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Rodziewicz M, Mendoza-Pinto C, Dyball S, Munguía-Realpozo P, Parker B, Bruce IN. Predictors and prognostic factors influencing outcomes of anti-CD20 monoclonal antibodies in systemic lupus erythematosus: A systematic review update. Semin Arthritis Rheum 2024; 65:152346. [PMID: 38185077 DOI: 10.1016/j.semarthrit.2023.152346] [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: 08/13/2023] [Revised: 10/09/2023] [Accepted: 12/05/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Anti-C20 monoclonal antibodies (MAb), such as rituximab, are commonly used for the treatment of patients with severe or refractory systemic lupus erythematosus (SLE) but clinical outcomes are highly variable. We aimed to provide an update of a systematic review of predictive and prognostic factors of anti-CD20 MAb treatment in SLE. METHODS A systematic literature search was undertaken to identify predictive and prognostic factors of clinical response following treatment with anti-CD20 therapies in SLE patients. Studies examining rituximab published prior to 2015 were excluded. Risk of bias was assessed for randomized controlled trials (RCTs) using the Cochrane Collaboration (RoB2) tool for RCTs and the Quality In Prognosis Studies Tool (QUIPS) for cohort studies. A narrative synthesis of the evidence was undertaken and quality of evidence (QoE) was assessed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS From 850 studies identified, 17 studies met the inclusion criteria. A further 8 studies were identified and included through search updates. There were two post-hoc analyses of RCTs of rituximab, one RCT of ocrelizumab and one of obinutuzumab; and 16 cohort studies examining rituximab treatment. The overall QoE was low or very low. There was wide heterogeneity in definitions of clinical disease activity and outcome measures, non-standardized laboratory cut-offs, failure to account for confounders and multiple subgroup analyses of differing outcomes. B cell depletion as well as novel biomarkers, such as S100 proteins, FCGR genotype, anti-vimentin and anti-drug antibodies showed some evidence of prognostic value but QoE was limited due to moderate to high risk of bias, early phase of investigation and imprecision of results. CONCLUSION There has been no validation of previously identified prognostic factors to guide outcome in anti-CD20 treated lupus patients. Hypothesis-driven studies of several novel markers however, demonstrate prognostic value and require replication and validation to support their use in routine clinical practice. PROSPERO REGISTRATION NUMBER CRD42020220339.
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Affiliation(s)
- Mia Rodziewicz
- Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre Manchester, Oxford Rd, Manchester M13 9PL, UK.
| | - Claudia Mendoza-Pinto
- High-Specialty Medical Unit-CIBIOR, Mexican Social Security Institute, Puebla, Mexico; Department of Rheumatology and Immunology, School of Medicine, Autonomous University of Puebla, Mexico
| | - Sarah Dyball
- Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre Manchester, Oxford Rd, Manchester M13 9PL, UK
| | - Pamela Munguía-Realpozo
- High-Specialty Medical Unit-CIBIOR, Mexican Social Security Institute, Puebla, Mexico; Department of Rheumatology and Immunology, School of Medicine, Autonomous University of Puebla, Mexico
| | - Ben Parker
- Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre Manchester, Oxford Rd, Manchester M13 9PL, UK; Kellgren Centre for Rheumatology, NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University Hospitals Foundation Trust, Manchester Academic Health Science Centre Manchester, UK
| | - Ian N Bruce
- Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre Manchester, Oxford Rd, Manchester M13 9PL, UK; Kellgren Centre for Rheumatology, NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University Hospitals Foundation Trust, Manchester Academic Health Science Centre Manchester, UK
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Khursheed T, Ovseiko P, Dyball S, Nakashima R, Gonzalez AMA, Babini A, Kalla AA, Hill C, Danda D, Dey D, Traboco L, Nikiphorou E, Harifi G, Badshah H, Hmamouchi I, Marie Von Feldt J, Farani JB, Andreoli L, Guimarães MP, Toro Gutiérrez CE, Sieiro Santos C, Duftner C, Alpizar Rodriguez D, Ziadé N, Palominos PE, Haq SA, Bautista-Molano W, Tanaka Y, Gossec L, Agarwal V, Wright GC, Coates L, Gupta L. Coalition for Health and Gender Equity (CHANGE)-a protocol for a global cross-sectional survey of health and gender equity in rheumatology. Rheumatol Adv Pract 2024; 8:rkae021. [PMID: 38560641 PMCID: PMC10980588 DOI: 10.1093/rap/rkae021] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 12/31/2023] [Indexed: 04/04/2024] Open
Abstract
Objectives The primary aim of the CHANGE survey is to determine the current state of gender equity within rheumatology, and secondarily, to review the physician perspective on bullying, harassment and equipoise of opportunities within rheumatology. Methods The CHANGE e-survey is a cross-sectional self-reported questionnaire adapted from EULAR's gender equity in academic rheumatology task force. The survey was launched in January 2023; it is available in six languages and distributed widely via rheumatology organizations and social media. Eligible participants include rheumatologist physicians and rheumatology health-care professionals. Survey responses will undergo descriptive analysis and inter-group comparison aiming to explore gender-based discrimination using logistic regression, with subgroup analyses for country/continent variations. Conclusion This e-survey represents a comprehensive global initiative led by an international consortium, aimed at exploring and investigating the gender-related disparities and obstacles encountered by rheumatologists and rheumatology health-care professionals across diverse communities and health-care environments. By pursuing this initiative, we aim to take the broader rheumatology community a step closer to understanding the underlying origins of inequities and their determinants. Such insights are pivotal in identifying viable interventions and strategies to foster gender equity within the field. Ultimately, our collective objective is to ensure equitable access to opportunities for every individual, irrespective of gender, thereby promoting inclusivity and fairness across the entire spectrum of professional practice and career development.
