, Burmester G, Hiepe F, Alexander T, Biesen R. Evaluation of SIGLEC1 in the diagnosis of suspected systemic lupus erythematosus. Rheumatology (Oxford) 2021; 61:3396-3400. [PMID: 34849605 DOI: 10.1093/rheumatology/keab875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 09/28/2021] [Revised: 11/13/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To evaluate and compare the diagnostic accuracy of SIGLEC1, a surrogate marker of type I IFN, with established biomarkers in an inception cohort of systemic lupus erythematosus (SLE). METHODS SIGLEC1 was analyzed by flow cytometry in 232 patients referred to our institution with suspected SLE between October 2015 and September 2020. RESULTS SLE was confirmed in 76 of 232 patients (32.8%) according to the 2019 EULAR/ACR classification criteria and their SIGLEC1 values were significantly higher compared with patients without SLE (p< 0.0001). A sensitivity of 98.7%, a specificity of 82.1%, a negative predictive value (NPV) of 99.2% and a positive predictive value (PPV) of 72.8% were calculated for SIGLEC1. Adjusted to the highest reported prevalence of SLE, the NPV and PPV were > 99.9% and 0.1%, respectively. Using ROC analysis and Delong testing, the area under the curve (AUC) for SIGLEC1 (AUC = 0.95) was significantly higher than for ANA (AUC = 0.88, p= 0.031), C3 (AUC = 0.83, p= 0.001) and C4 (AUC = 0.83, p= 0.002) but not for anti-dsDNA antibodies (AUC = 0.90, p= 0.163). CONCLUSION IFN-I pathway activation is detectable in almost all newly diagnosed SLE patients. Thus, a negative test result for SIGLEC1 is powerful to exclude SLE in suspected cases.
Collapse
Affiliation(s)
- Lydia Zorn-Pauly
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Anne Sae Lim von Stuckrad
- Pediatric Pneumology, Immunology and Intensive Care Medicine, Charité University Medicine Berlin, Berlin, Germany
| | - Jens Klotsche
- German Rheumatism Research Center Berlin-a Leibniz Institute (DRFZ), Berlin, Germany
| | - Thomas Rose
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Tilmann Kallinich
- Pediatric Pneumology, Immunology and Intensive Care Medicine, Charité University Medicine Berlin, Berlin, Germany.,German Rheumatism Research Center Berlin-a Leibniz Institute (DRFZ), Berlin, Germany
| | - Philipp Enghard
- Department of Nephrology and Intensive Care Medicine, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Lennard Ostendorf
- German Rheumatism Research Center Berlin-a Leibniz Institute (DRFZ), Berlin, Germany.,Department of Nephrology and Intensive Care Medicine, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Marie Burns
- German Rheumatism Research Center Berlin-a Leibniz Institute (DRFZ), Berlin, Germany
| | - Thomas Doerner
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Christian Meisel
- Institute for Medical Immunology, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Udo Schneider
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Nadine Unterwalder
- Institute for Medical Immunology, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Gerd Burmester
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Falk Hiepe
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Tobias Alexander
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,German Rheumatism Research Center Berlin-a Leibniz Institute (DRFZ), Berlin, Germany
| | - Robert Biesen
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| |
Collapse
|
13
|
Talarico R, Marinello D, Bombardieri S, Burmester G, Fonseca J, Frank C, Galetti I, Hachulla E, Houssiau F, Mueller-Ladner U, Schneider M, Smith V, Turchetti G, van Laar JM, Vieira A, Cutolo M, Mosca M. Clinical practice guidelines adherence, knowledge and awareness in rare and complex connective tissue diseases across Europe: results from the first ERN ReCONNET survey. RMD Open 2021; 6:0. [PMID: 32868449 PMCID: PMC7507993 DOI: 10.1136/rmdopen-2020-001344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 05/28/2020] [Revised: 06/26/2020] [Accepted: 08/10/2020] [Indexed: 11/08/2022] Open
Abstract
Introduction The European Reference Network (ERN) ReCONNET is the ERN aimed at improving the management of rare and complex connective tissue and musculoskeletal diseases (rCTDs) across the European Union (EU). In the mission of ERN ReCONNET, clinical practice guidelines (CPGs) play a crucial role, representing a valid tool towards the harmonisation of the management of rCTDs while improving effectiveness and quality of care delivered to patients. Methods ERN ReCONNET developed two surveys to map the adherence to rCTDs CPGs among healthcare providers and to assess the knowledge and awareness of CPGs for their diseases among patients, family members and caregivers. Results The results of the surveys highlighted that healthcare professionals find it useful to apply CPGs in clinical practice (93%), while 62% of them experience difficulties and barriers in the application in their centres. Healthcare professionals also highlighted the need to develop CPGs for all rCTDs and to implement the use of the existing CPGs in clinical practice. On the other hand, patients, families and caregivers are relatively aware of the purpose of CPGs (51%) and 62% of them were aware of the existence of CPGs for their disease. Patient-friendly versions of CPGs and patients’ lifestyle guidelines should be systematically developed contributing to the empowerment of patients in the disease management. Conclusion ERN ReCONNET is addressing the main issues identified in the results of the survey, promoting practical actions for the local adaptation of CPGs across Europe, improving their routine clinical use and increasing the awareness on CPGs among rCTDs patients, family members and caregivers.
Collapse
Affiliation(s)
- Rosaria Talarico
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Diana Marinello
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | | | - Gerd Burmester
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Joao Fonseca
- Serviço De Reumatologia E Doenças Ósseas Metabólicas, Centro Hospitalar Universitário Lisboa Norte E.P.E, Lisboa, Portugal.,Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
| | - Charissa Frank
- Flemish Association for Hereditary Connective Tissue Disorders in Belgium, Koersel, Belgium
| | - Ilaria Galetti
- FESCA, Federation of European Scleroderma Associations, Milan, Italy
| | - Eric Hachulla
- Département de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Ouest de France, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Frederic Houssiau
- Department of Rheumatology, Cliniques Universitaires Saint-Luc, Université Catholique De Louvain, Louvain-la-Neuve, Belgium
| | - Ulf Mueller-Ladner
- Department of Rheumatology and Clinical Immunology, Kerckhoff-Klinik GmbH, Bad Nauheim, Germany.,Justus Liebig Universitat Giessen, Giessen, Germany
| | - Matthias Schneider
- Department of Rheumatology, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Vanessa Smith
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.,Department of Internal Medicine, Ghent University, Ghent, Belgium
| | | | - Jacob M van Laar
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Ana Vieira
- Núcleo Síndrome De Sjögren, Liga Portuguesa Contra as Doenças Reumáticas, Lisbon, Portugal
| | - Maurizio Cutolo
- Department of Internal Medicine, University of Genoa, Genova, Italy.,Research Laboratory and Academic Division of Clinical Rheumatology, IRCCS Polyclinic Hospital San Martino, Genova, Italy
| | - Marta Mosca
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.,Rheumatology Unit, University of Pisa, Pisa, Italy
| |
Collapse
|
14
|
Specker C, Aries P, Braun J, Burmester G, Fischer-Betz R, Hasseli R, Holle J, Hoyer BF, Iking-Konert C, Krause A, Krüger K, Krusche M, Leipe J, Lorenz HM, Moosig F, Schmale-Grede R, Schneider M, Strangfeld A, Voll R, Voormann A, Wagner U, Schulze-Koops H. [Updated recommendations of the German Society for Rheumatology for the care of patients with inflammatory rheumatic diseases in the context of the SARS-CoV‑2/COVID‑19 pandemic, including recommendations for COVID‑19 vaccination]. Z Rheumatol 2021; 80:570-587. [PMID: 34309739 PMCID: PMC8311067 DOI: 10.1007/s00393-021-01056-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Christof Specker
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland.
- Klinik für Rheumatologie und Klinische Immunologie, Kliniken Essen-Mitte, Pattbergstr. 2, 45239, Essen, Deutschland.
| | - Peer Aries
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Rheumatologie im Struenseehaus, Hamburg, Deutschland
| | - Jürgen Braun
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Rheumazentrum Ruhrgebiet, Ruhr Universität Bochum, Bochum, Deutschland
| | - Gerd Burmester
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité - Universitätsmedizin Berlin, Freie Universität und Humboldt Universität zu Berlin, Berlin, Deutschland
| | - Rebecca Fischer-Betz
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Poliklinik, Funktionsbereich und Hiller Forschungszentrum für Rheumatologie, Universitätsklinikum Düsseldorf, , Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Rebecca Hasseli
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Abteilung für Rheumatologie und Klinische Immunologie, Justus-Liebig-Universität Gießen, Campus Kerckhoff, Bad Nauheim, Deutschland
| | - Julia Holle
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Rheumazentrum Schleswig-Holstein Mitte, Neumünster, Deutschland
| | - Bimba Franziska Hoyer
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Abteilung für Rheumatologie, 1. Medizinische Klinik, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - Christof Iking-Konert
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- III. Medizinische Klinik und Poliklinik Sektion Rheumatologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg-Eppendorf, Deutschland
| | - Andreas Krause
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Abteilung für Rheumatologie, Osteologie und Klinische Immunologie, Immanuel Krankenhaus Berlin, Berlin, Deutschland
| | - Klaus Krüger
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Rheumatologisches Praxiszentrum München, München, Deutschland
| | - Martin Krusche
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité - Universitätsmedizin Berlin, Freie Universität und Humboldt Universität zu Berlin, Berlin, Deutschland
| | - Jan Leipe
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Abteilung für Rheumatologie, Medizinische Klinik V, Universitätskrankenhaus Mannheim, Mannheim, Deutschland
| | - Hanns-Martin Lorenz
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Sektion Rheumatologie, Medizinische Klinik V, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Frank Moosig
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Rheumazentrum Schleswig-Holstein Mitte, Neumünster, Deutschland
| | | | - Matthias Schneider
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Poliklinik, Funktionsbereich und Hiller Forschungszentrum für Rheumatologie, Universitätsklinikum Düsseldorf, , Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Anja Strangfeld
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Programmbereich Epidemiologie und Versorgungsforschung, Deutsches Rheumaforschungszentrum Berlin, Berlin, Deutschland
| | - Reinhard Voll
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Klinik für Rheumatologie und Klinische Immunologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Universität Freiburg, Freiburg, Deutschland
| | - Anna Voormann
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
| | - Ulf Wagner
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Abteilung für Rheumatologie, Klinik und Poliklinik für Endokrinologie, Nephrologie, Rheumatologie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Hendrik Schulze-Koops
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland.
- Sektion Rheumatologie und Klinische Immunologie, Medizinische Klinik IV, Ludwig-Maximilians-Universität München, Pettenkoferstr. 8a, 80336, München, Deutschland.
| |
Collapse
|
15
|
Schälter F, Dürholz K, Bucci L, Burmester G, Caporali R, Figuereido C, Cobra JF, Manger B, Zaiss MM, Schett G. Does methotrexate influence COVID-19 infection? Case series and mechanistic data. Arthritis Res Ther 2021; 23:166. [PMID: 34112217 PMCID: PMC8190723 DOI: 10.1186/s13075-021-02464-4] [Citation(s) in RCA: 12] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 02/22/2021] [Indexed: 01/07/2023] Open
Abstract
Background To investigate whether methotrexate treatment may affect the susceptibility to infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods Clinical assessment of symptoms, SARS-CoV-2 RNA, and anti-SARS-CoV-2 IgG in an initial case series of four families and confirmatory case series of seven families, within which one family member developed coronavirus disease 19 (COVID-19) and exposed another family member receiving methotrexate treatment; experimental part with methotrexate treatment of mice and organoids followed by the assessment of mRNA and protein expression of the SARS-CoV-2 receptor angiotensin-converting enzyme (ACE)-2. Results In the initial case series, three of four women on a joint ski trip developed COVID-19, while the fourth woman, under treatment with methotrexate, remained virus-free. Two of the three diseased women infected their husbands, while the third husband treated with methotrexate remained virus-free. In addition, 7 other families were identified in a follow-up case series, in which one member developed COVID-19, while the other, receiving methotrexate, remained healthy. Experimentally, when mice were treated with methotrexate, ACE2 expression significantly decreased in the lung, in the intestinal epithelium, and in intestinal organoids. Conclusion These clinical and experimental data indicate that methotrexate has certain protective effects on SARS-CoV-2 infection via downregulating ACE2.
Collapse
Affiliation(s)
- Fabian Schälter
- Department of Internal Medicine 3, Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany.,Deutsches Zentrum fuer Immuntherapie (DZI), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Kerstin Dürholz
- Department of Internal Medicine 3, Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany.,Deutsches Zentrum fuer Immuntherapie (DZI), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Laura Bucci
- Department of Internal Medicine 3, Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany.,Deutsches Zentrum fuer Immuntherapie (DZI), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Gerd Burmester
- Department of Rheumatology and Clinical Immunology, Charité, Berlin, Germany
| | - Roberto Caporali
- Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, University of Milan, G. Pini Hospital, Milan, Italy
| | - Camille Figuereido
- Cobra Clinic of Rheumatology and Research Center, São Paulo, Brazil.,Department of Rheumatology, University of Sao Paulo, São Paulo, Brazil
| | - Jaime Fogagnolo Cobra
- Cobra Clinic of Rheumatology and Research Center, São Paulo, Brazil.,Department of Rheumatology, University of Sao Paulo, São Paulo, Brazil
| | - Bernhard Manger
- Department of Internal Medicine 3, Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany.,Deutsches Zentrum fuer Immuntherapie (DZI), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Mario M Zaiss
- Department of Internal Medicine 3, Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany.,Deutsches Zentrum fuer Immuntherapie (DZI), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Georg Schett
- Department of Internal Medicine 3, Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany. .,Deutsches Zentrum fuer Immuntherapie (DZI), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany.
| |
Collapse
|
16
|
Smolen JS, Xie L, Jia B, Taylor PC, Burmester G, Tanaka Y, Elias A, Cardoso A, Ortmann R, Walls C, Dougados M. Efficacy of baricitinib in patients with moderate-to-severe rheumatoid arthritis with 3 years of treatment: results from a long-term study. Rheumatology (Oxford) 2021; 60:2256-2266. [PMID: 33200220 PMCID: PMC8121442 DOI: 10.1093/rheumatology/keaa576] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 05/02/2020] [Revised: 07/30/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To evaluate the long-term efficacy of once-daily baricitinib 4 mg in patients with active RA who were either naïve to DMARDs or who had inadequate response (IR) to MTX. METHODS Analyses of data from two completed 52-week, phase III studies, RA-BEGIN (DMARD-naïve) and RA-BEAM (MTX-IR), and one ongoing long-term extension (LTE) study (RA-BEYOND) were performed (148 total weeks). At week 52, DMARD-naïve patients treated with MTX monotherapy or baricitinib 4 mg+MTX in RA-BEGIN were switched to open-label baricitinib 4 mg monotherapy; MTX-IR patients treated with adalimumab (+MTX) in RA-BEAM were switched to open-label baricitinib 4 mg (+MTX) in the LTE. Patients who received placebo (+MTX) were switched to baricitinib 4 mg (+MTX) at week 24. Low disease activity (LDA) [Simple Disease Activity Index (SDAI) ≤11], clinical remission (SDAI ≤ 3.3), and physical functioning [Health Assessment Questionnaire Disability Index (HAQ-DI) ≤ 0.5] were assessed. Data were assessed using a non-responder imputation. RESULTS At week 148, SDAI LDA was achieved in up to 61% of DMARD-naïve patients and 59% of MTX-IR patients initially treated with baricitinib, and SDAI remission was achieved in up to 34% of DMARD-naïve patients and 24% of MTX-IR patients; HAQ-DI ≤ 0.5 was reached in up to 48% of DMARD-naïve patients and 38% of MTX-IR patients initially treated with baricitinib. Over 148 weeks, 3.6% and 10.7% of MTX-IR patients discontinued across treatment groups due to lack of efficacy or due to adverse events, respectively; discontinuation rates were similar in the DMARD-naïve population. CONCLUSION Treatment with baricitinib 4 mg demonstrated efficacy for up to 3 years and was well tolerated.
Collapse
Affiliation(s)
- Josef S Smolen
- Division of Rheumatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Li Xie
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
| | - Bochao Jia
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
| | - Peter C Taylor
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Gerd Burmester
- Charité - University of Medicine Berlin, Berlin, Germany
| | - Yoshiya Tanaka
- The First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Ayesha Elias
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
| | - Anabela Cardoso
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
| | - Rob Ortmann
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
| | - Chad Walls
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
| | | |
Collapse
|
17
|
Conaghan PG, Mysler E, Tanaka Y, Da Silva-Tillmann B, Shaw T, Liu J, Ferguson R, Enejosa JV, Cohen S, Nash P, Rigby W, Burmester G. Upadacitinib in Rheumatoid Arthritis: A Benefit-Risk Assessment Across a Phase III Program. Drug Saf 2021; 44:515-530. [PMID: 33527177 PMCID: PMC8053169 DOI: 10.1007/s40264-020-01036-w] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 12/24/2022]
Abstract
Treating to a target of clinical remission or low disease activity is an important principle for managing rheumatoid arthritis (RA). Despite the availability of biologic disease-modifying antirheumatic drugs (bDMARDs), a substantial proportion of patients with RA do not achieve these treatment targets. Upadacitinib is a once-daily, oral Janus kinase (JAK) inhibitor with increased selectivity for JAK1 over JAK2, JAK3, and tyrosine kinase 2. The SELECT phase III upadacitinib clinical program comprised five pivotal trials of approximately 4400 patients with RA, including inadequate responders (IR) to conventional synthetic (cs)DMARDs or bDMARDs. This review aims to provide insights into the benefit-risk profile of upadacitinib in patients with RA. Upadacitinib 15 mg once daily, in combination with csDMARDs or as monotherapy, achieved all primary and ranked secondary endpoints in the five pivotal trials across csDMARD-naïve, csDMARD-IR, and bDMARD-IR populations. Upadacitinib 15 mg also demonstrated significantly higher rates of remission and low disease activity in all five pivotal trials, compared with placebo, methotrexate, or adalimumab. Labeled warnings of JAK inhibitors include serious infections, herpes zoster, malignancies, major cardiovascular events, and venous thromboembolic events. Short- and long-term integrated analyses showed that upadacitinib 15 mg was associated with increased risk of herpes zoster and creatine phosphokinase elevations compared with methotrexate and adalimumab but otherwise had comparable safety with these active comparators. This review suggests that upadacitinib 15 mg had a favorable benefit-risk profile. The safety of upadacitinib will continue to be monitored in long-term extensions and post-marketing studies.
