1
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Kruckow KL, Murray E, Shayhidin E, Rosenberg AF, Bowdish DME, Orihuela CJ. Chronic TNF exposure induces glucocorticoid-like immunosuppression in the alveolar macrophages of aged mice that enhances their susceptibility to pneumonia. Aging Cell 2024:e14133. [PMID: 38459711 DOI: 10.1111/acel.14133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 01/22/2024] [Accepted: 02/12/2024] [Indexed: 03/10/2024] Open
Abstract
Chronic low-grade inflammation, particularly elevated tumor necrosis factor (TNF) levels, occurs due to advanced age and is associated with greater susceptibility to infection. One reason for this is age-dependent macrophage dysfunction (ADMD). Herein, we use the adoptive transfer of alveolar macrophages (AM) from aged mice into the airway of young mice to show that inherent age-related defects in AM were sufficient to increase the susceptibility to Streptococcus pneumoniae, a Gram-positive bacterium and the leading cause of community-acquired pneumonia. MAPK phosphorylation arrays using AM lysates from young and aged wild-type (WT) and TNF knockout (KO) mice revealed multilevel TNF-mediated suppression of kinase activity in aged mice. RNAseq analyses of AM validated the suppression of MAPK signaling as a consequence of TNF during aging. Two regulatory phosphatases that suppress MAPK signaling, Dusp1 and Ptprs, were confirmed to be upregulated with age and as a result of TNF exposure both ex vivo and in vitro. Dusp1 is known to be responsible for glucocorticoid-mediated immune suppression, and dexamethasone treatment increased Dusp1 and Ptprs expression in cells and recapitulated the ADMD phenotype. In young mice, treatment with dexamethasone increased the levels of Dusp1 and Ptprs and their susceptibility to infection. TNF-neutralizing antibody reduced Dusp1 and Ptprs levels in AM from aged mice and reduced pneumonia severity following bacterial challenge. We conclude that chronic exposure to TNF increases the expression of the glucocorticoid-associated MAPK signaling suppressors, Dusp1 and Ptprs, which inhibits AM activation and increases susceptibility to bacterial pneumonia in older adults.
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Affiliation(s)
- Katherine L Kruckow
- Department of Microbiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Elizabeth Murray
- Department of Microbiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Elnur Shayhidin
- Firestone Institute for Respiratory Health, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- The M.G. DeGroote Institute for Infectious Disease Research, McMaster University, Hamilton, Ontario, Canada
| | - Alexander F Rosenberg
- Department of Microbiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Informatics Institute, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Dawn M E Bowdish
- Firestone Institute for Respiratory Health, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- The M.G. DeGroote Institute for Infectious Disease Research, McMaster University, Hamilton, Ontario, Canada
| | - Carlos J Orihuela
- Department of Microbiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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2
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Braun J. Correspondence on "ASAS-EULAR recommendations for the management of axial spondyloarthritis: 2022 update". Ann Rheum Dis 2023; 82:e205. [PMID: 36737105 PMCID: PMC10423486 DOI: 10.1136/ard-2023-223935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 01/25/2023] [Indexed: 02/05/2023]
Affiliation(s)
- Juergen Braun
- Rheumapraxis Berlin, Ruhr University Bochum, Berlin, Germany
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3
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[History of the treatment of axial spondylarthritis with biologics-Part 1]. Z Rheumatol 2022; 81:888-894. [PMID: 36063166 DOI: 10.1007/s00393-022-01262-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2022] [Indexed: 12/13/2022]
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4
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Lambrechts MJ, Brush P, Issa TZ, Toci GR, Heard JC, Syal A, Schilken MM, Canseco JA, Kepler CK, Vaccaro AR. Evaluating the Impact of Modic Changes on Operative Treatment in the Cervical and Lumbar Spine: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191610158. [PMID: 36011795 PMCID: PMC9408205 DOI: 10.3390/ijerph191610158] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/09/2022] [Accepted: 08/12/2022] [Indexed: 05/11/2023]
Abstract
Modic changes (MCs) are believed to be potential pain generators in the lumbar and cervical spine, but it is currently unclear if their presence affects postsurgical outcomes. We performed a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. All studies evaluating cervical or lumbar spine postsurgical outcomes in patients with documented preoperative MCs were included. A total of 29 studies and 6013 patients with 2688 of those patients having preoperative MCs were included. Eight included studies evaluated cervical spine surgery, eleven evaluated lumbar discectomies, nine studied lumbar fusion surgery, and three assessed lumbar disc replacements. The presence of cervical MCs did not impact the clinical outcomes in the cervical spine procedures. Moreover, most studies found that MCs did not significantly impact the clinical outcomes following lumbar fusion, lumbar discectomy, or lumbar disc replacement. A meta-analysis of the relevant data found no significant association between MCs and VAS back pain or ODI following lumbar discectomy. Similarly, there was no association between MCs and JOA or neck pain following ACDF procedures. Patients with MC experienced statistically significant improvements following lumbar or cervical spine surgery. The postoperative improvements were similar to patients without MCs in the cervical and lumbar spine.
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5
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Courtney R, Cock IE. Comparison of the antibacterial activity of Australian Terminalia spp. extracts against Klebsiella pneumoniae: a potential treatment for ankylosing spondylitis. Inflammopharmacology 2022; 30:207-223. [PMID: 34989930 DOI: 10.1007/s10787-021-00914-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 12/16/2021] [Indexed: 11/28/2022]
Abstract
Traditional medicines prepared using Terminalia species have been used globally to treat inflammation and pathogenic infections. Recent studies have demonstrated that multiple Asian and African Terminalia spp. inhibit bacterial triggers of some autoimmune inflammatory diseases, including ankylosing spondylitis. Despite this, the effects of Australian Terminalia spp. on a bacterial trigger of ankylosing spondylitis (K. pneumoniae) remain unexplored. Fifty-five extracts from five Australian Terminalia spp. were investigated for K. pneumoniae growth inhibitory activity. Methanolic, aqueous and ethyl acetate extracts of most species and plant parts inhibited K. pneumoniae growth, with varying potencies. Methanolic leaf extracts were generally the most potent bacterial growth inhibitors, with minimum inhibitory concentration (MIC) values of 66 μg/mL (T. ferdinandiana), 128 μg/mL (T. carpenteriae) and 83 μg/mL (T. petiolares). However, the aqueous leaf extract was the most potent T. grandiflora extract (MIC = 87 μg/mL). All T. catappa extracts displayed low growth inhibitory activity. The Terminalia spp. methanolic leaf extracts were examined by liquid chromatography-mass spectrometry (LC-MS) and gas chromatography-mass spectrometry (GC-MS). All contained a relative abundance of simple gallotannins (particularly gallic and chebulic acids), the flavonoid luteolin, as well as the monoterpenoids cineole and terpineol. Notably, all Terminalia spp. were non-toxic or of low toxicity in ALA and HDF toxicity assays, highlighting their potential for preventing the onset of ankylosing spondylitis and treating its symptoms once the disease is established, although this needs to be verified in in vivo systems.
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Affiliation(s)
- Reece Courtney
- Centre for Planetary Health and Food Security, Nathan Campus, Griffith University, 170 Kessels Rd, Nathan, QLD, 4111, Australia.,School of Environment and Science, Nathan Campus, Griffith University, 170 Kessels Rd, Nathan, QLD, 4111, Australia
| | - Ian Edwin Cock
- Centre for Planetary Health and Food Security, Nathan Campus, Griffith University, 170 Kessels Rd, Nathan, QLD, 4111, Australia. .,School of Environment and Science, Nathan Campus, Griffith University, 170 Kessels Rd, Nathan, QLD, 4111, Australia.
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6
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Tymms K, Butcher BE, Sletten TL, Smith T, O'Sullivan C, Littlejohn G, Sadler R, Tronnberg R, Griffiths H. Prevalence of sleep disturbance and the association between poor disease control in people with ankylosing spondylitis within the Australian clinical setting (ASLEEP study): a real-world observational study using the OPAL dataset. Clin Rheumatol 2021; 41:1105-1114. [PMID: 34825268 PMCID: PMC8913462 DOI: 10.1007/s10067-021-05953-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/27/2021] [Accepted: 09/30/2021] [Indexed: 11/08/2022]
Abstract
Introduction Sleep disturbance and fatigue are commonly reported in ankylosing spondylitis (AS) but specific prevalence and the relationship to disease control are unknown. Method This retrospective non-interventional observational study of data from the OPAL dataset included patients with AS (ICD code M45, M45.0 or M08.1), aged 18 to 95 years and had completed ≥ 1 sleep questionnaire between 1 January 2019 and 30 September 2020. The prevalence of insomnia and obstructive sleep apnoea were assessed using the Insomnia Severity Index (ISI) and Multivariate Apnoea Prediction Index (MAPI), respectively. Propensity score (PS) matching based on sex, age and symptom duration increased comparability between patients administered tumour necrosis factor inhibitors (TNFi) and interleukin 17A inhibitors (IL-17Ai). Results Four hundred ninety-five patients were included. The mean ISI total score in the overall population was 8.6 ± 6.2. Self-reported moderate or severe clinical insomnia was present in 16% and 3.2% of patients, respectively. The mean MAPI score was 0.4 ± 0.3, self-reported apnoea was identified in 31.5% of patients and the mean FACIT-Fatigue score was 36.1 ± 10.7. In the PS matched population, the only treatment-related difference was the mean MAPI score (IL-17Ai 0.4 ± 0.3 and TNFi 0.3 ± 0.2, p = 0.046). Those with poor disease control (BASDAI ≥ 4) were more likely (odds ratio [OR] 7.29, 95% CI 2.37 to 22.46, p = 0.001) to have a greater severity of insomnia symptoms than those with good disease control. Conclusion In this real-world AS cohort, poor disease control was associated with sleep disturbance. Little difference in sleep disturbance was observed between biologic TNFi and IL-17Ai treatment. Key Points | • Sleep disturbance and fatigue are common in patients with ankylosing spondylitis. • In our real-world cohort, self-reported apnoea was reported in one-third of patients; and one in five patients reported moderate to severe insomnia. • Those with poor disease control were more likely to experience greater sleep disturbance than those with good disease control. |
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Affiliation(s)
- Kathleen Tymms
- OPAL Rheumatology Ltd, Sydney, NSW, Australia. .,Canberra Rheumatology, 9/40 Marcus Clarke St, Canberra, ACT, 2601, Australia.
| | - Belinda E Butcher
- University of New South Wales, Kensington, NSW, Australia.,WriteSource Medical Pty Ltd, Lane Cove, NSW, Australia
| | - Tracey L Sletten
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Tegan Smith
- OPAL Rheumatology Ltd, Sydney, NSW, Australia
| | | | - Geoffrey Littlejohn
- OPAL Rheumatology Ltd, Sydney, NSW, Australia.,Department of Medicine, Monash University, Clayton, VIC, Australia
| | - Ricky Sadler
- Novartis Pharmaceuticals Australia Pty Ltd, Macquarie Park, NSW, Australia
| | - Rebecca Tronnberg
- Novartis Pharmaceuticals Australia Pty Ltd, Macquarie Park, NSW, Australia
| | - Hedley Griffiths
- OPAL Rheumatology Ltd, Sydney, NSW, Australia.,Barwon Rheumatology Service, Geelong, VIC, Australia
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7
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Chu CQ. Blocking tumor necrosis factor paved the way for targeted therapeutics in inflammatory diseases. Chin Med J (Engl) 2021; 134:2525-2528. [PMID: 34670251 PMCID: PMC8577656 DOI: 10.1097/cm9.0000000000001846] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Indexed: 12/12/2022] Open
Affiliation(s)
- Cong-Qiu Chu
- Division of Arthritis and Rheumatic Diseases, Oregon Health & Science University and Rheumatology Section, VA Portland Health Care System, Portland, OR 97239, USA
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8
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Ren CZ, Hu WY, Zhang JW, Wei YY, Yu ML, Hu TJ. Establishment of inflammatory model induced by Pseudorabies virus infection in mice. J Vet Sci 2021; 22:e20. [PMID: 33774936 PMCID: PMC8007442 DOI: 10.4142/jvs.2021.22.e20] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/18/2020] [Accepted: 01/07/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Pseudorabies virus (PRV) infection leads to high mortality in swine. Despite extensive efforts, effective treatments against PRV infection are limited. Furthermore, the inflammatory response induced by PRV strain GXLB-2013 is unclear. OBJECTIVES Our study aimed to investigate the inflammatory response induced by PRV strain GXLB-2013, establish an inflammation model to elucidate the pathogenesis of PRV infection further, and develop effective drugs against PRV infection. METHODS Kunming mice were infected intramuscularly with medium, LPS, and different doses of PRV-GXLB-2013. Viral spread and histopathological damage to brain, spleen, and lung were determined at 7 days post-infection (dpi). Immune organ indices, levels of reactive oxygen species (ROS), nitric oxide (NO), and inflammatory cytokines, as well as levels of activity of COX-2 and iNOS were determined at 4, 7, and 14 dpi. RESULTS At 10⁵-10⁶ TCID50 PRV produced obviously neurological symptoms and 100% mortality in mice. Viral antigens were detectable in kidney, heart, lung, liver, spleen, and brain. In addition, inflammatory injuries were apparent in brain, spleen, and lung of PRV-infected mice. Moreover, PRV induced increases in immune organ indices, ROS and NO levels, activity of COX-2 and iNOS, and the content of key pro-inflammatory cytokines, including interleukin (IL)-1β, IL-6, tumor necrosis factor-α, interferon-γ and MCP-1. Among the tested doses, 10² TCID50 of PRV produced a significant inflammatory mediator increase. CONCLUSIONS An inflammatory model induced by PRV infection was established in mice, and 10² TCID50 PRV was considered as the best concentration for the establishment of the model.