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Affiliation(s)
- Tayyeba Khursheed
- Department of Rheumatology, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Pavel Ovseiko
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Sarah Dyball
- Centre for Musculoskeletal Research, The University of Manchester, Manchester, UK
| | - Ran Nakashima
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ana Maria Arredondo Gonzalez
- Colombian Association of Rheumatology, Bogotá, Colombia
- Department of Rheumatology, Faculty of Medicine, Fundación Universitaria de Ciencias de la Salud (FUCS), Bogotá, Colombia
| | - Alejandra Babini
- Rheumatology Unit, Hospital Italiano de Cordoba, Cordoba, Argentina
| | - Asgar Ali Kalla
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Catherine Hill
- Rheumatology Unit, The Queen Elizabeth and Royal Adelaide Hospitals, Adelaide, SA, Australia
- Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Debashish Danda
- Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India
| | - Dzifa Dey
- Rheumatology Unit Department of Medicine and Therapeutics, Korle bu Teaching Hospital, University of Ghana Medical School, Accra, Ghana
| | - Lisa Traboco
- Department of Medicine, Section of Rheumatology, St Luke’s Medical Center-Global City, Taguig, Philippines
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases, King’s College London, London, UK
- Rheumatology Department, King’s College Hospital, London, UK
| | - Ghita Harifi
- Department of Rheumatology, Mediclinic Parkview Hospital, Dubai, United Arab Emirates
- Department of Medicine and Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Humeira Badshah
- Dr Humeira Badsha Medical Center, Dubai, United Arab Emirates
| | - Ihsane Hmamouchi
- Clinical Epidemiology, Health Sciences College, International University of Rabat (UIR), Rabat, Morocco
- Department of Rheumatology, Provincial Hospital of Temara, Temara, Morocco
| | | | - Júlia Boechat Farani
- Division of Rheumatology, Hospital Santa Casa de Misericórdia de Juiz de Fora, Juiz de Fora, Brazil
| | - Laura Andreoli
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili di Brescia, Brescia, Italy
| | | | - Carlos Enrique Toro Gutiérrez
- General Director, Reference Center for Osteoporosis, Rheumatology and Dermatology, Pontifica Universidad Javeriana Cali, Cali, Colombia
| | | | - Christina Duftner
- Internal Medicine, Clinical Division of Internal Medicine II, Medizinische Universität Innsbruck, Innsbruck, Austria
| | | | - Nelly Ziadé
- Rheumatology Department, Hôtel-Dieu de France Hospital, Saint Joseph’s University, Beirut, Lebanon
| | | | | | - Wilson Bautista-Molano
- Rheumatology Division, University Hospital Fundación Santa Fé de Bogotá, Bogota, Colombia
- School of Medicine, Universidad El Bosque, Bogotá, Colombia
| | - Yoshiya Tanaka
- First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Laure Gossec
- Sorbonne Université, INSERM, IPLESP, AP-HP, Pitié-Salpetrière Hospital, Paris, France
| | - Vikas Agarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Grace C Wright
- Association of Women in Rheumatology; United Rheumatology, New York, NY, USA
| | - Laura Coates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Latika Gupta
- Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, The University of Manchester, Manchester, UK
- Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
- Department of Rheumatology, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
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Rodziewicz M, Dyball S, Achieng S, Brix SR, Parker B, Bruce IN. An imperfect world: assessing safety of biological treatments in systemic lupus erythematosus. Comment on the article by Materne et al. Arthritis Rheumatol 2024; 76:315-316. [PMID: 37653671 DOI: 10.1002/art.42689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 08/21/2023] [Indexed: 09/02/2023]
Affiliation(s)
| | | | | | - Silke R Brix
- Manchester Academic Health Science Centre, Manchester, UK
| | - Ben Parker
- Manchester Academic Health Science Centre, Manchester, UK
| | - Ian N Bruce
- University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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Zhao SS, Dyball S. Cholesteryl ester transfer protein inhibition is associated with reduced risk of Sjögren's syndrome. Rheumatology (Oxford) 2023; 62:e258-e259. [PMID: 36897029 PMCID: PMC10473269 DOI: 10.1093/rheumatology/kead115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 03/01/2023] [Indexed: 03/11/2023] Open
Affiliation(s)
- Sizheng Steven Zhao
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Science, School of Biological Sciences, Faculty of Biological Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Sarah Dyball
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Science, School of Biological Sciences, Faculty of Biological Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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Rodziewicz M, Dyball S, Lunt M, McDonald S, Sutton E, Parker B, Bruce IN. Early infection risk in patients with systemic lupus erythematosus treated with rituximab or belimumab from the British Isles Lupus Assessment Group Biologics Register (BILAG-BR): a prospective longitudinal study. Lancet Rheumatol 2023; 5:e284-e292. [PMID: 38251591 DOI: 10.1016/s2665-9913(23)00091-7] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 03/15/2023] [Accepted: 03/15/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Patients with systemic lupus erythematosus (SLE) are at an increased risk of infection relative to the general population. We aimed to describe the frequency and risk factors for serious infections in patients with moderate-to-severe SLE treated with rituximab, belimumab, and standard of care therapies in a large national observational cohort. METHODS The British Isles Lupus Assessment Group Biologics Register (BILAG-BR) is a UK-based prospective register of patients with SLE. Patients were recruited by their treating physician as part of their scheduled care from 64 centres across the UK by use of a standardised case report form. Inclusion criteria for the BILAG-BR included age older than 5 years, ability to provide informed consent, a diagnosis of SLE, and starting a new biological therapy within the last 12 months or a new standard of care drug within the last month. The primary outcome for this study was the rate of serious infections within the first 12 months of therapy. Serious infections were defined as those requiring intravenous antibiotic treatment, hospital admission, or resulting in morbidity or death. Infection and mortality data were collected from study centres and further mortality data were collected from the UK Office for National Statistics. The relationship between serious infection and drug type was analysed using a multiple-failure Cox proportional hazards model. FINDINGS Between July 1, 2010, and Feb 23, 2021, 1383 individuals were recruited to the BILAG-BR. 335 patients were excluded from this analysis. The remaining 1048 participants contributed 1002·7 person-years of follow-up and included 746 (71%) participants on rituximab, 119 (11%) participants on belimumab, and 183 (17%) participants on standard of care. The median age of the cohort was 39 years (IQR 30-50), 942 (90%) of 1048 patients were women and 106 (10%) were men. Of the patients with available ethnicity data, 514 (56%) of 911 were White, 169 (19%) were Asian, 161 (18%) were Black, and 67 (7%) were of multiple-mixed or other ethnic backgrounds. 118 serious infections occurred in 76 individuals during the 12-month study period, which included 92 serious infections in 58 individuals on rituximab, eight serious infections in five individuals receiving belimumab, and 18 serious infections in 13 individuals on standard of care. The overall crude incidence rate of serious infection was 117·7 (95% CI 98·3-141·0) per 1000 person-years. Compared with standard of care, the serious infection risk was similar in the rituximab (adjusted hazard ratio [HR] 1·68 [0·60-4·68]) and belimumab groups (1·01 [0·21-4·80]). Across the whole cohort in multivariate analysis, serious infection risk was associated with prednisolone dose (>10 mg; 2·38 [95%CI 1·47-3·84]), hypogammaglobulinaemia (<6 g/L; 2·16 [1·38-3·37]), and multimorbidity (1·45 [1·17-1·80]). Additional concomitant immunosuppressive use appeared to be associated with a reduced risk (0·60 [0·41-0·90]). We found no significant safety signals regarding atypical infections. Six infection-related deaths occurred at a median of 121 days (IQR 60-151) days from cohort entry. INTERPRETATION In patients with moderate-to-severe SLE, rituximab, belimumab, and standard immunosuppressive therapy have similar serious infection risks. Key risk factors for serious infections included multimorbidity, hypogammaglobulinaemia, and increased glucocorticoid doses. When considering the risk of serious infection, we propose that immunosupppressives, rituximab, and belimumab should be prioritised as mainstay therapies to optimise SLE management and support proactive minimisation of glucocorticoid use. FUNDING None.
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Affiliation(s)
- Mia Rodziewicz
- Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Sarah Dyball
- Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Mark Lunt
- Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Stephen McDonald
- Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Emily Sutton
- Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Ben Parker
- Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK; NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Ian N Bruce
- Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK; NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
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Dyball S, Reynolds JA, Herrick AL, Haque S, Chinoy H, Bruce E, Naz S, Parker B, Bruce IN. Determinants of health-related quality of life across the spectrum of connective tissue diseases using latent profile analysis: Results from the LEAP cohort. Rheumatology (Oxford) 2022:6935805. [PMID: 36534822 PMCID: PMC10393437 DOI: 10.1093/rheumatology/keac680] [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: 09/12/2022] [Revised: 11/17/2022] [Accepted: 11/24/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Poor health-related quality of life (HR-QoL) is well recognised in patients with connective tissue diseases (CTD). We hypothesised that subgroups of patients across the spectrum of CTD experience different HR-QoL patterns, and aimed to determine patient-level characteristics associated with these different subgroups. METHODS Using the eight continuous domains of the Medical Outcomes Study Short-Form 36 (SF-36) questionnaire we performed data-driven clustering to derive latent profiles (LP) of patients with distinct HR-QoL patterns. Multivariable ordinal logistic regression was used to determine patient-level characteristics associated with each HR-QoL subgroup identified. RESULTS 309 CTD patients completed the SF-36 questionnaire. The most impaired SF-36 domains in each disease group were vitality, general health and bodily pain. The physical component of the SF-36 was consistently more impaired compared with the mental component, with similar scores across disease groups.Three latent profiles were identified with poor (n = 89; 29%), average (n = 190; 61.4%) and excellent (n = 30; 9.7%) HR-QoL. LP were not associated with diagnostic grouping or autoantibody profiles. Black background (OR 0.22 [95% CI 0.08-0.63]), Indo-Asian background (0.39 [0.19-0.78]), concomitant fibromyalgia (0.40 [0.20-0.78]), sicca symptoms (0.56 [0.32-0.98]) and multi-morbidity (Charlson Comorbidity Index, 0.81 [0.67-0.97]) were associated with the 'poor' HR-QoL LP. CONCLUSION Distinct HR-QoL subgroups exist that are not primarily driven by the specific diagnosis or autoantibody profiles. We identified a number of key demographic and clinical factors associated with poor HR-QoL. These factors need to be addressed across the whole CTD spectrum as part of a holistic management approach aimed at improving overall patient outcomes.