Collapse
Affiliation(s)
- Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and National Institute for Health Research Leeds Biomedical Research Centre, Leeds, UK.
| | - Eduardo Mysler
- Organización Médica de Investigación, Buenos Aires, Argentina
| | - Yoshiya Tanaka
- The First Department of Internal Medicine, University of Occupational and Environmental Health Japan, Kitakyushu, Japan
| | | | | | - John Liu
- AbbVie Inc., North Chicago, IL, USA
| | | | | | | | - Peter Nash
- Griffith University, Brisbane, QLD, Australia
| | - William Rigby
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | | |
Collapse
|
18
|
Winthrop KL, Takeuchi T, Burmester G, Deberdt W, Schlichting D, Mo D, Walls C, Smolen JS. O09 Safety profile of baricitinib for the treatment of RA up to 8.4 years: an updated integrated safety analysis. Rheumatology (Oxford) 2021. [DOI: 10.1093/rheumatology/keab246.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Aims
Baricitinib (BARI) is an oral selective inhibitor of Janus kinase (JAK)1/2, approved for treatment of moderate-to-severe- rheumatoid arthritis (RA) in adults. Here, we update the drug’s safety profile with data up to 8.4 years of treatment.
Methods
Long-term safety of BARI was assessed from 9 completed randomized trials(5 Ph3, 3 Ph2, 1 Ph 1b) and 1 ongoing long-term extension(LTE) study. Incidence rates(IRs) per 100 patient-years (PY) were calculated for all RA patients treated with ≥1 dose of BARI through 1-Sep-2019(All-BARI-RA set). IRs for deep vein thrombosis(DVT), pulmonary embolism(PE), and DVT and/or PE(DVT/PE) were also calculated for groups of patients while receiving BARI 2mg/4mg within All-BARI-RA. Major adverse cardiovascular events(MACE) were adjudicated in 5 Ph3 studies and the LTE.
Results
3770 pts received BARI for 13,148 PY, with median and maximum exposure: 4.2 and 8.4 years, respectively. Overall IRs per 100 PY were: for any treatment-emergent adverse event (AE)(25.8); serious AE (including death)(7.2); temporary interruption due to AE (9.5); permanent discontinuation due to AE (4.8); death (0.52); serious infection (2.7); opportunistic infection (0.46)(excluding tuberculosis [TB], including multidermatomal herpes zoster [HZ]); TB (0.15); HZ (3.0); MACE (0.50); DVT (0.31); PE (0.24); DVT/PE (0.46); malignancies excluding non-melanoma skin cancer (NMSC)(0.91); NMSC (0.33); lymphoma (0.07); and gastrointestinal perforation (0.04). (IRs)[95% confidence intervals] for patients while receiving BARI 2mg (N = 1077) and BARI 4mg (N = 3400) were DVT 2mg (0.38)[0.18, 0.73] and 4mg (0.30)[0.21, 0.43]; PE 2mg (0.26)[0.09, 0.56] and 4mg (0.25)[0.16, 0.36]; and DVT/PE 2mg (0.47)[0.23, 0.84] and 4mg (0.46)[0.34, 0.61]. IRs for death tended to increase in later time intervals (beyond 192 weeks). No particular cause of death contributed to this increase. For all other safety topics of interest, across 48-week treatment intervals, IRs remained stable over time. Across safety topics, IRs were consistent with previous analyses.
Conclusion
In this update, with 3021 additional PY of exposure, BARI maintained a safety profile similar to that previously reported, with no increase of IRs across safety topics through exposures up to 8.4 years.
Disclosure
K.L. Winthrop: Consultancies; AbbVie, Amgen, Bristol Myers Squibb, Eli Lilly and Company, Pfizer, and UCB Pharma. Grants/research support; Bristol Myers Squibb and Pfizer. T. Takeuchi: Consultancies; AbbVie, Asahi Kasei Medical, Astellas, AstraZeneca, Bristol Myers Squibb, Chugai, Daiichi Sankyo, Eisai, Eli Lilly and Company, GlaxoSmithKline, Janssen, Mitsubishi Tanabe Pharma, Nippon Kayaku, Novartis, Pfizer Japan, Taiho Pharmaceutical, Taiho Toyama Pharmaceutical, Takeda, and UCB Japan. G. Burmester: Consultancies; Eli Lilly and Company, Janssen, Novartis, and Pfizer. Grants/research support; Eli Lilly and Company. W. Deberdt: Shareholder/stock ownership; Eli Lilly and Company. D. Schlichting: Shareholder/stock ownership; Eli Lilly and Company. D. Mo: Shareholder/stock ownership; Eli Lilly and Company. C. Walls: Shareholder/stock ownership; Eli Lilly and Company. J.S. Smolen: Consultancies; AbbVie, Amgen, AstraZeneca, Astro Pharma, Bristol Myers Squibb, Celgene, Celltrion, Chugai, Eli Lilly and Company, Gilead Sciences, ILTOO Pharma, Janssen, MedImmune, Merck Sharp & Dohme, Novartis-Sandoz, Pfizer, Roche, Samsung, Sanofi-Aventis, and UCB Pharma. Grants/research support; AbbVie, Eli Lilly and Company, Janssen, Merck Sharp & Dohme, Novartis, Pfizer, and Roche.
Collapse
Affiliation(s)
- Kevin L Winthrop
- Division of Infectious Diseases, Oregon Health Sciences University, Portland, OR
| | - Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, JAPAN
| | - Gerd Burmester
- Department of Rheumatology and Clinical Immunology, Charité-University Medicine Berlin, Free University and Humboldt University Berlin, Berlin, GERMANY
| | | | | | - Daojun Mo
- Rheumatology, Eli Lilly and Company, Indianapolis, IN
| | - Chad Walls
- Rheumatology, Eli Lilly and Company, Indianapolis, IN
| | - Josef S Smolen
- Division of Rheumatology, Department of Medicine, Medical University of Vienna, Vienna, AUSTRIA
| |
Collapse
|
19
|
Harigai M, Winthrop K, Takeuchi T, Hsieh TY, Chen YM, Smolen JS, Burmester G, Walls C, Wu WS, Dickson C, Liao R, Genovese MC. Evaluation of hepatitis B virus in clinical trials of baricitinib in rheumatoid arthritis. RMD Open 2021; 6:rmdopen-2019-001095. [PMID: 32098857 PMCID: PMC7046961 DOI: 10.1136/rmdopen-2019-001095] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [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: 08/29/2019] [Revised: 01/22/2020] [Accepted: 01/31/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Reactivation of hepatitis B virus (HBV) replication is a well-recognised complication in patients receiving disease-modifying anti-rheumatic drugs (DMARDs) for rheumatoid arthritis (RA). Limited data exist on HBV reactivation among patients with RA treated with janus kinase (JAK) inhibitors. The objective of the current study was to assess HBV reactivation in clinical trials of baricitinib, an oral selective JAK1 and JAK2 inhibitor in RA. METHODS Data were integrated from four completed Phase 3 trials and one ongoing long-term extension (data up to 1 April 2017) in patients naïve to DMARDs or who had inadequate response (IR) to DMARDs including methotrexate (MTX)-IR and/or other conventional synthetic DMARD (csDMARD)-IR, or tumour necrosis factor inhibitors-IR. Within the clinical programme, baricitinib-treated patients may have received concomitant csDMARDs including MTX, or previous treatment with active comparators including MTX or adalimumab + MTX. At screening, all patients were tested for HBV surface antigen (HBsAg), core antibody (HBcAb) and surface antibody (HBsAb). Patients were excluded if they had (1) HBsAg+, (2) HBcAb+/HBsAb- (in Japan, could enrol if HBV DNA-) or (3) HBsAb+ and HBV DNA+. HBV DNA monitoring, following randomisation in the originating Phase 3 studies, was performed in Japan for patients with HBcAb+ and/or HBsAb+ at screening, and was later instituted globally for HBcAb+ patients in accordance with evolving guidance for HBV monitoring and management with immunomodulatory therapy. RESULTS In total, 2890 patients received at least one dose of baricitinib in Phase 3 (6993 patient-years exposure). Of 215 patients with baseline serology suggestive of prior HBV infection (HbcAb+) who received a post-baseline DNA test, 32 (14.9%) were HBV DNA+ at some point following treatment initiation; 8 of 215 patients (3.7%) had a single quantifiable result (≥29 IU/mL). Of these eight patients, four met the definition of reactivation of HBV (HBV DNA level ≥100 IU/mL); baricitinib was permanently discontinued in four patients, and temporarily interrupted in two patients. No patient developed clinical evidence of hepatitis and in five of eight patients, antiviral therapy was not used. CONCLUSION HBV reactivation can occur among RA patients treated with DMARDs, including baricitinib, with prior HBV exposure. Our data suggest that such patients should be monitored for HBV DNA during treatment and might be treated safely with the use of antiviral therapy as needed. The risk of HBV reactivation in patients with HBsAg treated with baricitinib is unknown.
Collapse
Affiliation(s)
- Masayoshi Harigai
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kevin Winthrop
- Division of Infectious Diseases, Oregon Health and Science University, Portland, Oregon, USA
| | | | - Tsu-Yi Hsieh
- Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan, Taiwan
| | - Yi-Ming Chen
- Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan, Taiwan
| | - Josef S Smolen
- Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Gerd Burmester
- Rheumatology, Charité - University Medicine Berlin, Berlin, Germany
| | - Chad Walls
- Eli Lilly and Co, Indianapolis, Indiana, USA
| | - Wen-Shuo Wu
- Eli Lilly and Co, Indianapolis, Indiana, USA
| | | | - Ran Liao
- Eli Lilly and Co, Indianapolis, Indiana, USA
| | - Mark C Genovese
- Division of Immunology and Rheumatology, Stanford University, Palo Alto, California, USA
| |
Collapse
|
20
|
Krusche M, Ruffer N, Schneider U, Meyer M, Burmester G, Kötter I. Tocilizumab treatment for polyarteritis nodosa. Rheumatology (Oxford) 2021; 59:e63-e65. [PMID: 32182367 DOI: 10.1093/rheumatology/keaa079] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 01/11/2020] [Accepted: 02/01/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- Martin Krusche
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin.,Department of Rheumatology, Clinical Immunology and Nephrology, Asklepios Klinik Altona, Hamburg, Klinikum Bad Bramstedt, Germany
| | - Nikolas Ruffer
- Department of Rheumatology, Clinical Immunology and Nephrology, Asklepios Klinik Altona, Hamburg, Klinikum Bad Bramstedt, Germany
| | - Udo Schneider
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin
| | - Marco Meyer
- Department of Rheumatology, Clinical Immunology and Nephrology, Asklepios Klinik Altona, Hamburg, Klinikum Bad Bramstedt, Germany
| | - Gerd Burmester
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin
| | - Ina Kötter
- Department of Rheumatology, Clinical Immunology and Nephrology, Asklepios Klinik Altona, Hamburg, Klinikum Bad Bramstedt, Germany.,Division of Rheumatology, University Hospital Hamburg-Eppendorf, Hamburg and Klinikum Bad Bramstedt, Bad Bramsted, Germany
| |
Collapse
|
21
|
Burmester G, Drescher E, Hrycaj P, Chien D, Pan Z, Cohen S. Efficacy and safety results from a randomized double-blind study comparing proposed biosimilar ABP 798 with rituximab reference product in subjects with moderate-to-severe rheumatoid arthritis. Clin Rheumatol 2020; 39:3341-3352. [PMID: 32876780 PMCID: PMC7567688 DOI: 10.1007/s10067-020-05305-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 01/22/2020] [Revised: 07/03/2020] [Accepted: 07/21/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND/OBJECTIVES ABP 798 is a proposed biosimilar to the originator biologic rituximab, an anti-CD20 monoclonal antibody. This comparative clinical study evaluated the pharmacokinetics (PK), safety, and efficacy of ABP 798 versus rituximab reference product (RP) in patients with moderate-to-severe rheumatoid arthritis (RA). METHODS Adults with moderate-to-severe RA with an inadequate response or intolerance to other disease-modifying anti-rheumatic drugs including 1 or more tumor necrosis factor inhibitor therapies (n = 311) received ABP 798, US-sourced rituximab RP (rituximab US), or EU-sourced rituximab RP (rituximab EU) (1000 mg, 2 weeks apart). At week 24, ABP 798- or rituximab EU-treated subjects received a second dose of the same treatment, while rituximab US-treated subjects transitioned to receive ABP 798. The key efficacy endpoint was DAS28-CRP change from baseline at week 24. Other efficacy endpoints included DAS28-CRP at other time points; ACR20, ACR50, and ACR70 criteria; and hybrid ACR. The rituximab RP groups were pooled for all efficacy endpoints since PK equivalence had been established between rituximab US and rituximab EU. RESULTS Clinical equivalence between ABP 798 and rituximab RP was established as the 90% confidence interval for DAS28-CRP change from baseline at week 24 fell within the prespecified equivalence margin (- 0.6, 0.6). Safety and immunogenicity profiles of ABP 798 were comparable across treatment groups and not affected by single transition from RP to ABP 798. CONCLUSIONS Clinical equivalence in terms of efficacy, safety, and immunogenicity was established between ABP 798 and rituximab RP in this comparative clinical trial in patients with moderate-to-severe RA. Key Points • ABP 798 provided similar efficacy as rituximab reference product (RP) in patients with moderate-severe rheumatoid arthritis. • The safety and immunogenicity profiles for ABP 798 were similar to those for the rituximab RP. • The single transition from rituximab RP to ABP 798 did not show differences in efficacy, safety, or immunogenicity.
Collapse
Affiliation(s)
- Gerd Burmester
- Department of Rheumatology and Clinical Immunology, Free University and Humboldt University Berlin, Charité-University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Edit Drescher
- Veszprém Csolnoky Ferenc County Hospital, Veszprém, Hungary
| | - Pawel Hrycaj
- Rheumatology, Koscian Municipal Hospital, Koscian, Poland
| | | | | | | |
Collapse
|
22
|
Ghannam K, Martinez Gamboa L, Kedor C, Spengler L, Kuckelkorn U, Häupl T, Burmester G, Feist E. Response to abatacept is associated with the inhibition of proteasome β1i expression in T cells of patients with rheumatoid arthritis. RMD Open 2020; 6:rmdopen-2020-001248. [PMID: 32998980 PMCID: PMC7547540 DOI: 10.1136/rmdopen-2020-001248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 03/20/2020] [Revised: 05/27/2020] [Accepted: 08/21/2020] [Indexed: 11/25/2022] Open
Abstract
Objective Abatacept is a biological disease-modifying antirheumatic drug (DMARD) used for the treatment of rheumatoid arthritis (RA) and modulates the costimulatory signal by cluster of differentiation (CD)28:CD80/CD86 interaction required for T cell activation. Since CD28-mediated signalling regulates many T cell functions including cytokine production of, for example, interferons (IFNs), it is of interest to clarify, whether response to abatacept has an effect on the IFN inducible immunoproteasome, as a central regulator of the immune response. Methods Effects of abatacept on the proteasome were investigated in 39 patients with RA over a period of 24 weeks. Using real-time PCR, transcript levels of constitutive and corresponding immunoproteasome catalytic subunits were investigated at baseline (T0), week 16 (T16) and week 24 (T24) in sorted blood cells. Proteasomal activity and induction of apoptosis after proteasome inhibition were also evaluated. Results Abatacept achieved remission or low disease activity in 55% of patients at T16 and in 70% of patients at T24. By two-way analysis of variance (ANOVA), a significant reduction of proteasome immunosubunit β1i was shown only in CD4+ and CD8+ T cells of sustained responders at both T16 and T24. One-way ANOVA analysis for each response group confirmed the results and showed a significant reduction at T24 in CD4+ and CD8+ T cells of the same group. Abatacept did not influence chymotrypsin-like activity of proteasome and had no effect on induction of apoptosis under exposure to a proteasome inhibitor in vitro. Conclusion The reduction of proteasome immunosubunit β1i in T cells of patients with RA with sustained response to abatacept suggests association of the immunoproteasome of T cells with RA disease activity.
Collapse
Affiliation(s)
- Khetam Ghannam
- Department of Rheumatology and Clinical Immunology, Charite University Hospital Berlin, Berlin, Germany
| | - Lorena Martinez Gamboa
- Department of Rheumatology and Clinical Immunology, Charite University Hospital Berlin, Berlin, Germany
| | - Claudia Kedor
- Department of Rheumatology and Clinical Immunology, Charite University Hospital Berlin, Berlin, Germany
| | - Lydia Spengler
- Department of Rheumatology and Clinical Immunology, Charite University Hospital Berlin, Berlin, Germany
| | - Ulrike Kuckelkorn
- Institute of Biochemistry, Charite University Hospital Berlin, Berlin, Germany
| | - Thomas Häupl
- Department of Rheumatology and Clinical Immunology, Charite University Hospital Berlin, Berlin, Germany
| | - Gerd Burmester
- Department of Rheumatology and Clinical Immunology, Charite University Hospital Berlin, Berlin, Germany
| | - Eugen Feist
- Helios Fachklinik Vogelsang-Gommern GmbH, Vogelsang-Gommern, Germany.,Department of Rheumatology and Clinical Immunology, Charite University Hospital Berlin, Berlin, Germany
| |
Collapse
|
23
|
Ostendorf L, Burns M, Durek P, Heinz GA, Heinrich F, Garantziotis P, Enghard P, Richter U, Biesen R, Schneider U, Knebel F, Burmester G, Radbruch A, Mei HE, Mashreghi MF, Hiepe F, Alexander T. Targeting CD38 with Daratumumab in Refractory Systemic Lupus Erythematosus. N Engl J Med 2020; 383:1149-1155. [PMID: 32937047 DOI: 10.1056/nejmoa2023325] [Citation(s) in RCA: 147] [Impact Index Per Article: 36.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Daratumumab, a human monoclonal antibody that targets CD38, depletes plasma cells and is approved for the treatment of multiple myeloma. Long-lived plasma cells are implicated in the pathogenesis of systemic lupus erythematosus because they secrete autoantibodies, but they are unresponsive to standard immunosuppression. We describe the use of daratumumab that induced substantial clinical responses in two patients with life-threatening lupus, with the clinical responses sustained by maintenance therapy with belimumab, an antibody to B-cell activating factor. Significant depletion of long-lived plasma cells, reduction of interferon type I activity, and down-regulation of T-cell transcripts associated with chronic inflammation were documented. (Supported by the Deutsche Forschungsgemeinschaft and others.).