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Affiliation(s)
- Chun Zhi Ren
- College of Animal Science and Technology, Guangxi University, Nanning 530004, PR China.,Guangxi Agricultural Vocational College, Nanning 530007, PR China
| | - Wen Yue Hu
- School of Life Sciences & Biotechnology, Shanghai Jiao Tong University, Shanghai 200030, PR China
| | - Jin Wu Zhang
- College of Animal Science and Technology, Guangxi University, Nanning 530004, PR China
| | - Ying Yi Wei
- College of Animal Science and Technology, Guangxi University, Nanning 530004, PR China
| | - Mei Ling Yu
- College of Animal Science and Technology, Guangxi University, Nanning 530004, PR China.
| | - Ting Jun Hu
- College of Animal Science and Technology, Guangxi University, Nanning 530004, PR China.
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9
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Braun J, Richter A, Schmidt C, Baraliakos X. [Answering epidemiologic rheumatologic questions by cooperation with the large population-based SHIP cohort-findings with relevance for the diagnosis of axial spondyloarthritis (axSpA)]. Z Rheumatol 2021; 81:150-156. [PMID: 34264363 PMCID: PMC8894149 DOI: 10.1007/s00393-021-01050-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2021] [Indexed: 11/26/2022]
Abstract
This article presents how, based on the availability of new imaging methods and medications, objectives regarding the rheumatic disease axial spondyloarthritis (axSpA) have developed over the course of more than two decades into a rheumatologic research group. During recent years, cooperation with the Study of Health in Pomerania (SHIP) cohort has given rise to new fundamental aspects. This involved intensive cooperation between the Ruhr University Bochum (Rheumazentrum Ruhrgebiet) and the Greifswald University Hospital (Community Medicine research collective). The design of the SHIP cohort was published 10 years ago and the cohort approach presented in the Bundesgesundheitsblatt, which also described central methodologic questions in detail. In 2014, a cooperation project between the Ruhr Rheumatology Center/Ruhr University Bochum and the SHIP Department of Clinical and Epidemiologic Research (Klinisch-Epidemiologische Forschung, KEF; SHIP-KEF) was established, which has already resulted in publication of interesting results in high-ranking journals. In order to stress the potential of such corporations, important contents thereof are presented herein, with a focus on MRI and consideration of historical aspects.
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Affiliation(s)
- J Braun
- Rheumazentrum Ruhrgebiet Herne, Ruhr-Universität Bochum, Claudiusstr. 45, 44649, Herne, Deutschland.
| | - A Richter
- Institut für Community Medicine, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - C Schmidt
- Institut für Community Medicine, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - X Baraliakos
- Rheumazentrum Ruhrgebiet Herne, Ruhr-Universität Bochum, Claudiusstr. 45, 44649, Herne, Deutschland
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10
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Mezghiche I, Yahia-Cherbal H, Rogge L, Bianchi E. Novel approaches to develop biomarkers predicting treatment responses to TNF-blockers. Expert Rev Clin Immunol 2021; 17:331-354. [PMID: 33622154 DOI: 10.1080/1744666x.2021.1894926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Chronic inflammatory diseases (CIDs) cause significant morbidity and are a considerable burden for the patients in terms of pain, impaired function, and diminished quality of life. Important progress in CID treatment has been obtained with biological therapies, such as tumor-necrosis-factor blockers. However, more than a third of the patients fail to respond to these inhibitors and are exposed to the side effects of treatment, without the benefits. Therefore, there is a strong interest in developing tools to predict response of patients to biologics. Areas covered: The authors searched PubMed for recent studies on biomarkers for disease assessment and prediction of therapeutic responses, focusing on the effect of TNF blockers on immune responses in spondyloarthritis (SpA), and other CID, in particular rheumatoid arthritis and inflammatory bowel disease. Conclusions will be drawn about the possible development of predictive biomarkers for response to treatment. Expert opinion: No validated biomarker is currently available to predict treatment response in CID. New insight could be generated through the development of new bioinformatic modeling approaches to combine multidimensional biomarkers that explain the different genetic, immunological and environmental determinants of therapeutic responses.
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Affiliation(s)
- Ikram Mezghiche
- Department of Immunology, Immunoregulation Unit, Institut Pasteur, Paris, France.,Université De Paris, Sorbonne Paris Cité, Paris, France
| | - Hanane Yahia-Cherbal
- Department of Immunology, Immunoregulation Unit, Institut Pasteur, Paris, France.,Fondation AP-HP, Paris, France
| | - Lars Rogge
- Department of Immunology, Immunoregulation Unit, Institut Pasteur, Paris, France.,Unité Mixte AP-HP/Institut Pasteur, Institut Pasteur, Paris, France
| | - Elisabetta Bianchi
- Department of Immunology, Immunoregulation Unit, Institut Pasteur, Paris, France.,Unité Mixte AP-HP/Institut Pasteur, Institut Pasteur, Paris, France
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11
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Prajzlerová K, Komarc M, Forejtová Š, Pavelka K, Vencovský J, Šenolt L, Filková M. Circulating miR-145 as a marker of therapeutic response to anti-TNF therapy in patients with ankylosing spondylitis. Physiol Res 2021; 70:255-264. [PMID: 33676382 DOI: 10.33549/physiolres.934542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Circulating miRNAs appear promising therapeutic and prognostic biomarkers. We aimed to investigate the predictive value of circulating miRNAs on the disease outcome following anti-TNF therapy in patients with ankylosing spondylitis (AS). Our study included 19 AS patients assessed at baseline (M0), after three (M3) and twelve months (M12) of therapy. Total RNA was isolated from plasma. A comprehensive analysis of 380 miRNAs using TaqMan Low Density Array (TLDA) was followed by a single assay validation of selected miRNAs. All AS patients had high baseline disease activity and an excellent response to anti-TNF therapy at M3 and M12. TLDA analysis revealed the dysregulation of 17 circulating miRNAs, including miR-145. Single assay validation confirmed that miR-145 is significantly downregulated at M3 compared to baseline. The decrease in the levels of miR-145 from M0 to M3 negatively correlated with the change in BASDAI from M0 to M3; and positively correlated with disease activity improvement from M3 to M12 as per BASDAI and ASDAS. The predictive value of the early change in miR-145 and levels of miR-145 at M3 were further validated by Receiver operating curves analysis. We show thatthe early change in circulating miR-145 may be a predictor for the future outcome ofAS patients treated with TNF inhibitors. Patients with a more significant decrease in miR-145 levels may show further significant improvement of disease activity after 12 months. Monitoring the expression of miR-145 in plasma in AS patients may, therefore, influence our therapeutic decision-making.
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12
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Ogdie A, Duarte-García A, Hwang M, Navarro-Compán V, van der Heijde D, Mease P. Measuring Outcomes in Axial Spondyloarthritis. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:47-71. [PMID: 33091248 DOI: 10.1002/acr.24266] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/12/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Alexis Ogdie
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | - Mark Hwang
- University of Texas Health Science Center at Houston
| | | | | | - Philip Mease
- Swedish Medical Center, Providence St. Joseph Health, and University of Washington School of Medicine, Seattle
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13
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Gensler LS, Chakravarty SD, Cameron C, Peterson S, Spin P, Kafka S, Nair S, Deodhar A. Propensity score matching/reweighting analysis comparing intravenous golimumab to infliximab for ankylosing spondylitis using data from the GO-ALIVE and ASSERT trials. Clin Rheumatol 2020; 39:2907-2917. [PMID: 32367407 PMCID: PMC7497341 DOI: 10.1007/s10067-020-05051-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 02/28/2020] [Accepted: 03/20/2020] [Indexed: 12/17/2022]
Abstract
Objective To compare the relative efficacy of intravenous golimumab (GOL IV) and infliximab (IFX) for active ankylosing spondylitis (AS). Methods Propensity score (PS) methods were used to compare the efficacy of GOL IV 2 mg/kg and IFX 5 mg/kg using individual patient data (IPD) from the active arms of the phase 3 GO-ALIVE and ASSERT studies. Outcomes included the proportion of patients with a ≥ 20% improvement in the Assessment of Spondyloarthritis International Society Criteria (ASAS20), change from baseline in Bath Ankylosing Spondylitis Functional Index (BASFI) score, and change from baseline in C-reactive protein (CRP) levels from weeks 4–52. Results Before matching, 105 patients were treated with GOL IV and 201 patients were treated with IFX. After matching on all covariates, 118 patients were included in the ASAS20 analysis, 96 in the BASFI analysis, and 160 in the CRP analysis. After matching, GOL IV showed significantly greater improvement in ASAS20 response than IFX for weeks 28–44 (e.g., OR = 9.05 [95% CI 1.62–50.4] at week 44) and was comparable in change from baseline in BASFI scores and CRP levels to IFX at all time points. Results were robust for inclusion of different sets of covariates in scenario analyses. Conclusions This is the first analysis of its kind to leverage clinical trial data to compare two biologics using PS methods in the treatment of active AS. Overall, GOL IV was associated with greater improvement in ASAS20 response than IFX in patients with AS at 28, 36, and 44 weeks of follow-up.Key Points • Although intravenous golimumab (GOL IV) and infliximab (IFX) are the only two IV-based tumor necrosis factor (TNF) inhibitors with demonstrated phase 3 clinical efficacy in patients with ankylosing spondylitis (AS), no study has evaluated their comparative efficacy in a head-to-head trial. • Propensity score matching was used to derive indirect treatment comparisons of GOL IV and IFX for ≥ 20% in the Assessment of Spondyloarthritis International Society Criteria (ASAS20), change in Bath Ankylosing Spondylitis Functional Index (BASFI), and change in C-reactive protein (CRP) using individual patient data from the GO-ALIVE and ASSERT phase 3 trials. • Propensity score matched indirect comparisons showed improved relative efficacy of GOL IV compared to IFX; after matching for up to 16 baseline covariates, GOL IV was associated with significantly greater odds of ASAS20 response at weeks 28, 36, and 44 than IFX as well as equivalent changes from baseline in BASFI and CRP. • This novel application of propensity score matching using data from phase 3 trials, the first analysis of its kind in AS, allowed adjustment for important imbalances in prognostic factors between trials to generate estimates of comparative efficacy between GOL IV and IFX in the absence of a head-to-head trial between these treatments. |
Electronic supplementary material The online version of this article (10.1007/s10067-020-05051-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- L S Gensler
- Department of Medicine/Rheumatology, University of California, San Francisco, 400 Parnassus Ave, Box 0326, San Francisco, CA, 94143-0326, USA.
| | - S D Chakravarty
- Janssen Scientific Affairs, LLC, Horsham, PA, USA.,Drexel University College of Medicine, Philadelphia, PA, USA
| | - Chris Cameron
- EVERSANA™, Burlington, Ontario, Canada. .,EVERSANA™, 275 Charlotte St. Suite 207, Sydney, Nova Scotia, B1P 1C6, Canada.
| | - S Peterson
- Janssen Global Services, LLC, Horsham, PA, USA
| | - P Spin
- EVERSANA™, Burlington, Ontario, Canada
| | - S Kafka
- Janssen Scientific Affairs, LLC, Horsham, PA, USA
| | - S Nair
- Janssen Pharmaceutica NV, Turnhoutseweg 30, 2340, Beerse, Belgium
| | - A Deodhar
- Oregon Health & Science University, Portland, OR, USA
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14
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Ruiz-Limon P, Ladehesa-Pineda ML, Castro-Villegas MDC, Abalos-Aguilera MDC, Lopez-Medina C, Lopez-Pedrera C, Barbarroja N, Espejo-Peralbo D, Gonzalez-Reyes JA, Villalba JM, Perez-Sanchez C, Escudero-Contreras A, Collantes-Estevez E, Font-Ugalde P, Jimenez-Gomez Y. Enhanced NETosis generation in radiographic axial spondyloarthritis: utility as biomarker for disease activity and anti-TNF-α therapy effectiveness. J Biomed Sci 2020; 27:54. [PMID: 32303225 PMCID: PMC7164280 DOI: 10.1186/s12929-020-00634-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 02/26/2020] [Indexed: 12/21/2022] Open
Abstract
Background Radiographic axial spondyloarthritis (r-axSpA) is a chronic inflammatory form of arthritis in which tumor necrosis factor (TNF)-α, a potent inducer of inflammatory response and a key regulator of innate immunity and of Th1 immune responses, plays a central role. NETosis is a mechanism of innate immune defense that is involved in diverse rheumatology diseases. Nevertheless, spontaneous NETosis generation in r-axSpA, its association to disease pathogenesis, and the NETosis involvement on anti-TNF-α therapy’s effects has never been explored. Methods Thirty r-axSpA patients and 32 healthy donors (HDs) were evaluated. Neutrophil extracellular trap (NET) formation, mediators of signal-transduction cascade required for NETosis induction and cell-free NETosis-derived products were quantified. An additional cohort of 15 r-axSpA patients treated with infliximab (IFX) for six months were further analyzed. In vitro studies were designed to assess the effects of IFX in NETosis generation and the inflammatory profile triggered. Results Compared to HDs, neutrophils from r-axSpA patients displayed augmented spontaneous NET formation, elevated expression of NET-associated signaling components, nuclear peptidylarginine deiminase 4 translocation and increased citrullinated histone H3. Furthermore, patients exhibited altered circulating levels of cell-free NETosis-derived products (DNA, nucleosomes and elastase). Additional studies revealed that cell-free NETosis-derived products could be suitable biomarkers for distinguish r-axSpA patients from HDs. Correlation studies showed association between cell-free NETosis-derived products and clinical inflammatory parameters. Besides, nucleosomes displayed potential as a biomarker for discriminate patients according to disease activity. IFX therapy promoted a reduction in both NETosis generation and disease activity in r-axSpA patients. Mechanistic in vitro studies further unveiled the relevance of IFX in reducing NET release and normalizing the augmented inflammatory activities promoted by NETs in mononuclear cells. Conclusions This study reveals that NETosis is enhanced in r-axSpA patients and identifies the NETosis-derived products as potential disease activity biomarkers. In addition, the data suggests the potential role of NET generation analysis for assessment of therapeutic effectiveness in r-axSpA.
