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Kaymaz-Tahra S, Bayindir O, Ince B, Ozdemir İsik O, Kutu ME, Karakas O, Yildirim TD, Ademoglu Z, Ediboglu ED, Uludogan BCE, Ilgin C, Bilge NSY, Kasifoglu T, Akar S, Emmungil H, Onen F, Omma A, Kanitez NA, Yazici A, Cefle A, Inanc M, Aksu K, Keser G, Direskeneli H, Alibaz-Oner F. Comparison of methotrexate and azathioprine as the first-line steroid-sparing immunosuppressive agents in patients with Takayasu's arteritis. Semin Arthritis Rheum 2024; 66:152446. [PMID: 38669786 DOI: 10.1016/j.semarthrit.2024.152446] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 03/17/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Immunosuppressive (IS) agents are recommended for the first-line treatment of patients with active Takayasu's arteritis (TAK) together with glucocorticoids (GCs). However, there is limited data comparing the efficacy and outcomes of different IS agents for this purpose. OBJECTIVES In this study, we aimed to compare the outcomes of two most frequently used first-line IS agents, namely methotrexate (MTX) and azathioprine (AZA) in TAK patients. METHODS TAK patients who received any IS agent in addition to GCs as the initial therapy were included in this multicentre, retrospective cohort study. Clinical, laboratory and imaging data of the patients were assessed. In addition, a matched analysis (cc match) using variables 'age', 'gender' and 'diffuse aortic involvement' was performed between patients who received MTX or AZA as the first-line IS treatment. RESULTS We recruited 301 patients (F/M: 260/41, mean age: 42.2 ± 13.3 years) from 10 tertiary centres. As the first-line IS agent, 204 (67.8 %) patients received MTX, and 77 (25.6 %) received AZA. Less frequently used IS agents included cyclophosphamide in 17 (5.6 %), leflunomide in 2 (0.5 %) and mycophenolate mofetil in one patient. The remission, relapse, radiographic progression and adverse effect rates were similar between patients who received MTX and AZA as the first-line IS agent. Vascular surgery rate was significantly higher in the AZA group (23% vs. 9 %, p = 0.001), whereas the frequency of patients receiving ≤5 mg/day GCs at the end of the follow-up was significantly higher in the MTX group (76% vs 62 %, p = 0.034). Similarly, the rate of vascular surgery was higher in AZA group in matched analysis. Drug survival was similar between MTX and AZA groups (median 48 months, MTX vs AZA: 32% vs 42 %, p = 0.34). IS therapy was discontinued in 18 (12 MTX, 6 AZA) patients during the follow-up period due to remission. Among those patients, two patients had a relapse at 2 and 6 months, while 16 patients were still on remission at the end of a mean 69.4 (±50.9) months of follow-up. CONCLUSIONS Remission, relapse, radiographic progression and drug survival rates of AZA and MTX were similar for patients with TAK receiving an IS agent as the first-line f therapy. The rate of vascular surgery was higher and the rate of GC dose reduction was lower with AZA compared to MTX at the end of the follow-up.
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Affiliation(s)
- Sema Kaymaz-Tahra
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Bahceşehir University, Kadıkoy, Istanbul, Turkey.