Collapse
Affiliation(s)
- Lennard Ostendorf
- From the Departments of Rheumatology and Clinical Immunology (L.O., P.G., R.B., U.S., G.B., F. Hiepe, T.A.), Nephrology and Internal Intensive Care Unit (P.E.), Hematology, Oncology and Tumor Immunology (U.R.), and Cardiology and Angiology, Campus Mitte (F.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Deutsches Rheuma-Forschungszentrum (DRFZ) Institute of the Leibniz Association (L.O., M.B., P.D., G.A.H., F. Heinrich, A.R., H.E.M., M.-F.M., F. Hiepe, T.A.), German Center for Cardiovascular Research (DZHK) (F.K.), and BIH Brandenburg Center for Regenerative Therapies (BCRT), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin (M.-F.M.) - all in Berlin; and the Laboratory of Inflammation and Autoimmunity, Biomedical Research Foundation, Academy of Athens, Athens (P.G.)
| | - Marie Burns
- From the Departments of Rheumatology and Clinical Immunology (L.O., P.G., R.B., U.S., G.B., F. Hiepe, T.A.), Nephrology and Internal Intensive Care Unit (P.E.), Hematology, Oncology and Tumor Immunology (U.R.), and Cardiology and Angiology, Campus Mitte (F.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Deutsches Rheuma-Forschungszentrum (DRFZ) Institute of the Leibniz Association (L.O., M.B., P.D., G.A.H., F. Heinrich, A.R., H.E.M., M.-F.M., F. Hiepe, T.A.), German Center for Cardiovascular Research (DZHK) (F.K.), and BIH Brandenburg Center for Regenerative Therapies (BCRT), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin (M.-F.M.) - all in Berlin; and the Laboratory of Inflammation and Autoimmunity, Biomedical Research Foundation, Academy of Athens, Athens (P.G.)
| | - Pawel Durek
- From the Departments of Rheumatology and Clinical Immunology (L.O., P.G., R.B., U.S., G.B., F. Hiepe, T.A.), Nephrology and Internal Intensive Care Unit (P.E.), Hematology, Oncology and Tumor Immunology (U.R.), and Cardiology and Angiology, Campus Mitte (F.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Deutsches Rheuma-Forschungszentrum (DRFZ) Institute of the Leibniz Association (L.O., M.B., P.D., G.A.H., F. Heinrich, A.R., H.E.M., M.-F.M., F. Hiepe, T.A.), German Center for Cardiovascular Research (DZHK) (F.K.), and BIH Brandenburg Center for Regenerative Therapies (BCRT), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin (M.-F.M.) - all in Berlin; and the Laboratory of Inflammation and Autoimmunity, Biomedical Research Foundation, Academy of Athens, Athens (P.G.)
| | - Gitta Anne Heinz
- From the Departments of Rheumatology and Clinical Immunology (L.O., P.G., R.B., U.S., G.B., F. Hiepe, T.A.), Nephrology and Internal Intensive Care Unit (P.E.), Hematology, Oncology and Tumor Immunology (U.R.), and Cardiology and Angiology, Campus Mitte (F.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Deutsches Rheuma-Forschungszentrum (DRFZ) Institute of the Leibniz Association (L.O., M.B., P.D., G.A.H., F. Heinrich, A.R., H.E.M., M.-F.M., F. Hiepe, T.A.), German Center for Cardiovascular Research (DZHK) (F.K.), and BIH Brandenburg Center for Regenerative Therapies (BCRT), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin (M.-F.M.) - all in Berlin; and the Laboratory of Inflammation and Autoimmunity, Biomedical Research Foundation, Academy of Athens, Athens (P.G.)
| | - Frederik Heinrich
- From the Departments of Rheumatology and Clinical Immunology (L.O., P.G., R.B., U.S., G.B., F. Hiepe, T.A.), Nephrology and Internal Intensive Care Unit (P.E.), Hematology, Oncology and Tumor Immunology (U.R.), and Cardiology and Angiology, Campus Mitte (F.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Deutsches Rheuma-Forschungszentrum (DRFZ) Institute of the Leibniz Association (L.O., M.B., P.D., G.A.H., F. Heinrich, A.R., H.E.M., M.-F.M., F. Hiepe, T.A.), German Center for Cardiovascular Research (DZHK) (F.K.), and BIH Brandenburg Center for Regenerative Therapies (BCRT), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin (M.-F.M.) - all in Berlin; and the Laboratory of Inflammation and Autoimmunity, Biomedical Research Foundation, Academy of Athens, Athens (P.G.)
| | - Panagiotis Garantziotis
- From the Departments of Rheumatology and Clinical Immunology (L.O., P.G., R.B., U.S., G.B., F. Hiepe, T.A.), Nephrology and Internal Intensive Care Unit (P.E.), Hematology, Oncology and Tumor Immunology (U.R.), and Cardiology and Angiology, Campus Mitte (F.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Deutsches Rheuma-Forschungszentrum (DRFZ) Institute of the Leibniz Association (L.O., M.B., P.D., G.A.H., F. Heinrich, A.R., H.E.M., M.-F.M., F. Hiepe, T.A.), German Center for Cardiovascular Research (DZHK) (F.K.), and BIH Brandenburg Center for Regenerative Therapies (BCRT), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin (M.-F.M.) - all in Berlin; and the Laboratory of Inflammation and Autoimmunity, Biomedical Research Foundation, Academy of Athens, Athens (P.G.)
| | - Philipp Enghard
- From the Departments of Rheumatology and Clinical Immunology (L.O., P.G., R.B., U.S., G.B., F. Hiepe, T.A.), Nephrology and Internal Intensive Care Unit (P.E.), Hematology, Oncology and Tumor Immunology (U.R.), and Cardiology and Angiology, Campus Mitte (F.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Deutsches Rheuma-Forschungszentrum (DRFZ) Institute of the Leibniz Association (L.O., M.B., P.D., G.A.H., F. Heinrich, A.R., H.E.M., M.-F.M., F. Hiepe, T.A.), German Center for Cardiovascular Research (DZHK) (F.K.), and BIH Brandenburg Center for Regenerative Therapies (BCRT), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin (M.-F.M.) - all in Berlin; and the Laboratory of Inflammation and Autoimmunity, Biomedical Research Foundation, Academy of Athens, Athens (P.G.)
| | - Ulrich Richter
- From the Departments of Rheumatology and Clinical Immunology (L.O., P.G., R.B., U.S., G.B., F. Hiepe, T.A.), Nephrology and Internal Intensive Care Unit (P.E.), Hematology, Oncology and Tumor Immunology (U.R.), and Cardiology and Angiology, Campus Mitte (F.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Deutsches Rheuma-Forschungszentrum (DRFZ) Institute of the Leibniz Association (L.O., M.B., P.D., G.A.H., F. Heinrich, A.R., H.E.M., M.-F.M., F. Hiepe, T.A.), German Center for Cardiovascular Research (DZHK) (F.K.), and BIH Brandenburg Center for Regenerative Therapies (BCRT), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin (M.-F.M.) - all in Berlin; and the Laboratory of Inflammation and Autoimmunity, Biomedical Research Foundation, Academy of Athens, Athens (P.G.)
| | - Robert Biesen
- From the Departments of Rheumatology and Clinical Immunology (L.O., P.G., R.B., U.S., G.B., F. Hiepe, T.A.), Nephrology and Internal Intensive Care Unit (P.E.), Hematology, Oncology and Tumor Immunology (U.R.), and Cardiology and Angiology, Campus Mitte (F.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Deutsches Rheuma-Forschungszentrum (DRFZ) Institute of the Leibniz Association (L.O., M.B., P.D., G.A.H., F. Heinrich, A.R., H.E.M., M.-F.M., F. Hiepe, T.A.), German Center for Cardiovascular Research (DZHK) (F.K.), and BIH Brandenburg Center for Regenerative Therapies (BCRT), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin (M.-F.M.) - all in Berlin; and the Laboratory of Inflammation and Autoimmunity, Biomedical Research Foundation, Academy of Athens, Athens (P.G.)
| | - Udo Schneider
- From the Departments of Rheumatology and Clinical Immunology (L.O., P.G., R.B., U.S., G.B., F. Hiepe, T.A.), Nephrology and Internal Intensive Care Unit (P.E.), Hematology, Oncology and Tumor Immunology (U.R.), and Cardiology and Angiology, Campus Mitte (F.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Deutsches Rheuma-Forschungszentrum (DRFZ) Institute of the Leibniz Association (L.O., M.B., P.D., G.A.H., F. Heinrich, A.R., H.E.M., M.-F.M., F. Hiepe, T.A.), German Center for Cardiovascular Research (DZHK) (F.K.), and BIH Brandenburg Center for Regenerative Therapies (BCRT), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin (M.-F.M.) - all in Berlin; and the Laboratory of Inflammation and Autoimmunity, Biomedical Research Foundation, Academy of Athens, Athens (P.G.)
| | - Fabian Knebel
- From the Departments of Rheumatology and Clinical Immunology (L.O., P.G., R.B., U.S., G.B., F. Hiepe, T.A.), Nephrology and Internal Intensive Care Unit (P.E.), Hematology, Oncology and Tumor Immunology (U.R.), and Cardiology and Angiology, Campus Mitte (F.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Deutsches Rheuma-Forschungszentrum (DRFZ) Institute of the Leibniz Association (L.O., M.B., P.D., G.A.H., F. Heinrich, A.R., H.E.M., M.-F.M., F. Hiepe, T.A.), German Center for Cardiovascular Research (DZHK) (F.K.), and BIH Brandenburg Center for Regenerative Therapies (BCRT), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin (M.-F.M.) - all in Berlin; and the Laboratory of Inflammation and Autoimmunity, Biomedical Research Foundation, Academy of Athens, Athens (P.G.)
| | - Gerd Burmester
- From the Departments of Rheumatology and Clinical Immunology (L.O., P.G., R.B., U.S., G.B., F. Hiepe, T.A.), Nephrology and Internal Intensive Care Unit (P.E.), Hematology, Oncology and Tumor Immunology (U.R.), and Cardiology and Angiology, Campus Mitte (F.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Deutsches Rheuma-Forschungszentrum (DRFZ) Institute of the Leibniz Association (L.O., M.B., P.D., G.A.H., F. Heinrich, A.R., H.E.M., M.-F.M., F. Hiepe, T.A.), German Center for Cardiovascular Research (DZHK) (F.K.), and BIH Brandenburg Center for Regenerative Therapies (BCRT), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin (M.-F.M.) - all in Berlin; and the Laboratory of Inflammation and Autoimmunity, Biomedical Research Foundation, Academy of Athens, Athens (P.G.)
| | - Andreas Radbruch
- From the Departments of Rheumatology and Clinical Immunology (L.O., P.G., R.B., U.S., G.B., F. Hiepe, T.A.), Nephrology and Internal Intensive Care Unit (P.E.), Hematology, Oncology and Tumor Immunology (U.R.), and Cardiology and Angiology, Campus Mitte (F.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Deutsches Rheuma-Forschungszentrum (DRFZ) Institute of the Leibniz Association (L.O., M.B., P.D., G.A.H., F. Heinrich, A.R., H.E.M., M.-F.M., F. Hiepe, T.A.), German Center for Cardiovascular Research (DZHK) (F.K.), and BIH Brandenburg Center for Regenerative Therapies (BCRT), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin (M.-F.M.) - all in Berlin; and the Laboratory of Inflammation and Autoimmunity, Biomedical Research Foundation, Academy of Athens, Athens (P.G.)
| | - Henrik E Mei
- From the Departments of Rheumatology and Clinical Immunology (L.O., P.G., R.B., U.S., G.B., F. Hiepe, T.A.), Nephrology and Internal Intensive Care Unit (P.E.), Hematology, Oncology and Tumor Immunology (U.R.), and Cardiology and Angiology, Campus Mitte (F.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Deutsches Rheuma-Forschungszentrum (DRFZ) Institute of the Leibniz Association (L.O., M.B., P.D., G.A.H., F. Heinrich, A.R., H.E.M., M.-F.M., F. Hiepe, T.A.), German Center for Cardiovascular Research (DZHK) (F.K.), and BIH Brandenburg Center for Regenerative Therapies (BCRT), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin (M.-F.M.) - all in Berlin; and the Laboratory of Inflammation and Autoimmunity, Biomedical Research Foundation, Academy of Athens, Athens (P.G.)
| | - Mir-Farzin Mashreghi
- From the Departments of Rheumatology and Clinical Immunology (L.O., P.G., R.B., U.S., G.B., F. Hiepe, T.A.), Nephrology and Internal Intensive Care Unit (P.E.), Hematology, Oncology and Tumor Immunology (U.R.), and Cardiology and Angiology, Campus Mitte (F.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Deutsches Rheuma-Forschungszentrum (DRFZ) Institute of the Leibniz Association (L.O., M.B., P.D., G.A.H., F. Heinrich, A.R., H.E.M., M.-F.M., F. Hiepe, T.A.), German Center for Cardiovascular Research (DZHK) (F.K.), and BIH Brandenburg Center for Regenerative Therapies (BCRT), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin (M.-F.M.) - all in Berlin; and the Laboratory of Inflammation and Autoimmunity, Biomedical Research Foundation, Academy of Athens, Athens (P.G.)
| | - Falk Hiepe
- From the Departments of Rheumatology and Clinical Immunology (L.O., P.G., R.B., U.S., G.B., F. Hiepe, T.A.), Nephrology and Internal Intensive Care Unit (P.E.), Hematology, Oncology and Tumor Immunology (U.R.), and Cardiology and Angiology, Campus Mitte (F.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Deutsches Rheuma-Forschungszentrum (DRFZ) Institute of the Leibniz Association (L.O., M.B., P.D., G.A.H., F. Heinrich, A.R., H.E.M., M.-F.M., F. Hiepe, T.A.), German Center for Cardiovascular Research (DZHK) (F.K.), and BIH Brandenburg Center for Regenerative Therapies (BCRT), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin (M.-F.M.) - all in Berlin; and the Laboratory of Inflammation and Autoimmunity, Biomedical Research Foundation, Academy of Athens, Athens (P.G.)
| | - Tobias Alexander
- From the Departments of Rheumatology and Clinical Immunology (L.O., P.G., R.B., U.S., G.B., F. Hiepe, T.A.), Nephrology and Internal Intensive Care Unit (P.E.), Hematology, Oncology and Tumor Immunology (U.R.), and Cardiology and Angiology, Campus Mitte (F.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Deutsches Rheuma-Forschungszentrum (DRFZ) Institute of the Leibniz Association (L.O., M.B., P.D., G.A.H., F. Heinrich, A.R., H.E.M., M.-F.M., F. Hiepe, T.A.), German Center for Cardiovascular Research (DZHK) (F.K.), and BIH Brandenburg Center for Regenerative Therapies (BCRT), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin (M.-F.M.) - all in Berlin; and the Laboratory of Inflammation and Autoimmunity, Biomedical Research Foundation, Academy of Athens, Athens (P.G.)
| |
Collapse
|
24
|
Schulze-Koops H, Iking-Konert C, Leipe J, Hoyer BF, Holle J, Moosig F, Aries P, Burmester G, Fiehn C, Krause A, Lorenz HM, Schneider M, Sewerin P, Voormann A, Wagner U, Krüger K, Specker C. [Recommendations of the German Society for Rheumatology for management of patients with inflammatory rheumatic diseases in the context of the SARS-CoV-2/COVID-19 pandemic - Update July 2020]. Z Rheumatol 2020; 79:679-685. [PMID: 32757030 PMCID: PMC7403789 DOI: 10.1007/s00393-020-00851-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
A few days after the SARS-CoV-2 infection was declared a pandemic, the German Society for Rheumatology (DGRh) compiled first recommendations for the care of patients with inflammatory rheumatic diseases (IRD). These first recommendations were based on an expert consensus and were largely non-evidence-based. Now that the first scientific data from registers, cross-sectional studies, case reports and case series are available, the present update is intended to update the previous recommendations and to add new findings. The current recommendations are based on a literature search of publications available up to 15 June 2020 and address preventive measures (such as hygiene measures or vaccinations) and the use of immunomodulatory/immunosuppressive drugs. An important goal of the current recommendations is also to prevent harm to patients with IRD through unjustified restriction of care. The DGRh will continue to update its recommendations in the case of new aspects and will publish them as well as further information on the COVID-19 pandemic on its homepage ( www.dgrh.de ) in an ongoing process.
Collapse
Affiliation(s)
- Hendrik Schulze-Koops
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland.