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Affiliation(s)
- Patricia Ruiz-Limon
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain. .,Unidad de Gestión Clínica Reumatología, Hospital Universitario Reina Sofía, Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain. .,Departamento de Medicina (Medicina, Dermatología y Otorrinolaringología), Universidad de Córdoba, Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain. .,Unidad de Gestión Clínica Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Clínico Virgen de la Victoria, Campus Teatinos s/n, 29010, Málaga, Spain.
| | - Maria Lourdes Ladehesa-Pineda
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain.,Unidad de Gestión Clínica Reumatología, Hospital Universitario Reina Sofía, Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain.,Departamento de Medicina (Medicina, Dermatología y Otorrinolaringología), Universidad de Córdoba, Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain
| | - Maria Del Carmen Castro-Villegas
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain.,Unidad de Gestión Clínica Reumatología, Hospital Universitario Reina Sofía, Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain.,Departamento de Medicina (Medicina, Dermatología y Otorrinolaringología), Universidad de Córdoba, Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain
| | - Maria Del Carmen Abalos-Aguilera
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain.,Unidad de Gestión Clínica Reumatología, Hospital Universitario Reina Sofía, Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain.,Departamento de Medicina (Medicina, Dermatología y Otorrinolaringología), Universidad de Córdoba, Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain
| | - Clementina Lopez-Medina
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain.,Departamento de Medicina (Medicina, Dermatología y Otorrinolaringología), Universidad de Córdoba, Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain
| | - Chary Lopez-Pedrera
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain.,Unidad de Gestión Clínica Reumatología, Hospital Universitario Reina Sofía, Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain.,Departamento de Medicina (Medicina, Dermatología y Otorrinolaringología), Universidad de Córdoba, Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain
| | - Nuria Barbarroja
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain.,Unidad de Gestión Clínica Reumatología, Hospital Universitario Reina Sofía, Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain.,Departamento de Medicina (Medicina, Dermatología y Otorrinolaringología), Universidad de Córdoba, Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain
| | - Daniel Espejo-Peralbo
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain.,Unidad de Gestión Clínica Reumatología, Hospital Universitario Reina Sofía, Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain.,Departamento de Medicina (Medicina, Dermatología y Otorrinolaringología), Universidad de Córdoba, Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain
| | - Jose Antonio Gonzalez-Reyes
- Departamento de Biología Celular, Fisiología e Inmunología, Universidad de Córdoba, Campus de Excelencia Internacional Agroalimentario ceiA3, Campus de Rabanales, Edificio Severo Ochoa, 3ª planta, 14014, Córdoba, Spain
| | - Jose Manuel Villalba
- Departamento de Biología Celular, Fisiología e Inmunología, Universidad de Córdoba, Campus de Excelencia Internacional Agroalimentario ceiA3, Campus de Rabanales, Edificio Severo Ochoa, 3ª planta, 14014, Córdoba, Spain
| | - Carlos Perez-Sanchez
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain.,Unidad de Gestión Clínica Reumatología, Hospital Universitario Reina Sofía, Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain.,Departamento de Medicina (Medicina, Dermatología y Otorrinolaringología), Universidad de Córdoba, Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain
| | - Alejandro Escudero-Contreras
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain.,Unidad de Gestión Clínica Reumatología, Hospital Universitario Reina Sofía, Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain.,Departamento de Medicina (Medicina, Dermatología y Otorrinolaringología), Universidad de Córdoba, Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain
| | - Eduardo Collantes-Estevez
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain.,Unidad de Gestión Clínica Reumatología, Hospital Universitario Reina Sofía, Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain.,Departamento de Medicina (Medicina, Dermatología y Otorrinolaringología), Universidad de Córdoba, Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain
| | - Pilar Font-Ugalde
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain.,Unidad de Gestión Clínica Reumatología, Hospital Universitario Reina Sofía, Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain.,Departamento de Medicina (Medicina, Dermatología y Otorrinolaringología), Universidad de Córdoba, Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain
| | - Yolanda Jimenez-Gomez
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain. .,Unidad de Gestión Clínica Reumatología, Hospital Universitario Reina Sofía, Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain. .,Departamento de Medicina (Medicina, Dermatología y Otorrinolaringología), Universidad de Córdoba, Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain.
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16
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Kiltz U, Braun J, Becker A, Chenot JF, Dreimann M, Hammel L, Heiligenhaus A, Hermann KG, Klett R, Krause D, Kreitner KF, Lange U, Lauterbach A, Mau W, Mössner R, Oberschelp U, Philipp S, Pleyer U, Rudwaleit M, Schneider E, Schulte TL, Sieper J, Stallmach A, Swoboda B, Winking M. [Long version on the S3 guidelines for axial spondyloarthritis including Bechterew's disease and early forms, Update 2019 : Evidence-based guidelines of the German Society for Rheumatology (DGRh) and participating medical scientific specialist societies and other organizations]. Z Rheumatol 2020; 78:3-64. [PMID: 31784900 DOI: 10.1007/s00393-019-0670-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- U Kiltz
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Claudiusstr. 45, 44649, Herne, Deutschland.
| | - J Braun
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Claudiusstr. 45, 44649, Herne, Deutschland
| | | | - A Becker
- Allgemeinmedizin, präventive und rehabilitative Medizin, Universität Marburg, Karl-von-Frisch-Str. 4, 35032, Marburg, Deutschland
| | | | - J-F Chenot
- Universitätsmedizin Greifswald, Fleischmann Str. 6, 17485, Greifswald, Deutschland
| | - M Dreimann
- Zentrum für Operative Medizin, Klinik und Poliklinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistraße 52, 20251, Hamburg, Deutschland
| | | | - L Hammel
- Geschäftsstelle des Bundesverbandes der DVMB, Metzgergasse 16, 97421, Schweinfurt, Deutschland
| | | | - A Heiligenhaus
- Augenzentrum und Uveitis-Zentrum, St. Franziskus Hospital, Hohenzollernring 74, 48145, Münster, Deutschland
| | | | - K-G Hermann
- Institut für Radiologie, Charité Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | | | - R Klett
- Praxis Manuelle & Osteopathische Medizin, Fichtenweg 17, 35428, Langgöns, Deutschland
| | | | - D Krause
- , Friedrich-Ebert-Str. 2, 45964, Gladbeck, Deutschland
| | - K-F Kreitner
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - U Lange
- Kerckhoff-Klinik, Rheumazentrum, Osteologie & Physikalische Medizin, Benekestr. 2-8, 61231, Bad Nauheim, Deutschland
| | | | - A Lauterbach
- Schule für Physiotherapie, Orthopädische Universitätsklinik Friedrichsheim, Marienburgstraße 2, 60528, Frankfurt, Deutschland
| | | | - W Mau
- Institut für Rehabilitationsmedizin, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, 06097, Halle (Saale), Deutschland
| | - R Mössner
- Klinik für Dermatologie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland
| | | | - U Oberschelp
- , Barlachstr. 6, 59368, Werne a.d. L., Deutschland
| | | | - S Philipp
- Praxis für Dermatologie, Bernauer Str. 66, 16515, Oranienburg, Deutschland
| | - U Pleyer
- Campus Virchow-Klinikum, Charité Centrum 16, Klinik f. Augenheilkunde, Charité, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - M Rudwaleit
- Klinikum Bielefeld, An der Rosenhöhe 27, 33647, Bielefeld, Deutschland
| | - E Schneider
- Abt. Fachübergreifende Frührehabilitation und Sportmedizin, St. Antonius Hospital, Dechant-Deckersstr. 8, 52249, Eschweiler, Deutschland
| | - T L Schulte
- Klinik für Orthopädie und Unfallchirurgie, Orthopädische Universitätsklinik, Ruhr-Universität Bochum, Gudrunstr. 65, 44791, Bochum, Deutschland
| | - J Sieper
- Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Deutschland
| | - A Stallmach
- Klinik für Innere Medizin IV, Universitätsklinikum Jena, Am Klinikum 1, 07743, Jena, Deutschland
| | | | - B Swoboda
- Abteilung für Orthopädie und Rheumatologie, Orthopädische Universitätsklinik, Malteser Waldkrankenhaus St. Marien, 91054, Erlangen, Deutschland
| | | | - M Winking
- Zentrum für Wirbelsäulenchirurgie, Klinikum Osnabrück, Am Finkenhügel 3, 49076, Osnabrück, Deutschland
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Moreno M, Gratacós J, Torrente-Segarra V, Sanmarti R, Morlà R, Pontes C, Llop M, Juanola X. Withdrawal of infliximab therapy in ankylosing spondylitis in persistent clinical remission, results from the REMINEA study. Arthritis Res Ther 2019; 21:88. [PMID: 30953541 PMCID: PMC6451276 DOI: 10.1186/s13075-019-1873-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 03/22/2019] [Indexed: 12/16/2022] Open
Abstract
Background Recent data suggest that anti-TNF doses can be reduced in ankylosing spondylitis (AS) patients. Some authors even propose withdrawing treatment in patients in clinical remission; however, at present there is no evidence to support this. Objective To assess how long AS patients with persistent clinical remission remained free of flares after anti-TNF withdrawal and to evaluate the effects of treatment reintroduction. We also analyze the characteristics of patients who did not present clinical relapse. Methods Multicenter, prospective, observational study of a cohort of patients with active AS who had received infliximab as a first anti-TNF treatment and who presented persistent remission (more than 6 months). We recorded at baseline and every 6–8 weeks over the 12-month period the age, gender, disease duration, peripheral arthritis or enthesitis, HLA-B27 status, BASDAI, CRP, ESR, BASFI, and three visual analogue scales, spine global pain, spinal night time pain, and patient’s global assessment. Results Thirty-six out of 107 patients (34%) presented persistent remission and were included in our study. After treatment withdrawal, 21 of these 36 patients (58%) presented clinical relapse during follow-up. Infliximab therapy was reintroduced and only 52% achieved clinical remission, as they had before the discontinuation of infliximab; in an additional 10%, reintroduction of infliximab was ineffective, obliging us to change the anti-TNF therapy. No clinical or biological factors were associated with the occurrence of relapse during the follow-up. Conclusions Two thirds of patients in clinical remission presented clinical relapse shortly after infliximab withdrawal. Although the reintroduction of infliximab treatment was safe, half of the patients did not present the same clinical response that they had achieved prior to treatment withdrawal.
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Affiliation(s)
- Mireia Moreno
- Rheumatology Department, Parc Taulí Hospital Universitari, I3PT, Universitat Autònoma de Barcelona, 08208, Sabadell, Barcelona, Spain
| | - Jordi Gratacós
- Rheumatology Department, Parc Taulí Hospital Universitari, I3PT, Universitat Autònoma de Barcelona, 08208, Sabadell, Barcelona, Spain.
| | | | - Raimon Sanmarti
- Rheumatology Department, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Rosa Morlà
- Rheumatology Department, Hospital del Vendrell, Tarragona, Spain
| | - Caridad Pontes
- Clinical Pharmacology Department, ParcTaulí Hospital Universitari, I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, Spain
| | - Maria Llop
- Rheumatology Department, Parc Taulí Hospital Universitari, I3PT, Universitat Autònoma de Barcelona, 08208, Sabadell, Barcelona, Spain
| | - Xavier Juanola
- Rheumatology Department, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
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18
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Menegatti S, Bianchi E, Rogge L. Anti-TNF Therapy in Spondyloarthritis and Related Diseases, Impact on the Immune System and Prediction of Treatment Responses. Front Immunol 2019; 10:382. [PMID: 30941119 PMCID: PMC6434926 DOI: 10.3389/fimmu.2019.00382] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 02/14/2019] [Indexed: 12/14/2022] Open
Abstract
Immune-mediated inflammatory diseases (IMIDs), such as spondyloarthritis (SpA), psoriasis, Crohn's disease (CD), and rheumatoid arthritis (RA) remain challenging illnesses. They often strike at a young age and cause lifelong morbidity, representing a considerable burden for the affected individuals and society. Pioneering studies have revealed the presence of a TNF-dependent proinflammatory cytokine cascade in several IMIDs, and the introduction of anti-TNF therapy 20 years ago has proven effective to reduce inflammation and clinical symptoms in RA, SpA, and other IMID, providing unprecedented clinical benefits and a valid alternative in case of failure or intolerable adverse effects of conventional disease-modifying antirheumatic drugs (DMARDs, for RA) or non-steroidal anti-inflammatory drugs (NSAIDs, for SpA). However, our understanding of how TNF inhibitors (TNFi) affect the immune system in patients is limited. This question is relevant because anti-TNF therapy has been associated with infectious complications. Furthermore, clinical efficacy of TNFi is limited by a high rate of non-responsiveness (30–40%) in RA, SpA, and other IMID, exposing a substantial fraction of patients to side-effects without clinical benefit. Despite the extensive use of TNFi, it is still not possible to determine which patients will respond to TNFi before treatment initiation. The recent introduction of antibodies blocking IL-17 has expanded the therapeutic options for SpA, as well as psoriasis and psoriatic arthritis. It is therefore essential to develop tools to guide treatment decisions for patients affected by SpA and other IMID, both to optimize clinical care and contain health care costs. After a brief overview of the biology of TNF, its receptors and currently used TNFi in the clinics, we summarize the progress that has been made to increase our understanding of the action of TNFi on the immune system in patients. We then summarize efforts dedicated to identify biomarkers that can predict treatment responses to TNFi and we conclude with a section dedicated to the recently introduced inhibitors of IL-17A and IL-23 in SpA and related diseases. The focus of this review is on SpA, however, we also refer to RA on topics for which only limited information is available on SpA in the literature.