| | - Ozun Bayindir
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Burak Ince
- Department of Internal Medicine, Division of Rheumatology Istanbul, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ozlem Ozdemir İsik
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Muhammet Emin Kutu
- Division of Rheumatology, Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ozlem Karakas
- Division of Rheumatology, Ankara City Hospital, Ankara, Turkey
| | - Tuba Demirci Yildirim
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Zeliha Ademoglu
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Elif Durak Ediboglu
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Katip Celebi University, Izmir, Turkey
| | - Burcu Ceren Ekti Uludogan
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Osmangazi University, Eskisehir, Turkey
| | - Can Ilgin
- Department of Public Health, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Nazife Sule Yasar Bilge
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Osmangazi University, Eskisehir, Turkey
| | - Timucin Kasifoglu
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Osmangazi University, Eskisehir, Turkey
| | - Servet Akar
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Katip Celebi University, Izmir, Turkey
| | - Hakan Emmungil
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Fatos Onen
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Ahmet Omma
- Division of Rheumatology, Ankara City Hospital, Ankara, Turkey
| | - Nilufer Alpay Kanitez
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Koc University, Istanbul, Turkey
| | - Ayten Yazici
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Ayse Cefle
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Murat Inanc
- Department of Internal Medicine, Division of Rheumatology Istanbul, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Kenan Aksu
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Gokhan Keser
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Haner Direskeneli
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Fatma Alibaz-Oner
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Marmara University, Istanbul, Turkey
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Yagiz B, Lermi N, Coskun BN, Dalkilic E, Kiraz S, Erden A, Ertenli I, Duran E, Bilgin E, Yılmaz R, Ateş A, Tufan A, Küçük H, Mercan R, Cinaklı H, Akar S, Yaşar Bilge NŞ, Kaşifoglu T, Türk SM, Gonullu EO, Bes C, Alpay Kanitez N, Emmungil H, Kalyoncu U, Pehlivan Y. The predictors of paradoxical reactions, especially psoriasis, to biologic therapy-findings from the TReasure database: a 5-year follow-up study. Rheumatology (Oxford) 2023; 62:3962-3967. [PMID: 37354493 DOI: 10.1093/rheumatology/kead318] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 04/27/2023] [Accepted: 05/07/2023] [Indexed: 06/26/2023] Open
Abstract
OBJECTIVES The objectives of this study were to assess the clinical characteristics, predictive factors, and practical algorithms of paradoxical reactions (PRs), specifically paradoxical psoriasis (PP). METHODS The TReasure database is a web-based prospective observational cohort comprised of patients with RA and SpA from 17 centres around Turkey since 2017. A cohort study and a case-control study nestled within the cohort were identified. RESULTS In total, 2867 RA and 5316 SpA patients were evaluated. The first biologic agent was found to have caused PRs in 60% of the 136 patients (1.66%) who developed the PRs. The median time interval between the PRs and biological onset was 12 months (range 1-132 months, mean 21 months). The most common types of PP, constituting 92.6% of PRs, were pustular (60.3%) and palmoplantar (30.9%). Adalimumab (30.9%), infliximab (19%) and etanercept (17.4%) were the most common agents causing the PP. In the treatment of most PP patients (73.2%), switching biologic agents was favoured, with TNF inhibitor (TNFi) chosen in 46.03% and non-TNFi in 26.9% of cases. The three most frequently selected drugs were etanercept (24.6%), secukinumab (9.5%) and adalimumab (8.7%). Only 5.17% of patients who switched to another TNFi showed progression. The odds ratios (s) for SSZ, HCQ, and LEF use were significantly higher in RA controls than in PP patients (P = 0.033, OR = 0.15; P = 0.012, OR = 0.15; and P = 0.015, OR = 0.13, respectively). In the PP group with SpA, the number of smokers was significantly higher (P = 0.003, OR: 2.0, 95% CI: 1.05, 3.81). CONCLUSION Contrary to expectations based on earlier research suggesting that paradoxical reactions develop with the class effect of biological agents, the response of patients who were shifted to another TNFi was favourable.
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Affiliation(s)
- Burcu Yagiz
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Uludağ University, Bursa, Turkey
| | - Nihal Lermi
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Uludağ University, Bursa, Turkey
| | - Belkis N Coskun
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Uludağ University, Bursa, Turkey
| | - Ediz Dalkilic
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Uludağ University, Bursa, Turkey
| | - Sedat Kiraz
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Abdulsamet Erden
- Division of Rheumatology, Department of Internal Medicine, Ankara City Hospital, Ankara, Turkey
| | - Ihsan Ertenli
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Emine Duran
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Emre Bilgin
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Recep Yılmaz
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Aşkın Ateş
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Abdurrahman Tufan
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Hamit Küçük
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Ridvan Mercan
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Namık Kemal University, Tekirdağ, Turkey
| | - Haluk Cinaklı
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, İzmir Kâtip Çelebi University, İzmir, Turkey
| | - Servet Akar
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, İzmir Kâtip Çelebi University, İzmir, Turkey
| | - Nazife Ş Yaşar Bilge
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Timucin Kaşifoglu
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Sümeyye M Türk
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Emel Orge Gonullu
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Cemal Bes
- University of Health Sciences, Department of Rheumatology, Çam and Sakura City Hospital, İstanbul, Turkey
| | - Nilufer Alpay Kanitez
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Koc University, İstanbul, Turkey
| | - Hakan Emmungil
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Umut Kalyoncu
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Yavuz Pehlivan
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Uludağ University, Bursa, Turkey
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