- Sektion Rheumatologie und Klinische Immunologie, Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität München, Pettenkoferstr. 8a, 80336, München, Deutschland.
| | - Christof Iking-Konert
- III. Medizinische Klinik und Poliklinik, Sektion Rheumatologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Jan Leipe
- Abteilung für Rheumatologie, Medizinische Klinik V, Universitätskrankenhaus Mannheim, Mannheim, Deutschland
| | - Bimba Franziska Hoyer
- Abteilung für Rheumatologie, 1. Medizinische Klinik, Universitätskrankenhaus Schleswig-Holstein Campus Kiel, Kiel, Deutschland
| | - Julia Holle
- Rheumazentrum Schleswig-Holstein Mitte, Neumünster, Deutschland
| | - Frank Moosig
- Rheumazentrum Schleswig-Holstein Mitte, Neumünster, Deutschland
| | - Peer Aries
- Rheumatologie im Struenseehaus, Hamburg, Deutschland
| | - Gerd Burmester
- Klinik für Rheumatologie und Klinische Immunologie, Charité - Universitätsmedizin Berlin, Freie Universität und Humboldt Universität Berlin, Berlin, Deutschland
| | - Christoph Fiehn
- Praxis für Rheumatologie und Klinische Immunologie, Medical Center Baden-Baden und ViDia-Kliniken Karlsruhe, Baden-Baden, Deutschland
| | - Andreas Krause
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Abteilung für Rheumatologie, Osteologie und Klinische Immunologie, Immanuel Krankenhaus Berlin, Berlin, Deutschland
| | - Hanns-Martin Lorenz
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Abteilung für Rheumatologie, Medizinische Klinik V, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Matthias Schneider
- Poliklinik, Funktionsbereich und Hiller Forschungszentrum für Rheumatologie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Philipp Sewerin
- Poliklinik, Funktionsbereich und Hiller Forschungszentrum für Rheumatologie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Anna Voormann
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
| | - Ulf Wagner
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Abteilung für Rheumatologie, Klinik und Poliklinik für Endokrinologie, Nephrologie, Rheumatologie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Klaus Krüger
- Rheumatologisches Praxiszentrum München, St. Bonifatius-Str. 5, 81541, München, Deutschland.
- Kommission Pharmakotherapie, DGRh e. V., Berlin, Deutschland.
| | - Christof Specker
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Klinik für Rheumatologie und Klinische Immunologie, Kliniken Essen-Mitte, Essen, Deutschland
| |
Collapse
|
25
|
Sivera F, Alunno A, Najm A, Avcin T, Baraliakos X, Bijlsma JW, Badreh S, Burmester G, Cikes N, Da Silva JA, Damjanov N, Dougados M, Dudler J, Edwards CJ, Iagnocco A, Lioté F, Nikiphorou E, van Onna M, Stones SR, Vassilopoulos D, Haines C, Ramiro S. 2019 EULAR points to consider for the assessment of competences in rheumatology specialty training. Ann Rheum Dis 2020; 80:65-70. [PMID: 32788400 DOI: 10.1136/annrheumdis-2020-218015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/23/2020] [Accepted: 07/14/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM Striving for harmonisation of specialty training and excellence of care in rheumatology, the European League Against Rheumatism (EULAR) established a task force to develop points to consider (PtCs) for the assessment of competences during rheumatology specialty training. METHODS A systematic literature review on the performance of methods for the assessment of competences in rheumatology specialty training was conducted. This was followed by focus groups in five selected countries to gather information on assessment practices and priorities. Combining the collected evidence with expert opinion, the PtCs were formulated by the multidisciplinary task force, including rheumatologists, medical educationalists, and people with rheumatic and musculoskeletal diseases. The level of agreement (LoA) for each PtC was anonymously voted online. RESULTS Four overarching principles and 10 PtCs were formulated. The overarching principles highlighted the importance of assessments being closely linked to the rheumatology training programme and protecting sufficient time and resources to ensure effective implementation. In the PtCs, two were related to overall assessment strategy (PtCs 1 and 5); three focused on formative assessment and portfolio (PtCs 2-4); three focused on the assessment of knowledge, skills or professionalism (PtCs 6-8); one focused on trainees at risk of failure (PtC 9); and one focused on training the trainers (PtC 10). The LoA (0-10) ranged from 8.75 to 9.9. CONCLUSION These EULAR PtCs provide European guidance on assessment methods throughout rheumatology training programmes. These can be used to benchmark current practices and to develop future strategies, thereby fostering continuous improvement in rheumatology learning and, ultimately, in patient care.
Collapse
Affiliation(s)
- Francisca Sivera
- Department of Clinical Medicine, Miguel Hernandez University of Elche, Elche, Spain .,Department of Rheumatology, Hospital General Universitario Elda, Elda, Spain
| | - Alessia Alunno
- Department of Medicine, Rheumatology Unit, University of Perugia, Perugia, Italy
| | - Aurélie Najm
- INSERM UMR1238, University of Medicine, CHU Nantes, Nantes, France.,Institute of Infection, Immunity and Inflammation, University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, UK
| | - Tadej Avcin
- Department of Allergology, Rheumatology and Clinical Immunology, University Children's Hospital Ljubljana, Ljubljana, Slovenia
| | - Xenofon Baraliakos
- Rheumazentrum Ruhrgebiet, Herne, Germany.,Ruhr University Bochum, Bochum, Nordrhein-Westfalen, Germany
| | - Johannes W Bijlsma
- Department of Rheumatology and Clinical Immunology, UMCUtrecht, Utrecht, Netherlands
| | - Sara Badreh
- EULAR Patient Research Partner, Stockholm, Sweden
| | - Gerd Burmester
- Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany
| | - Nada Cikes
- Division of Clinical Immunology and Rheumatology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Jose Ap Da Silva
- Reumatologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Nemanja Damjanov
- Institute of Rheumatology, University of Belgrade School of Medicine, Belgrade, Serbia
| | - Maxime Dougados
- Rheumatologie B, Hopital Cochin, Paris, Île-de-France, France
| | - Jean Dudler
- Service de Rhumatologie, HFR Fribourg, Hôpital Cantonal, Fribourg, Switzerland
| | - Christopher J Edwards
- Musculoskeletal Research Unit, NIHR Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Annamaria Iagnocco
- Academic Rheumatology Center, Università degli Studi di Torino, Torino, Italy
| | - Frédéric Lioté
- Department of Rhumatologie, Hôpital Lariboisière, Paris, France.,INSERM UMR-1132, University of Paris, Paris, France
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases, King's College London, London, London, UK
| | - Marloes van Onna
- Department of Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands.,School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | | | - Dimitrios Vassilopoulos
- 2nd Department of Medicine and Laboratory, Clinical Immunology-Rheumatology Unit, Athens University School of Medicine, Athens, Greece
| | - Catherine Haines
- Center for Teaching and Learning, University of Oxford, Oxford, UK
| | - Sofia Ramiro
- Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.,Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands
| |
Collapse
|
26
|
Burmester G, Chien D, Chow V, Gessner M, Pan J, Cohen S. A Randomized, Double‐Blind Study Comparing Pharmacokinetics and Pharmacodynamics of Proposed Biosimilar ABP 798 With Rituximab Reference Product in Subjects With Moderate to Severe Rheumatoid Arthritis. Clin Pharmacol Drug Dev 2020; 9:1003-1014. [DOI: 10.1002/cpdd.845] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 06/01/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Gerd Burmester
- Department of Rheumatology and Clinical Immunology Charité – University Medicine Berlin Berlin Germany
| | - David Chien
- Clinical R&D, Biosimilars Amgen Inc. Thousand Oaks California USA
| | - Vincent Chow
- Clinical Pharmacology M&S Amgen Inc. Thousand Oaks CA USA
| | | | - Jean Pan
- Clinical R&D, Biosimilars Amgen Inc. Thousand Oaks California USA
| | | |
Collapse
|
27
|
Genovese MC, Smolen JS, Takeuchi T, Burmester G, Brinker D, Rooney TP, Zhong J, Daojun M, Saifan C, Cardoso A, Issa M, Wu WS, Winthrop KL. Safety profile of baricitinib for the treatment of rheumatoid arthritis over a median of 3 years of treatment: an updated integrated safety analysis. Lancet Rheumatol 2020; 2:e347-e357. [PMID: 38273598 DOI: 10.1016/s2665-9913(20)30032-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/27/2020] [Accepted: 01/28/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Baricitinib is an oral selective inhibitor of Janus kinase (JAK) 1 and JAK2, approved for the treatment of patients with active rheumatoid arthritis. Because baricitinib, like other disease-modifying antirheumatic drugs, is used chronically, continuous assessment of its long-term safety profile is important. Here we provide updated data supporting the existing safety profile of baricitinib in this patient population. METHODS In this safety analysis, integrated data were included from nine phase 3, phase 2, and phase 1b clinical trials, and one long-term extension study with data up to 360 weeks, ending Feb 13, 2018. We analysed three integrated datasets, the largest of which was the all-bari-RA dataset, which includes patients who received any dose of baricitinib. We compared the safety of baricitinib with placebo on the basis of data from seven studies with baricitinib 4 mg and placebo and four studies with baricitinib 2 mg, including placebo to week 24 (placebo-controlled dataset). We did a dose-response assessment based on four studies with baricitinib 2 mg and 4 mg, including long-term extension data (2-4 mg extended dataset). We did an exploratory analysis of deaths and venous thromboembolic events in a subset of data from the all-bari-RA dataset that included patients who had ever taken baricitinib 2-mg or baricitinib 4-mg. We did an analysis for malignancies (excluding non-melanoma skin cancer) in the as-randomised population (patients not censored at rescue or dose change). FINDINGS We collected data for 3770 patients who were given baricitinib for 10 127 patient-years of exposure in the all-bari-RA dataset (median 1115 days [IQR 426-1441], maximum 2520 days). The placebo-controlled dataset comprised 2836 patients, with 1215 in the placebo group, with 451 patient-years of exposure data; 479 in the baricitinib 2 mg group, with 186 patient-years of exposure data; and 1142 in the baricitinib 4 mg group, with 472 patient-years of exposure data. The 2-4 mg extended dataset comprised 958 patients, with 479 in both the 2 mg and 4 mg groups. No significant differences were seen for baricitinib 4 mg or 2 mg versus placebo, or for 4 mg versus 2 mg in the incidence of death, malignancy, serious infection, or major adverse cardiovascular events. Incidence of herpes zoster per 100 patient-years was higher for baricitinib (4 mg: 4·4 [95% CI 2·7-6·7]; 2 mg: 3·1 [1·1-6·8]) versus total placebo group (1·1 [0·4-2·5]), as were treatment-emergent infections (4 mg: 89·7 [81·3-98·6]; 2 mg: 84·0 [71·3-98·2] vs placebo 75·4 [67·6-83·9]). Consistent with previous reports, incidences in the all-bari-RA dataset for venous thromboembolic events was 0·5 (95% CI 0·4-0·6) per 100 patient-years, deep-vein thrombosis was 0·3 (0·2-0·5) per 100 patient-years, and pulmonary embolism was 0·2 (0·2-0·4) per 100 patient-years. Incidences of malignancy (excluding non-melanoma skin cancer) in the 2-4 mg extended dataset were 0·8 (0·4-1·5) per 100 patient-years for baricitinib 2 mg and 1·0 (0·5-1·7) per 100 patient-years for baricitinib 4 mg, without censoring patients who had dose changes or received rescue treatment. We found no indication of higher incidence of venous thromboembolic events in the baricitinib 4 mg group compared with the 2 mg group in the 2-4 mg extended dataset. INTERPRETATION In this updated integrated analysis of patients with active rheumatoid arthritis exposed to baricitinib for a maximum of almost 7 years, baricitinib 2 mg and 4 mg maintained a similar safety profile to earlier analyses. No new safety signals were identified. Patients in the long-term extension study continue to be followed up to date. FUNDING Eli Lilly and Company, under license from Incyte Corporation.
Collapse
Affiliation(s)
- Mark C Genovese
- Division of Immunology and Rheumatology, Stanford University, Palo Alto, CA, USA.
| | - Josef S Smolen
- Division of Rheumatology, Department of Medicine, Medical University of Vienna, Vienna, Austria
| | - Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Gerd Burmester
- Department of Rheumatology and Clinical Immunology, Charité-University Medicine Berlin, Free University and Humboldt University Berlin, Berlin, Germany
| | - Dennis Brinker
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - Terence P Rooney
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA; Immunology at The Janssen Pharmaceutical Companies of Johnson & Johnson, Raritan, NJ, USA
| | | | - Mo Daojun
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - Chadi Saifan
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - Anabela Cardoso
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - Maher Issa
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - Wen-Shuo Wu
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | | |
Collapse
|
28
|
Schulze-Koops H, Holle J, Moosig F, Specker C, Aries P, Burmester G, Fiehn C, Hoyer B, Krause A, Leipe J, Lorenz HM, Schneider M, Sewerin P, Voormann A, Wager U, Krüger K, Iking-Konert C. [Current guidance of the German Society of Rheumatology for the care of patients with rheumatic diseases during the SARS-CoV-2/Covid 19 pandemic]. Z Rheumatol 2020; 79:385-388. [PMID: 32342184 PMCID: PMC7184809 DOI: 10.1007/s00393-020-00799-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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] [Indexed: 11/24/2022]
Abstract
In der aktuellen SARS-CoV-2 Pandemie bestehen viele Fragen mit Blick auf die sichere Behandlung von Patienten mit entzündlich-rheumatischen Erkrankungen. Auf viele dieser Fragen gibt es zur Zeit noch keine evidenzbasierte Antwort und das macht die Betreuung der Patienten nicht leicht. Die Deutsche Gesellschaft für Rheumatologie e. V. (DGRh) will mit diesen ersten Empfehlungen Hilfestellung für spezielle Belange in der Betreuung von Rheumapatienten angesichts der aktuellen Bedrohung durch SARS-CoV-2 geben. Um den dynamischen weltweiten Erkenntnisgewinn für unsere Patienten zu nutzen, werden die Empfehlungen regelmäßig aktualisiert. Die aktualisierten Versionen der Empfehlungen werden auf der Homepage der DGRh hinterlegt.
Collapse
Affiliation(s)
- H Schulze-Koops
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland. .,Sektion Rheumatologie und Klinische Immunologie, Medizinische Klinik IV, Ludwig-Maximilians-Universität München, Pettenkoferstraße 8a, München, Deutschland.
| | - J Holle
- Rheumazentrum Schleswig-Holstein Mitte, Neumünster, Deutschland
| | - F Moosig
- Rheumazentrum Schleswig-Holstein Mitte, Neumünster, Deutschland
| | - C Specker
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland.,Klinik für Rheumatologie und Klinische Immunologie, Kliniken Essen-Mitte, Essen, Deutschland
| | - P Aries
- Rheumatologie im Struenseehaus, Hamburg, Deutschland
| | - G Burmester
- Klinik für Rheumatologie und Klinische Immunologie, Charité - Universitäts Medizin Berlin, Freie Universität und Humboldt Universität Berlin, Berlin, Deutschland
| | - C Fiehn
- Medical Center Baden-Baden und ViDia-Kliniken Karlsruhe, Praxis für Rheumatologie und Klinische Immunologie, Baden-Baden, Deutschland
| | - B Hoyer
- Abteilung für Rheumatologie, 1. Medizinische Klinik, Universitätskrankenhaus Schleswig-Holstein Campus Kiel, Kiel, Deutschland
| | - A Krause
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland.,Abteilung für Rheumatologie, Osteologie und Klinische Immunologie, Immanuel Krankenhaus Berlin, Berlin, Deutschland
| | - J Leipe
- Abteilung für Rheumatologie, Medizinische Klinik V, Universitätskrankenhaus Mannheim, Mannheim, Deutschland
| | - H-M Lorenz
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland.,Abteilung für Rheumatologie, Medizinische Klinik V, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - M Schneider
- Poliklinik, Funktionsbereich und Hiller Forschungszentrum für Rheumatologie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - P Sewerin
- Poliklinik, Funktionsbereich und Hiller Forschungszentrum für Rheumatologie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - A Voormann
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
| | - U Wager
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland.,Abteilung für Rheumatologie, Klinik und Poliklinik für Endokrinologie, Nephrologie, Rheumatologie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - K Krüger
- Rheumatologisches Praxiszentrum, Kommission Pharmakotherapie der DGRh e. V., St. Bonifatius-Straße 5, 81541, München, Deutschland.
| | - C Iking-Konert
- III. Medizinische Klinik und Poliklinik Sektion Rheumatologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | | |
Collapse
|
29
|
Najm A, Nikiphorou E, Kostine M, Richez C, Pauling JD, Finckh A, Ritschl V, Prior Y, Balážová P, Stones S, Szekanecz Z, Iagnocco A, Ramiro S, Sivera F, Dougados M, Carmona L, Burmester G, Wiek D, Gossec L, Berenbaum F. EULAR points to consider for the development, evaluation and implementation of mobile health applications aiding self-management in people living with rheumatic and musculoskeletal diseases. RMD Open 2019; 5:e001014. [PMID: 31565245 PMCID: PMC6744072 DOI: 10.1136/rmdopen-2019-001014] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/24/2019] [Accepted: 08/19/2019] [Indexed: 11/29/2022] Open
Abstract
Background Mobile health applications (apps) are available to enable people with rheumatic and musculoskeletal diseases (RMDs) to better self-manage their health. However, guidance on the development and evaluation of such apps is lacking. Objectives The objective of this EULAR task force was to establish points to consider (PtC) for the development, evaluation and implementation of apps for self-management of RMDs. Methods A systematic literature review of app content and development strategies was conducted, followed by patient focus group and an online survey. Based on this information and along with task force expert opinion, PtC were formulated in a face-to-face meeting by a multidisciplinary task force panel of experts, including two patient research partners. The level of agreement among the panel in regard to each PtC was established by anonymous online voting. Results Three overarching principles and 10 PtC were formulated. Three PtC are related to patient safety, considered as a critical issue by the panel. Three are related to relevance of the content and functionalities. The requirement for transparency around app development and funding sources, along with involvement of relevant health professionals, were also raised. Ease of app access across ages and abilities was highlighted, in addition to considering the cost benefit of apps from the outset. The level of agreement was from 8.8 to 9.9 out of 10. Conclusion These EULAR PtC provide guidance on important aspects that should be considered for the development, evaluation and implementation of existing and new apps.