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Affiliation(s)
- Silvia Menegatti
- Immunoregulation Unit, Department of Immunology, Institut Pasteur, Paris, France.,Unité Mixte de Recherche, Institut Pasteur/AP-HP Hôpital Cochin, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Elisabetta Bianchi
- Immunoregulation Unit, Department of Immunology, Institut Pasteur, Paris, France.,Unité Mixte de Recherche, Institut Pasteur/AP-HP Hôpital Cochin, Paris, France
| | - Lars Rogge
- Immunoregulation Unit, Department of Immunology, Institut Pasteur, Paris, France.,Unité Mixte de Recherche, Institut Pasteur/AP-HP Hôpital Cochin, Paris, France
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19
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Braun J, Baraliakos X, Kiltz U, Krüger K, Burmester GR, Wassenberg S, Thomas MH. Disease Activity Cutoff Values in Initiating Tumor Necrosis Factor Inhibitor Therapy in Ankylosing Spondylitis: A German GO-NICE Study Subanalysis. J Rheumatol 2019; 47:35-41. [PMID: 30877206 DOI: 10.3899/jrheum.181040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVE International recommendations for the management of axial spondyloarthritis including ankylosing spondylitis (AS) recommend a Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) level of disease activity of ≥ 4 to initiate treatment with biologics. We aimed to evaluate the level of disease activity used to initiate tumor necrosis factor inhibitor (TNFi) treatment and the level of responses to treatment based on different BASDAI cutoffs. METHODS This is a posthoc analysis of the noninterventional, prospective, GO-NICE study in the subgroup of biologic-naive AS treated with golimumab (GOL) 50 mg subcutaneously once monthly. RESULTS Of the 244 biologic-naive AS patients at baseline, 70.5% had a BASDAI ≥ 4 (Group 1), 14.3% had 2.8 to < 4 (Group 2), and 15.2% had even < 2.8 (Group 3). A total of 134 patients (54.9%) completed the 24-month observational period. The mean BASDAI in Groups 1, 2, and 3 was initially 5.9 ± 1.3, 3.4 ± 0.4, and 2.0 ± 0.8, decreased to 2.2 ± 2.0, 1.9 ± 1.2, and 1.0 ± 1.2 within 3 months (all p < 0.0001 vs baseline), and decreased significantly to 2.2 ± 1.7, 1.9 ± 1.7, and 1.4 ± 1.0 at Month 24 (all p < 0.005), respectively. BASDAI 50% improvement was noted in 68.8%, 44.8%, and 45.2% of patients at Month 3, and in 84.9%, 61.9%, and 55.0% at Month 24. CONCLUSION TNFi treatment was initiated in almost a third of AS patients with lower disease activity states as assessed by BASDAI cutoff of ≥ 4. Patients with a BASDAI between 2.8 and < 4 appeared to benefit significantly from GOL treatment, while patients with BASDAI < 2.8 did not. This finding should lead to a reevaluation of the established BASDAI cutoff of ≥ 4.
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Affiliation(s)
- Jürgen Braun
- From the Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum, Herne; Rheumatologisches Praxiszentrum München; Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin, Berlin; Rheumazentrum Ratingen, Ratingen; Medical Affairs, MSD Sharp & Dohme GmbH, Haar, Germany. .,M. Thomas is a full-time employee of MSD Sharp & Dohme GmbH, Haar. U. Kiltz received an unrestricted grant from AbbVie. G.R. Burmester received lecture and/or consulting fees from MSD. K. Krüger received speaker fees and research grants from AbbVie, MSD, and Pfizer. .,J. Braun, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; X. Baraliakos, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; U. Kiltz, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; K. Krüger, MD, Rheumatologisches Praxiszentrum München; G.R. Burmester, MD, Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin; S. Wassenberg, MD, Rheumazentrum Ratingen; M.H. Thomas, PhD, Medical Affairs, MSD Sharp & Dohme GmbH.
| | - Xenofon Baraliakos
- From the Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum, Herne; Rheumatologisches Praxiszentrum München; Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin, Berlin; Rheumazentrum Ratingen, Ratingen; Medical Affairs, MSD Sharp & Dohme GmbH, Haar, Germany.,M. Thomas is a full-time employee of MSD Sharp & Dohme GmbH, Haar. U. Kiltz received an unrestricted grant from AbbVie. G.R. Burmester received lecture and/or consulting fees from MSD. K. Krüger received speaker fees and research grants from AbbVie, MSD, and Pfizer.,J. Braun, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; X. Baraliakos, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; U. Kiltz, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; K. Krüger, MD, Rheumatologisches Praxiszentrum München; G.R. Burmester, MD, Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin; S. Wassenberg, MD, Rheumazentrum Ratingen; M.H. Thomas, PhD, Medical Affairs, MSD Sharp & Dohme GmbH
| | - Uta Kiltz
- From the Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum, Herne; Rheumatologisches Praxiszentrum München; Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin, Berlin; Rheumazentrum Ratingen, Ratingen; Medical Affairs, MSD Sharp & Dohme GmbH, Haar, Germany.,M. Thomas is a full-time employee of MSD Sharp & Dohme GmbH, Haar. U. Kiltz received an unrestricted grant from AbbVie. G.R. Burmester received lecture and/or consulting fees from MSD. K. Krüger received speaker fees and research grants from AbbVie, MSD, and Pfizer.,J. Braun, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; X. Baraliakos, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; U. Kiltz, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; K. Krüger, MD, Rheumatologisches Praxiszentrum München; G.R. Burmester, MD, Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin; S. Wassenberg, MD, Rheumazentrum Ratingen; M.H. Thomas, PhD, Medical Affairs, MSD Sharp & Dohme GmbH
| | - Klaus Krüger
- From the Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum, Herne; Rheumatologisches Praxiszentrum München; Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin, Berlin; Rheumazentrum Ratingen, Ratingen; Medical Affairs, MSD Sharp & Dohme GmbH, Haar, Germany.,M. Thomas is a full-time employee of MSD Sharp & Dohme GmbH, Haar. U. Kiltz received an unrestricted grant from AbbVie. G.R. Burmester received lecture and/or consulting fees from MSD. K. Krüger received speaker fees and research grants from AbbVie, MSD, and Pfizer.,J. Braun, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; X. Baraliakos, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; U. Kiltz, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; K. Krüger, MD, Rheumatologisches Praxiszentrum München; G.R. Burmester, MD, Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin; S. Wassenberg, MD, Rheumazentrum Ratingen; M.H. Thomas, PhD, Medical Affairs, MSD Sharp & Dohme GmbH
| | - Gerd R Burmester
- From the Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum, Herne; Rheumatologisches Praxiszentrum München; Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin, Berlin; Rheumazentrum Ratingen, Ratingen; Medical Affairs, MSD Sharp & Dohme GmbH, Haar, Germany.,M. Thomas is a full-time employee of MSD Sharp & Dohme GmbH, Haar. U. Kiltz received an unrestricted grant from AbbVie. G.R. Burmester received lecture and/or consulting fees from MSD. K. Krüger received speaker fees and research grants from AbbVie, MSD, and Pfizer.,J. Braun, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; X. Baraliakos, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; U. Kiltz, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; K. Krüger, MD, Rheumatologisches Praxiszentrum München; G.R. Burmester, MD, Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin; S. Wassenberg, MD, Rheumazentrum Ratingen; M.H. Thomas, PhD, Medical Affairs, MSD Sharp & Dohme GmbH
| | - Siegfried Wassenberg
- From the Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum, Herne; Rheumatologisches Praxiszentrum München; Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin, Berlin; Rheumazentrum Ratingen, Ratingen; Medical Affairs, MSD Sharp & Dohme GmbH, Haar, Germany.,M. Thomas is a full-time employee of MSD Sharp & Dohme GmbH, Haar. U. Kiltz received an unrestricted grant from AbbVie. G.R. Burmester received lecture and/or consulting fees from MSD. K. Krüger received speaker fees and research grants from AbbVie, MSD, and Pfizer.,J. Braun, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; X. Baraliakos, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; U. Kiltz, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; K. Krüger, MD, Rheumatologisches Praxiszentrum München; G.R. Burmester, MD, Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin; S. Wassenberg, MD, Rheumazentrum Ratingen; M.H. Thomas, PhD, Medical Affairs, MSD Sharp & Dohme GmbH
| | - Matthias H Thomas
- From the Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum, Herne; Rheumatologisches Praxiszentrum München; Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin, Berlin; Rheumazentrum Ratingen, Ratingen; Medical Affairs, MSD Sharp & Dohme GmbH, Haar, Germany.,M. Thomas is a full-time employee of MSD Sharp & Dohme GmbH, Haar. U. Kiltz received an unrestricted grant from AbbVie. G.R. Burmester received lecture and/or consulting fees from MSD. K. Krüger received speaker fees and research grants from AbbVie, MSD, and Pfizer.,J. Braun, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; X. Baraliakos, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; U. Kiltz, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; K. Krüger, MD, Rheumatologisches Praxiszentrum München; G.R. Burmester, MD, Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin; S. Wassenberg, MD, Rheumazentrum Ratingen; M.H. Thomas, PhD, Medical Affairs, MSD Sharp & Dohme GmbH
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20
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Lories RJ. Advances in understanding the pathophysiology of spondyloarthritis. Best Pract Res Clin Rheumatol 2019; 32:331-341. [PMID: 31171306 DOI: 10.1016/j.berh.2018.12.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 11/10/2018] [Indexed: 01/02/2023]
Abstract
Progressive understanding of the underlying pathophysiology of axial spondyloarthritis has successfully translated into innovative therapeutic strategies and successful management of patients in the clinic. This review summarizes the key roles of the pro-inflammatory cytokines tumor necrosis factor and interleukin-17 in the onset and progression of disease and how these cytokines are instrumental in shaping the concept that enthesitis is a key feature of axial spondyloarthritis. Advances in immunological technologies have led to the important insight that different cell populations, part of both the innate and adaptive immune system, play a key role in axial spondyloarthritis. In addition to inflammation, structural damage to the axial skeleton, in particular progressive ankylosis of the sacroiliac joints and the spine, is key to the outcome of patients. Novel data integrate the role of pro-inflammatory cytokines and enthesitis in this context.
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Affiliation(s)
- Rik J Lories
- KU Leuven, Skeletal Biology and Engineering Research Center, Laboratory of Tissue Homeostasis and Disease, Leuven, Belgium; University Hospitals Leuven, Division of Rheumatology, Leuven, Belgium.
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21
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Martínez T, Garcia-Robledo JE, Plata I, Urbano MA, Posso-Osorio I, Rios-Serna LJ, Barrera MC, Tobón GJ. Mechanisms of action and historical facts on the use of intravenous immunoglobulins in systemic lupus erythematosus. Autoimmun Rev 2019; 18:279-286. [PMID: 30639648 DOI: 10.1016/j.autrev.2018.10.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 10/14/2018] [Indexed: 12/29/2022]
Abstract
The current existing therapies for severe cases of systemic lupus erythematosus (SLE) patients are still limited. Intravenous immunoglobulin (IVIGs), which are purified from the plasma of thousands of healthy human donors, have been profiled as efficacious and life-saving options for SLE patients refractory to conventional therapy. The specific mechanism of action by which IVIGs generate immunomodulation in SLE is not currently understood. In this manuscript, we reviewed some of the hypothesis that have been postulated to explain the IVIG effects, including those on T and B cell intracellular signalling and activation, as well as the interferon signalling pathways involved in the detection of nucleic acids and the defective removal of immune complexes and debris.
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Affiliation(s)
- Tatiana Martínez
- GIRAT: Grupo de Investigación en Reumatología, Autoinmunidad y Medicina traslacional. Fundación Valle del Lili, Univesidad Icesi, Colombia
| | | | - Ilich Plata
- Medical School, Universidad Icesi, Cali, Colombia
| | | | - Ivan Posso-Osorio
- GIRAT: Grupo de Investigación en Reumatología, Autoinmunidad y Medicina traslacional. Fundación Valle del Lili, Univesidad Icesi, Colombia
| | - Lady J Rios-Serna
- GIRAT: Grupo de Investigación en Reumatología, Autoinmunidad y Medicina traslacional. Fundación Valle del Lili, Univesidad Icesi, Colombia
| | - María Claudia Barrera
- GIRAT: Grupo de Investigación en Reumatología, Autoinmunidad y Medicina traslacional. Fundación Valle del Lili, Univesidad Icesi, Colombia
| | - Gabriel J Tobón
- GIRAT: Grupo de Investigación en Reumatología, Autoinmunidad y Medicina traslacional. Fundación Valle del Lili, Univesidad Icesi, Colombia; Laboratory of immunology, Fundación Valle del Lili, Cali, Colombia.
