Safety and effectiveness of sarilumab in Japanese patients with rheumatoid arthritis refractory to previous treatments: An interim analysis of a post-marketing surveillance

OBJECTIVES

An interim analysis of post-marketing surveillance data to assess the safety and effectiveness of sarilumab in Japanese patients with rheumatoid arthritis refractory to previous treatment.

METHODS

The interim analysis included patients who initiated sarilumab therapy between June 2018 and January 2021. The primary objective of this surveillance was safety.

RESULTS

In total, 1036 patients were enrolled and registered by 12 January 2021 (interim cut-off date). Of these, 678 were included in the safety analysis [75.4% female; mean age (± standard deviation) 65.8 ± 13.0 years]. Adverse drug reactions, defined as adverse events classified as possibly or probably related to sarilumab, were reported in 170 patients (incidence: 25.1%), with white blood cell count decreased (4.4%) and neutrophil count decreased (1.6%) most frequently reported. Serious haematologic disorders (3.4%) and serious infections (including tuberculosis) (2.5%) were the most frequently reported priority surveillance items. No malignant tumour was reported. An absolute neutrophil count (ANC) below the minimum standard value did not increase the incidence of serious infections.

CONCLUSIONS

Sarilumab was well tolerated, and no new safety signals were noted in this analysis. There was no difference in the frequency of serious infections between patients with an ANC below or above normal.

Utilization of a mass-infusion system in the management of ruptured abdominal aortic aneurysms: an alternative application for devices employed in cardiopulmonary bypass

To stabilize the hemodynamics before and during ruptured abdominal aortic aneurysmal repair, a mass-infusion system was developed and successfully employed in the treatment of two patients. The system consists of a combination of devices used in cardiopulmonary bypass, namely: suction, a reservoir, a heat exchanger, a bubble trap, and an intracaval large-sized venous femoral cannula for infusion. It proved extremely useful to tide the patients over hypovolemic shock before cross-clamping of the proximal aorta, preventing intraoperative hypothermia, which is known to cause multiple physiologic derangement associated with an adverse outcome. Moreover, the employment of a large-sized cannula allowed for a temporary switch from the preceding venous infusion support to the hypothermic circulatory assist with central aortic cannulation, using the caval cannula for drainage. This system provides an optional advantage for patients requiring an open proximal anastomosis.

[A case report of successful removal of entrapped IABP by Lambert's method]

A 68-year-old man who necessitated IABP support for acute myocardial infarction suffered from IABP entrapment after its perforation. We washed intra-balloon space several times with heparinized normal saline, and finally could successfully remove it without surgery. It appears that the washing method (Lambert's method) for IABP entrapment could be done with lower risk especially for severe cases.

Properties of NADH-dependent estradiol 2-hydroxylase in rat liver

The NADH-supported cytochrome P-450-dependent 2-hydroxylation of estradiol in rat liver microsomes has been investigated. Estradiol 2-hydroxylation proceeded well with NADH instead of NADPH as a cofactor. Dimethyltetrahydropterine was incapable of serving as a hydrogen donor for this biotransformation. When both NADH and NADPH were used, the 2-hydroxylation increased additively. Molecular oxygen dissolved in the incubation medium was enough for the occurrence of the NADH-dependent 2-hydroxylation. The presence of carbon monooxide suppressed the formation of catechol estrogen where the CO/O2 ratio needed for 50% inhibition of the bioconversion was 7.7. The inhibitory effect was reversed completely by illumination with white light. p-Chloromercuribenzoate inhibited almost completely the 2-hydroxylase activity, and the enzyme activity was also inhibited by SKF-525A. These results strongly imply the possible involvement of a cytochrome P-450 system in the NADH-dependent 2-hydroxylation of estradiol with rat liver microsomes.

[Compared studies of antimicrobial agents against E. coli, Klebsiella, Citrobacter and Proteus isolated from urinary tract infections]

In vitro activities of antibacterial agents against E. coli, Klebsiella, Citrobacter and Proteus which were isolated from patients urinary tract infections at 8 hospitals in Japan, were investigated by agar dilution method from July to October in 1979. The summarized results are as follows. 1. Among oral antibacterial agents, MPC and PPA have showed potent antibacterial activities against E. coli and Klebsiella. Among parenteral antibiotics, CTM was the most active against E. coli and Klebsiella. However, ABPC-resistant E. coli and Klebsiella have appeared to occupy about 40% and 96% of bacteria isolated from urinary tract infections, respectively. 2. In vitro activities of antibacterial agents against Proteus and Citrobacter showed not so potent. 3. Causative organisms in female patients with simple urinary tract infections were mainly E. coli and Klebsiella. 4. Among oral antibacterial agents, PPA have shown similar antimicrobial activities against E. coli isolated from simple and complicated urinary tract infections. ABPC and MPC have been influenced in some degree by these factors. However, parenteral antibiotics are not influenced by these factors. On the other hand, in vitro activities of antibacterial agents against Klebsiella isolated from simple and complicated urinary tract infections were similar.

Biochemical properties of glomerular basement membrane in daunomycin nephrosis and nephrotoxic serum nephritis

Glomerular basement membrane (GBM) were isolated from the kidneys of rats suffering from daunomycin nephrosis or nephrotoxic serum nephritis. The GBM from daunomycin nephrotic rats contained significantly less hydroxyproline, hydroxylysine and glycine than that of control rats. There was an increase in glucosamine content in the membrane. No significant change was found in the neutral sugar content. In nephrotoxic serum nephritis, the relative amounts of hydroxyproline, glycine and half-cystine were decreased, whereas the relative amounts of aspartic acid, alanine, lysine and hydroxylysine were increased. The ratio of hydroxyproline to proline and the ratio of hydroxylysine to lysine were decreased. An increase in sialic acid content and a decrease in fucose and hexosamine content and glucosyl-galactosyl-hydroxylysine content were noted in nephrotoxic nephritic GBM. These chemical structural alterations could accounted for the functional disorders of diseased GBM.