Observational study of inflammatory arthritis treatment by etanercept originator switched to an etanercept biosimilar

OBJECTIVES

The aim of the study was to assess the safety and efficacy of switching an etanercept originator to an etanercept biosimilar in rheumatoid arthritis, juvenile idiopathic arthritis, psoriatic arthritis, and ankylosing spondylitis patients.

MATERIAL AND METHODS

In 162 patients etanercept originator treatment had been replaced with the biosimilar (Group 1), and in six patients the biosimilar was initiated as the first biological agent (Group 2). The efficacy and safety of the treatment were monitored at 3-6 months.

RESULTS

In the majority of patients in Group 1 (n = 138) the etanercept biosimilar was well tolerated, whereas in 24 patients a switch back to the originator was required. The loss of efficacy was confirmed in nine patients using clinical scoring system, and nine patients reported subjective loss of efficacy; 13 patients reported adverse events, most often headache (n = 3) and skin lesions (n = 3). In four patients injection site reactions were present. The adverse events (AE) and/or the loss of the biosimilar efficacy were more commonly observed in women, patients with rheumatoid arthritis (especially in those who did not receive methotrexate), and in patients with a previous history of any other biological treatment. In patients in Group 2 the therapy was effective and no adverse events were observed.

CONCLUSIONS

The etanercept biosimilar seems to be effective and well-tolerated in the majority of patients. Nevertheless, in some cases, switching from the originator to the biosimilar was associated with AEs or loss of efficacy.

[IgG4-related disease - a case report]

Immunoglobulin G4-related disease (IgG4-RD) is a comparatively new condition that may involve more than one organ. The lack of characteristic, pathognomonic clinical symptoms may delay the diagnosis of this disease. The diagnosis is based upon clinical manifestation, elevated serum levels of IgG4 and histopathologic examination with immunohistochemical staining to reveal infiltration of IgG4-positive plasma cells. The first line treatment is oral glucocorticoids.

A CASE REPORT

38-year-old woman with Hashimoto disease, chronic sinusitis and chronic hepatitis of unknown etiology was admitted to the Department of Endocrinology because of moderate eyelids swelling accompanied by redness for 3 years. Graves' orbitopathy and systemic vasculitis were suspected, however both were excluded (negative antibodies results: anty-TSHR, ANCA, ANA). Serologic investigation of Sjögren's syndrome was also negative. In Magnetic Resonance Imaging (MRI) of orbits there were described bilateral mild extension of lateral rectus muscles, normal signal of adipose tissue and bilateral lacrimal glands enlargement. Moreover, increased IgG4 serum levels were detected. The material derived from perinasal sinuses surgery was analyzed in histopathology examination with immunohistochemical staining, which revealed characteristic features of chronic inflammatory process and increased numbers of IgG4 - positive plasma cells (>50 in a large field of view). The diagnosis of IgG4-RD was established. Because of non-effective oral methylprednisolone therapy in the past, the patient was referred to Clinic of Rheumatology for further treatment. After the therapy with methylprednisolone and azathioprine there were observed the significant reduction of symptoms.

CONCLUSIONS

Because of lack of characteristic symptoms of IgG4- RD, it should be always considered in differential diagnosis of chronic inflammatory diseases of various organs.

Outcomes of colonoscopic polypectomy for malignant adenomas: a prospective 30‑year cohort study from a single center (STROBE 1a)

INTRODUCTION

Surgery is recommended following endoscopic polypectomy for malignant adenoma (MA) in the large bowel in patients with risk factors for tumor recurrence or distant metastasis are present.

OBJECTIVES

We present long‑term outcomes of a prospective study in patients with endoscopically removed MAs.

PATIENTS AND METHODS

A total of 128 patients who underwent endoscopic polypectomy were followed up for a median of 70.4 months. The criteria for adequate polypectomy included endoscopically and histologically (margin ≥2 mm) complete excision, lack of angioinvasion, and good tumor differentiation (G1 or G2). Sixty‑seven patients did not meet 1 or more of the criteria (high‑risk group) and 61 met all of the criteria (low‑risk group). Unfavorable outcomes were residual disease, lymph node metastasis, recurrent disease, distant metastasis, or death due to colorectal cancer. Histological samples from 85 patients were reassessed to determine the effect of a margin width of 1 mm or more and tumor budding on the outcomes.

RESULTS

Surgery was performed in 36 patients (28.1%), of whom 32 (47.7%) were high‑risk and 4 (6.5%) were low‑risk. Unfavorable outcome was observed in 10 patients (7.8%; all high‑risk; 10 of 67 patients, 14.9%). Favorable outcome was observed in 61 of 128 patients who had a 2‑mm free margin, and in 44 of 85 patients who fulfilled the modified criterion of 1‑mm free margin. Tumor budding was detected in 17 of 85 patients (20.9%). Unfavorable outcome was observed in 2 of these patients (11.7%) and in 5 patients (7.3%) without tumor budding (P >0.05).

DISCUSSION

Long‑term outcomes of an endoscopic resection of MAs are good. Bowel resection does not prevent unfavorable outcomes, while a reduction of the tumor‑free margin would not deteriorate the results (STROBE 1B).