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22
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Moura CS, Rahme E, Maksymowych WP, Abrahamowicz M, Bessette L, Bernatsky S. Use of disease-modifying anti-rheumatic or anti-tumour necrosis factor drugs and risk of hospitalized infection in ankylosing spondylitis. Scand J Rheumatol 2018; 48:121-127. [DOI: 10.1080/03009742.2018.1470253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- CS Moura
- Centre for Outcome Research and Evaluation (CORE), McGill University, Montreal, Canada
- Department of Medicine, Division of Rheumatology, McGill University, Montreal, Canada
| | - E Rahme
- Department of Medicine, Division of Rheumatology, McGill University, Montreal, Canada
- Department of Medicine, Division of Clinical Epidemiology, McGill University, Montreal, Canada
| | - WP Maksymowych
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - M Abrahamowicz
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - L Bessette
- Division of Rheumatology, Department of Medicine, Laval University, Quebec City, Canada
| | - S Bernatsky
- Centre for Outcome Research and Evaluation (CORE), McGill University, Montreal, Canada
- Department of Medicine, Division of Rheumatology, McGill University, Montreal, Canada
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23
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Sikorska D, Orzechowska Z, Rutkowski R, Prymas A, Mrall-Wechta M, Bednarek-Hatlińska D, Roszak M, Surdacka A, Samborski W, Witowski J. Diagnostic value of salivary CRP and IL-6 in patients undergoing anti-TNF-alpha therapy for rheumatic disease. Inflammopharmacology 2018; 26:1183-1188. [PMID: 30043213 PMCID: PMC6153921 DOI: 10.1007/s10787-018-0515-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 06/27/2018] [Indexed: 01/28/2023]
Abstract
Introduction Saliva has been increasingly used as a diagnostic medium for disease detection and monitoring. The aim of this observational, prospective, pilot study was to investigate whether salivary concentrations of CRP and IL-6 correlate with those in serum and with the clinical course of a rheumatic disease. Materials and methods Nineteen patients with rheumatic disease newly scheduled for anti-TNFα therapy were included. Patients received anti-TNFα treatment (adalimumab, certolizumab, golimumab or infliximab) as per standard protocols. CRP and IL-6 were measured with high-sensitivity immunoassays before and after 12 weeks of therapy, according to standard regimens. The data were analyzed with nonparametric statistics. Results Concentrations of CRP in saliva correlated significantly with those in serum (R = 0.62; p < 0.0001) and decreased markedly after successful response to treatment. In patients with a limited response to treatment salivary CRP levels increased. In contrast to CRP, the salivary concentrations of IL-6 did not change significantly over the course of therapy and they did not correlate with serum IL-6 concentrations. Salivary levels of neither CRP nor IL-6 corresponded to parameters of oral health and hygiene. Conclusions Salivary CRP but not IL-6 could be of potential use for monitoring the rheumatic disease activity.
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Affiliation(s)
- Dorota Sikorska
- Department of Rheumatology and Rehabilitation, Poznan University of Medical Sciences, 28-Czerwca 1956 Street 135/147, 61-545, Poznan, Poland.
| | - Zofia Orzechowska
- Department of Pathophysiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Rafał Rutkowski
- Department of Pathophysiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Anna Prymas
- Department of Conservative Dentistry and Endodontics, Poznan University of Medical Sciences, Poznan, Poland
| | - Marta Mrall-Wechta
- Department of Conservative Dentistry and Endodontics, Poznan University of Medical Sciences, Poznan, Poland
| | - Daria Bednarek-Hatlińska
- Department of Conservative Dentistry and Endodontics, Poznan University of Medical Sciences, Poznan, Poland
| | - Magdalena Roszak
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, Poznan, Poland
| | - Anna Surdacka
- Department of Conservative Dentistry and Endodontics, Poznan University of Medical Sciences, Poznan, Poland
| | - Włodzimierz Samborski
- Department of Rheumatology and Rehabilitation, Poznan University of Medical Sciences, 28-Czerwca 1956 Street 135/147, 61-545, Poznan, Poland
| | - Janusz Witowski
- Department of Pathophysiology, Poznan University of Medical Sciences, Poznan, Poland
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24
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Choudhury MR, Hassan MM, Kabir ME, Rabbani MG, Haq SA, Rahman MK. An open label clinical trial of thalidomide in NSAIDs refractory ankylosing spondylitis. Mod Rheumatol 2018; 28:730-732. [PMID: 29327635 DOI: 10.1080/14397595.2018.1427430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Minhaj Rahim Choudhury
- a Department of Rheumatology , Bangabandhu Sheikh Mujib Medical University , Dhaka , Bangladesh
| | - M Masudul Hassan
- a Department of Rheumatology , Bangabandhu Sheikh Mujib Medical University , Dhaka , Bangladesh
| | - M Ekramul Kabir
- b Department of Medicine , Kurmitola General Hospital, Dhaka Cantonment , Dhaka , Bangladesh
| | - M Golam Rabbani
- c Department of Statistics, Biostatistics and Informatics , University of Dhaka , Dhaka , Bangladesh
| | - Syed Atiqul Haq
- a Department of Rheumatology , Bangabandhu Sheikh Mujib Medical University , Dhaka , Bangladesh
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Dubrovsky AM, Lim MJ, Lane NE. Osteoporosis in Rheumatic Diseases: Anti-rheumatic Drugs and the Skeleton. Calcif Tissue Int 2018; 102:607-618. [PMID: 29470611 DOI: 10.1007/s00223-018-0401-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 02/01/2018] [Indexed: 12/26/2022]
Abstract
Osteoporosis in rheumatic diseases is a very well-known complication. Systemic inflammation results in both generalized and localized bone loss and erosions. Recently, increased knowledge of inflammatory process in rheumatic diseases has resulted in the development of potent inhibitors of the cytokines, the biologic DMARDs. These treatments reduce systemic inflammation and have some effect on the generalized and localized bone loss. Progression of bone erosion was slowed by TNF, IL-6 and IL-1 inhibitors, a JAK inhibitor, a CTLA4 agonist, and rituximab. Effects on bone mineral density varied between the biological DMARDs. Medications that are approved for the treatment of osteoporosis have been evaluated to prevent bone loss in rheumatic disease patients, including denosumab, cathepsin K, bisphosphonates, anti-sclerostin antibodies and parathyroid hormone (hPTH 1-34), and have some efficacy in both the prevention of systemic bone loss and reducing localized bone erosions. This article reviews the effects of biologic DMARDs on bone mass and erosions in patients with rheumatic diseases and trials of anti-osteoporotic medications in animal models and patients with rheumatic diseases.
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Affiliation(s)
- Alanna M Dubrovsky
- Center for Musculoskeletal Health, University of California at Davis Medical Center, Sacramento, CA, 95817, USA
| | - Mie Jin Lim
- Center for Musculoskeletal Health, University of California at Davis Medical Center, Sacramento, CA, 95817, USA
- Division of Rheumatology, Department of Internal Medicine, Inha University Hospital, Incheon, South Korea
| | - Nancy E Lane
- Center for Musculoskeletal Health, University of California at Davis Medical Center, Sacramento, CA, 95817, USA.
- Department of Internal Medicine, University of California at Davis Medical Center, 4625 2nd Avenue, Suite 2000, Sacramento, CA, 95817, USA.
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Disease activity in axial spondyloarthritis after discontinuation of TNF inhibitors therapy. Reumatologia 2017; 55:157-162. [PMID: 29056769 PMCID: PMC5647530 DOI: 10.5114/reum.2017.69775] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 08/02/2017] [Indexed: 01/07/2023] Open
Abstract
Objective Use of tumour necrosis factor inhibitors (TNFi) has proved to be an important step forward in the treatment of axial spondyloarthritis (axSpA), but the duration of the therapy as well as the management in case of low disease activity (LDA) or remission are not clearly established. Currently, the identification of potential predictors associated with the treatment discontinuation is the basic purpose of many clinical studies. The aim of this study was to analyze the influence of the discontinuation of TNFi therapy on the disease activity in patients with low disease activity. Material and methods The study included 65 patients; 47 of patients (72%) were treated with etanercept, 16 (2%) with adalimumab and 2 (3%) with infliximab. Results The mean age of the patients was 45 years, the mean BASDAI score was 6.8 and VAS for low back pain was 76 mm at baseline. 54 patients with axSpA (83%) achieved LDA after 9 months of anti-TNF therapy. During follow-up 40 patients (74% of patients with LDA) had an increase of the disease activity after mean 14 weeks and needed to restart the treatment with TNFi. After restart of the therapy LDA was regained in all patients after mean 7 weeks. 11 patients (17%) have never achieved LDA and 14 patients (22%) had LDA longer than 6 months without relapse. At baseline higher levels of CRP and ESR were observed in patients with relapse of the disease at the end of treatment and with LDA shorter than 6 months. Conclusions Changes in the values of disease activity indicators (CRP, ESR) correlated with more stable response to TNFi therapy. Over 50% of patients who were treated with TNFi needed to restart the therapy. Treatment resumption allowed to regain a good clinical effect among affected patients.
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Sieper J. New treatment targets for axial spondyloarthritis. Rheumatology (Oxford) 2017; 55:ii38-ii42. [PMID: 27856659 DOI: 10.1093/rheumatology/kew349] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Revised: 08/23/2016] [Indexed: 01/15/2023] Open
Abstract
Axial spondyloarthritis (axSpA) patients can be divided into those with structural damage in the SI joint visible on X-rays, termed radiographic axSpA or AS, and those in an earlier phase of the disease, without structural damage in the SI joint, termed non-radiographic axSpA. TNF-blockers have been shown to be highly effective in the treatment of active axSpA. Interestingly, conventional DMARDs and also non-TNF-blocker biologics targeting IL-1, IL-6 and T cells (abatacept) are not effective. Recent interest has focused on the cytokines IL-23 and IL-17 as potential treatment targets in axSpA. An open-label trial with ustekinumab showed a good efficacy in AS patients. Two placebo-controlled phase 3 trials with a mAb blocking IL-17, secukinumab, showed a good reduction in disease activity, similar to that shown for TNF blockers. Probably triggered by inflammation, new bone formation is another hallmark in AS and a potentially important treatment target. However, a previously reported inhibitory effect of NSAID treatment could not be confirmed in a recent NSAID trial.
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Affiliation(s)
- Joachim Sieper
- Department of Medicine I, Rheumatology, Charité, Campus Benjamin Franklin, Berlin, Germany
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28
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Anti-TNF-Mediated Modulation of Prohepcidin Improves Iron Availability in Inflammatory Bowel Disease, in an IL-6-Mediated Fashion. Can J Gastroenterol Hepatol 2017; 2017:6843976. [PMID: 28191453 PMCID: PMC5278212 DOI: 10.1155/2017/6843976] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 10/15/2016] [Accepted: 12/20/2016] [Indexed: 12/15/2022] Open
Abstract
Background. Anaemia is common in inflammatory bowel disease (IBD), frequently resulting from a combination of iron deficiency and of anaemia of chronic disease (ACD). ACD is characterized by macrophage iron retention induced by proinflammatory cytokines. Hepcidin is the master inducer of iron accumulation during ACD, and its production is mainly regulated by IL-6 and the novel erythroid hormone erythroferrone (ERFE). This study evaluates whether anti-TNF monoclonal antibodies therapy modurates hepcidin production and the levels of its main regulators, leading to a restoration of iron homeostasis. Methods. Sera were collected from 21 IBD patients, before each anti-TNF administration, for the first 6 weeks of therapy. Prohepcidin, erythropoietin, erythroferrone, C reactive protein, interleukin-6, iron markers, and haemoglobin levels were measured and clinical activity indexes were evaluated. Results. Serum prohepcidin, IL-6, CRP, and ferritin were significantly reduced after 6-week treatment; an increase in serum iron and total transferrin was observed. No changes in the EPO-ERFE axis were found. Remarkably, haemoglobin was significantly increased. Conclusions. Anti-TNF therapy improves iron metabolism and, subsequently, anaemia in IBD. This effect appears to be related to the modulation of the cytokine network and specifically IL-6 leading to a relevant decrease of hepcidin, a master regulator of ACD.
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Kobayashi S, Yoshinari T. A multicenter, open-label, long-term study of three-year infliximab administration in Japanese patients with ankylosing spondylitis. Mod Rheumatol 2016; 27:142-149. [PMID: 27299733 DOI: 10.1080/14397595.2016.1176635] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To investigate the efficacy, safety, and pharmacokinetics of infliximab (IFX) in Japanese patients with active ankylosing spondylitis (AS). METHODS In this multicenter open-label study, IFX was infused at 5 mg/kg to 33 Japanese patients with active AS using or intolerable to non-steroidal anti-inflammatory drugs (NSAIDs) at Weeks 0, 2, and 6, and then every six weeks for approximately three years (mean: 149.5 weeks). RESULTS Assessment in Ankylosing Spondylitis (ASAS) 20 response at Week 24 (primary endpoint) was 97.0% (32/33) and was thereafter maintained at approximately 90% over the three-year study period. Improvements in range of motion, physical function, inflammatory parameters, and quality of life (QOL) were all maintained throughout the three-year study period. A serum IFX level of ≥5 μg/mL was maintained with six-week infusion intervals, and only two patients (6.1%) developed antibodies to IFX. Specific adverse events in AS patients were not observed. CONCLUSION These findings suggest that a 5 mg/kg administration of IFX at six-week intervals to Japanese patients with active AS is safe, effective and provides long-term therapeutic benefits.