Collapse
Affiliation(s)
- Aurélie Najm
- Rheumatology Department, University Hospital Centre Nantes, Nantes, France
- INSERM UMR 1238, Universite de Nantes Ecole Doctorale Biologie-Sante, Nantes, France
| | - Elena Nikiphorou
- Department of Inflammation Biology, King's College London Academic, London, UK
| | - Marie Kostine
- Rheumatology Department, Centre Hospitalier Universitaire de Bordeaux Groupe hospitalier Pellegrin, Bordeaux, France
| | - Christophe Richez
- Rheumatology Department, Centre Hospitalier Universitaire de Bordeaux Groupe hospitalier Pellegrin, Bordeaux, France
| | - John D Pauling
- Royal National Hospital for Rheumatic Diseases, Royal United Hospital Bath NHS Trust, Bath, UK
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - Axel Finckh
- Division of Rheumatology, University Hospital of Geneva, Geneva, Switzerland
| | - Valentin Ritschl
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Wien, Austria
- Division of Occupational Therapy, University of Applied Sciences, FH Campus Wien, Wien, Austria
| | - Yeliz Prior
- Centre for Health Sciences Research, University of Salford, Salford, UK
- Mid Cheshire NHS Foundation Trust Hospitals, Crewe, UK
| | - Petra Balážová
- EULAR Young PARE, Zurich, Switzerland
- Slovak League Against Rheumatism, Piestany, Slovakia
| | - Simon Stones
- School of Healthcare, University of Leeds, Leeds, UK
| | - Zoltan Szekanecz
- Department of Rheumatology, University of Debrecen, Faculty of Medicine, Debrecen, Hungary
| | - Annamaria Iagnocco
- Academic Rheumatology Centre, Università degli Studi di Torino, Torino, Italy
| | - Sofia Ramiro
- Department of Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Francisca Sivera
- Rheumatology, Hospital General Universitario de Elda, Elda, Spain
| | - Maxime Dougados
- Hopital Cochin, Rheumatology, Université Paris Descartes, Paris, France
| | | | - Gerd Burmester
- Rheumatology, Charité - University Medicine Berlin, Berlin, Germany
| | | | - Laure Gossec
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM UMR S1136, Sorbonne Universite, Paris, France
- APHP, Rheumatology Department, Hopital Universitaire Pitie Salpetriere, Paris, France
| | - Francis Berenbaum
- Rheumatology Department, AP-HP, Hopital Saint-Antoine, Paris, France
- INSERM CRSA, Sorbonne Université, Paris, France
| |
Collapse
|
30
|
Burmester G, Nüsslein H, von Hinüber U, Detert J, Richter C, Kumke T, Leunikava I, Lendl U, Fricke D, Müller-Ladner U. Effectiveness and safety of anti-tumour necrosis factor therapy with certolizumab pegol observed in real-life rheumatoid arthritis patients in Germany: results from the non-interventional FαsT study. Clin Exp Rheumatol 2019; 37:842-851. [PMID: 30873942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 12/10/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To report the tolerability and effectiveness of certolizumab pegol (CZP) for the treatment of patients with active rheumatoid arthritis (RA) in a routine clinical practice setting. METHODS FαsT (NCT01069419) was a non-interventional, observational 104-week (wk) study performed at 163 sites in Germany. RA patients were treated according to the treating physician's discretion. Clinical remission (DAS28-CRP<2.6) at wk 104 was the primary endpoint of the study. Remission data based on ESR (DAS28-ESR<2.6) were also assessed. Secondary endpoints included the effect of CZP treatment on pain, physical function and disease activity. Safety data were collected at all study visits. RESULTS 1,117 patients were enrolled in the FαsT study (78% female, mean age: 55 years). Rapid responses were observed at wk 6 (18.7% and 12.9% patients in DAS28-CRP and DAS28-ESR remission, respectively) with improvements sustained over 2 years (20.0% and 13.9% patients achieved DAS28-CRP and DAS28-ESR remission, respectively at wk 104). Anti-TNF naïve patients exhibited greater improvements than anti-TNF experienced patients (mean DAS28-ESR change from baseline [CfB] -1.3, -1.5 and -1.7 for patients with ≥2, 1 and no anti-TNFs, respectively at wk104). Improvements were reported in all secondary endpoint measures. 1,111 patients were exposed to CZP for a total of 1,538 patient-years during the study. 2,000 treatment-emergent adverse events (TEAEs) were reported in 745 patients (67.1%); 9 (0.8%) experienced TEAEs with fatal outcome. CONCLUSIONS CZP demonstrated efficacy and safety outcomes reflective of those observed in trial settings. Rapid reductions in disease activity and improvements in physical function were maintained up to wk 104.
Collapse
Affiliation(s)
- Gerd Burmester
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany.
| | - Hubert Nüsslein
- Rheumatology Practice, University of Erlangen-Nürnberg, Germany
| | | | - Jacqueline Detert
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany
| | | | | | | | | | | | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Campus Kerckhoff Bad Nauheim, Germany
| |
Collapse
|
31
|
Kedra J, Radstake T, Pandit A, Baraliakos X, Berenbaum F, Finckh A, Fautrel B, Stamm TA, Gomez-Cabrero D, Pristipino C, Choquet R, Servy H, Stones S, Burmester G, Gossec L. Current status of use of big data and artificial intelligence in RMDs: a systematic literature review informing EULAR recommendations. RMD Open 2019; 5:e001004. [PMID: 31413871 PMCID: PMC6668041 DOI: 10.1136/rmdopen-2019-001004] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 05/09/2019] [Revised: 06/26/2019] [Accepted: 06/29/2019] [Indexed: 12/27/2022] Open
Abstract
Objective To assess the current use of big data and artificial intelligence (AI) in the field of rheumatic and musculoskeletal diseases (RMDs). Methods A systematic literature review was performed in PubMed MEDLINE in November 2018, with key words referring to big data, AI and RMDs. All original reports published in English were analysed. A mirror literature review was also performed outside of RMDs on the same number of articles. The number of data analysed, data sources and statistical methods used (traditional statistics, AI or both) were collected. The analysis compared findings within and beyond the field of RMDs. Results Of 567 articles relating to RMDs, 55 met the inclusion criteria and were analysed, as well as 55 articles in other medical fields. The mean number of data points was 746 million (range 2000–5 billion) in RMDs, and 9.1 billion (range 100 000–200 billion) outside of RMDs. Data sources were varied: in RMDs, 26 (47%) were clinical, 8 (15%) biological and 16 (29%) radiological. Both traditional and AI methods were used to analyse big data (respectively, 10 (18%) and 45 (82%) in RMDs and 8 (15%) and 47 (85%) out of RMDs). Machine learning represented 97% of AI methods in RMDs and among these methods, the most represented was artificial neural network (20/44 articles in RMDs). Conclusions Big data sources and types are varied within the field of RMDs, and methods used to analyse big data were heterogeneous. These findings will inform a European League Against Rheumatism taskforce on big data in RMDs.
Collapse
Affiliation(s)
- Joanna Kedra
- Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), UMR S 1136, Sorbonne Universite, Paris, France.,Rheumatology Department, Hôpital Universitaire Pitié Salpêtrière, APHP, Paris, France
| | - Timothy Radstake
- Department of Rheumatology, Clinical Immunology and Laboratory for Translational Immunology, University of Utrecht Faculty of Medicine, Utrecht, The Netherlands
| | - Aridaman Pandit
- Department of Rheumatology, Clinical Immunology and Laboratory for Translational Immunology, University of Utrecht Faculty of Medicine, Utrecht, The Netherlands
| | | | - Francis Berenbaum
- Rheumatology Department, Hospital Saint-Antoine, APHP, Paris, Île-de-France, France
| | - Axel Finckh
- Division of Rheumatology, University Hospital of Geneva, Geneva, Switzerland
| | - Bruno Fautrel
- Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), UMR S 1136, Sorbonne Universite, Paris, France.,Rheumatology Department, Hôpital Universitaire Pitié Salpêtrière, APHP, Paris, France
| | - Tanja A Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - David Gomez-Cabrero
- Departamento de Salud-Universidad Pública de Navarra, Translational Bioinformatics Unit, Navarra Biomed, Pamplona, Spain
| | | | | | | | - Simon Stones
- School of Healthcare, University of Leeds, Leeds, West Yorkshire, UK
| | - Gerd Burmester
- Department of Rheumatology and Clinical Immunology, Charité - University Medicine Berlin, Berlin, Germany
| | - Laure Gossec
- Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), UMR S 1136, Sorbonne Universite, Paris, France.,Rheumatology Department, Hôpital Universitaire Pitié Salpêtrière, APHP, Paris, France
| |
Collapse
|
32
|
Buttgereit F, Nebesky JM, Burmester G, Hochberg M, Bernasconi C, John M, Donath M. SAT-382 Glucocorticoid Tapering in Monthly 1-mg Decrements Does Not Result in Clinically Manifest Adrenal Insufficiency in Patients with Rheumatoid Arthritis: Learnings from the Phase 3/4 SEMIRA Study. J Endocr Soc 2019. [PMCID: PMC6552170 DOI: 10.1210/js.2019-sat-382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction: Systemic glucocorticoids (GCs) are used to treat serious inflammatory diseases but are associated with adverse events. Guidelines recommend tapering GCs to the lowest possible dose and discontinuing as soon as possible. Physicians have concerns that reductions, even from low doses, may increase disease symptoms or cause adrenal insufficiency (AI), especially in patients (pts) receiving long-term GCs. The expectation of AI risk may be inflated by false positives in cortisol testing of pts without relevant symptoms and by a lack of robustly designed GC taper trials. The international, multicenter SEMIRA trial evaluated a taper scheme in rheumatoid arthritis (RA) pts receiving tocilizumab (TCZ) ± conventional synthetic disease-modifying antirheumatic drugs (csDMARDs).1Methods: Eligible pts had low disease activity or remission for ≥4 weeks (wks) and were receiving a stable prednisone regimen (5 mg/day) + TCZ ± csDMARDs for ≥4 wks. Pts had to have received ≥6 months’ total TCZ + GCs (prednisone equivalent 5-15 mg/day). Pts were randomized (1:1) to double-blind continued prednisone 5 mg/day (n=128) or prednisone taper (n=131). TCZ ± csDMARDs remained stable during the 24-wk study. GC tapering consisted of 1-mg decrements from randomization and every 4 wks thereafter until discontinuation. RA flares were treated with prednisone 5 mg/day for 2 wks. The primary assessment was maintenance of disease control with GC discontinuation. The protocol provided evidence-based guidance for diagnosis and management of AI. Confirmatory testing was recommended for pts with suspected AI, but routine precautionary ACTH stimulation testing was not mandated. Results: In the taper arm, 65% of pts achieved “treatment success,” meeting all key secondary endpoint components (maintained low disease activity, experienced no flares, and had no confirmed AI requiring replacement therapy) at wk 24 versus 77% of continued pts (risk ratio for treatment success 0.833 [95% CI: 0.714, 0.972] p=0.021). None of the taper pts required ACTH stimulation testing, and no cases of AI were reported. Conclusions: SEMIRA demonstrated the usefulness of a new standardized GC dose taper scheme. Two-thirds of pts receiving TCZ underwent successful tapering and could stop GCs entirely, which is higher than a spontaneous 35% discontinuation rate observed in real-world RA pts2 and underscores the potential to further reduce steroid burden. Clinical AI was not observed; thus, routine laboratory testing may be unnecessary in real-world applications of this taper scheme. References: 1. Burmester GR et al. Arthritis Rheumatol. 2018;70(suppl 10):L18. 2. Yagız B et al. Arthritis Rheumatol. 2018;70(suppl 10):627.
Collapse
Affiliation(s)
- Frank Buttgereit
- Charité-Universitätsmedizin Berlin, Free University and Humboldt University of Berlin, Berlin, , Germany
| | | | - Gerd Burmester
- Charité-Universitätsmedizin Berlin, Free University and Humboldt University of Berlin, Berlin, , Germany
| | - Marc Hochberg
- University of Maryland School of Medicine, Baltimore, MD, United States
| | | | | | - Marc Donath
- University Hospital Basel, Basel, , Switzerland
| |
Collapse
|
33
|
Emery P, Dudler J, Smolen J, Zerbini C, Burmester G, Fautrel B, van der Laar M, Fleischmann R, Fakhouri W, Leonardis FD, Zhu B, Kadziola Z, Torre IDL, Perrier C, Taylor PC. 074 Summary of indirect comparison to evaluate efficacy of baricitinib with targeted synthetic and biologic disease anti-rheumatic drugs in patients with rheumatoid arthritis. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez106.073] [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: 11/12/2022] Open
Affiliation(s)
- Paul Emery
- Faculty of Medicine and Health, Leeds MSK Biomed/Chapel Allerton Hosp, Leeds, UNITED KINGDOM
| | - Jean Dudler
- Department of Rheumatology, HFR Fribourg Hopital cantonal, Fribourg, SWITZERLAND
| | - Josef Smolen
- Department of Rheumatology, Medical University of Vienna, Vienna, AUSTRIA
| | - Cristiano Zerbini
- Department of Rheumatology, Centro de Investigação Clinica, Sao Paulo, BRAZIL
| | - Gerd Burmester
- Department of Rheumatology and Clinical Immunology, Charité - University Medicine Berlin, Berlin, GERMANY
| | - Bruno Fautrel
- Department of Rheumatology, Pierre and Marie Curie University, Paris, FRANCE
| | - Mart van der Laar
- Department of Rheumatology, Arthritis Center Twente, Enschede, NETHERLANDS
| | - Roy Fleischmann
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Walid Fakhouri
- Global Health Outcomes, Eli Lilly & Company, Indianapolis, IN
| | | | - Baojin Zhu
- Real-World Analytics-Immunology, Eli Lilly & Company, Indianapolis, IN
| | - Zbigniew Kadziola
- Real-World Analytics-Capabilities and Data Mart, Eli Lilly & Company, Indianapolis, IN
| | | | - Clementine Perrier
- Department of Medicine-Autoimmune, Eli Lilly & Company, Indianapolis, IN
| | - Peter C Taylor
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Botnar Research Centre, University of Oxford, Headington, UNITED KINGDOM
| |
Collapse
|
34
|
Meyer A, Scirè CA, Talarico R, Alexander T, Amoura Z, Avcin T, Barsotti S, Beretta L, Blagojevic J, Burmester G, Cavazzana I, Cherrin P, Damian L, Doria A, Fonseca JE, Furini F, Galetti I, Houssiau F, Krieg T, Larosa M, Launay D, Campanilho-Marques R, Martin T, Matucci-Cerinic M, Moinzadeh P, Montecucco C, Moraes-Fontes MF, Mouthon L, Neri R, Paolino S, Piette Y, Rednic S, Tamirou F, Tincani A, Toplak N, Bombardieri S, Hachulla E, Mueller-Ladner U, Schneider M, Smith V, Vieira A, Cutolo M, Mosca M, Cavagna L. Idiopathic inflammatory myopathies: state of the art on clinical practice guidelines [corrected]. RMD Open 2019; 4:e000784. [PMID: 30886730 PMCID: PMC6397434 DOI: 10.1136/rmdopen-2018-000784] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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] [Received: 08/04/2018] [Revised: 01/07/2019] [Accepted: 01/08/2019] [Indexed: 12/16/2022] Open
Abstract
Idiopathic inflammatory myopathies (IIMs) encompass a heterogeneous group of rare autoimmune diseases characterised by muscle weakness and inflammation, but in antisynthetase syndrome arthritis and interstitial lung disease are more frequent and often inaugurate the disease. Clinical practice guidelines (CPGs) have been proposed for IIMs, but they are sparse and heterogeneous. This work aimed at identifying: i) current available CPGs for IIMs, ii) patients ' and clinicians' unmet needs not covered by CPGs. It has been performed in the framework of the European Reference Network on rare and complex connective tissue and musculoskeletal diseases (ReCONNET), a network of centre of expertise and patients funded by the European Union's Health Programme. Fourteen original CPGs were identified, notably recommending that: i) extra-muscular involvements should be assessed; ii) corticosteroids and methotrexate or azathioprine are first-line therapies of IIMs. ii) IVIG is a treatment of resistant-DM that may be also used in other resistant-IIMs; iii) physical therapy and sun protection (in DM patients) are part of the treatment; v) tumour screening for patients with DM include imaging of chest, abdomen, pelvis and breast (in woman) along with colonoscopy (in patients over 50 years); vi) disease activity and damages should be monitor using standardised and validated tools. Yet, only half of these CPGs were evidence-based. Crucial unmet needs were identified both by patients and clinicians. In particular, there was a lack of large multidisciplinary working group and of patients ' preferences. The following fields were not or inappropriately targeted: diagnosis; management of extra-muscular involvements other than skin; co-morbidities and severe manifestations.
