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Narita Y, Funatogawa T, Mii K, Adachi H, Tamura A, Yamakido S. Use of Biologics for Systemic Sclerosis and Systemic Sclerosis-Associated Interstitial Lung Disease: Information from a Japanese Hospital Claims Database. Mod Rheumatol 2022; 33:525-532. [PMID: 35652700 DOI: 10.1093/mr/roac055] [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: 05/12/2022] [Revised: 05/22/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Limited information is available on the use of biologics in patients with systemic sclerosis (SSc) or SSc-associated interstitial lung disease (SSc-ILD) in Japan. The types of biologics, treatment duration, treatment prior to biologics, concomitant treatment, and characteristics of patients receiving biologics were investigated. METHOD We used a Japanese hospital claims database provided by Medical Data Vision Co. (2008-2021). RESULTS In the database, 1,186 of 34,207 SSc patients (3.5%) and 620 of 12,303 SSc-ILD patients (5.0%) received anti-interleukin-6 (anti-IL-6) drugs, anti-tumor necrosis factor (anti-TNF) drugs, abatacept, or rituximab. The most common were anti-IL-6 drugs (used in 35.5% of SSc patients and 38.5% of SSc-ILD patients [tocilizumab, 34.5% and 36.6%]), followed by anti-TNF drugs (31.3% and 26.5% [etanercept, 10.5% and 9.0%; others, <8%]), abatacept (17.5% and 20.6%), and rituximab (15.7% and 14.4%). Among SSc and SSc-ILD patients treated with anti-IL-6 drugs, anti-TNF drugs, or abatacept, the most common immunosuppressive drugs prior to initiation of biologics were methotrexate and tacrolimus. Approximately half of patients receiving anti-IL-6 drugs, anti-TNF drugs, or abatacept continued treatment beyond 1 year. CONCLUSIONS Our study indicates that off-label biologics have been used in a certain number of SSc or SSc-ILD patients in Japan, with tocilizumab the most common.
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Affiliation(s)
| | | | - Kazuma Mii
- Chugai Pharmaceutical Co., Ltd., Tokyo, Japan
| | | | - Aya Tamura
- Chugai Pharmaceutical Co., Ltd., Tokyo, Japan
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Nakaoka Y, Yanagawa M, Hata A, Yamashita K, Okada N, Yamakido S, Hayashi H, Jayne D. Vascular imaging of patients with refractory Takayasu arteritis treated with tocilizumab: post hoc analysis of a randomized controlled trial. Rheumatology (Oxford) 2021; 61:2360-2368. [PMID: 34528074 PMCID: PMC9157117 DOI: 10.1093/rheumatology/keab684] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/17/2021] [Accepted: 09/02/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Tocilizumab, an anti-interleukin-6 receptor antibody, was investigated in patients with refractory Takayasu arteritis (TAK) in a phase 3 randomized controlled trial. In this post hoc analysis, we investigated whether tocilizumab treatment inhibited the progression of vascular lesions caused by TAK in these patients. METHODS Included patients received at least one dose of tocilizumab and underwent computed tomography (CT) at baseline and at week 48 after tocilizumab initiation. Three radiologists not involved in the original trial independently evaluated the CT images. Twenty-two arteries from each patient were assessed for change from baseline in wall thickness (primary end point), dilatation/aneurysm, stenosis/occlusion or wall enhancement for at least 96 weeks after tocilizumab initiation. Patient-level assessments were also conducted. RESULTS In 28 patients, 86.7% of 22 arteries had improved/stable wall thickness at week 96. Proportions of patients with improved/stable, partially progressed or newly progressed lesions were 57.1%, 10.7% and 28.6% for wall thickness; proportions with improved/stable lesions were 92.9% for dilatation/aneurysm and 85.7% for stenosis/occlusion. Patients with newly progressed lesions, reflecting more refractory disease, were prescribed glucocorticoids at dosages that could not be reduced below 0.1 mg/kg/day at week 96. CONCLUSIONS ∼60% of patients with TAK did not experience progression in wall thickness within 96 weeks after initiation of tocilizumab treatment. Few patients experienced progressed dilatation/aneurysm or stenosis/occlusion. Wall thickness progression likely resulted from refractory TAK. Patients who experience this should be monitored regularly by imaging, and additional glucocorticoid or immunosuppressive treatment should be considered to avoid vascular progression.