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Affiliation(s)
- Shigeto Kobayashi
- a Division of Rheumatology, Department of Internal Medicine , Juntendo University Koshigaya Hospital , Koshigaya , Japan and
| | - Toru Yoshinari
- b Sohyaku Innovative Research Division , Mitsubishi Tanabe Pharma Corporation , Tokyo , Japan
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30
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Kim HW, Kwon SR, Jung KH, Kim SK, Baek HJ, Seo MR, Bang SY, Lee HS, Suh CH, Jung JY, Son CN, Shim SC, Lee SH, Lee SG, Lee YA, Lee EY, Kim TH, Kim YG. Safety of Resuming Tumor Necrosis Factor Inhibitors in Ankylosing Spondylitis Patients Concomitant with the Treatment of Active Tuberculosis: A Retrospective Nationwide Registry of the Korean Society of Spondyloarthritis Research. PLoS One 2016; 11:e0153816. [PMID: 27101309 PMCID: PMC4839632 DOI: 10.1371/journal.pone.0153816] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 04/04/2016] [Indexed: 12/17/2022] Open
Abstract
Backgrounds Patients who develop an active tuberculosis infection during tumor necrosis factor (TNF) inhibitor treatment typically discontinue TNF inhibitor and receive standard anti-tuberculosis treatment. However, there is currently insufficient information on patient outcomes following resumption of TNF inhibitor treatment during ongoing anti- tuberculosis treatment. Our study was designed to investigate the safety of resuming TNF inhibitors in ankylosing spondylitis (AS) patients who developed tuberculosis as a complication of the use of TNF inhibitors. Methods Through the nationwide registry of the Korean Society of Spondyloarthritis Research, 3929 AS patients who were prescribed TNF inhibitors were recruited between June 2003 and June 2014 at fourteen referral hospitals. Clinical information was analyzed about the patients who experienced tuberculosis after exposure to TNF inhibitors. The clinical features of resumers and non-resumers of TNF inhibitors were compared and the outcomes of tuberculosis were surveyed individually. Findings Fifty-six AS patients were treated for tuberculosis associated with TNF inhibitors. Among them, 23 patients resumed TNF inhibitors, and these patients were found to be exposed to TNF inhibitors for a longer period of time and experienced more frequent disease flare-up after discontinuation of TNF inhibitors compared with those who did not resume. Fifteen patients resumed TNF inhibitors during anti-tuberculosis treatment (early resumers) and 8 after completion of anti-tuberculosis treatment (late resumers). Median time to resuming TNF inhibitor from tuberculosis was 3.3 and 9.0 months in the early and late resumers, respectively. Tuberculosis was treated successfully in all resumers and did not relapse in any of them during follow-up (median 33.8 [IQR; 20.8–66.7] months). Conclusions Instances of tuberculosis were treated successfully in our AS patients, even when given concomitantly with TNF inhibitors. We suggest that early resumption of TNF inhibitors in AS patients could be safe under effective coverage of tuberculosis.
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Affiliation(s)
- Hye Won Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Division of Rheumatology, Gangnam Severance Hospital, Seoul, Korea
| | - Seong Ryul Kwon
- Division of Rheumatology, Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Kyong-Hee Jung
- Division of Rheumatology, Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Seong-Kyu Kim
- Division of Rheumatology, Department of Internal Medicine, Arthritis and Autoimmunity Research Center, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Han Joo Baek
- Division of Rheumatology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Korea
| | - Mi Ryung Seo
- Division of Rheumatology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Korea
| | - So-Young Bang
- Division of Rheumatology, Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea
| | - Hye-Soon Lee
- Division of Rheumatology, Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea
| | - Chang-Hee Suh
- Division of Rheumatology, Department of Internal Medicine, Ajou University Hospital, Suwon, Korea
| | - Ju Yang Jung
- Division of Rheumatology, Department of Internal Medicine, Ajou University Hospital, Suwon, Korea
| | - Chang-Nam Son
- Division of Rheumatology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Seung Cheol Shim
- Division of Rheumatology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Sang-Hoon Lee
- Department of Rheumatology, Center of Arthritis and Rheumatism, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Seung-Geun Lee
- Division of Rheumatology, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
| | - Yeon-Ah Lee
- Division of Rheumatology, Department of Internal Medicine, Kyung Hee University Medical center, Seoul, Korea
| | - Eun Young Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Tae-Hwan Kim
- Division of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
- * E-mail: . (YGK); (THK)
| | - Yong-Gil Kim
- Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
- * E-mail: . (YGK); (THK)
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Rahman P, Choquette D, Bensen WG, Khraishi M, Chow A, Zummer M, Shaikh S, Sheriff M, Dixit S, Sholter D, Psaradellis E, Sampalis JS, Letourneau V, Lehman AJ, Nantel F, Rampakakis E, Otawa S, Shawi M. Biologic Treatment Registry Across Canada (BioTRAC): a multicentre, prospective, observational study of patients treated with infliximab for ankylosing spondylitis. BMJ Open 2016; 6:e009661. [PMID: 27048632 PMCID: PMC4823435 DOI: 10.1136/bmjopen-2015-009661] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES To describe the profile of patients with ankylosing spondylitis (AS) treated with infliximab in Canadian routine care and to assess the effectiveness and safety of infliximab in real world. SETTING 46 primary care rheumatology practices across Canada. PARTICIPANTS 303 biological-naïve patients with AS or patients previously treated with a biological for <6 months and who were eligible for infliximab treatment as per routine care within the Biologic Treatment Registry Across Canada (BioTRAC). INTERVENTION Not applicable (non-interventional study). PRIMARY AND SECONDARY OUTCOMES Effectiveness was assessed with changes in disease parameters (AS Disease Activity Score (ASDAS), Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), Health Assessment Questionnaire Disease Index (HAQ-DI), physician global assessment of disease activity (MDGA), patient global disease activity (PtGA), back pain, C-reactive protein, erythrocyte sedimentation rate (ESR), morning stiffness). Safety was assessed with the incidence of adverse events (AEs). RESULTS Of the 303 patients included, 44.6% were enrolled in 2005-2007 and 55.4% in 2008-2013. Patients enrolled in 2005-2007 had significantly higher MDGA and ESR at baseline while all other disease parameters examined were numerically higher with the exception of PtGA. Treatment with infliximab significantly (p<0.001) improved all disease parameters over time in both groups. At 6 months, 56% and 31% of patients achieved clinically important (change≥1.1) and major (change≥2.0) improvement in ASDAS, respectively; at 48 months, these proportions increased to 75% and 50%, respectively. Among patients unemployed due to disability at baseline, 12.1% returned to work (mean Kaplan-Meier (KM)-based time=38.8 months). The estimated retention rate at 12 and 24 months was 78.3% and 60.1%, respectively. The profile and incidence of AEs were comparable to data previously reported for tumour necrosis factor-α inhibitors. CONCLUSIONS Characteristics of patients with AS at infliximab initiation changed over time towards lower disease activity and shorter disease duration. Infliximab treatment significantly reduced disease activity independent of treatment initiation year, although patients enrolled in recent years achieved lower disease activity over 48 months. TRIAL REGISTRATION NUMBER NCT00741793.
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Affiliation(s)
- Proton Rahman
- Department of Medicine & Rheumatology, Memorial University, St. John's, Newfoundland, Canada
| | - Denis Choquette
- Institut de Rhumatologie de Montréal, Montreal, Quebec, Canada
| | - William G Bensen
- St. Joseph's Hospital, Hamilton, Ontario, Canada
- McMaster University, Hamilton, Ontario, Canada
| | - Majed Khraishi
- Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Andrew Chow
- Credit Valley Rheumatology, Mississauga, Ontario, Canada
| | - Michel Zummer
- Université de Montréal, Montreal, Quebec, Canada
- Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | | | - Maqbool Sheriff
- Nanaimo Regional General Hospital, Nanaimo, British Columbia, Canada
| | | | | | - Eliofotisti Psaradellis
- JSS Medical Research Inc., St-Laurent, Quebec, Canada
- McGill University, Montreal, Quebec, Canada
| | - John S Sampalis
- JSS Medical Research Inc., St-Laurent, Quebec, Canada
- McGill University, Montreal, Quebec, Canada
| | | | | | | | - Emmanouil Rampakakis
- JSS Medical Research Inc., St-Laurent, Quebec, Canada
- McGill University, Montreal, Quebec, Canada
| | - Susan Otawa
- Janssen Inc. Medical Affairs, Toronto, Ontario, Canada
| | - May Shawi
- Janssen Inc. Medical Affairs, Toronto, Ontario, Canada
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Elalouf O, Elkayam O. Long-term safety and efficacy of infliximab for the treatment of ankylosing spondylitis. Ther Clin Risk Manag 2015; 11:1719-26. [PMID: 26640380 PMCID: PMC4657809 DOI: 10.2147/tcrm.s55928] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The introduction of TNFα blockers has revolutionized the treatment of ankylosing spondylitis (AS). The objectives of this review are to summarize the most up-to-date data on long-term efficacy and safety of infliximab in AS, with special emphasis on axial and extra-articular disease, predictors of response, and radiological response. The general consensus of this literature search was that infliximab is highly efficacious in the treatment of AS. Most studies have demonstrated good clinical outcomes after 3 years of treatment, as measured by Spondyloarthritis International Society response in 75%-85% of treated AS patients. Reports on the long-term effects of infliximab as documented by radiological findings, however, are controversial. While some studies reported a similar progression rate as that of the historical OASIS cohort, others have suggested that infliximab may halt new bone formation. The long-term safety of infliximab is well known, mainly from data stored in national registries. While it has been suggested that side effects of infliximab may be fewer in AS compared to rheumatoid arthritis, data on this issue are sparse, with most of the information on long-term safety pertaining to rheumatoid arthritis. It can however be concluded that the long-term efficacy of infliximab is apparently maintained in AS and with an acceptable safety profile.
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Affiliation(s)
- Ofir Elalouf
- Department of Rheumatology, Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Ori Elkayam
- Department of Rheumatology, Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv, Israel
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Quality of Life and Clinical Response to On-Demand Maintenance Doses of Infliximab in Patients With Ankylosing Spondylitis. J Clin Rheumatol 2015; 21:355-8. [PMID: 26398462 DOI: 10.1097/rhu.0000000000000295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
AIM The aim of this study was to study the effect of modified maintenance doses (MDs) of infliximab on the quality of life (QoL) of patients with ankylosing spondylitis (AS) over a period of 3 years. METHODS Medical records of AS patients (n = 25) who received a normal induction dose but modified MDs as required were retrospectively analyzed. After induction dose and the first MD, patients were followed up every month and were treated with infliximab whenever Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score was 4 or greater. The study end points were the percentage of responders defined as reduction of 40% or greater in BASDAI score and improvement in QoL defined by mean change in SF-36 Physical Component Summary score, SF-36 Mental Component Summary score, and Ankylosing Spondylitis Quality of Life (ASQoL) values at week 6 and after the last MD (ie, at the end of 3 years) compared with baseline. RESULTS Majority of the patients were males (n = 20), and the mean age of the analysis population was 40.6 ± 10.79 years. At the end of 6 weeks and after the last MD, BASDAI 40 scores were achieved in 100% and 92% of the patients, respectively. From baseline, the mean change in BASDAI score at the end of 6 weeks and after the last MD is -3.56 and -3.40, respectively. The overall mean change in scores (BASDAI, SF-36 Physical and Mental Component Summary, and ASQoL) versus baseline, at 6 weeks, and after the last MD was statistically significant (P < 0.0001). CONCLUSIONS The results of the study suggest that initial induction and an on-demand MD regimen of infliximab based on BASDAI were associated with significant improvement in disease activity and QoL.
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Sandıkçı SC, Özbalkan Z. Fatigue in rheumatic diseases. Eur J Rheumatol 2015; 2:109-113. [PMID: 27708942 DOI: 10.5152/eurjrheum.2015.0029] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 05/15/2015] [Indexed: 12/24/2022] Open
Abstract
Fatigue is a common and important problem in many diseases including rheumatologic illnesses, and it has a negative impact on health-related quality of life. Fatigue is described as having an impact on multiple aspects of a patient's life. There is a need for knowledge about causes of and treatments for fatigue to ensure that patient outcomes are improved. There are several effective treatment strategies available for fatigue including pharmacological and non-pharmacological therapies. We aim to provide an overview of fatigue in rheumatologic disorders and some recommendations on its optimal management.
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Affiliation(s)
- Sevinç Can Sandıkçı
- Clinic of Rheumatology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Zeynep Özbalkan
- Clinic of Rheumatology, Ankara Numune Training and Research Hospital, Ankara, Turkey
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Turina MC, Ramiro S, Baeten DL, Mease P, Paramarta JE, Song IH, Pangan AL, Landewé R. A psychometric analysis of outcome measures in peripheral spondyloarthritis. Ann Rheum Dis 2015; 75:1302-7. [PMID: 26245756 PMCID: PMC4941177 DOI: 10.1136/annrheumdis-2014-207235] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 07/14/2015] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To assess the discriminatory capacity of various outcome measures and response criteria in patients with peripheral spondyloarthritis (pSpA). METHODS Data originated from two randomised controlled trials, ABILITY-2 and Tnf Inhibition in PEripheral SpondyloArthritis (TIPES). Continuous outcome measures included patient's global assessment (PGA)/physician's global assessment of disease (PhGA), C-reactive protein (CRP), tender joint counts (TJC)/swollen joint counts (SJC), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and the Ankylosing Spondylitis Disease Activity Score (ASDAS). Dichotomous response criteria included Peripheral SpondyloArthritis Response Criteria (PSpARC), American College of Rheumatology (ACR), ASDAS and BASDAI response criteria. The capacity to discriminate between adalimumab and placebo groups was assessed by standardised mean differences (SMD) for continuous variables, and Pearson's χ(2) for dichotomous response criteria. RESULTS Within each trial, the composite indices for axial SpA assessment, ASDAS-CRP (SMD: -0.63 and -0.89 in ABILITY-2 and the TIPES trial, respectively) and BASDAI (SMD: -0.50 and -0.73), and the single-item measures PGA (SMD: -0.47 and -1.12) and PhGA (SMD: -0.64 and -0.87) performed better than other single-item measures, such as CRP (SMD: -0.18 and -0.53), SJC or TJC. In general, the PSpARC and ACR response criteria discriminated better than ASDAS and BASDAI response criteria. CONCLUSIONS The axial SpA-specific ASDAS-CRP and BASDAI, but also PGA and PhGA, demonstrated good discriminatory ability in patients with pSpA. The pSpA-specific pSpARC response criteria and the rheumatoid arthritis-specific ACR response criteria also discriminated well. To fully capture typical pSpA manifestations, it may be worth developing new pSpA-specific indices with better performance and face validity. TRIAL REGISTRATION NUMBERS ABILITY-2: NCT01064856; TIPES: EUDRACT 2008-006885-27.