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Affiliation(s)
- Sarah Dyball
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Stopford Building, Oxford Road, Manchester, UK.,The Kellgren Centre for Rheumatology, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - John A Reynolds
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Rheumatology Department, Sandwell and West Birmingham NHS Trust, Birmingham, UK
| | - Ariane L Herrick
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, The University of Manchester, Manchester, UK.,Department of Rheumatology, Salford Care Organisation, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK
| | - Sahena Haque
- Department of Rheumatology, Manchester University Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - Hector Chinoy
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Stopford Building, Oxford Road, Manchester, UK.,National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, The University of Manchester, Manchester, UK.,Department of Rheumatology, Salford Care Organisation, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK
| | - Ellen Bruce
- The Kellgren Centre for Rheumatology, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Sophia Naz
- Department of Rheumatology, Pennine Acute Hospitals NHS Trust, Manchester, UK
| | - Ben Parker
- The Kellgren Centre for Rheumatology, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, The University of Manchester, Manchester, UK
| | - Ian N Bruce
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Stopford Building, Oxford Road, Manchester, UK.,The Kellgren Centre for Rheumatology, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, The University of Manchester, Manchester, UK
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Han J, Dyball S, Boon-Itt A, Taylor M. An acutely painful hot swollen knee. BMJ 2022; 379:e070231. [PMID: 36302515 DOI: 10.1136/bmj-2022-070231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Jennie Han
- Imperial College Healthcare NHS Trust, London W2 1NY, UK
| | - Sarah Dyball
- Royal Lancaster Infirmary, Lancaster LA1 4RP, UK
| | | | - Mark Taylor
- Royal Lancaster Infirmary, Lancaster LA1 4RP, UK
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Dyball S, Parker B, Bruce IN. Ianalumab in Sjögren's syndrome: what can we learn from lupus trials? Lancet 2022; 400:807-808. [PMID: 36088945 DOI: 10.1016/s0140-6736(22)01536-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 08/03/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Sarah Dyball
- Centre for Musculoskeletal Research, Faculty of Biology, Medicine, and Health, The University of Manchester, Manchester M13 9PT, UK
| | - Ben Parker
- Centre for Musculoskeletal Research, Faculty of Biology, Medicine, and Health, The University of Manchester, Manchester M13 9PT, UK
| | - Ian N Bruce
- Centre for Musculoskeletal Research, Faculty of Biology, Medicine, and Health, The University of Manchester, Manchester M13 9PT, UK.
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Dyball S, Rodziewicz M, Mendoza-Pinto C, Bruce IN, Parker B. Predicting progression from undifferentiated connective tissue disease to definite connective tissue disease: A systematic review and meta-analysis. Autoimmun Rev 2022; 21:103184. [PMID: 36031048 DOI: 10.1016/j.autrev.2022.103184] [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: 08/14/2022] [Accepted: 08/21/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE Undifferentiated connective tissue disease (UCTD) encapsulates a broad range of conditions including incomplete forms of systemic lupus erythematosus (SLE) and systemic sclerosis (SSc), some of whom progress to a formal clinical diagnosis over time. This systematic review (SR) and meta-analysis aimed to identify clinical and laboratory features and biomarkers that can predict progression of UCTD. METHODS A systematic literature search was carried out on MEDLINE, EMBASE and the Cochrane Central Register of Randomized Controlled Trials. Abstracts and full-text manuscripts were screened by two reviewers. Publications were included if they included at least 20 UCTD patients, a minimum of six months of follow up, and provided data on at least one risk factor for developing a defined CTD. The QUIPS tool was used to assess risk of bias (RoB) and GRADE for grading the quality of the evidence. The study is registered with PROSPERO (ID: CRD42021237725). RESULTS Fifty-nine studies were included in the SR, and forty-one in the meta-analysis. The predictors for progression to SLE with the highest certainty of evidence included those with younger age (MD -5.96 [-11.05-0.87 years]), serositis (RR 2.69 [1.61-4.51]), or the presence of anti-dsDNA antibodies (RR 4.27 [1.92-9.51]). For SSc, the highest certainty of evidence included puffy fingers (RR [3.09 [1.48-6.43]), abnormal nailfold changes (NFC) (avascular areas [RR 5.71 (3.03-10.8)] or active or late SSc pattern [RR 2.24 (1.25-4.01)] and anti-topoisomerase-I (RR 1.83 [1.45-2.30]). No novel biomarkers were included in the meta-analysis; however HLA molecules, regulatory T cell shift, pro-inflammatory cytokines and complement activation products were identified as potential predictors for evolution of disease. CONCLUSIONS Clinical and immunological parameters may predict which patients with UCTD progress to definitive disease; however, the heterogeneous nature and RoB in most studies limits the ability to apply these results in routine clinical practice. Limited data suggest that some novel biomarkers may provide additional predictive value but these will need larger well designed studies to fully delineate their clinical utility.
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Affiliation(s)
- Sarah Dyball
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Stopford Building, Oxford Road, Manchester, UK
| | - Mia Rodziewicz
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Stopford Building, Oxford Road, Manchester, UK
| | - Claudia Mendoza-Pinto
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Stopford Building, Oxford Road, Manchester, UK; Systemic Autoimmune Diseases Research Unit Specialties Hospital UMAE-CIBIOR, Mexican Social Security Institute, Puebla, Mexico
| | - Ian N Bruce
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, The University of Manchester, Manchester, UK
| | - Ben Parker
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, The University of Manchester, Manchester, UK.
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Dyball S, Rodziewicz M, Sutton E, Parker B, Bruce IN. AB0513 COVID-19 PREVENTION IN PATIENTS WITH MODERATE-TO-SEVERE LUPUS DURING THE PANDEMIC: RESULTS FROM THE BILAG-BIOLOGICS REGISTER (BILAG-BR). Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundThere have been concerns over the susceptibility of SLE patients to severe COVID-19 illness since the beginning of the pandemic, and many patients were assigned ‘clinically extremely vulnerable’ according to the UK’s shielding guidance issued in March 2020. Here we report on vaccination and shielding behaviours of a moderate-to-severe SLE cohort with high immunosuppressant burden.ObjectivesTo review the shielding behaviours, and the safety and tolerability of COVID-19 vaccines in a real-world cohort of patients with moderate to severe SLE.MethodsThe British Isles Lupus Assessment Group Biologics Registry (BILAG-BR) is a national prospective registry of lupus patients from the UK (2010-21). Patients from the BILAG-BR were invited to complete a paper or online questionnaire which consisted of 17 questions to assess their self-reported shielding behaviour, vaccination status, and any adverse responses following COVID-19 vaccination. Questionnaires were completed between 9th Oct 2021 and 7th Jan 2022. Responses were linked with data collected in the BILAG-BR.ResultsData were collected from the first 202/1268 patients (186 [92.1%] women) to respond, with a median age of 51 (IQR 38-61) years from 37 UK centres. The majority of patients were Caucasian (78.1%, 150/192). Previous therapy included rituximab (165, 81.7%), belimumab (33, 16.3%) and cyclophosphamide (54, 26.7%). In the past 12 months, over two thirds of patients (138, 68.3%) had received oral prednisolone (current dose median 5mg [IQR 5-8mg, range 2-40mg] daily), and almost a third had received parental steroids (60, 29.7%).Shielding was reported in the first national lockdown (March-June 2020) by 93.6% (189/202) of patients, and of those in employment at the time, over half (58/100) were unable to work from home. The vast majority of