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Affiliation(s)
- Yoshikazu Nakaoka
- Department of Vascular Physiology, National Cerebral and Cardiovascular Centre Research Institute, Suita, Japan.,Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masahiro Yanagawa
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Akinori Hata
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Katsuhisa Yamashita
- Medical Science Department, Medical Affairs, Chugai Pharmaceutical Co., Ltd, Tokyo, Japan
| | - Norihiro Okada
- Biometrics Department, Chugai Pharmaceutical Co., Ltd, Tokyo, Japan
| | - Shinji Yamakido
- Primary Clinical Development, Chugai Pharmaceutical Co., Ltd, Tokyo, Japan
| | | | - David Jayne
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
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Nakaoka Y, Yanagawa M, Hata A, Yamashita K, Okada N, Yamakido S, Hayashi H, Jayne D. POS0340 VASCULAR IMAGING IN PATIENTS WITH REFRACTORY TAKAYASU ARTERITIS TREATED WITH TOCILIZUMAB: ANALYSIS FROM A RANDOMIZED CONTROLLED TRIAL. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2768] [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:In the TAKT study, a randomized controlled trial of tocilizumab (TCZ) in patients with refractory Takayasu arteritis (TAK) in Japan, the primary end point of time to relapse after induction of remission with glucocorticoid (GC) treatment showed a trend favoring TCZ over placebo (hazard ratio 0.41 [95.41% confidence interval, 0.15-1.10; p=0.0596]),1 but the double-blind period was too short for imaging evaluation.Objectives:To independently evaluate vascular imaging in a post hoc analysis of radiographs from the TAKT study.Methods:Computed tomography images from patients in the TAKT study were evaluated by three independent radiologists who were not involved in the original trial. Patients who received TCZ and had computed tomography images available (n=28) were included. Assessments were made in 22 arteries for the change from baseline in wall thickness (primary end point), dilatation/aneurysm, stenosis/occlusion, or wall enhancement for at least 96 weeks after the start of tocilizumab treatment. Patient-level assessments were also conducted.Results:Among 28 patients who received at least one dose of TCZ and for whom images were available, 86.7% of 22 arteries had improved/stable (no progression) wall thickness at week 96. The proportions of patients with no progressed, partially progressed, or newly progressed lesions were 57.1%, 10.7%, and 28.6% for wall thickness, and the proportions without progressed lesions were 92.9% for dilatation/aneurysm and 85.7% for stenosis/occlusion (Figure 1). Patients with newly progressed lesions, reflecting more refractory disease, were receiving glucocorticoid doses that could not be reduced below 0.1 mg/kg/day at week 96.Conclusion:Approximately 60% of patients with TAK treated with tocilizumab did not experience progression in wall thickness. Few patients experienced progressive dilatation/aneurysm or stenosis/occlusion. Wall thickness progression likely resulted from refractory TAK. Patients who experience this should be monitored regularly by imaging, and additional glucocorticoid or immunosuppressive treatment should be considered to avoid vascular progression.References:[1]Nakaoka Y et al. Ann Rheum Dis. 2018;77:348-354.Disclosure of Interests:Yoshikazu Nakaoka Consultant of: Roche/Genentech, Grant/research support from: Roche/Genentech, Masahiro Yanagawa Consultant of: Roche/Genentech, Akinori Hata Consultant of: Roche/Genentech, Katsuhisa Yamashita Employee of: Chugai Pharmaceutical Co., Ltd., Norihiro Okada Employee of: Chugai Pharmaceutical Co., Ltd., Shinji Yamakido Employee of: Chugai Pharmaceutical Co., Ltd., Hiromitsu Hayashi Consultant of: Roche/Genentech, David Jayne Consultant of: Roche/Genentech, Grant/research support from: Roche/Genentech