Collapse
Affiliation(s)
- Alain Meyer
- Centre National de Référence des Maladies Systémiques et Auto-immunes Rares Grand-Est Sud-Ouest (RESO), Service de humatologie, Service de physiologie, Unité d’explorations fonctionnelles musculaires, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- EA3072, Fédération de Médecine Translationelle, Université de Strasbourg, Strasbourg, France
| | - Carlo Alberto Scirè
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | | | - Tobias Alexander
- Department of Rheumatology and Clinical Immunology, Charité University Hospital Berlin, Berlin, Germany
| | - Zahir Amoura
- Department of Internal Medicine, Hospital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Tadej Avcin
- Department of Allergology, Rheumatology and Clinical Immunology, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Simone Barsotti
- Rheumatology Unit, University of Pisa, Pisa, Italy
- Department of Medical Biotechnology, University of Siena, Siena, Italy
| | - Lorenzo Beretta
- Referral Center for Systemic Autoimmue Diseases, Referral Center for Systemic Autoimmue DiseasesFondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Jelena Blagojevic
- Department of Clinical and Experimental Medicine, Department of Geriatric Medicine, Division of Rheumatology and Scleroderma Unit, University of Florence, AOUC, Florence, Italy
| | - Gerd Burmester
- Department of Rheumatology and Clinical Immunology, Charité University Hospital Berlin, Berlin, Germany
| | - Ilaria Cavazzana
- Rheumatology and Clinical Immunology Unit, Civil Hospital, Brescia, Italy
| | - Patrick Cherrin
- Department of Internal Medicine, Hospital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Laura Damian
- Department of Rheumatology, Emergency County Teaching Hospital, Cluj-Napoca, Romania
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine, AO Padova and University of Padua, Padua, Italy
| | - João Eurico Fonseca
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Federica Furini
- Section of Rheumatology, Department of Medical Sciences, Sant’Anna University Hospital, Ferrara, Italy
| | - Ilaria Galetti
- FESCA, Federation of European Scleroderma Associations, Milan, Italy
| | - Frederic Houssiau
- Department of Rheumatology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Thomas Krieg
- Department of Dermatology, Universitätsklinikum Köln, Cologne, Germany
| | - Maddalena Larosa
- Rheumatology Unit, Department of Medicine, AO Padova and University of Padua, Padua, Italy
| | - David Launay
- Département de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Systémiques et Auto-Immunes Rares du Nord-Ouest (CERAINO), Université de Lille, CHU Lille, LIRIC, INSERM, Lille, France
| | - Raquel Campanilho-Marques
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Thierry Martin
- Departement of Internal Medicine, Centre National de Référence des Maladies Systémiques et Auto-immunes Rares Grand-Est Sud-Ouest (RESO), Hôpitaux Universitaires de Strasbourg, France, Strasbourg, France
| | - Marco Matucci-Cerinic
- Department of Clinical and Experimental Medicine, Department of Geriatric Medicine, Division of Rheumatology and Scleroderma Unit, University of Florence, AOUC, Florence, Italy
| | - Pia Moinzadeh
- Department of Dermatology, Universitätsklinikum Köln, Cologne, Germany
| | | | - Maria Francisca Moraes-Fontes
- Unidade de Doenças Auto-imunes/Medicina 7.2, Hospital de Curry Cabral, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Luc Mouthon
- Service de Médecine Interne, Centre de Référence Maladies systémiques Autoimmunes Rares d’Ile de France, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Cochin, Université Paris Descartes, Paris, France
| | | | - Sabrina Paolino
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, IRCCS Polyclinic Hospital San Martino, University of Genoa, Genoa, Italy
| | - Yves Piette
- Department of Rheumatology, Department of Internal Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Simona Rednic
- Department of Rheumatology, Emergency County Teaching Hospital, Cluj-Napoca, Romania
| | - Farah Tamirou
- Department of Rheumatology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Angela Tincani
- Rheumatology and Clinical Immunology Unit, Civil Hospital, Brescia, Italy
| | - Natasa Toplak
- Department of Allergology, Rheumatology and Clinical Immunology, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | | | - Eric Hachulla
- Département de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Systémiques et Auto-Immunes Rares du Nord-Ouest (CERAINO), Université de Lille, CHU Lille, LIRIC, INSERM, Lille, France
| | - Ulf Mueller-Ladner
- Department of Rheumatology and Clinical Immunology, Kerckhoff Klinik, Justus-Liebig University of Giessen, Bad Nauheim, Germany
| | - Matthias Schneider
- Department of Rheumatology, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Vanessa Smith
- Department of Rheumatology, Department of Internal Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Ana Vieira
- Liga Portuguesa Contra as Doenças Reumáticas, Núcleo Síndrome de Sjögren, Lisbon, Portugal
| | - Maurizio Cutolo
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, IRCCS Polyclinic Hospital San Martino, University of Genoa, Genoa, Italy
| | - Marta Mosca
- Rheumatology Unit, AOU Pisana, Pisa, Italy
- Rheumatology Unit, University of Pisa, Pisa, Italy
| | - Lorenzo Cavagna
- Division of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| |
Collapse
|
35
|
Iaccarino L, Talarico R, Scirè CA, Amoura Z, Burmester G, Doria A, Faiz K, Frank C, Hachulla E, Hie M, Launay D, Montecucco C, Monti S, Mouthon L, Tincani A, Toniati P, Van Hagen PM, Van Vollenhoven RF, Bombardieri S, Mueller-Ladner U, Schneider M, Smith V, Cutolo M, Mosca M, Alexander T. IgG4-related diseases: state of the art on clinical practice guidelines. RMD Open 2019; 4:e000787. [PMID: 30729031 PMCID: PMC6341179 DOI: 10.1136/rmdopen-2018-000787] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 08/05/2018] [Revised: 11/24/2018] [Accepted: 12/03/2018] [Indexed: 12/24/2022] Open
Abstract
Immunoglobulin G4-related diseases (IgG4-RD) are a group of chronic relapsing–remitting inflammatory conditions, characterised by tissue infiltration with lymphocytes and IgG4-secreting plasma cells, fibrosis and a usually favourable response to steroids. In this narrative review, we summarise the results of a systematic literature research, which was performed as part of the European Reference Network ReCONNET, aimed at evaluating existing clinical practice guidelines (CPGs) and recommendations in IgG4-RD. From 167 publications initially obtained from a systematic literature search, only one was identified as a systematic multispecialist, evidence-based, consensus guidance statement on diagnosis and treatment of IgG4-RD, which may be recommended for use as CPG in IgG4-RD. With the recognition of a limited evidence based in this increasingly recognised disease, the group discussion has identified the following unmet needs: lack of shared classification criteria, absence of formal guidelines on diagnosis, no evidence-based therapeutic recommendations and lack of activity and damage indices. Areas of unmet needs include the difficulties in diagnosis, management and monitoring and the scarcity of expert centres.
Collapse
Affiliation(s)
- Luca Iaccarino
- Rheumatology Unit, Department of Medicine, AO Padova and University of Padua, Padua, Italy
| | | | - Carlo Alberto Scirè
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Zahir Amoura
- Department of Internal Medicine, Hospital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Gerd Burmester
- Department of Rheumatology and Clinical Immunology, Charité-University Medicine Berlin, Berlin, Germany
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine, AO Padova and University of Padua, Padua, Italy
| | - Karim Faiz
- Department of Internal Medicine and Immunology, Erasmus MC, Rotterdam, The Netherlands
| | | | - Eric Hachulla
- Département de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Systémiques et Auto-Immunes Rares du Nord-Ouest (CERAINO), LIRIC, INSERM, Univ. Lille, CHU Lille, Lille, France
| | - Miguel Hie
- Department of Internal Medicine, Hospital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - David Launay
- Département de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Systémiques et Auto-Immunes Rares du Nord-Ouest (CERAINO), LIRIC, INSERM, Univ. Lille, CHU Lille, Lille, France
| | | | - Sara Monti
- Division of Rheumatology, University and IRCCS Policlinico S Matteo Foundation, Pavia, Italy
| | - Luc Mouthon
- Service de Médecine Interne, Hôpital Cochin, Centre de Référence Maladies systémiques Autoimmunes Rares d'Ile de France, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Descartes, Paris, France
| | - Angela Tincani
- Rheumatology and Clinical Immunology Unit, Civil Hospital, Brescia, Italy
| | - Paola Toniati
- Rheumatology and Clinical Immunology Unit, Civil Hospital, Brescia, Italy
| | | | - Ronald F Van Vollenhoven
- Clinical Immunology and Rheumatology, Amsterdam Rheumatology and Immunology Center, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | | | - Ulf Mueller-Ladner
- Department of Rheumatology and Clinical Immunology, Kerckhoff Klinik, Justus-Liebig University of Giessen, Bad Nauheim, Germany
| | - Matthias Schneider
- Department of Rheumatology, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Vanessa Smith
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.,Department of Internal Medicine, Ghent University, Ghent, Belgium
| | - Maurizio Cutolo
- Academic Division of Clinical Rheumatology, Department of Internal Medicine, IRCCS Polyclinic Hospital San Martino, University of Genoa, Genoa, Italy
| | - Marta Mosca
- Rheumatology Unit, AOU Pisana, Pisa, Italy.,Rheumatology Unit, University of Pisa, Pisa, Italy
| | - Tobias Alexander
- Department of Rheumatology and Clinical Immunology, Charité-University Medicine Berlin, Berlin, Germany
| |
Collapse
|
36
|
Tamirou F, Arnaud L, Talarico R, Scirè CA, Alexander T, Amoura Z, Avcin T, Bortoluzzi A, Cervera R, Conti F, Cornet A, Devilliers H, Doria A, Frassi M, Fredi M, Govoni M, Houssiau F, Lladò A, Macieira C, Martin T, Massaro L, Moraes-Fontes MF, Pamfil C, Paolino S, Tani C, Tas SW, Tektonidou M, Tincani A, Van Vollenhoven RF, Bombardieri S, Burmester G, Eurico FJ, Galetti I, Hachulla E, Mueller-Ladner U, Schneider M, Smith V, Cutolo M, Mosca M, Costedoat-Chalumeau N. Systemic lupus erythematosus: state of the art on clinical practice guidelines. RMD Open 2018; 4:e000793. [PMID: 30564454 PMCID: PMC6269635 DOI: 10.1136/rmdopen-2018-000793] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [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: 08/06/2018] [Revised: 10/05/2018] [Accepted: 10/08/2018] [Indexed: 12/16/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is the paradigm of systemic autoimmune diseases characterised by a wide spectrum of clinical manifestations with an unpredictable relapsing-remitting course. The aim of the present work was to identify current available clinical practice guidelines (CPGs) for SLE, to provide their review and to identify physicians’ and patients’ unmet needs. Twenty-three original guidelines published between 2004 and 2017 were identified. Many aspects of disease management are covered, including global disease management, lupus nephritis and neuropsychiatric involvement, management of pregnancies, vaccinations and comorbidities monitoring. Unmet needs relate with disease management of some clinical manifestations and adherence to treatment. Many patient’s unmet needs have been identified starting with faster diagnosis, need for more therapeutic options, guidelines on lifestyle issues, attention to quality of life and adequate education.
Collapse
Affiliation(s)
- Farah Tamirou
- Rheumatology Department, Cliniques universitaires Saint-Luc, Université catholique deLouvain, Bruxelles, Belgium
| | - Laurent Arnaud
- Service de rhumatologie, Hôpitaux Universitaires de Strasbourg, Centre National de Referencedes Maladies Auto-immunes et Systémiques Rares RESO, Strasbourg, France
| | | | - Carlo Alberto Scirè
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Tobias Alexander
- Department of Rheumatology and Clinical Immunology, Charité - University Medicine Berlin, Berlin, Germany
| | - Zahir Amoura
- Department of Internal Medicine, Hospital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Tadej Avcin
- Department of Allergology, Rheumatology and Clinical Immunology, University Children'sHospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Alessandra Bortoluzzi
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain
| | - Fabrizio Conti
- Rheumatology Unit, Dipartimento di Medicina Interna e Specialità Mediche, Università degliStudi di Roma La Sapienza, Rome, Italy
| | | | - Hervé Devilliers
- Department of Internal Medicine and Systemic Diseases, François-Mitterrand Teaching Hospital, University of Bourgogne-Franche-Comté, Dijon, France
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine, AO Padova and University of Padua, Padua, Italy
| | - Micol Frassi
- Rheumatology and Clinical Immunology Unit, Civil Hospital, Brescia, Italy
| | - Micaela Fredi
- Rheumatology and Clinical Immunology Unit, Civil Hospital, Brescia, Italy
| | - Marcello Govoni
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Frederic Houssiau
- Rheumatology Department, Cliniques universitaires Saint-Luc, Université catholique deLouvain, Bruxelles, Belgium
| | - Ana Lladò
- Unidade de Doenças Auto-imunes/Medicina 7.2, Hospital de Curry Cabral, Centro Hospitalarde Lisboa Central, Lisbon, Portugal
| | - Carla Macieira
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Thierry Martin
- Department of Rheumatology, Emergency County Teaching Hospital, Cluj-Napoca, Romania
| | - Laura Massaro
- Rheumatology Unit, Dipartimento di Medicina Interna e Specialità Mediche, Università degliStudi di Roma La Sapienza, Rome, Italy
| | - Maria Francisca Moraes-Fontes
- Unidade de Doenças Auto-imunes/Medicina 7.2, Hospital de Curry Cabral, Centro Hospitalarde Lisboa Central, Lisbon, Portugal
| | - Cristina Pamfil
- Department of Rheumatology, Emergency County Teaching Hospital, Cluj-Napoca, Romania
| | - Sabrina Paolino
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, IRCCS Polyclinic Hospital San Martino, University of Genoa, Genoa, Italy
| | | | - Sander W Tas
- Amsterdam UMC, Department of Clinical Immunology & Rheumatology and Department of Experimental Immunology, Amsterdam Infection and Immunity Institute, Meibergdreef 9, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Rheumatology & immunology Center (ARC), Academic Medical Center, Amsterdam, The Netherlands
| | - Maria Tektonidou
- Joint Rheumatology Academic Program, First Department of Propaedeutic Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Angela Tincani
- Rheumatology and Clinical Immunology Unit, Civil Hospital, Brescia, Italy
| | - Ronald F Van Vollenhoven
- Clinical Immunology & Rheumatology, Amsterdam Rheumatology & Immunology Center, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | | | - Gerd Burmester
- Department of Rheumatology and Clinical Immunology, Charité - University Medicine Berlin, Berlin, Germany
| | - Fonseca João Eurico
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Ilaria Galetti
- FESCA - Federation of European Scleroderma Association, Milan, Italy
| | - Eric Hachulla
- Département de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Systémiques et Auto-Immunes Rares du Nord-Ouest (CERAINO), LIRIC, INSERM, Univ. Lille, CHU Lille, Lille, France
| | - Ulf Mueller-Ladner
- Department of Rheumatology and Clinical Immunology, Kerckhoff Clinic, Bad Nauheim, Germany
| | - Matthias Schneider
- Department of Rheumatology, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Vanessa Smith
- Department of Rheumatology, Department of Internal Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Maurizio Cutolo
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, IRCCS Polyclinic Hospital San Martino, University of Genoa, Genoa, Italy
| | - Marta Mosca
- Rheumatology Unit, AOU Pisana, Pisa, Italy.,Rheumatology Unit, University of Pisa, Pisa, Italy
| | - Nathalie Costedoat-Chalumeau
- Assistance Publique-Hôpitaux de Paris (AP-HP), Internal Medicine Department, Cochin Hospital, Referral center for rare autoimmune and systemic diseases, Paris, France.,Paris Descartes Sorbonne, Paris Cité University, Paris, France.,INSERM U 1153, Center for Epidemiology andStatistics Sorbonne Paris Cité (CRESS), Paris, France
| |
Collapse
|
37
|
Limper M, Scirè CA, Talarico R, Amoura Z, Avcin T, Basile M, Burmester G, Carli L, Cervera R, Costedoat-Chalumeau N, Doria A, Dörner T, Fonseca JE, Galetti I, Hachulla E, Launay D, Lourenco F, Macieira C, Meroni P, Montecucco CM, Moraes-Fontes MF, Mouthon L, Nalli C, Ramoni V, Tektonidou M, van Laar JM, Bombardieri S, Schneider M, Smith V, Vieira A, Cutolo M, Mosca M, Tincani A. Antiphospholipid syndrome: state of the art on clinical practice guidelines. RMD Open 2018; 4:e000785. [PMID: 30402272 PMCID: PMC6203101 DOI: 10.1136/rmdopen-2018-000785] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [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: 08/01/2018] [Revised: 08/23/2018] [Accepted: 08/28/2018] [Indexed: 01/14/2023] Open
Abstract
Antiphospholipid syndrome (APS) is a rare disease characterised by venous and/or arterial thrombosis, pregnancy complications and the presence of specific autoantibodies called antiphospholipid antibodies. This review aims to identify existing clinical practice guidelines (CPG) as part of the ERN ReCONNET project, aimed at evaluating existing CPGs or recommendations in rare and complex diseases. Seventeen papers providing important data were identified; however, the literature search highlighted the scarceness of reliable clinical data to develop CPGs. With no formal clinical guidelines in place, diagnosis and treatment of APS is largely based on consensus and expert opinion. Patients' unmet need refers to the understanding of the disease and its clinical picture and implications, the need of education for patients, family members and healthcare providers, as well as to the development of monitoring pathways involving multiple healthcare providers.