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Affiliation(s)
- Maureen C Turina
- Department of Clinical Immunology and Rheumatology, Amsterdam Rheumatology and immunology Center, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - Sofia Ramiro
- Department of Clinical Immunology and Rheumatology, Amsterdam Rheumatology and immunology Center, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - Dominique L Baeten
- Department of Clinical Immunology and Rheumatology, Amsterdam Rheumatology and immunology Center, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - Philip Mease
- Swedish Medical Center & University of Washington, Seattle, Washington, USA
| | - Jacqueline E Paramarta
- Department of Clinical Immunology and Rheumatology, Amsterdam Rheumatology and immunology Center, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - In-Ho Song
- AbbVie Inc., North Chicago, Illinois, USA
| | | | - Robert Landewé
- Department of Clinical Immunology and Rheumatology, Amsterdam Rheumatology and immunology Center, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
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Yeremenko N, Zwerina K, Rigter G, Pots D, Fonseca JE, Zwerina J, Schett G, Baeten D. Brief Report: Tumor Necrosis Factor and Interleukin-6 Differentially Regulate Dkk-1 in the Inflamed Arthritic Joint. Arthritis Rheumatol 2015; 67:2071-5. [DOI: 10.1002/art.39183] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 04/28/2015] [Indexed: 12/17/2022]
Affiliation(s)
- Nataliya Yeremenko
- Academic Medical Center/University of Amsterdam; Amsterdam The Netherlands
| | | | - Gemma Rigter
- Academic Medical Center/University of Amsterdam; Amsterdam The Netherlands
| | - Desiree Pots
- Academic Medical Center/University of Amsterdam; Amsterdam The Netherlands
| | - Joao E. Fonseca
- Hospital de Santa Maria, Lisbon Academic Medical Center, and Instituto de Medicina Molecular; Lisbon Portugal
| | | | - Georg Schett
- University of Erlangen-Nurnberg; Erlangen Germany
| | - Dominique Baeten
- Academic Medical Center/University of Amsterdam; Amsterdam The Netherlands
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Abstract
The term axial spondyloarthritis covers both non-radiographic disease and radiographic disease (also known as ankylosing spondylitis). Some studies have been performed to investigate the prevalence of axial spondyloarthritis, although most are limited to patients with radiographic disease. A strong genetic association has been shown between axial spondyloarthritis and human leukocyte antigen-B27 (HLA-B27), but the pathogenetic role of HLA-B27 has not yet been clarified. Tumour necrosis factor (TNF), IL-17, IL-23 and downstream pathways also seem to be important - based on the good results of therapies directed against these molecules - but their exact role in the inflammatory process is also not yet clear. Elucidating the interaction between osteoproliferation and inflammation will be crucial for the prevention of long-term structural damage of the bone. The development of new criteria for classification, diagnosis and screening of patients with axial spondyloarthritis will enable earlier intervention for this chronic inflammatory disease. MRI has become an important tool for the early detection of axial spondyloarthritis. NSAIDs and TNF blockers are effective therapies, including in the early non-radiographic stage. Therapeutic blockade of IL-17 or IL-23 seems to be a promising new treatment option. Tools for measuring quality of life in axial spondyloarthritis have become relevant to assess the impact that the disease has on patients. These diagnostic and therapeutic advances will continue to change the management of axial spondyloarthritis, and new insights into the disease pathogenesis will hopefully accelerate this process. For an illustrated summary of this Primer, visit: http://go.nature.com/51b1af.
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Affiliation(s)
- Joachim Sieper
- Rheumatology, Charité, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany
| | | | - Maxime Dougados
- Faculty of Medicine, Paris Descartes University, Department of Rheumatology, Hôpital Cochin, Assistance Publique, Hôpitaux de Paris, INSERM (U1153), Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France
| | - Dominique Baeten
- Clinical Immunology and Rheumatology and Amsterdam Rheumatology and Immunology Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Abstract
Psoriatic arthritis (PsA) is a chronic, progressive, inflammatory spondyloarthropathy that affects approximately one-third of patients with all types of psoriasis. Dermatologists are in a unique position to recognize early symptoms of PsA, initiate appropriate therapy, and prevent development of further disability. The course of PsA can be modulated by immunosuppressive therapy; patients with moderate-to-severe disease require aggressive management with medications proven to halt disease progression. It is essential for the dermatologist to understand the safety, tolerability, efficacy, cost, and potential to halt disease progression with available medications for this relatively common and potentially disabling disease.
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Affiliation(s)
- Suzanne J Tintle
- Department of Dermatology, Tufts Medical Center, 800 Washington Street, Box #114, Boston, MA 02111, USA.
| | - Alice B Gottlieb
- Department of Dermatology, Tufts Medical Center, 800 Washington Street, Box #114, Boston, MA 02111, USA
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Xue HX, Fu WY, Cui HD, Yang LL, Zhang N, Zhao LJ. High-dose thalidomide increases the risk of peripheral neuropathy in the treatment of ankylosing spondylitis. Neural Regen Res 2015; 10:814-8. [PMID: 26109960 PMCID: PMC4468777 DOI: 10.4103/1673-5374.156988] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2015] [Indexed: 12/17/2022] Open
Abstract
Thalidomide is an effective drug for the treatment of ankylosing spondylitis but might induce peripheral neuropathy. This major adverse reaction has attracted much concern. The current study aimed to observe the incidence of thalidomide-induced peripheral neuropathy among ankylosing spondylitis patients for 1 year after treatment. In this study, 207 ankylosing spondylitis cases received thalidomide treatment, while 116 ankylosing spondylitis cases received other treatments. Results showed that the incidence of thalidomide-induced peripheral neuropathy in the thalidomide group was higher than that in the non-thalidomide group. There was no significant difference in the incidence of neuropathy between the < 6 months medication and ≥ 6 months medication groups. There were no differences in the mean age, gender, or daily dose between the two groups. The incidence of peripheral neuropathy among patients receiving 25, 50, 75, or 100 mg thalidomide per day was 4.6%, 8.5%, 17.1%, 21.7%, respectively. The incidence was significantly different between the groups receiving 25 mg and 100 mg thalidomide. In conclusion, thalidomide can induce peripheral neuropathy within 1 year after treatment of ankylosing spondylitis; however, age and gender have no obvious impact on the incidence of peripheral neuropathy. The incidence of peripheral neuropathy is associated with increasing daily doses of thalidomide.
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Affiliation(s)
- Hong-Xia Xue
- Department of Rheumatology and Immunology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Wen-Yi Fu
- Department of Rheumatology and Immunology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Hua-Dong Cui
- Department of Rheumatology and Immunology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Li-Li Yang
- Department of Rheumatology and Immunology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Ning Zhang
- Department of Rheumatology and Immunology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Li-Juan Zhao
- Department of Rheumatology and Immunology, the First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
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Abstract
The window of opportunity is a concept critical to rheumatoid arthritis treatment. Early treatment changes the outcome of rheumatoid arthritis treatment, in that response rates are higher with earlier disease-modifying anti-rheumatic drug treatment and damage is substantially reduced. Axial spondyloarthritis is an inflammatory axial disease encompassing both nonradiographic axial spondyloarthritis and established ankylosing spondylitis. In axial spondyloarthritis, studies of magnetic resonance imaging as well as tumor necrosis factor inhibitor treatment and withdrawal studies all suggest that early effective suppression of inflammation has the potential to reduce radiographic damage. This potential would suggest that the concept of a window of opportunity is relevant not only to rheumatoid arthritis but also to axial spondyloarthritis. The challenge now remains to identify high-risk patients early and to commence treatment without delay. Developments in risk stratification include new classification criteria, identification of clinical risk factors, biomarkers, genetic associations, potential antibody associations and an ankylosing spondylitis-specific microbiome signature. Further research needs to focus on the evidence for early intervention and the early identification of high-risk individuals.
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Maxwell LJ, Zochling J, Boonen A, Singh JA, Veras MMS, Tanjong Ghogomu E, Benkhalti Jandu M, Tugwell P, Wells GA. TNF-alpha inhibitors for ankylosing spondylitis. Cochrane Database Syst Rev 2015:CD005468. [PMID: 25887212 DOI: 10.1002/14651858.cd005468.pub2] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND TNF (tumor necrosis factor)-alpha inhibitors block a key protein in the inflammatory chain reaction responsible for joint inflammation, pain, and damage in ankylosing spondylitis. OBJECTIVES To assess the benefit and harms of adalimumab, etanercept, golimumab, and infliximab (TNF-alpha inhibitors) in people with ankylosing spondylitis. SEARCH METHODS We searched the following databases to January 26, 2009: MEDLINE (from 1966); EMBASE (from 1980); the Cochrane Central Register of Controlled Trials (CENTRAL; 2008, Issue 4); ACP Journal Club; CINAHL (from 1982); and ISI Web of Knowledge (from 1900). We ran updated searches in May 2012, October 2013, and in June 2014 for McMaster PLUS. We searched major regulatory agencies for safety warnings and clinicaltrials.gov for registered trials. SELECTION CRITERIA Randomized controlled trials (RCTs) comparing adalimumab, etanercept, golimumab and infliximab to placebo, other drugs or usual care in patients with ankylosing spondylitis, reported in abstract or full-text. DATA COLLECTION AND ANALYSIS Two authors independently assessed search results, risk of bias, and extracted data. We conducted Bayesian mixed treatment comparison (MTC) meta-analyses using WinBUGS software. To investigate a class-effect of harms across biologics, we pooled harms data using Review Manager 5. MAIN RESULTS We included twenty-one, short-term (24 weeks or less) RCTs with a total of 3308 participants; 18 contributed data to the MTC analysis: adalimumab (4 studies), etanercept (8 studies), golimumab (2 studies), infliximab (3 studies), and one head-to-head study (etanercept versus infliximab) which was unblinded and considered at a higher risk of bias. The risk of selection and detection bias was low or unclear for most of the studies. The risk of selective outcome reporting was low for most studies as they reported on outcomes recommended by the Assessment of SpondyloArthritis international Society. We found little heterogeneity and no significant inconsistency in the MTC analyses. The majority of the studies were funded by pharmaceutical companies. Most studies permitted concomitant therapy of stable doses of disease-modifying anti-rheumatic drugs, non-steroidal anti-inflammatory drugs, or corticosteroids, but allowances varied across studies.Compared with placebo, there was high quality evidence that patients on an anti-TNF agent were three to four times more likely to achieve an ASAS40 response (assessing spinal pain, function, and inflammation, as measured by the mean of intensity and duration of morning stiffness, and patient global assessment) by six months (adalimumab: risk ratio (RR) 3.53, 95% credible interval (Crl) 2.49 to 4.91; etanercept: RR 3.31, 95% Crl 2.38 to 4.53; golimumab: RR 2.90, 95% Crl 1.90 to 4.23; infliximab: RR 4.07, 95% Crl 2.80 to 5.74, with a 25% to 40% absolute difference between treatment and placebo groups. The number needed to treat (NNT) to achieve an ASAS 40 response ranged from 3 to 5.There was high quality evidence of improvement in physical function on a 0 to 10 scale (adalimumab: mean difference (MD) -1.6, 95% Crl -2.2 to -0.9; etanercept: MD -1.1, 95% CrI -1.6 to -0.6; golimumab: MD -1.5, 95% Crl -2.3 to -0.7; infliximab: MD -2.1, 95% Crl -2.7 to -1.4, with an 11% to 21% absolute difference between treatment and placebo groups. The NNT to achieve the minimally clinically important difference of 0.7 points ranged from 2 to 4.Compared with placebo, there was moderate quality evidence (downgraded for imprecision) that patients on an anti-TNF agent were more likely to achieve an ASAS partial remission by six months (adalimumab: RR 6.28, 95% Crl 3.13 to 12.78; etanercept: RR 4.24, 95% Crl 2.31 to 8.09; golimumab: RR 5.18, 95% Crl 1.90 to 14.79; infliximab: RR 15.41, 95% Crl 5.09 to 47.98 with a 10% to 44% absolute difference between treatment and placebo groups. The NNT to achieve an ASAS partial remission response ranged from 3 to 11.There was low to moderate level evidence of a greater reduction in spinal inflammation as measured by magnetic resonance imaging though the absolute differences were small and the clinical relevance of the difference was unclear: adalimumab (1 trial; -6% (95% confidence interval (CI) -12% to 0.05%); 1 trial: 53.6% mean decrease from baseline versus 9.4% mean increase in the placebo group), golimumab (1 trial; -2.5%, (95% CI -5.6% to -0.7%)), and infliximab (1 trial; -3% (95% CI -4% to -2.4%)).Radiographic progression was measured in one trial (N = 60) of etanercept versus placebo and it found that radiologic changes were similar in both groups (detailed data not provided).There were few events of withdrawals due to adverse events leading to imprecision around the estimates. When all the anti-TNF agents were combined against placebo, there was moderate quality evidence from 16 studies of an increased risk of withdrawals due to adverse events in the anti-TNF group (Peto odds ratio (OR) 2.44, 95% CI 1.26 to 4.72; total events: 38/1637 in biologic group; 7/986 in placebo) though the absolute increase in harm was small (1%; 95% CI 0% to 2%).Due to low event rates, evidence of the effect of individual TNF-inhibitors against placebo or for all four biologics pooled together versus placebo on serious adverse events is inconclusive (moderate quality; downgraded for imprecision). For all anti-TNF pooled versus placebo based on 16 studies: Peto OR 1.45, 95% CI 0.85 to 2.48; 51/1530 in biologic group; 18/878 in placebo; absolute difference: 1% (95% CI 0% to 2%).Using indirect comparison methodology, and one head-to-head study of etanercept versus infliximab, wide confidence intervals meant that results were inconclusive for evidence of differences in the major outcomes between different anti-TNF agents. Regulatory agencies have published warnings about rare adverse events of serious infections, including tuberculosis, malignancies and lymphoma. AUTHORS' CONCLUSIONS There is moderate to high quality evidence that anti-TNF agents improve clinical symptoms in the treatment of ankylosing spondylitis. More participants withdrew due to adverse events when on an anti-TNF agent but we did not find evidence of an increase in serious adverse events, though event rates were low and trials had a short duration. The short-term toxicity profile appears acceptable. Based on indirect comparison methodology, we are uncertain whether there are differences between anti-TNF agents in terms of the key benefit or harm outcomes.