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Nakaoka Y, Isobe M, Tanaka Y, Ishii T, Ooka S, Niiro H, Tamura N, Banno S, Yoshifuji H, Sakata Y, Kawakami A, Atsumi T, Furuta S, Kohsaka H, Suzuki K, Hara R, Maejima Y, Tsukamoto H, Takasaki Y, Yamashita K, Okada N, Yamakido S, Takei S, Yokota S, Nishimoto N. Long-term efficacy and safety of tocilizumab in refractory Takayasu arteritis: final results of the randomized controlled phase 3 TAKT study. Rheumatology (Oxford) 2021; 59:2427-2434. [PMID: 31951279 PMCID: PMC7449811 DOI: 10.1093/rheumatology/kez630] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/25/2019] [Indexed: 11/27/2022] Open
Abstract
Objective To investigate the long-term efficacy and safety of the IL-6 receptor antibody tocilizumab in patients with Takayasu arteritis (TAK). Methods Patients completing the randomized, double-blind, placebo-controlled period of the TAKT (Takayasu arteritis Treated with Tocilizumab) trial were followed up during open-label extended treatment with weekly s.c. tocilizumab 162 mg for up to 96 weeks or longer, with oral glucocorticoid tapering performed at the investigators’ discretion. Endpoints of the extension analysis included steroid-sparing effects of tocilizumab, imaging data, patient-reported outcomes (36-Item Short Form Health Survey) and safety. Results All 36 patients enrolled in the double-blind period entered the open-label extension; 28 patients received tocilizumab for 96 weeks. The median glucocorticoid dose was 0.223 mg/kg/day at the time of relapse before study entry, 0.131 mg/kg/day (interquartile range 0.099, 0.207) after 48 weeks and 0.105 mg/kg/day (interquartile range 0.039, 0.153) after 96 weeks. Overall, 46.4% of patients reduced their dose to <0.1 mg/kg/day, which was less than half the dose administered at relapse before study entry (mean difference –0.120 mg/kg/day; 95% CI −0.154, −0.087). Imaging evaluations indicated that most patients’ disease was improved (17.9%) or stable (67.9%) after 96 weeks compared with baseline. Mean 36-Item Short Form Health Survey physical and mental component summary scores and 7 of 8 domain scores were clinically improved from baseline and maintained over 96 weeks of tocilizumab treatment. No unexpected safety issues were reported. Conclusion These results in patients with Takayasu arteritis provide evidence of a steroid-sparing effect and improvements in well-being during long-term treatment with once-weekly tocilizumab 162 mg, with no new safety concerns. Trial registration JAPIC Clinical Trials Information, http://www.clinicaltrials.jp/user/cteSearch_e.jsp, JapicCTI-142616.
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Affiliation(s)
- Yoshikazu Nakaoka
- Department of Vascular Physiology, National Cerebral and Cardiovascular Center Research Institute, Suita Japan.,Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka Japan
| | | | - Yoshiya Tanaka
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu Japan
| | - Tomonori Ishii
- Clinical Research, Innovation and Education Center, Tohoku University Hospital, Sendai Japan
| | - Seido Ooka
- Division of Rheumatology and Allergology, Department of Internal Medicine, St Marianna University School of Medicine, Kawasaki Japan
| | - Hiroaki Niiro
- Department of Medical Education, Faculty of Medical Sciences, Kyushu University, Fukuoka Japan
| | - Naoto Tamura
- Department of Internal Medicine and Rheumatology, Juntendo University Faculty of Medicine, Tokyo Japan
| | - Shogo Banno
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute Japan
| | - Hajime Yoshifuji
- Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine, Kyoto Kyoto, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka Japan
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki Japan
| | - Tatsuya Atsumi
- Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo Japan
| | - Shunsuke Furuta
- Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba Japan
| | - Hitoshi Kohsaka
- Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo Japan
| | - Katsuya Suzuki
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo Japan
| | - Ryoki Hara