patients complied with the UK government guidance (97.0%, 196/202) and did not socialise with other households indoors during this time period. Fifty-four percent of patients (109/202) reported attending a hospital or GP appointment during the first lockdown, and 24/202 (11.9%) reported regular appointments. During the first lockdown, 13/109 (11.9%) patients reported receiving rituximab infusions and 9/109 (8.3%) belimumab infusions.Ninety-seven percent (196/202) had received at least 1 COVID-19 vaccination (Oxford AstraZeneca 95/146, 65.1%; Pfizer/ BioNtech 50/146, 34.3%). Approximately half of patients (54.2%, 104/192) reported an adverse reaction to the vaccine (both vaccine doses in 45 (23.9%) patients). The majority of these included lethargy/ flu-like symptoms (82, 78.8%) or local site reactions (32, 30.8%). Six (3.0%) patients reported a lupus flare and 3 (1.5%) patients reported a hospital attendance due to vaccine side effects.ConclusionIn this cohort of moderate-to-severe SLE patients there was strong engagement with UK shielding guidance, however only half of patients attended a GP or hospital appointment during the earliest peak of the pandemic, highlighting disruptions to routine clinical care. There was high uptake of COVID-19 vaccination, which whilst generally well tolerated in this cohort, may be temporally associated with a flare, albeit in only a small number of patients. We recognise it may be difficult to distinguish between vaccine adverse events and lupus flares in patients with SLE, therefore this may be an overestimation. Of note, three patients reported a hospital attendance post-vaccination which warrants further investigation.AcknowledgementsSubmitted on behalf of the BILAG-biologics registerDisclosure of InterestsSarah Dyball Grant/research support from: UCB and Eli Lilly, Mia Rodziewicz Grant/research support from: UCB, Emily Sutton: None declared, Ben Parker Speakers bureau: Eli Lilly and Roche, Consultant of: Fresenius-Kabi and AbbVie, Grant/research support from: Genzyme/Sanofi and GSK, Ian N. Bruce Speakers bureau: AstraZeneca, GSK and UCB, Consultant of: AstraZeneca, Eli Lilly, GSK, Merck Serono, UCB and ILTOO, Grant/research support from: Genzyme/Sanofi, GSK, Roche and UCB
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Dyball S, Reynolds J, Herrick A, Chinoy H, Haque S, Naz S, Bruce E, Bruce IN, Parker B. POS0756 DETERMINANTS OF HEALTH-RELATED QUALITY OF LIFE (HR-QoL) ACROSS THE SPECTRUM OF SYSTEMIC AUTOIMMUNE RHEUMATIC DISEASES: RESULTS FROM THE LEAP COHORT. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundPoor health-related quality of life (HR-QoL) is recognised in patients with established connective tissue diseases (CTDs), however it is not clear how it affects patients with undifferentiated CTD (UCTD) which has traditionally been associated with a mild or more benign profile.ObjectivesTo investigate HR-QoL in patients affected with a variety of CTDs (including UCTD) using the SF-36 questionnaire; and secondly, to review demographic and clinical factors predictive of a poor HR-QoLMethodsThe Lupus Extended Autoimmune Phenotype (LEAP) cohort is a multicentre prospective study of patients with a CTD. Rheumatologist diagnosis was used to classify patients into four groups: systemic lupus erythematosus (SLE), primary Sjögren’s syndrome (pSS), UCTD, and (combined because of low numbers) those with an idiopathic inflammatory myopathy (IIM), systemic sclerosis (SSc) or overlap syndrome. The SF-36 quality of life questionnaire was completed at enrolment and includes eight domains: physical function (PF), role physical (RP), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), role emotional (RE) and mental health (MH) which range from 0 to 100, with higher scores reflecting better HR-QoL. Physical (PCS) and mental component score (MCS) were calculated for each group, with a score below 50 representing a worse HR-QoL compared to the general UK population. Predictors for poor HR-QoL was chosen a priori, then tested using linear regression adjusted for age, gender and ethnicity. All statistical analysis was performed using STATA v14, with results expressed as beta coefficients with 95% confidence intervals (95%CI).ResultsData were collected from 309 patients (280 [90.6%] women, with a mean [SD] age of 48.9 [12.9] years) from three UK rheumatology centres. The majority of patients were Caucasian (n=235, 76.1%). By rheumatologist diagnosis, 115 (37.2%) had SLE, 56 (18.1%) pSS, 72 (23.3%) UCTD and 66 (21.4%) SSc, IIM or an overlap syndrome. Patients with UCTD, pSS and SSc/IIM spectrum disorders had a shorter median disease duration (3.8, 3.7 and 6.1 years respectively) compared with patients with those with SLE (11.0 years), p<0.001. Previous steroid and immunosuppressant use was highest in patients with SLE and SSc/IIM spectrum disorders (p<0.001). The most affected domains include VT, GH and BP (Figure 1), and the PCS is more impaired compared with the MCS, with similar scores across disease groups. Agnostic of disease group, factors associated with a lower PCS include increasing age (beta -0.15 [95%CI -0.26, -0.06], p=0.008), prednisolone use (-3.1 [-6.05, -0.19], p=0.037), c-reactive protein (-0.09 [-0.62, -0.10], p=0.007), fatigue (-2.00 [-3.79, -0.22], p=0.028), and sicca syndrome (-4.70 [-7.66, -1.74] p=0.002), and these remained significant in a multivariate model.Figure 1.radar diagrams of eight SF-36 domains, and MCS and PCS boxplots. SLE; systemic lupus erythematosus; UCTD, undifferentiated CTD; pSS, primary Sjögren’s syndrome; IIM, idiopathic inflammatory myopathy; SSc, systemic sclerosis; PF, physical function; RP, role physical; BP, bodily pain; GH, general health; VT, vitality; SF, social functioning; RE, role emotional; MH, mental healthConclusionPatients with UCTD exhibit similar impairment in physical components of HR-QoL compared with other established CTDs, despite perceived differences in disease severity. This study highlights sicca syndrome, fatigue, and steroid burden as key targets for improving HR-QoL in patients across the spectrum of CTDs.Disclosure of InterestsSarah Dyball Grant/research support from: UCB and Eli Lilly, John Reynolds: None declared, Ariane Herrick Speakers bureau: Janssen, Consultant of: Arena, Boehringer-Ingelheim, Camurus, CSL-Behring, and Gesynta, Grant/research support from: Gesynta, Hector Chinoy Speakers bureau: UCB, Biogen, Consultant of: Novartis, Eli Lilly, Orphazyme, Astra Zeneca, Grant/research support from: Eli Lilly and UCB, Sahena Haque: None declared, Sophia Naz: None declared, Ellen Bruce: None declared, Ian N. Bruce Speakers bureau: AstraZeneca, GSK and UCB, Consultant of: AstraZeneca, Eli Lilly, GSK, Merck Serono, UCB and ILTOO, Grant/research support from: Genzyme/Sanofi, GSK, Roche and UCB, Ben Parker Speakers bureau: Eli Lilly and Roche, Consultant of: Fresenius-Kabi and AbbVie, Grant/research support from: Genzyme/Sanofi and GSK
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Dyball S, Rodziewicz M, Sutton E, Parker B, Bruce IN. POS0757 COVID-19 INFECTION AND RECOVERY AMONGST PATIENTS WITH MODERATE-TO-SEVERE LUPUS DURING THE PANDEMIC: RESULTS FROM THE BILAG-BIOLOGICS REGISTER (BILAG-BR). Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundPatients with systemic lupus erythematosus (SLE) are thought to be at greater risk of severe COVID-19 illness and associated complications due to a combination of inherent aberrant immune responses, immunosuppressive medications and co-morbidities.ObjectivesTo review COVID-19 infections, hospitalisation and recovery in a real-world cohort of patients with moderate to severe SLE and high immunosuppressant use.MethodsThe British Isles Lupus Assessment Group Biologics Registry (BILAG-BR) is a national prospective registry of lupus patients from the UK (2010-21) requiring significant immunosuppressive therapies. Patients from the BILAG-BR were invited to complete a paper or online questionnaire which consisted of 17 questions to assess prior COVID-19 infection and their recovery during the COVID-19 pandemic. Questionnaires were completed between 9th Oct 2021 and 7th Jan 2022. Responses were linked with data collected in the BILAG-BR. Mortality data were collected from study centres and the Office of National Statistics from Dec 2019-Jan 2022.ResultsData were collected from the first 202/1268 patients to respond. Patients were predominately female (186, 92.1%), had a median age of 51 (IQR 38-61) years and were from 37 UK centres. Previous therapy included rituximab (165, 81.7%), belimumab (33, 16.3%) and cyclophosphamide (54, 26.7%). In the past 12 months, over two thirds of patients (138, 68.3%) had received oral prednisolone (current median dose 5mg [IQR 5-8mg] daily), and almost a third had received parental steroids (60, 29.7%).Self-reported COVID-19 diagnosis occurred in 48 (23.8%) patients, of whom 20 reported a positive test. Eleven (55%) patients reported testing positive for COVID-19 after being vaccinated. Median reported recovery was 80% (IQR 60-100%), with subjective full recovery reported in 30% of patients (6/20) who had received a positive test. Of the 20 patients who tested positive for COVID-19, 5 were receiving belimumab, 1 tocilizumab, and in the prior 12 months, 2 had received cyclophosphamide and 4 rituximab.Of all respondents, three individuals were hospitalised with COVID-19, and one required an ICU admission. Of those hospitalised, two patients were unvaccinated prior to COVID-19 infection, and the other patient had received rituximab and cyclophosphamide prior to vaccination. Four/1387 patients registered in the BILAG-BR were confirmed to have died from COVID-19 since the beginning of the pandemic.ConclusionIn this cohort of moderate-to-severe SLE patients there was a low incidence of COVID-19 infection. Despite this, full recovery from PCR or lateral flow test proven COVID-19 infection was seen in only a third of patients. This raises concerns over the potential risk of long COVID in patients with SLE and warrants further investigation.AcknowledgementsSubmitted on behalf of the BILAG-biologics registerDisclosure of InterestsSarah Dyball Grant/research support from: UCB and Eli Lilly, Mia Rodziewicz Grant/research support from: UCB, Emily Sutton: None declared, Ben Parker Speakers bureau: Eli Lilly and Roche, Consultant of: Fresenius-Kabi and AbbVie, Grant/research support from: Genzyme/Sanofi and GSK, Ian N. Bruce Speakers bureau: AstraZeneca, GSK and UCB, Consultant of: AstraZeneca, Eli Lilly, GSK, Merck Serono, UCB and ILTOO, Grant/research support from: Genzyme/Sanofi, GSK, Roche and UCB
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Rodziewicz M, Dyball S, Bruce I, Parker B. Pausing drugs and spacing vaccines: an open question. Lancet Rheumatol 2021; 3:e683. [PMID: 34580663 PMCID: PMC8457766 DOI: 10.1016/s2665-9913(21)00274-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mia Rodziewicz
- Centre for Epidemiology Versus Arthritis, Manchester, UK
| | - Sarah Dyball
- Centre for Epidemiology Versus Arthritis, Manchester, UK
| | - Ian Bruce
- Centre for Epidemiology Versus Arthritis, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Kellgren Centre for Rheumatology, Manchester University Hospitals, Manchester Academic Health Science Centre, Manchester M13 9PT, UK
| | - Ben Parker
- NIHR Manchester Biomedical Research Centre, Kellgren Centre for Rheumatology, Manchester University Hospitals, Manchester Academic Health Science Centre, Manchester M13 9PT, UK
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Dyball S, Collinson S, Sutton E, McCarthy EM, Bruce IN, Parker B. Lupus clinical trial eligibility in a real-world setting: results from the British Isles Lupus Assessment Group-Biologics Register (BILAG-BR). Lupus Sci Med 2021; 8:e000513. [PMID: 34301852 PMCID: PMC8311338 DOI: 10.1136/lupus-2021-000513] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 04/28/2021] [Accepted: 07/13/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To quantify how well phase III randomised clinical trials in both SLE and lupus nephritis (LN) represents a real-world SLE cohort. METHODS Literature reviews were performed of major published phase III SLE (n=12) and LN (n=6) clinical trials (ClinicalTrials.gov). Inclusion and exclusion criteria common across these trials were collated for non-renal SLE or LN trials, and applied to patients recruited to the British Isles Lupus Assessment Group-Biologics Register (BILAG-BR) starting either biological or standard-of-care (SOC) therapies. RESULTS We recruited 837 patients to the BILAG-BR from September 2010 to June 2018, starting either SOC (n=125, 15%) or a biological medication (n=712, 85%). Active LN, defined as a BILAG A in the renal domain occurred in 20% (n=166). Overall, 530 (63%) patients were ineligible to participate in non-renal SLE clinical trials and 72 (43%) patients with active LN would be ineligible for LN trials. The most common reasons for ineligibility from the non-renal lupus trials included active renal involvement (n=166, 20%) and low disease activity (n=114, 15%). For LN trials, the most common exclusion met was pre-existing renal impairment (n=15, 9%). Patients with fewer comorbidities were more likely to be eligible to participate in non-renal SLE trials. CONCLUSIONS In this national register of patients with moderate-to-severe SLE, nearly two-thirds would not be eligible for recruitment to key SLE clinical trials nor would almost half of those with active LN. Eligibility criteria may excessively constrain enrolment and thus, how we can generalise trial results in a real-world setting.
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Affiliation(s)
- Sarah Dyball
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal & Dermatological Sciences, The University of Manchester Faculty of Biology Medicine and Health, Manchester, UK
| | - Sophie Collinson
- The Kellgren Centre for Rheumatology, NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Emily Sutton
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal & Dermatological Sciences, The University of Manchester Faculty of Biology Medicine and Health, Manchester, UK
| | - Eoghan M McCarthy
- The Kellgren Centre for Rheumatology, NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Ian N Bruce
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal & Dermatological Sciences, The University of Manchester Faculty of Biology Medicine and Health, Manchester, UK
- The Kellgren Centre for Rheumatology, NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Ben Parker
- The Kellgren Centre for Rheumatology, NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
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Dyball S, Collinson S, Sutton E, McCarthy E, Parker B, Bruce I. P166 Multimorbidity in SLE, a barrier to clinical trial eligibility: results from the BILAG-BR. Rheumatology (Oxford) 2021. [DOI: 10.1093/rheumatology/keab247.162] [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
Stringent inclusion and exclusion criteria are employed in SLE clinical trials. Organ dysfunction and co-morbidities are common exclusion criteria which may affect how representative trials are of real-world SLE populations. We aimed to apply published trial eligibility criteria to patients with SLE in a large national register.
Methods
A literature review of all major published double-blinded randomised phase III trials in non-renal SLE was performed. Common inclusion and exclusion criteria were applied to all patients recruited to the BILAG-Biologics Register (BILAG-BR), a large UK-wide register of SLE patients. Data on comorbidities for all patients registered was collected. The mean (SD) number of co-morbidities was calculated. Patients were then classified as being eligible or ineligible. Groups were compared initially using a chi-squared or Wilcoxon rank-sum test and logistic regression model was used to test the age and sex adjusted association between trial eligibility and comorbidities.
Results
Common inclusion and exclusion criteria were identified from 12 published trials. When applied to the 837 patients recruited to BILAG-BR, 562 (67%) patients would not be eligible for inclusion in these trials. Ineligible patients had a shorter disease duration (2.9 vs. 5.1 years, p < 0.01), but were similar in age (P = 1.0), sex (P = 0.7) and ethnicity (p = 0.5) to those who were eligible. Of eligible patients, 128 (53%) had 1 or more comorbidities compared with 340 (60%) who were ineligible (p = 0.05). The mean (SD) number of comorbidities was 0.9 (1.2) vs 1.2 (1.3) for eligible and ineligible patients respectively. After adjusting for age and sex, inclusion in clinical trials was associated with fewer comorbidities (OR 0.81, 95% CI 0.70, 0.94, p < 0.01).
Conclusion
Patients with multi-morbidity are more likely to be ineligible for SLE clinical trials. Evidence from real world studies and registers are therefore needed to fully understand the safety and effectiveness of new therapies. Our data also underscores the need to develop more pragmatic eligibility criteria for clinical trials.