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Affiliation(s)
- Lara J Maxwell
- Centre for Practice-Changing Research (CPCR), Ottawa Hospital Research Institute (OHRI), The Ottawa Hospital - General Campus, 501 Smyth Road, Box 711, Ottawa, ON, Canada, K1H 8L6
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Sieper J, Braun J. [Lessons learnt from 15 years of investigator-initiated trials on axial spondyloarthritis]. Z Rheumatol 2015; 74:125-31. [PMID: 25805515 DOI: 10.1007/s00393-014-1452-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Clinical research is receiving an increasing amount of attention and is essential for improving treatment of patients with rheumatic diseases. AIMS This article reports on 15 years of experience with conducting investigator-initiated studies on axial spondyloarthritis including ankylosing spondylitis. RESULTS We have organized and successfully conducted a series of open-labelled and placebo-controlled double-blind treatment studies and also non-interventional studies on this topic. The installation of a qualified and motivated trial unit and intensive collaboration with a statistician were crucial requirements for success. These results have increased our knowledge about the disease and changed and improved the diagnostic possibilities and the therapeutic options. CONCLUSION Investigator-initiated trials are an important link between basic and clinical research and can substantially contribute to improvement of patient care. This kind of research should be more systematically funded in the future.
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Affiliation(s)
- J Sieper
- Med. Klinik I, Rheumatologie, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Deutschland,
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Clinical characteristics of Japanese patients with axial spondyloarthritis, and short-term efficacy of adalimumab. J Orthop Sci 2015; 20:1070-7. [PMID: 26245191 PMCID: PMC4653233 DOI: 10.1007/s00776-015-0755-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 07/13/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Ankylosing spondylitis (AS) is rarer in Japan than in Europe, probably because the European criteria, not well known by Japanese general physicians, regard AS as a progressive stage of axial spondyloarthritis (SpA). HLA-B27 is an important diagnostic marker of SpA; however, the incidence of the HLA-B27 allele is as low as 0.4 % in Japan. For Japanese SpA patients, other HLA alleles and clinical findings are required for earlier definitive diagnosis, for determining appropriate treatment timing, and for disease monitoring. METHODS We investigated the HLA-B alleles of 36 patients clinically diagnosed with SpA. For 8 axial SpA patients we evaluated the short-term efficacy of subcutaneous adalimumab injections (40 mg every other week for ≥11 months). Treatment efficacy was evaluated by use of the Bath Ankylosing Spondylitis Activity Index (BASDAI) score, and serum TNF-α and IL-6 levels were measured pre and post-treatment. RESULTS Among the 36 Japanese SpA patients, the HLA-B27 allele occurred infrequently (5.6 %) whereas the HLA-B44 and 61 alleles were the most frequently detected (25.0 %). We also detected severe bamboo spine on radiography in the absence of the HLA-B27 allele. All 8 patients with axial SpA experienced significant symptom improvement after adalimumab treatment; the HLA-B27 allele was absent from these patients. Serum TNF-α and IL-6 levels were elevated in cases with remarkable inflammatory pain and high disease activity. These cytokines decreased after therapy, however. Most patients with normal cytokine levels at baseline retained these low levels. CONCLUSIONS The findings reveal the short-term efficacy of adalimumab. The remarkably low incidence of HLA-B27 among our patients indicates that HLA-B distribution is different from that in other countries. Serum TNF-α and IL-6 levels were not effective as biomarkers for cases without high disease activity, and further research with larger samples is needed. The efficacy of TNF blockers, however, suggested a potential localized TNF effect was present among SpA patients.
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Huang F, Gu J, Liu Y, Zhu P, Zheng Y, Fu J, Pan S, Le S. Efficacy and safety of celecoxib in chinese patients with ankylosing spondylitis: a 6-week randomized, double-blinded study with 6-week open-label extension treatment. CURRENT THERAPEUTIC RESEARCH 2014; 76:126-33. [PMID: 25516774 PMCID: PMC4266770 DOI: 10.1016/j.curtheres.2014.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/19/2014] [Indexed: 02/05/2023]
Abstract
Background Nonsteroidal anti-inflammatory drugs are the first-line option for treating ankylosing spondylitis (AS) in China. However, no large-scale controlled trials have been conducted in this ethnic population. Objective To evaluate the efficacy and safety of 6 weeks’ treatment with celecoxib in patients with AS in China. Methods This Phase 3, double-blind, parallel-group study randomized patients with AS aged ≥18 to 65 years 1:1 to receive celecoxib 200 mg once daily or diclofenac sustained release 75 mg once daily. After 6 weeks, patients could use celecoxib 400 mg once daily or maintain blinded therapy. The primary efficacy end point was mean change from baseline at Week 6 for Patient’s Global Assessment of Pain Intensity score (100-mm visual analog scale). Noninferiority was established if the upper bound of the CI was <10 mm. Secondary objectives included patients’ and physicians’ assessments of disease activity, change from baseline in C-reactive protein level, and safety. Results In the per-protocol analysis set the least squares mean change from baseline in the Patient’s Global Assessment of Pain Intensity score at Week 6 was –23.8 mm and –27.1 mm in patients receiving celecoxib (n = 111) and diclofenac (n = 108), respectively. The 2-sided 95% CI for the treatment difference (celecoxib – diclofenac) was –2.2 to 8.8. Overall, 4.2% and 6.7% of patients in the celecoxib and diclofenac groups, respectively, reported treatment-related adverse events. All were mild to moderate in severity. Conclusions Celecoxib 200 mg once daily is noninferior to diclofenac sustained release 75 mg once daily for pain treatment in Chinese patients with AS. ClinicalTrials.gov identifier: NCT00762463.
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Affiliation(s)
- Feng Huang
- Department of Rheumatology, Chinese PLA General Hospital, Beijing, China
| | - Jieruo Gu
- Department of Rheumatology and Immunology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yi Liu
- Department of Rheumatology and Immunology, West China Hospital of Sichuan University, Sichuan, China
| | - Ping Zhu
- Department of Rheumatology and Immunology, Xijing Hospital, Shanxi, China
| | - Yi Zheng
- Department of Rheumatology and Immunology, Beijing Chaoyang Hospital, Capital University of Medical Science, Beijing, China
| | - Jin Fu
- Clinical Program Lead, Global Innovation Pharma, Clinical Science, Pfizer Investment Co, Ltd, Beijing, China
| | - Sharon Pan
- Emerging Markets Business Unit, Pfizer Inc, New York, NY
| | - Shi Le
- Former employee of Department of Clinical Development and Operation (China), Pfizer Investment Co, Ltd, Beijing, China
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Wang C, Liao Q, Hu Y, Zhong DA. T lymphocyte subset imbalances in patients contribute to ankylosing spondylitis. Exp Ther Med 2014; 9:250-256. [PMID: 25452811 PMCID: PMC4247318 DOI: 10.3892/etm.2014.2046] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 10/09/2014] [Indexed: 01/05/2023] Open
Abstract
Ankylosing spondylitis is a chronic inflammatory rheumatic disease, which is characterized by inflammation of the spine and the sacroiliac joints. To date, the disease etiology remains unclear. In the present study, the correlation of T lymphocyte subset changes with the progression of ankylosing spondylitis was investigated. A total of 55 patients with ankylosing spondylitis (22 severe and 23 mild cases) and 20 healthy individuals were selected. Firstly, the punctured cells in the lesions and the serum were collected, and the lymphocytes and the peripheral blood mononuclear cells were prepared. Secondly, quantitative PCR, ELISA and flow cytometry analyses were carried out to detect the levels of a series of immunoglobulins, complements, helper T cells, cytotoxic T cells, regulatory cells and cytokines. The expression levels of α-globulin, γ-globulin, immunoglobulin (Ig)G, IgA, IgM, serum complement C3, and complement C4 were found to be significantly increased in ankylosing spondylitis patients. In addition, the percentage of Th1 and Th17 cells was found to be significantly higher in the ankylosing spondylitis groups (mild and severe) compared with the healthy individuals. As a result, the Th1/Th2 and Th17/Treg ratios were significantly higher in patients with ankylosing spondylitis. In addition, T lymphocyte subset ratio imbalances contributed to an increased expression of immune mediators, including interferon (IFN)-γ and interleukin (IL)-17A. The mRNA and protein expression levels of IFN-γ and IL-17A were found to be higher in the ankylosing spondylitis groups compared with the control group. The present study provided further evidence on the function and underlying mechanism of T lymphocyte subsets, which may be useful in the diagnosis and treatment of ankylosing spondylitis.
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Affiliation(s)
- Chenggong Wang
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Qiande Liao
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Yihe Hu
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - DA Zhong
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
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Kampling C, Chehab G, Schneider M, Richter JG. [Self-monitoring in inflammatory rheumatic diseases]. Z Rheumatol 2014; 73:706-13. [PMID: 25260817 DOI: 10.1007/s00393-014-1413-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Active involvement of patients in their care has led to better treatment and outcomes. Tight control concepts emphasize the need for regular assessments including patients' active involvement by self-monitoring. METHODS The literature was screened with respect to published experiences of self-monitoring of rheumatoid arthritis and spondyloarthritides. The use of "patient-reported outcome" (PRO) instruments can facilitate self-monitoring. Potentially applicable PROs and their correlations to clinical parameters as well as modern data acquisition modes are presented. RESULTS Some experiences for self-monitoring have been reported. Recommendations from national and international professional rheumatology societies do not yet consider self-monitoring; however, PROs might be used for self-monitoring but instructions for patients on "how to deal with self-monitored PRO values" are missing. CONCLUSION Self-monitoring of inflammatory rheumatic diseases seems feasible. Further evaluation studies are warranted to guarantee an optimized direct patient involvement in their management beyond outpatient care in hospitals and private practices so that they can thus contribute to a better outcome.
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Affiliation(s)
- C Kampling
- Poliklinik für Rheumatologie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland
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[German Society for Rheumatology S3 guidelines on axial spondyloarthritis including Bechterew's disease and early forms: 7 Disease activity and prognosis of spondyloarthritis]. Z Rheumatol 2014; 73 Suppl 2:66-8. [PMID: 25181975 DOI: 10.1007/s00393-014-1432-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Závada J, Uher M, Sisol K, Forejtová Š, Jarošová K, Mann H, Vencovský J, Pavelka K. A tailored approach to reduce dose of anti-TNF drugs may be equally effective, but substantially less costly than standard dosing in patients with ankylosing spondylitis over 1 year: a propensity score-matched cohort study. Ann Rheum Dis 2014; 75:96-102. [DOI: 10.1136/annrheumdis-2014-205202] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 08/10/2014] [Indexed: 12/17/2022]
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The interleukin-23/interleukin-17 immune axis as a promising new target in the treatment of spondyloarthritis. Curr Opin Rheumatol 2014; 26:361-70. [DOI: 10.1097/bor.0000000000000069] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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The efficacy and safety of infliximab used in patients with ankylosing spondylitis after unilateral total hip arthroplasty. Hip Int 2014; 23:406-10. [PMID: 23873508 DOI: 10.5301/hipint.5000033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/18/2013] [Indexed: 02/04/2023]
Abstract
A retrospective study was performed in patients with ankylosing spondylitis (AS) from south China, to investigate the efficacy and safety of infliximab after total hip arthroplasty (THA). Thirty-two AS patients were divided into two groups. The treatmen group recieved infliximab at four weeks after unilateral THA (11 patients) and were compare to a control group (21 patients). Patients in the control group were treated with traditional medications. Clinical assessment, laboratory examinations, and x-rays were performed pre- and postoperatively. The BASDAI score decreased more in the infliximab group at six and 12 months after THA, as did the CRP and ESR. The contralateral hips without arthroplasty of patients in the infliximab group improved significantly compared to the control group, in terms of Harris score (HHS), range of motion (ROM) and VAS. However, the hips with an arthroplasty in the control group had a better prognosis than those without arthroplasty of the infliximab group. Hips with arthroplasty in the infliximab group achieved better improvement of HHS than hips without arthroplasty in the control group, but not for ROM and pain relief. No radiological evidence of prosthetic loosening was found in either group. There was no significant difference of the incidence of adverse events between the two groups. Compared with THA, AS patients using infliximab only did not obtain as good an outcome. Infliximab was shown to be safe and could be effective to improve hip function and systemic symptoms.
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