- Department of Pediatrics, Graduate School of Medicine, Yokohama City University, Yokohama Japan
| | - Yasuhiro Maejima
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo Japan
| | | | - Yoshinari Takasaki
- Juntendo University Koshigaya Hospital, Juntendo University Faculty of Medicine, Saitama Japan
| | | | | | | | - Syuji Takei
- Pediatrics and Developmental Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima Japan
| | - Shumpei Yokota
- Pediatric Rheumatology, Fuji Toranomon Orthopedics Hospital, Shizuoka, Japan
| | - Norihiro Nishimoto
- Department of Molecular Regulation for Intractable Diseases, Institute of Medical Science, Tokyo Medical University, Tokyo, Japan
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Nakaoka Y, Yamashita K, Yamakido S. Comment on: Long-term efficacy and safety of tocilizumab in refractory Takayasu arteritis: final results of the randomized controlled phase 3 TAKT study: reply. Rheumatology (Oxford) 2020; 59:e48-e49. [PMID: 32594147 PMCID: PMC7449802 DOI: 10.1093/rheumatology/keaa255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 04/17/2020] [Indexed: 11/23/2022] Open
Affiliation(s)
- Yoshikazu Nakaoka
- Department of Vascular Physiology, National Cerebral and Cardiovascular Center Research Institute, Suita
| | - Katsuhisa Yamashita
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka
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Nakaoka Y, Yamashita K, Okada N, Yamakido S. 332. LONG-TERM EFFICACY AND SAFETY OF TOCILIZUMAB IN PATIENTS WITH REFRACTORY TAKAYASU ARTERITIS: FINAL RESULTS FROM THE TAKT STUDY. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez063.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Matsumoto T, Takano T, Yamakido S, Takahashi F, Tsuji N. Comparison of the effects of eldecalcitol and alfacalcidol on bone and calcium metabolism. J Steroid Biochem Mol Biol 2010; 121:261-4. [PMID: 20298784 DOI: 10.1016/j.jsbmb.2010.03.035] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Revised: 03/08/2010] [Accepted: 03/08/2010] [Indexed: 11/28/2022]
Abstract
Eldecalcitol [ED-71, 2beta-(3-hydroxypropyloxy)-1,25-dihydroxyvitamin D3] increases lumbar and hip bone mineral density (BMD) in a dose-dependent manner in osteoporotic patients with vitamin D supplementation. However, there has been no head-to-head comparison of the effects of eldecalcitol with alfacalcidol on bone and calcium metabolism in human subjects. Therefore, a randomized open-label clinical trial was conducted to compare the effect of eldecalcitol on bone turnover markers and calcium metabolism in 59 Japanese postmenopausal women. Subjects were randomly assigned to receive 1.0 microg alfacalcidol, 0.5 or 1.0 microg eldecalcitol once a day for 12 weeks. There was almost no increase in serum calcium (Ca) throughout the study period. Eldecalcitol from 0.5 to 1.0 microg increased daily urinary Ca excretion in a dose-dependent manner, and 1.0 microg eldecalcitol increased urinary Ca to a similar extent to 1.0 microg alfacalcidol. Both 0.5 and 1.0 microg eldecalcitol suppressed urinary NTX stronger than 1.0 microg alfacalcidol (-6, -30 and -35% in 1.0 microg alfacalcidol, 0.5 and 1.0 microg eldecalcitol-treated groups, respectively, at 12 weeks). In contrast, changes in serum BALP were similar among the three groups (-22, -22 and -29% in 1.0 microg alfacalcidol, 0.5 and 1.0 microg eldecalcitol-treated groups, respectively, at 12 weeks). These results demonstrate that 0.5-1.0 microg eldecalcitol can effectively inhibit bone resorption stronger than alfacalcidol with a similar effect on bone formation and a comparable effect on urinary Ca excretion, and suggest that eldecalcitol may have a better osteoprotective effect than alfacalcidol.
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Affiliation(s)
- Toshio Matsumoto
- Department of Medicine and Bioregulatory Sciences, University of Tokushima Graduate School of Medical Sciences, 3-18-15 Kuramoto-cho, Tokushima 770-8503, Japan.
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