Disclosure
S. Dyball: None. S. Collinson: None. E. Sutton: None. E. McCarthy: None. B. Parker: Consultancies; GSK, AstraZenica, UCB, Abbvie, Pfizer, BMS, Celltrion. Grants/research support; GSK, Sanofi Genzyme. I. Bruce: Consultancies; GSK, Medimmune, AstraZenica, Eli Lilly, Merck Serono, UCB, ILTOO. Member of speakers’ bureau; AstraZeneca, Medimmune, GSK, UCB. Grants/research support; GSK, Genzyme Sanofi, UCB.
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Affiliation(s)
- Sarah Dyball
- University of Manchester, Centre for Epidemiology Versus Arthritis, Manchester, UNITED KINGDOM
| | - Sophie Collinson
- University of Manchester, Centre for Epidemiology Versus Arthritis, Manchester, UNITED KINGDOM
| | - Emily Sutton
- University of Manchester, Centre for Epidemiology Versus Arthritis, Manchester, UNITED KINGDOM
| | - Eoghan McCarthy
- The Kellgren Centre for Rheumatology, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UNITED KINGDOM
| | - Ben Parker
- University of Manchester, Centre for Epidemiology Versus Arthritis, Manchester, UNITED KINGDOM
- The Kellgren Centre for Rheumatology, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UNITED KINGDOM
| | - Ian Bruce
- University of Manchester, Centre for Epidemiology Versus Arthritis, Manchester, UNITED KINGDOM
- The Kellgren Centre for Rheumatology, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UNITED KINGDOM
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Dyball S, Collinson S, Sutton E, Mccarthy E, Parker B, Bruce IN. SAT0168 ONLY ONE THIRD OF REAL WORLD LUPUS PATIENTS MEET ELIGIBILITY CRITERIA FOR CLINICAL TRIALS: IMPLICATIONS FOR TRIAL VALIDITY AND GENERALISABILITY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Despite unprecedented drug development in SLE, the paucity of approved therapies remains a significant challenge. Recent trials have highlighted the need for minimising heterogeneity within SLE populations; however, there is concern this results in the recruitment of patients that are not representative of the SLE population.Objectives:Our aim was to apply published trial eligibility criteria to patients with non-renal SLE in a large UK-wide register to quantify how accurately these clinical trials represent a real-world cohort.Methods:A literature review of all major published double-blinded randomised phase III trials in non-renal SLE was performed (n=12). Inclusion and exclusion criteria common across the majority of clinical trials were applied to all patients recruited to the BILAG-BR (BILAG biologics register) starting either biological therapy or standard of care (SOC). We applied available data to common inclusion criteria including age ≥18 years, ACR 1997 SLE classification criteria, positive anti-dsDNA or ANA antibodies, active disease (defined as a BILAG A in 1 domain or a BILAG B in ≥2 domains, or a SLEDAI ≥6); and common exclusion criteria including restricted medication rules, active renal or neurological SLE (defined as a BILAG A in either domain), a history of hepatitis B or C, a history of malignancy (excluding basal cell carcinoma), CKD stage 4 or 5, a UPCR ≥100mg/mmol, and cytopenias (defined as neutrophils <1.0 x109/L, platelets <10 x109/L or Hb <70g/L). Baseline variables were compared using chi-squared test.Results:As of July 2018, 837 patients were recruited to the BILAG-BR starting either SOC (n=125) or a biologic therapy (n=712). The commonest biologic and SOC therapy was rituximab (n=662, 93%) and mycophenolate (n=64, 51%) respectively. Patients taking SOC were more likely to have inactive disease, as well as having higher steroid doses and less exposure to previous cyclophosphamide or B cell therapy. In the biologic and SOC groups, 476 (67%) and 71 (57%) respectively met all inclusion criteria (table 1). One or more exclusion criteria were met by 324 (46%) of the biologics group and 46 (37%) of the SOC group. As such, 562 (67%) patients were not eligible to enrol in a clinical trial. The patients not eligible to participate were similar in age (P=1.0), gender (P=0.7) and ethnicity (p=0.5) to those who were eligible. Median disease duration was longer in patients eligible to participate (2.9 vs. 5.1 years, p<0.01).Table 1.Patients from the BILAG-BR who meet eligibility criteria for major SLE clinical trialsInclusion criteriaBiologic (n=712)SOC (n=125)P valueAge ≥18 years7061220.1Meet ACR criteria for SLE6751160.4Antibody positive567990.9Active disease62697<0.01Total meeting all inclusion criteria476710.03Exclusion criteriaBiologic (n=712)SOC (n=125)P valueSteroids >40mg prednisolone98<0.001Active CNS SLE3971.0Active renal SLE138280.4Hepatitis B or C2010.2Malignancy5250.2Cyclophosphamide <90 days before entry370<0.01B cell therapy <1 year before entry500<0.01CKD 4/ 52230.7UPCR ≥100mg/mmol92201.0Low blood counts2510.1Pregnancy310.6Total number of patients excluded324460.1TotalNOT*eligible for clinical trial(n)562/837 (67%)1.0Conclusion:In a large national register of SLE patients, we found that two thirds of patients would not be eligible for recruitment to clinical trials using published inclusion and exclusion criteria. These results suggest that clinical trial recruits are not fully representative of the target disease population. This limits the generalisability of clinical trial results and supports the need for evidence from real world studies to fully understand the effectiveness of new therapies.Disclosure of Interests: :Sarah Dyball: None declared, Sophie Collinson: None declared, Emily Sutton: None declared, Eoghan McCarthy: None declared, Ben Parker Grant/research support from: GSK and Sanofi Genzyme, Consultant of: GSK, AstraZenaca, UCV, Abbvie, Pfizer, BMS, Celltrion, Ian N. Bruce Grant/research support from: Genzyme Sanofi, GSK, and UCB, Consultant of: Eli Lilly, AstraZeneca, UCB, Iltoo, and Merck Serono, Speakers bureau: UCB
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Dyball S, Reynolds J, Mccarthy E, Haque S, Herrick A, Chinoy H, Bruce E, Parker B, Bruce IN. OP0094 EULAR-ACR 2019 CLASSIFICATION CRITERIA FOR SLE: CAN WE CLASSIFY USING LABORATORY TESTS ALONE? Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:The EULAR-ACR 2019 (EULAR19) classification criteria for systemic lupus erythematosus (SLE) were developed to improve the sensitivity and specificity of previous criteria. Notably, both the EULAR19 and existing SLICC-SLE 2012 (SLICC12) criteria can classify patients as having SLE by the presence of immunology and haematological abnormalities in the absence of any signs or symptoms.Objectives:To validate the EULAR19 criteria, with comparison to existing criteria, in a large cohort of patients with an established systemic autoimmune rheumatic disease (SARD).Methods:We recruited 227 adult patients who were ANA positive with ≥1 clinical feature suggestive of a SARD, from three hospitals in the North West of England. Clinician diagnosis was used as gold standard; we then applied the EULAR19, SLICC12 and the ACR-SLE 1997 (ACR97) criteria.Results:Of the 227 patients recruited, by clinician diagnosis, 89 patients (36%) had SLE, 43 (17%) primary Sjögren’s (pSS), 62 (25%) undifferentiated CTD (UCTD), 25 (10%) systemic sclerosis (SSc) and 8 (3%) an inflammatory myositis. The characteristics of these patients and the breakdown of the EULAR19 criteria are outlined in figure 1.Figure 1.Baseline characteristics and classification criteria compared across five SARD diagnoses.The sensitivity and specificity of the EULAR19 is similar to ACR97 (sensitivity 84% (95% CI 75-91%) vs. 87% (95% CI 78-93%) and specificity 78% (95% CI 70-84%) vs. 76% (95% CI 68-83%) respectively). The SLICC12 criteria by contrast are more sensitive (94% (95% CI 87-98%)) and less specific (61% (95% CI 52-69%)) in this cohort.Figure 2 illustrates patients with a clinician diagnosis of SLE or UCTD who meet each of the classification criteria. Of the 89 patients with a clinician diagnosis of SLE, 39 (44%) patients would have sufficient points to meet EULAR19 criteria on blood test results alone in the absence of clinical symptoms. Four pSS patients and 4 UCTD patients would also meet EULAR19 criteria from positive blood results alone.Figure 2.Venn diagrams illustrating patients with SLE and UCTD who meet the EULAR19, ACR97 