Collapse
Affiliation(s)
- Marteen Limper
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Carlo Alberto Scirè
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | | | - Zahir Amoura
- Department of Internal Medicine, Hospital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Tadej Avcin
- Department of Allergology, Rheumatology and Clinical Immunology, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | | | - Gerd Burmester
- Department of Rheumatology and Clinical Immunology, Charité University Hospital Berlin, Berlin, Germany
| | | | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Nathalie Costedoat-Chalumeau
- Service de Médecine Interne, Hôpital Cochin, Centre de Référence Maladies systémiques Autoimmunes Rares d’Ile de France, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Descartes, Paris, France
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine, AO Padova and University of Padua, Padua, Italy
| | - Thomas Dörner
- Department of Rheumatology and Clinical Immunology, Charité University Hospital Berlin, Berlin, Germany
| | - João Eurico Fonseca
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Ilaria Galetti
- Federation of European Scleroderma Associations (FESCA), Milan, Italy
| | - Eric Hachulla
- Département de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Systémiques et Auto-Immunes Rares du Nord-Ouest (CERAINO), LIRIC, INSERM, Univ. Lille, CHU Lille, Lille, France
| | - David Launay
- Département de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Systémiques et Auto-Immunes Rares du Nord-Ouest (CERAINO), LIRIC, INSERM, Univ. Lille, CHU Lille, Lille, France
| | - Filipa Lourenco
- Auto-immune Disease Unit, Hospital de Curry Cabral, Centro Hospitalar de Lisboa Central, EPE, Lisbon, Portugal
| | - Carla Macieira
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Pierluigi Meroni
- Division of Rheumatology, ASST.G Pini, Department of Clinical Sciences and Community Health, University of Milan and Istituto Auxologico Italiano, Milan, Italy
| | | | | | - Luc Mouthon
- Service de Médecine Interne, Hôpital Cochin, Centre de Référence Maladies systémiques Autoimmunes Rares d’Ile de France, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Descartes, Paris, France
| | - Cecilia Nalli
- Rheumatology and Clinical Immunology Unit, Civil Hospital, Brescia, Italy
| | - Veronique Ramoni
- Division of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Maria Tektonidou
- Joint Rheumatology Academic Program, First Department of Propaedeutic Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Jacob M van Laar
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - Matthias Schneider
- Department of Rheumatology, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Vanessa Smith
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
- Department of Internal Medicine, Ghent University, Ghent, Belgium
| | - Ana Vieira
- Liga Portuguesa Contra as Doenças Reumáticas, Núcleo Síndrome de Sjögren, Lisbon, Portugal
| | - Maurizio Cutolo
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, IRCCS Polyclinic Hospital San Martino, University of Genoa, Genoa, Italy
| | - Marta Mosca
- Rheumatology Unit, AOU Pisana, Pisa, Italy
- Rheumatology Unit, University of Pisa, Pisa, Italy
| | - Angela Tincani
- Rheumatology and Clinical Immunology Unit, Civil Hospital, Brescia, Italy
| |
Collapse
|
38
|
Smith V, Scirè CA, Talarico R, Airo P, Alexander T, Allanore Y, Bruni C, Codullo V, Dalm V, De Vries-Bouwstra J, Della Rossa A, Distler O, Galetti I, Launay D, Lepri G, Mathian A, Mouthon L, Ruaro B, Sulli A, Tincani A, Vandecasteele E, Vanhaecke A, Vanthuyne M, Van den Hoogen F, Van Vollenhoven R, Voskuyl AE, Zanatta E, Bombardieri S, Burmester G, Eurico FJ, Frank C, Hachulla E, Houssiau F, Mueller-Ladner U, Schneider M, van Laar JM, Vieira A, Cutolo M, Mosca M, Matucci-Cerinic M. Systemic sclerosis: state of the art on clinical practice guidelines. RMD Open 2018; 4:e000782. [PMID: 30402270 PMCID: PMC6203100 DOI: 10.1136/rmdopen-2018-000782] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [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: 07/31/2018] [Revised: 09/21/2018] [Accepted: 09/22/2018] [Indexed: 12/29/2022] Open
Abstract
Systemic sclerosis (SSc) is an orphan disease characterised by autoimmunity, fibrosis of the skin and internal organs, and vasculopathy. SSc may be associated with high morbidity and mortality. In this narrative review we summarise the results of a systematic literature research, which was performed as part of the European Reference Network on Rare and Complex Connective Tissue and Musculoskeletal Diseases project, aimed at evaluating existing clinical practice guidelines or recommendations. Only in the domains ‘Vascular & Ulcers’ (ie, non-pharmacological approach to digital ulcer), ‘PAH’ (ie, screening and treatment), ‘Treatment’ and ‘Juveniles’ (ie, evaluation of juveniles with Raynaud’s phenomenon) evidence-based and consensus-based guidelines could be included. Hence there is a preponderance of unmet needs in SSc referring to the diagnosis and (non-)pharmacological treatment of several SSc-specific complications. Patients with SSc experience significant uncertainty concerning SSc-related taxonomy, management (both pharmacological and non-pharmacological) and education. Day-to-day impact of the disease (loss of self-esteem, fatigue, sexual dysfunction, and occupational, nutritional and relational problems) is underestimated and needs evaluation.
Collapse
Affiliation(s)
- Vanessa Smith
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.,Department of Internal Medicine, Ghent University, Ghent, Belgium
| | - Carlo Alberto Scirè
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy.,Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan, Italy
| | - Rosaria Talarico
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Paolo Airo
- Rheumatology and Clinical Immunology Unit, Azienda Ospedaliera Spedali Civili di Brescia, Brescia, Italy
| | - Tobias Alexander
- Department of Rheumatology and Clinical Immunology Unit, Charité University Hospital Berlin, Berlin, Germany
| | - Yannick Allanore
- Service de Médicine Interne, Université Paris Descartes, Paris, France.,Centre de Référence Maladies systémiques Autoimmunes Rares d'Ile de France, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Cochin, Paris, France
| | - Cosimo Bruni
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy.,Division of Rheumatology and Scleroderma Unit, AOU Careggi, Florence, Italy
| | - Veronica Codullo
- Department of Rheumatology, University of Pavia, Pavia, Italy.,Department of Rheumatology, IRCCS Policlinico San Matteo, Pavia, Italy
| | - Virgil Dalm
- Department of Internal Medicine and Department of Immunology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Alessandra Della Rossa
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Ilaria Galetti
- Federation of European Scleroderma Associations (FESCA), Brussels, Belgium
| | - David Launay
- Département de Médecine Interne et Immunologie Clinique, Université de Lille, Lille, France.,Centre de Référence des Maladies Systémiques et Auto-Immunes Rares du Nord-Ouest (CERAINO), LIRIC, INSERM, CHU Lille, Lille, France
| | - Gemma Lepri
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy.,Division of Rheumatology and Scleroderma Unit, AOU Careggi, Florence, Italy
| | - Alexis Mathian
- Department of Internal Medicine, Hospital Pitié-Salpêtrière, Paris, France
| | - Luc Mouthon
- Service de Médicine Interne, Université Paris Descartes, Paris, France.,Centre de Référence Maladies systémiques Autoimmunes Rares d'Ile de France, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Cochin, Paris, France
| | - Barbara Ruaro
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, IRCCS San Martino Polyclinic Hospital, University of Genoa, Genoa, Italy
| | - Alberto Sulli
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, IRCCS San Martino Polyclinic Hospital, University of Genoa, Genoa, Italy
| | - Angela Tincani
- Rheumatology and Clinical Immunology Unit, Azienda Ospedaliera Spedali Civili di Brescia, Brescia, Italy
| | - Els Vandecasteele
- Department of Internal Medicine, Ghent University, Ghent, Belgium.,Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Amber Vanhaecke
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.,Department of Internal Medicine, Ghent University, Ghent, Belgium
| | - Marie Vanthuyne
- Department of Rheumatology, Université Catholique de Louvain, Louvain-la-Neuve, Belgium.,Department of Rheumatology, Cliniques Universitaires Saint-Luc, Louvain-la-Neuve, Belgium
| | - Frank Van den Hoogen
- Department of Rheumatology, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands.,Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Ronald Van Vollenhoven
- Clinical Immunology & Rheumatology, Amsterdam Rheumatology & Immunology Center, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - Alexandre E Voskuyl
- Department of Rheumatology, Amsterdam UMC, Amsterdam, The Netherlands.,Amsterdam Infection & Immunity Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Elisabetta Zanatta
- Division of Rheumatology, Department of Medicine, University of Padova, Padova, Italy
| | - Stefano Bombardieri
- Rheumatology Unit, Department of Clinical & Experimental Medicine, University of Pisa, Pisa, Italy
| | - Gerd Burmester
- Department of Rheumatology and Clinical Immunology, Charité University Hospital Berlin, Berlin, Germany
| | - Fonseca João Eurico
- Department of Rheumatology, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal.,Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Charissa Frank
- Flemish Patient Organization of Hereditary Collagen Disorders in Belgium, Koersel, Belgium
| | - Eric Hachulla
- Département de Médecine Interne et Immunologie Clinique, Université de Lille, Lille, France.,Centre de Référence des Maladies Systémiques et Auto-Immunes Rares du Nord-Ouest (CERAINO), LIRIC, INSERM, CHU Lille, Lille, France
| | - Frederic Houssiau
- Department of Rheumatology, Université Catholique de Louvain, Louvain-la-Neuve, Belgium.,Department of Rheumatology, Cliniques Universitaires Saint-Luc, Louvain-la-Neuve, Belgium
| | - Ulf Mueller-Ladner
- Department of Rheumatology and Clinical Immunology, Kerckhoff Klinik, Justus-Liebig University of Giessen, Giessen, Germany
| | - Matthias Schneider
- Institute for Rheumatology, Hiller Research Unit for Rheumatology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Jacob M van Laar
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ana Vieira
- Núcleo Síndrome de Sjögren of Liga Portuguesa Contra as Doenças Reumáticas (LPCDR, Portuguese League Against Rheumatic Diseases), Lisbon, Portugal
| | - Maurizio Cutolo
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, IRCCS San Martino Polyclinic Hospital, University of Genoa, Genoa, Italy
| | - Marta Mosca
- Rheumatology Unit, Department of Internal Medicine, University of Pisa, Pisa, Italy
| | - Marco Matucci-Cerinic
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy.,Division of Rheumatology and Scleroderma Unit, AOU Careggi, Florence, Italy
| |
Collapse
|
39
|
Stamm TA, Machold KP, Aletaha D, Alasti F, Lipsky P, Pisetsky D, Landewe R, van der Heijde D, Sepriano A, Aringer M, Boumpas D, Burmester G, Cutolo M, Ebner W, Graninger W, Huizinga T, Schett G, Schulze-Koops H, Tak PP, Martin-Mola E, Breedveld F, Smolen J. Induction of sustained remission in early inflammatory arthritis with the combination of infliximab plus methotrexate: the DINORA trial. Arthritis Res Ther 2018; 20:174. [PMID: 30092827 PMCID: PMC6085639 DOI: 10.1186/s13075-018-1667-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 04/16/2018] [Accepted: 07/12/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND In the present study, we explored the effects of immediate induction therapy with the anti-tumour necrosis factor (TNF)α antibody infliximab (IFX) plus methotrexate (MTX) compared with MTX alone and with placebo (PL) in patients with very early inflammatory arthritis. METHODS In an investigator-initiated, double-blind, randomised, placebo-controlled, multi-centre trial (ISRCTN21272423, http://www.isrctn.com/ISRCTN21272423 ), patients with synovitis of 12 weeks duration in at least two joints underwent 1 year of treatment with IFX in combination with MTX, MTX monotherapy, or PL randomised in a 2:2:1 ratio. The primary endpoint was clinical remission after 1 year (sustained for at least two consecutive visits 8 weeks apart) with remission defined as no swollen joints, 0-2 tender joints, and an acute-phase reactant within the normal range. RESULTS Ninety patients participated in the present study. At week 54 (primary endpoint), 32% of the patients in the IFX + MTX group achieved sustained remission compared with 14% on MTX alone and 0% on PL. This difference (p < 0.05 over all three groups) was statistically significant for IFX + MTX vs PL (p < 0.05), but not for IFX + MTX vs MTX (p = 0.10), nor for MTX vs PL (p = 0.31). Remission was maintained during the second year on no therapy in 75% of the IFX + MTX patients compared with 20% of the MTX-only patients. CONCLUSIONS These results indicate that patients with early arthritis can benefit from induction therapy with anti-TNF plus MTX compared with MTX alone, suggesting that intensive treatment can alter the disease evolution. TRIAL REGISTRATION The trial was registered at http://www.isrctn.com/ISRCTN21272423 on 4 October 2007 (date applied)/12 December 2007 (date assigned). The first patient was included on 24 October 2007.
Collapse
Affiliation(s)
- Tanja Alexandra Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.,Department of Medicine III, Division of Rheumatology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Klaus Peter Machold
- Department of Medicine III, Division of Rheumatology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Daniel Aletaha
- Department of Medicine III, Division of Rheumatology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Farideh Alasti
- Department of Medicine III, Division of Rheumatology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Peter Lipsky
- RILITE Research Institute, 250 W Main Street, Charlottesville, Virginia, 22902, USA
| | - David Pisetsky
- Medical Research Service Durham VA Medical Center, and Duke University Medical Center, 151G Durham VA Medical Center, 508 Fulton Street, Durham, North Carolina, 27705, USA
| | - Robert Landewe
- Department of Medicine, Division of Rheumatology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Desiree van der Heijde
- Department of Rheumatology, Leiden University Medical Centre, Albinusdreef 2, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Alexandre Sepriano
- Department of Rheumatology, Leiden University Medical Centre, Albinusdreef 2, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Martin Aringer
- Division of Rheumatology, Department of Medicine III, University Medical Center and Faculty of Medicine Carl Gustav Carus at the TU Dresden, Fetscherstrasse 74, 01309, Dresden, Germany
| | - Dimitri Boumpas
- Rheumatology Medical School University of Crete, Heraklion and Joint Rheumatology Program, National and Kapodestrian University of Athens, Athens, Greece
| | - Gerd Burmester
- Department of Rheumatology and Clinical Immunology, Charité - University Medicine Berlin, Free University and Humboldt University Berlin, Berlin, Germany
| | - Maurizio Cutolo
- Research Laboratory and Division of Rheumatology, Department of Internal Medicine, University of Genova, Viale Benedetto XV, 6, 16132, Genoa, Italy
| | - Wolfgang Ebner
- Department of Internal Medicine, Centre for Rheumatic Diseases, Hietzing Hospital, Wolkersbergenstraße 1, 1130, Vienna, Austria
| | - Winfried Graninger
- Department of Rheumatology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Styria, Austria
| | - Tom Huizinga
- Department of Rheumatology, Leiden University Medical Centre, Albinusdreef 2, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Georg Schett
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Hendrik Schulze-Koops
- Division of Rheumatology and Clinical Immunology, Department of Internal Medicine IV, Ludwig Maximilians University of Munich, Pettenkoferstraße 8a, 80336, Munich, Germany
| | - Paul-Peter Tak
- Amsterdam Rheumatology and Immunology Center, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.,Department of Medicine, Cambridge University, Cambridge, UK.,Department of Rheumatology, Ghent University, Ghent, Belgium.,GlaxoSmithKline Research & Development, Stevenage, UK
| | - Emilio Martin-Mola
- Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Ferdinand Breedveld
- Leiden University Medical Center, Albinusdreef 2, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Josef Smolen
- Department of Medicine III, Division of Rheumatology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria. .,Department of Internal Medicine, Centre for Rheumatic Diseases, Hietzing Hospital, Wolkersbergenstraße 1, 1130, Vienna, Austria.
| |
Collapse
|
40
|
Horneff G, Emmrich F, Burmester G, Kalden J, Wolf F, Becker W. Kinetics of 99mTc-Labelled Antibodies against CD4 (T-Helper) Lymphocytes in Man. Nuklearmedizin 2018. [DOI: 10.1055/s-0038-1629607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
ZusammenfassungDie Verfügbarkeit 99mTc-markierter CD4-Antikörper erlaubt das Studium ihres kinetischen Verhaltens bei rheumatischen Patienten. Prospektiv wurden Patienten mit rheumatoider Arthritis untersucht. Drei dieser Patienten erhielten 250 µg eines mit 555 MBq 99mTc markierten CD4-Antikörpers (MAX16H5) injiziert. Ein Patient erhielt in vitro mit 99mTc markierte Lymphozyten. 4% der Aktivität wurden renal eliminiert. Von 4 nach 24 h p. i. fiel der Milzuptake von 7,5 auf 4%, der Leberuptake stieg von 25 auf 30%, der Knochemarkuptake blieb vergleichbar (50%), während der Uptake über einem großen erkrankten Gelenk von 2 geringfügig auf 2,5% stieg. 15 bis 30 min nach der Antikörperinjektion war eine Umverteilung von Aktivität zu registrieren, die einer Lymphozytenredistribution vergleichbar war. Die Recoveryrate (0-1 h) der in vivo markierten Zellen betrug 30%, die der in vitro markierten Zellen 19%. Ein Patient wurde mit in vitro CD4-Antikörper-markierten Lymphozyten untersucht. Ein signifikanter Unterschied der Kinetik beider Präparationen war nicht zu registrieren. Zusammenfassend schließen die Autoren, daß zirkulierende CD4-exprimierende Lymphozyten mit CD4-Antikörpern markiert werden können. Die kinetischen Daten erinnern an jene rezirkulierender Lymphozyten.
Collapse
|
41
|
Chatzidionysiou K, Emamikia S, Nam J, Ramiro S, Smolen J, van der Heijde D, Dougados M, Bijlsma J, Burmester G, Scholte M, van Vollenhoven R, Landewé R. Efficacy of glucocorticoids, conventional and targeted synthetic disease-modifying antirheumatic drugs: a systematic literature review informing the 2016 update of the EULAR recommendations for the management of rheumatoid arthritis. Ann Rheum Dis 2017; 76:1102-1107. [DOI: 10.1136/annrheumdis-2016-210711] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 01/26/2017] [Accepted: 02/28/2017] [Indexed: 12/26/2022]
Abstract
ObjectivesTo perform a systematic literature review (SLR) informing the 2016 update of the recommendations for the management of rheumatoid arthritis (RA).MethodsAn SLR for the period between 2013 and 2016 was undertaken to assess the efficacy of glucocorticoids (GCs), conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and targeted synthetic DMARDs (tsDMARDs) (tofacitinib and baricitinib) in randomised clinical trials.ResultsFor GCs, four studies were included in the SLR. Patients without poor prognostic factors experienced benefit when GCs were added to methotrexate (MTX). Lower doses of GCs were similar to higher doses. For csDMARDs, two new studies comparing MTX monotherapy with combination csDMARD were included in the SLR. In the tREACH trial at the end of 12 months no difference between the groups in disease activity, functional ability and radiographic progression was seen, using principles of tight control (treat-to-target). In the CareRA trial, combination therapy with csDMARDs was not superior to MTX monotherapy and monotherapy was better tolerated.For tsDMARDs, tofacitinib and baricitinib were shown to be more effective than placebo (MTX) in different patient populations.ConclusionsAddition of GCs to csDMARD therapy may be beneficial but the benefits should be balanced against the risk of toxicity. Under tight control conditions MTX monotherapy is not less effective than combination csDMARDs, but better tolerated. Tofacitinib and baricitinib are efficacious in patients with RA, including those with refractory disease.