and SLICC12 classification criteria. No criteria refers to the patients not meeting any of the three SLE classification criteria.Conclusion:These results suggest that the EULAR19 criteria perform comparably to the ACR97 criteria when applied to an established cohort of SARDs. Similar to SLICC12, it is possible to classify patients as having SLE using the EULAR19 criteria by haematological and other laboratory tests. To what extent haematological abnormalities can be potentially used as the sole ‘clinical criteria’ needs consideration.SLE n=89pSS n=43UCTD n=62SSc n=25Myositis n=8Female N (%)82 (92)42 (98)53 (85)24 (96)8 (100)Age, mean (SD) /years44 (13)52 (12)47 (13)60 (9)53 (7)Disease duration, mean (SD) /years12 (10)6 (5)5 (7)9 (11)3 (3)SLE classification criteriaEULAR SLE 2019, N (%)75 (84)10 (23)20 (32)1 (4)0ACR SLE 1997, N (%)77 (87)9 (21)21 (34)2 (8)1 (13)SLICC SLE 2012, N (%)84 (94)15 (35)33 (53)4 (16)2 (25)EULAR-ACR 2019 criteriaConstitutional, N (%)10 (11)2 (5)1 (2)01 (13)Neuropsychiatric, N (%)3 (3)01 (2)1 (4)0Mucocutaneous, N (%)71 (80)13 (30)27 (44)2 (8)2 (25)Serosal, N (%)13 (15)1 (2)2 (3)00Musculoskeletal, N (%)52 (58)14 (33)22 (35)3 (12)3 (38)Renal, N (%)30 (34)001 (4)0Haematological, N (%)44 (49)12 (28)10 (16)3 (12)0Antiphospholipid antibodies, N (%)43 (48)7 (16)17 (27)4 (16)0Low complement, N (%)48 (54)10 (23)10 (16)3 (12)1 (13)Anti-Sm, N (%)19 (21)2 (5)4 (6)1 (4)0Anti-dsDNA, N (%)50 (56)8 (19)12 (19)01 (13)Disclosure of Interests:Sarah Dyball: None declared, John Reynolds: None declared, Eoghan McCarthy: None declared, Sahena Haque: None declared, Ariane Herrick: None declared, Hector Chinoy: None declared, Ellen Bruce: None declared, Ben Parker Grant/research support from: GSK and Sanofi Genzyme, Consultant of: GSK, AstraZenaca, UCV, Abbvie, Pfizer, BMS, Celltrion, Ian N. Bruce Grant/research support from: Genzyme Sanofi, GSK, and UCB, Consultant of: Eli Lilly, AstraZeneca, UCB, Iltoo, and Merck Serono, Speakers bureau: UCB
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Yeo B, Dyball S, Low A. P03 Effectiveness and tolerability of Benepali in patients switched from Enbrel with rheumatoid arthritis, psoriatic arthritis, and axial spondyloarthropathy. Rheumatology (Oxford) 2020. [DOI: 10.1093/rheumatology/keaa111.002] [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
Benepali (SB4) is an etanercept biosimilar licensed for rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondyloarthropathy (AS) and is cheaper than Enbrel (ETN). We aimed to evaluate the effectiveness and tolerability of switching from ETN to SB4 and costs saved.
Methods
All patients on ETN were identified from pharmacy records and reviewed by consultants for clinical suitability to switch to SB4. Letters informing patients of the proposed switch were sent and replies collated. Patients were switched when prescriptions were due for renewal. Switching started in June 2018 and patients were prospectively followed at 3 and 6 months after switching. Anonymised demographic and clinical data were collected from patient records. DAS28 was calculated for RA and PsA due to availability of score components from patient records. The difference between disease activity scores prior to the switch, 3 months, and 6 months after switching was analysed using the Wilcoxon signed-rank test.
Results
113 patients were prescribed ETN and 17 patients were clinically unsuitable to switch. Of the remaining 96 patients, 6 declined switching and 7 stopped ETN before switching. The remaining 83 patients were switched from ETN to SB4 over a year and analysed (Table 1). Comparing measures of disease activity prior to switching versus 3 months or 6 months of follow-up on SB4, there were no statistically significant differences in disease activity for patients with RA (Table). Missing data for PsA and AS precluded statistical comparisons. 5 patients switched back to ETN due to subjective worsening of joint symptoms. 3 patients switched back to ETN due to adverse effects (infections, dizziness and nausea, unknown). 1 patient switched from SB4 to abatacept due to high disease activity. 1 patient stopped SB4 due to incident lung cancer.
Conclusion
SB4 was generally well tolerated with a retention rate of 88% (73/83) over 6 months of follow-up. In RA there was no significant difference in patients’ disease activity when switching from ETN to SB4, at 3 or 6 months of follow-up. Assuming all 73 switched patients remained on SB4 for a year, this would equate to £56,000 cost savings per year.
Disclosures
B. Yeo None. S. Dyball None. A. Low None.
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Affiliation(s)
- Brandon Yeo
- Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UNITED KINGDOM
| | - Sarah Dyball
- Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UNITED KINGDOM
| | - Audrey Low
- Rheumatology, Salford Royal NHS Foundation Trust, Manchester, UNITED KINGDOM
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Dyball S, Cordingley L, Isaacs JD, Wilson G, Morgan A, Hyrich K, Plant D, Barton A. 231 Pre-treatment anxiety and depression levels are correlated with less improvement in self-reported disease activity in rheumatoid arthritis patients treated with biological therapy: results from the BRAGGSS cohort. Rheumatology (Oxford) 2018. [DOI: 10.1093/rheumatology/key075.455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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)
- Sarah Dyball
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, UNITED KINGDOM
| | - Lis Cordingley
- Division of Musculoskeletal and Dermatological Sciences, Manchester Academic Health Science Centre, University of Manchester, UNITED KINGDOM
| | - John D Isaacs
- Institute of Cellular Medicine, Newcastle University, Newcastle, UNITED KINGDOM
- National Institute for Health Research, Newcastle Biomedical Research Centre, Newcastle University, UNITED KINGDOM
| | - Gerry Wilson
- Genomic Medicine, University of Sheffield, Sheffield, UNITED KINGDOM
| | - Ann Morgan
- Leeds Institute of Rheumatic and Musculoskeletal Molecular Medicine, St James's University Hospital, Leeds, UNITED KINGDOM
| | - Kimme Hyrich
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, UNITED KINGDOM
- National Institute of Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester Foundation Trust, Manchester, UNITED KINGDOM
| | - Darren Plant
- National Institute of Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester Foundation Trust, Manchester, UNITED KINGDOM
| | - Anne Barton
- Arthritis Research UK Centre for Genetics and Genomics, Institute of Inflammation and Repair, University of Manchester, UNITED KINGDOM
- National Institute of Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester Foundation Trust, Manchester, UNITED KINGDOM
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De Cock D, Dyball S, Kearsley-Fleet L, Watson K, Hyrich K. 241 Profiling rheumatoid arthritis biosimilar switchers: datafrom the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis. Rheumatology (Oxford) 2018. [DOI: 10.1093/rheumatology/key075.465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Diederik De Cock
- Arthritis Research UK Centre for Epidemiology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UNITED KINGDOM
| | - Sarah Dyball
- Arthritis Research UK Centre for Epidemiology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UNITED KINGDOM
| | - Lianne Kearsley-Fleet
- Arthritis Research UK Centre for Epidemiology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UNITED KINGDOM
| | - Kath Watson
- Arthritis Research UK Centre for Epidemiology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UNITED KINGDOM
| | - Kimme Hyrich
- Arthritis Research UK Centre for Epidemiology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UNITED KINGDOM
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Dyball S, Reynolds JA, Haque S, Chinoy H, Herrick A, Bruce E, Bruce IN, Parker B. 122 High burden of immunosuppressant use in undifferentiated connective tissue disease: results from the Lupus Extended Autoimmune Phenotype Study (LEAP) cohort. Rheumatology (Oxford) 2018. [DOI: 10.1093/rheumatology/key075.346] [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: 11/13/2022] Open
Affiliation(s)
- Sarah Dyball
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, UNITED KINGDOM
| | - John A Reynolds
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, UNITED KINGDOM
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UNITED KINGDOM
| | - Sahena Haque
- Department of Rheumatology, University Hospital South Manchester, Manchester, UNITED KINGDOM
| | - Hector Chinoy
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, UNITED KINGDOM
- Department of Rheumatology, Salford Royal NHS Foundation Trust, Manchester, UNITED KINGDOM
| | - Ariane Herrick
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, UNITED KINGDOM
- Department of Rheumatology, Salford Royal NHS Foundation Trust, Manchester, UNITED KINGDOM
| | - Ellen Bruce
- Department of Rheumatology, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UNITED KINGDOM
| | - Ian N Bruce
- Centre for Musculoskeletal Research, Institute of Inflammation and Repair, University of Manchester, UNITED KINGDOM
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UNITED KINGDOM
| | - Ben Parker
- Centre for Musculoskeletal Research, Institute of Inflammation and Repair, University of Manchester, UNITED KINGDOM
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UNITED KINGDOM
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Reynolds JA, Dyball S, Haque S, Chinoy H, Herrick A, Bruce E, Parker B, Bruce IN. 127 Quality of life in patients with connective tissue diseases: results from the Lupus Extended Autoimmune Phenotype (LEAP) study. Rheumatology (Oxford) 2018. [DOI: 10.1093/rheumatology/key075.351] [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: 11/13/2022] Open
Affiliation(s)
- John A Reynolds
- Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UNITED KINGDOM
- Kellgren Centre for Rheumatology, NIHR Manchester Biomedical Resesarch Centre, Manchester University NHS Foundation Trust, Manchester, UNITED KINGDOM
| | - Sarah Dyball
- Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UNITED KINGDOM
| | - Sahena Haque
- Rheumatology Department, Manchester University NHS Foundation Trust, Manchester, UNITED KINGDOM
| | - Hector Chinoy
- Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UNITED KINGDOM
| | - Ariane Herrick
- Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UNITED KINGDOM
| | - Ellen Bruce
- Kellgren Centre for Rheumatology, NIHR Manchester Biomedical Resesarch Centre, Manchester University NHS Foundation Trust, Manchester, UNITED KINGDOM
| | - Ben Parker
- Kellgren Centre for Rheumatology, NIHR Manchester Biomedical Resesarch Centre, Manchester University NHS Foundation Trust, Manchester, UNITED KINGDOM
| | - Ian N Bruce
- Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UNITED KINGDOM
- Kellgren Centre for Rheumatology, NIHR Manchester Biomedical Resesarch Centre, Manchester University NHS Foundation Trust, Manchester, UNITED KINGDOM
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Diss L, Dyball S, Ghela T, Golding J, Morris R, Robinson S, Tucker R, Walter T, Young P, Allen M, Fidalgo S, Gard P, Mabley J, Patel B, Chatterjee P, Yeoman M. Acute paraquat exposure impairs colonic motility by selectively attenuating nitrergic signalling in the mouse. Auton Neurosci 2016; 195:8-15. [PMID: 26853977 DOI: 10.1016/j.autneu.2016.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 09/03/2015] [Revised: 01/25/2016] [Accepted: 01/27/2016] [Indexed: 01/06/2023]
Abstract
Paraquat, a common herbicide, is responsible for large numbers of deaths worldwide through both deliberate and accidental ingestion. Previous studies have eluded that the bioavailability of paraquat increases substantially with increasing dose and that these changes may in part be due to the effects that these high concentrations have on the gastrointestinal tract (GI tract). To date, the actions of acute, high concentrations (20mM for 60 min) of paraquat on the GI tract, particularly the colon which is a major site of paraquat absorption, are unknown. This study examined the effects of acute paraquat administration on colonic motility in the C57BL/6 mouse. Acute paraquat exposure decreased colonic motility and the amplitude of colonic migrating motor complexes (CMMCs), which are major motor patterns involved in faecal pellet propulsion. In isolated segments of distal colon, paraquat increased resting tension and markedly attenuated electrical field stimulation-evoked relaxations. Pharmacological dissection of paraquat's mechanism of action on both the CMMCs and field stimulated tissue using the nitric oxide synthase inhibitor NG-nitro-L-arginine and direct measurement of NO release from the myenteric plexus, demonstrated that paraquat selectively attenuates nitrergic signalling pathways. These changes did not appear to be due to alterations in colonic oxidative stress, inflammation or complex 1 activity, but were most likely caused by paraquat's ability to act as a redox couple. In summary, these data demonstrate that acute paraquat exposure attenuates colonic transit. These changes may facilitate the absorption of paraquat into the circulation and so facilitate its toxicity.
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Affiliation(s)
- Lucy Diss
- School of Pharmacy and Biomolecular Sciences, Huxley Building, College of Life, Health and Physical Sciences, University of Brighton, Brighton, East Sussex BN2 4GJ, UK
| | - Sarah Dyball
- School of Pharmacy and Biomolecular Sciences, Huxley Building, College of Life, Health and Physical Sciences, University of Brighton, Brighton, East Sussex BN2 4GJ, UK
| | - Tina Ghela
- School of Pharmacy and Biomolecular Sciences, Huxley Building, College of Life, Health and Physical Sciences, University of Brighton, Brighton, East Sussex BN2 4GJ, UK
| | - Jonathan Golding
- School of Pharmacy and Biomolecular Sciences, Huxley Building, College of Life, Health and Physical Sciences, University of Brighton, Brighton, East Sussex BN2 4GJ, UK
| | - Rachel Morris
- School of Pharmacy and Biomolecular Sciences, Huxley Building, College of Life, Health and Physical Sciences, University of Brighton, Brighton, East Sussex BN2 4GJ, UK
| | - Stephen Robinson
- School of Pharmacy and Biomolecular Sciences, Huxley Building, College of Life, Health and Physical Sciences, University of Brighton, Brighton, East Sussex BN2 4GJ, UK
| | - Rosemary Tucker
- School of Pharmacy and Biomolecular Sciences, Huxley Building, College of Life, Health and Physical Sciences, University of Brighton, Brighton, East Sussex BN2 4GJ, UK
| | - Talia Walter
- School of Pharmacy and Biomolecular Sciences, Huxley Building, College of Life, Health and Physical Sciences, University of Brighton, Brighton, East Sussex BN2 4GJ, UK
| | - Paul Young
- School of Pharmacy and Biomolecular Sciences, Huxley Building, College of Life, Health and Physical Sciences, University of Brighton, Brighton, East Sussex BN2 4GJ, UK
| | - Marcus Allen
- School of Pharmacy and Biomolecular Sciences, Huxley Building, College of Life, Health and Physical Sciences, University of Brighton, Brighton, East Sussex BN2 4GJ, UK
| | - Sara Fidalgo
- School of Pharmacy and Biomolecular Sciences, Huxley Building, College of Life, Health and Physical Sciences, University of Brighton, Brighton, East Sussex BN2 4GJ, UK
| | - Paul Gard
- School of Pharmacy and Biomolecular Sciences, Huxley Building, College of Life, Health and Physical Sciences, University of Brighton, Brighton, East Sussex BN2 4GJ, UK
| | - Jon Mabley
- School of Pharmacy and Biomolecular Sciences, Huxley Building, College of Life, Health and Physical Sciences, University of Brighton, Brighton, East Sussex BN2 4GJ, UK
| | - Bhavik Patel
- School of Pharmacy and Biomolecular Sciences, Huxley Building, College of Life, Health and Physical Sciences, University of Brighton, Brighton, East Sussex BN2 4GJ, UK
| | - Prabal Chatterjee
- School of Pharmacy and Biomolecular Sciences, Huxley Building, College of Life, Health and Physical Sciences, University of Brighton, Brighton, East Sussex BN2 4GJ, UK
| | - Mark Yeoman
- School of Pharmacy and Biomolecular Sciences, Huxley Building, College of Life, Health and Physical Sciences, University of Brighton, Brighton, East Sussex BN2 4GJ, UK.
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