Collapse
|
42
|
Smolen JS, Landewé R, Bijlsma J, Burmester G, Chatzidionysiou K, Dougados M, Nam J, Ramiro S, Voshaar M, van Vollenhoven R, Aletaha D, Aringer M, Boers M, Buckley CD, Buttgereit F, Bykerk V, Cardiel M, Combe B, Cutolo M, van Eijk-Hustings Y, Emery P, Finckh A, Gabay C, Gomez-Reino J, Gossec L, Gottenberg JE, Hazes JMW, Huizinga T, Jani M, Karateev D, Kouloumas M, Kvien T, Li Z, Mariette X, McInnes I, Mysler E, Nash P, Pavelka K, Poór G, Richez C, van Riel P, Rubbert-Roth A, Saag K, da Silva J, Stamm T, Takeuchi T, Westhovens R, de Wit M, van der Heijde D. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. Ann Rheum Dis 2017; 76:960-977. [PMID: 28264816 DOI: 10.1136/annrheumdis-2016-210715] [Citation(s) in RCA: 1725] [Impact Index Per Article: 246.4] [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: 10/22/2016] [Revised: 01/05/2017] [Accepted: 02/09/2017] [Indexed: 02/07/2023]
Abstract
Recent insights in rheumatoid arthritis (RA) necessitated updating the European League Against Rheumatism (EULAR) RA management recommendations. A large international Task Force based decisions on evidence from 3 systematic literature reviews, developing 4 overarching principles and 12 recommendations (vs 3 and 14, respectively, in 2013). The recommendations address conventional synthetic (cs) disease-modifying antirheumatic drugs (DMARDs) (methotrexate (MTX), leflunomide, sulfasalazine); glucocorticoids (GC); biological (b) DMARDs (tumour necrosis factor (TNF)-inhibitors (adalimumab, certolizumab pegol, etanercept, golimumab, infliximab), abatacept, rituximab, tocilizumab, clazakizumab, sarilumab and sirukumab and biosimilar (bs) DMARDs) and targeted synthetic (ts) DMARDs (Janus kinase (Jak) inhibitors tofacitinib, baricitinib). Monotherapy, combination therapy, treatment strategies (treat-to-target) and the targets of sustained clinical remission (as defined by the American College of Rheumatology-(ACR)-EULAR Boolean or index criteria) or low disease activity are discussed. Cost aspects were taken into consideration. As first strategy, the Task Force recommends MTX (rapid escalation to 25 mg/week) plus short-term GC, aiming at >50% improvement within 3 and target attainment within 6 months. If this fails stratification is recommended. Without unfavourable prognostic markers, switching to-or adding-another csDMARDs (plus short-term GC) is suggested. In the presence of unfavourable prognostic markers (autoantibodies, high disease activity, early erosions, failure of 2 csDMARDs), any bDMARD (current practice) or Jak-inhibitor should be added to the csDMARD. If this fails, any other bDMARD or tsDMARD is recommended. If a patient is in sustained remission, bDMARDs can be tapered. For each recommendation, levels of evidence and Task Force agreement are provided, both mostly very high. These recommendations intend informing rheumatologists, patients, national rheumatology societies, hospital officials, social security agencies and regulators about EULAR's most recent consensus on the management of RA, aimed at attaining best outcomes with current therapies.
Collapse
Affiliation(s)
- Josef S Smolen
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria.,2nd Department of Medicine, Hietzing Hospital, Vienna, Austria
| | - Robert Landewé
- Amsterdam Rheumatology & Immunology Center, Amsterdam, The Netherlands.,Zuyderland Medical Center, Heerlen, The Netherlands
| | - Johannes Bijlsma
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gerd Burmester
- Department of Rheumatology and Clinical Immunology, Charité-University Medicine Berlin, Free University and Humboldt University Berlin, Berlin, Germany
| | | | | | - Jackie Nam
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Sofia Ramiro
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marieke Voshaar
- Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
| | - Ronald van Vollenhoven
- Amsterdam Rheumatology & Immunology Center, Amsterdam, The Netherlands.,Zuyderland Medical Center, Heerlen, The Netherlands
| | - Daniel Aletaha
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Martin Aringer
- Division of Rheumatology, Medizinische Klinik und Poliklinik III, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Maarten Boers
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Chris D Buckley
- Birmingham NIHR Wellcome Trust Clinical Research Facility, Rheumatology Research Group, Institute of Inflammation and Ageing (IIA), University of Birmingham, Queen Elizabeth Hospital, Birmingham, UK
| | - Frank Buttgereit
- Department of Rheumatology and Clinical Immunology, Charité-University Medicine Berlin, Free University and Humboldt University Berlin, Berlin, Germany
| | - Vivian 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
| | - Mario Cardiel
- Centro de Investigación Clínica de Morelia SC, Michoacán, México
| | - Bernard Combe
- Rheumatology Department, Lapeyronie Hospital, Montpellier University, UMR 5535, Montpellier, France
| | - Maurizio Cutolo
- Research Laboratory and Division of Clinical Rheumatology, University of Genoa, Genoa, Italy
| | - Yvonne van Eijk-Hustings
- Department of Patient & Care and Department of Rheumatology, University of Maastricht, Maastricht, The Netherlands
| | - Paul Emery
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Axel Finckh
- Division of Rheumatology, University Hospitals of Geneva, Geneva, Switzerland
| | - Cem Gabay
- Division of Rheumatology, University Hospitals of Geneva, Geneva, Switzerland
| | - Juan Gomez-Reino
- Fundación Ramón Dominguez, Hospital Clinico Universitario, Santiago, Spain
| | - Laure Gossec
- Department of Rheumatology, Sorbonne Universités, Pitié Salpêtrière Hospital, Paris, France
| | - Jacques-Eric Gottenberg
- Institut de Biologie Moléculaire et Cellulaire, Immunopathologie, et Chimie Thérapeutique, Strasbourg University Hospital and University of Strasbourg, CNRS, Strasbourg, France
| | - Johanna M W Hazes
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Tom Huizinga
- Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
| | - Meghna Jani
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, University of Manchester, Manchester, UK
| | - Dmitry Karateev
- V.A. Nasonova Research Institute of Rheumatology, Moscow, Russian Federation
| | - Marios Kouloumas
- European League Against Rheumatism, Zurich, Switzerland.,Cyprus League against Rheumatism, Nicosia, Cyprus
| | - Tore Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Zhanguo Li
- Department of Rheumatology and Immunology, Beijing University People's Hospital, Beijing, China
| | - Xavier Mariette
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, INSERM U1184, Center for Immunology of viral Infections and Autoimmune Diseases (IMVA), Le Kremlin Bicêtre, France
| | - Iain McInnes
- Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Eduardo Mysler
- Organización Médica de Investigación, Buenos Aires, Argentina
| | - Peter Nash
- Department of Medicine, University of Queensland, Queensland, Australia
| | - Karel Pavelka
- Institute of Rheumatology and Clinic of Rheumatology, Charles University, Prague, Czech Republic
| | - Gyula Poór
- National Institute of Rheumatology and Physiotherapy, Semmelweis University, Budapest, Hungary
| | - Christophe Richez
- Rheumatology Department, FHU ACRONIM, Pellegrin Hospital and UMR CNRS 5164, Bordeaux University, Bordeaux, France
| | - Piet van Riel
- Department of Rheumatology, Bernhoven, Uden, The Netherlands
| | | | - Kenneth Saag
- Division of Rheumatology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jose da Silva
- Serviço de Reumatologia, Centro Hospitalar e Universitário de Coimbra Praceta Mota Pinto, Coimbra, Portugal
| | - Tanja Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Tsutomu Takeuchi
- Keio University School of Medicine, Keio University Hospital, Tokyo, Japan
| | - René Westhovens
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, KU Leuven, Leuven, Belgium.,Department of Rheumatology, University Hospitals Leuven, Leuven, Belgium
| | - Maarten de Wit
- Department Medical Humanities, VU Medical Centre, Amsterdam, The Netherlands
| | | |
Collapse
|
43
|
Massenkeil G, Alexander T, Rosen O, Dörken B, Burmester G, Radbruch A, Hiepe F, Arnold R. Long-term follow-up of fertility and pregnancy in autoimmune diseases after autologous haematopoietic stem cell transplantation. Rheumatol Int 2016; 36:1563-1568. [PMID: 27522225 DOI: 10.1007/s00296-016-3531-2] [Citation(s) in RCA: 17] [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] [Received: 01/04/2016] [Accepted: 07/08/2016] [Indexed: 12/29/2022]
Abstract
Issues of fertility and pregnancy require special attention in the long-term care of patients with autoimmune diseases (AD), who are candidates for haematopoietic stem cell transplantation (HSCT). In this single-centre observational study, we report fertility status and pregnancy outcomes in 15 patients (11 female and 4 male) after immunoablation with cyclophosphamide, antithymocyte globulin and autologous CD34+-selected HSCT for severe, refractory AD. The median follow-up after HSCT was 12 years (range 2-16 years). Impaired fertility was observed in six patients (five females and one male) before HSCT based on sexual hormone measurements. Higher age and cumulative cyclophosphamide dosage before HSCT correlated with fertility impairment. Median serum level of follicle-stimulating hormone (FSH) was significantly higher in female patients at 1 year after HSCT compared to baseline values, but premature ovarian failure developed in only one patient. Four women had five pregnancies and six healthy offsprings during follow-up, and no miscarriages were observed. The mothers were in treatment-free remissions during conception. No peripartal flare of their AD occurred. Although AD patients undergoing HSCT are at risk of developing infertility, pre-HSCT treatment and patients' age seem to have higher impact on long-term fertility status than HSCT itself. HSCT offers the opportunity to conceive during treatment-free remissions with favourable pregnancy outcomes.
Collapse
Affiliation(s)
- G Massenkeil
- Department of Haematology and Oncology, Charité University Medicine, Berlin, Germany. .,Department of Internal Medicine, Klinikum Guetersloh, Reckenberger Strasse 19, 33332, Guetersloh, Germany.
| | - T Alexander
- Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin, Germany
| | - O Rosen
- Department of Haematology and Oncology, Charité University Medicine, Berlin, Germany
| | - B Dörken
- Department of Haematology and Oncology, Charité University Medicine, Berlin, Germany
| | - G Burmester
- Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin, Germany
| | - A Radbruch
- German Rheumatism Research Centre, Berlin, Germany
| | - F Hiepe
- Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin, Germany
| | - R Arnold
- Department of Haematology and Oncology, Charité University Medicine, Berlin, Germany
| |
Collapse
|
44
|
Baraliakos X, Heldmann F, van den Bosch F, Burmester G, Gaston H, van der Horst-Bruinsma IE, Krause A, Schmidt R, Schneider M, Sieper J, Andermann B, van Tubergen A, Witt M, Braun J. Long-term efficiency of infliximab in patients with ankylosing spondylitis: real life data confirm the potential for dose reduction. RMD Open 2016; 2:e000272. [PMID: 27493791 PMCID: PMC4964174 DOI: 10.1136/rmdopen-2016-000272] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 02/27/2016] [Revised: 04/24/2016] [Accepted: 05/03/2016] [Indexed: 01/15/2023] Open
Abstract
Objective To analyse the treatment outcome of patients with ankylosing spondylitis (AS) in the European AS infliximab cohort (EASIC) study after a total period of 8 years with specific focus on dosage and the duration of intervals between infliximab infusions. Methods EASIC included patients with AS who had received infliximab for 2 years as part of the ASSERT trial. After that period, rheumatologists were free to change the dose or the intervals of infliximab. Clinical data were status at baseline, end of ASSERT and for a total of 8 years of follow-up. Results Of the initially 71 patients with AS from EASIC, 55 patients (77.5%) had completed the 8th year of anti-tumour necrosis factor (TNF) treatment. Of those, 48 patients (87.3%) still continued on infliximab. The mean infusion interval increased slightly from 6 to 7.1±1.5 weeks, while 45.8% patients had increased the intervals up to a maximum of 12 weeks. The mean infliximab dose remained stable over time, with a minimum of 3.1 mg/kg and a maximum of 6.4 mg/kg. In patients receiving <5 mg/kg infliximab, the mean infusion interval increased to 7.0±1.2 weeks. In total, the mean cumulative dose per patient and per year decreased from 3566.30 to 2973.60 mg. Conclusions We could observe that over a follow-up of 8 years of treatment with infliximab, >85% patients still remained on the same treatment, without any major safety events. Furthermore, both the infusion intervals and also the mean infliximab dose were modestly reduced in ≥70% of the patients without the loss of clinical efficiency.
Collapse
Affiliation(s)
| | - F Heldmann
- Zeisigwaldkliniken Bethanien , Chemnitz , Germany
| | | | - G Burmester
- Charité University Medicine Berlin , Berlin , Germany
| | - H Gaston
- University of Cambridge , Cambridge , UK
| | | | - A Krause
- Immanuel Krankenhaus , Berlin , Germany
| | - R Schmidt
- Medical University Hannover , Germany
| | | | - J Sieper
- Charité Campus Benjamin Franklin , Berlin , Germany
| | - B Andermann
- Private rheumatology practice , Berlin , Germany
| | | | - M Witt
- University of Munich , Germany
| | - J Braun
- Rheumazentrum Ruhrgebiet , Herne , Germany
| |
Collapse
|
45
|
Charles-Schoeman C, Burmester G, Nash P, Zerbini CAF, Soma K, Kwok K, Hendrikx T, Bananis E, Fleischmann R. Efficacy and safety of tofacitinib following inadequate response to conventional synthetic or biological disease-modifying antirheumatic drugs. Ann Rheum Dis 2016; 75:1293-301. [PMID: 26275429 PMCID: PMC4941182 DOI: 10.1136/annrheumdis-2014-207178] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 06/24/2015] [Accepted: 07/14/2015] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Biological disease-modifying antirheumatic drugs (bDMARDs) have shown diminished clinical response following an inadequate response (IR) to ≥1 previous bDMARD. Here, tofacitinib was compared with placebo in patients with an IR to conventional synthetic DMARDs (csDMARDs; bDMARD-naive) and in patients with an IR to bDMARDs (bDMARD-IR). METHODS Data were taken from phase II and phase III studies of tofacitinib in patients with rheumatoid arthritis (RA). Patients received tofacitinib 5 or 10 mg twice daily, or placebo, as monotherapy or with background methotrexate or other csDMARDs. Efficacy endpoints and incidence rates of adverse events (AEs) of special interest were assessed. RESULTS 2812 bDMARD-naive and 705 bDMARD-IR patients were analysed. Baseline demographics and disease characteristics were generally similar between treatment groups within subpopulations. Across subpopulations, improvements in efficacy parameters at month 3 were generally significantly greater for both tofacitinib doses versus placebo. Clinical response was numerically greater with bDMARD-naive versus bDMARD-IR patients (overlapping 95% CIs). Rates of safety events of special interest were generally similar between tofacitinib doses and subpopulations; however, patients receiving glucocorticoids had more serious AEs, discontinuations due to AEs, serious infection events and herpes zoster. Numerically greater clinical responses and incidence rates of AEs of special interest were generally reported for tofacitinib 10 mg twice daily versus tofacitinib 5 mg twice daily (overlapping 95% CIs). CONCLUSIONS Tofacitinib demonstrated efficacy in both bDMARD-naive and bDMARD-IR patients with RA. Clinical response to tofacitinib was generally numerically greater in bDMARD-naive than bDMARD-IR patients. The safety profile appeared similar between subpopulations. TRIAL REGISTRATION NUMBERS (NCT00413660, NCT00550446, NCT00603512, NCT00687193, NCT00960440, NCT00847613, NCT00814307, NCT00856544, NCT00853385).
Collapse
Affiliation(s)
| | | | - Peter Nash
- Rheumatology Research Unit, Nambour Hospital, Sunshine Coast, Australia
- Department of Medicine, University of Queensland, Queensland, Australia
| | | | | | | | | | | | - Roy Fleischmann
- Department of Medicine, Metroplex Clinical Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| |
Collapse
|
46
|
Schett G, Emery P, Tanaka Y, Burmester G, Pisetsky DS, Naredo E, Fautrel B, van Vollenhoven R. Tapering biologic and conventional DMARD therapy in rheumatoid arthritis: current evidence and future directions. Ann Rheum Dis 2016; 75:1428-37. [DOI: 10.1136/annrheumdis-2016-209201] [Citation(s) in RCA: 181] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 05/16/2016] [Indexed: 01/01/2023]
|
47
|
Köhm M, Rossmanith T, Langer HE, Burmester G, Wassenberg S, Kaesser U, Backhaus M, Burkhardt H, Behrens F. AB0741 Detection of Psoriatic Arthritis in Patients with Psoriasis in Daily Routine Care Using Questionnaires for Diagnosis of Psoriatic Arthritis and Fluorescence-Optical Imaging Technique: Diagnostic Value for Detection of Subclinical Signs of Musculoskeletal Inflammation in Psoriasis? Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.5770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
48
|
Rose T, Szelinski F, Burmester G, Hiepe F, Biesen R, Dörner T. FRI0350 The IFN Biomarker Siglec1 Indicates Extraglandular Manifestation in Primary Sjögren's Syndrome. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
49
|
Behrens F, Rossmanith T, Köhm M, Alten R, Aringer M, Backhaus M, Baerwald C, Burmester G, Feist E, Kellner H, Krüger K, Müller-Ladner U, Rubbert-Roth A, Tony HP, Wassenberg S, Burkhardt H. FRI0199 Rituximab in Combination with Leflunomide: Results from A Multicenter Randomized Placebo Controlled Investigator Initiated Clinical Trial in Active Rheumatoid Arthritis (Amara-Study): Table 1. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.5684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
50
|
Burmester G, Hrycaj P, Pacheco-Tena C, van Hoogstraten H, Mangan E, Lin Y, Bauer D, Fay J, Parrino J, Kivitz A. SAT0168 Clinical Remission Outcomes with Sarilumab plus Csdmards in Active, Moderate-To-Severe RA Patients with Inadequate Response To Tumor Necrosis Factor Inhibitors. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|