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Kaplan H, Cengiz G, Cuce I, Sas S, Senkoy E, Calis M, Ozturk O, Demir H, Kirnap M. Rheumatoid factor titers, but not Fc fragments, may be strongly associated with drug survival of anti-TNF agents in patients with rheumatoid arthritis. North Clin Istanb 2024; 11:147-157. [PMID: 38757098 PMCID: PMC11095329 DOI: 10.14744/nci.2023.01643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 03/27/2023] [Accepted: 04/24/2023] [Indexed: 05/18/2024] Open
Abstract
OBJECTIVE To investigate the effects of both the Fc fragment in tumor necrosis factor (TNF) inhibitors and rheumatoid factor (RF) titers on treatment survival, disease activity, and laboratory parameters in patients with rheumatoid arthritis (RA). METHODS In this retrospective cohort study, patients with RA who had started any anti-TNF therapy between January 2017 and March 2020 and who had stayed on this treatment for at least six months were included. The data of the patients were compared separately according to continuation or discontinuation of treatment and the presence or absence of Fc portion in the structure of anti-TNFs. Patients who were taking certolizumab pegol (CZP) without the Fc fragment were placed in the "without Fc group" (wo/Fc), while patients who were taking other drugs (adalimumab, etanercept, golimumab, and infliximab) were placed in the "with Fc group" (w/Fc). RESULTS Among the 221 RA patients whose data were available, 52 patients met the inclusion criteria and were included in the study. There was a significant difference in the DAS28-CRP score between wo/Fc group and w/Fc group in the third month of treatment (p=0.012). However, this difference did not persist at the sixth month of treatment (p=0.384). According to the cox-regression results, RF titers were determined to have a significant impact on the drug survival of anti-TNF agents when adjustments were made for the effects of other candidate predictors (Hazard ratio: 1.007 (1.002-1.012), p=0.009). CONCLUSION Our results suggest that compared to the Fc fragment, RF titers were the more important risk factor in survival of anti-TNF drugs.
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Affiliation(s)
- Huseyin Kaplan
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Erciyes University Faculty of Medicine, Kayseri, Turkiye
| | - Gizem Cengiz
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Erciyes University Faculty of Medicine, Kayseri, Turkiye
| | - Isa Cuce
- Department of Physical Medicine and Rehabilitation, Erciyes University Faculty of Medicine, Kayseri, Turkiye
| | - Senem Sas
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Erciyes University Faculty of Medicine, Kayseri, Turkiye
| | - Emre Senkoy
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Erciyes University Faculty of Medicine, Kayseri, Turkiye
| | - Mustafa Calis
- Department of Physical Medicine and Rehabilitation, Erciyes University Faculty of Medicine, Kayseri, Turkiye
| | - Orhun Ozturk
- Department of Statistics, Hacettepe University, Ankara, Turkiye
| | - Huseyin Demir
- Department of Physical Medicine and Rehabilitation, Medical Palace Hospital, Kayseri, Turkiye
| | - Mehmet Kirnap
- Department of Physical Medicine and Rehabilitation, Erciyes University Faculty of Medicine, Kayseri, Turkiye
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Bui HB, Lai HT, Nguyen TL, Vu TD, Bui NL, Nguyen VH, Tran TTC, Nguyen TPT, Nguyen TNL, Al-Tawfiq JA, Chu DT. The impact of COVID-19 and other factors on the usage status of the biologic drug therapies for rheumatoid arthritis: A study from Vietnam. REUMATOLOGIA CLINICA 2024; 20:128-135. [PMID: 38494304 DOI: 10.1016/j.reumae.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 09/21/2023] [Indexed: 03/19/2024]
Abstract
OBJECTIVES To describe the status of using biological Disease Modifying Anti Rheumatic Drugs (bDMARDs) to treat rheumatoid arthritis (RA) and related factors. In addition, the study determined the impact of COVID-19 on the usage of bDMARDs. METHODS This is a cross-sectional study and included 219 RA patients over 18 years old. The Kaplan-Meier method and the log-rank test (p<0.05) were used to estimate the retention time and compare between different times. Cox regression analysis was used to determine the factors affecting the retention time of biological drugs (p<0.05). RESULTS Out of 1967 courses of treatment, there were 149 (7.6%) drug discontinuations, 760 (38.6%) doses extensions and 64 (3.3%) drug switch. Moderate disease level and choosing tumor necrosis factor (TNF) inhibitors initially were associated with retention time of COVID-19. Drug discontinuations and dose extensions increased after COVID-19 emergence. The retention time during COVID-19 was significantly different from that of pre-COVID-19. Gender, type of first-used bDMARD, conventional synthetic DMARDs (csDMARDs) and corticoid usage status, disease activity levels were associated with retention time. CONCLUSION The presence of COVID-19 has a significant effect on usage status of the biologic drug. Further longitudinal studies are needed to clarify the relationship between COVID-19 and drug usage as well as related factors.
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Affiliation(s)
- Hai-Binh Bui
- Department of Rheumatology, Bach Mai Hospital, Hanoi 100000, Viet Nam
| | - Hong-Thinh Lai
- Department of Neurology and Rheumatology, Ha Nam Provincial General Hospital, Hanam, Viet Nam
| | - Thanh-Lam Nguyen
- Center for Biomedicine and Community Health, International School, Vietnam National University, Hanoi 100000, Viet Nam
| | - Thuy-Duong Vu
- Center for Biomedicine and Community Health, International School, Vietnam National University, Hanoi 100000, Viet Nam
| | - Nhat-Le Bui
- Center for Biomedicine and Community Health, International School, Vietnam National University, Hanoi 100000, Viet Nam
| | - Van-Hung Nguyen
- Department of Rheumatology, Bach Mai Hospital, Hanoi 100000, Viet Nam; Internal Medicine Department, Hanoi Medical University, Hanoi, Viet Nam
| | - Thi-To-Chau Tran
- Department of Rheumatology, Bach Mai Hospital, Hanoi 100000, Viet Nam
| | - Thi-Phuong-Thuy Nguyen
- Department of Rheumatology, Bach Mai Hospital, Hanoi 100000, Viet Nam; Internal Medicine Department, Hanoi Medical University, Hanoi, Viet Nam
| | | | - Jaffar A Al-Tawfiq
- Infectious Disease Unit, Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dinh-Toi Chu
- Center for Biomedicine and Community Health, International School, Vietnam National University, Hanoi 100000, Viet Nam; Faculty of Applied Sciences, International School, Vietnam National University, Hanoi 100000, Viet Nam.
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Bordean L, Chis M, Cimpean AM, Barb AC, Cosma AA, Fenesan MP, Cotoi OS, Nicolescu L, Nicolescu CM, Avram C. Age, Sex, Metabolic and Pharmacologic Factors May Predict Nonresponse Status to Rheumatoid Arthritis Therapies. In Vivo 2023; 37:2387-2401. [PMID: 37652478 PMCID: PMC10500531 DOI: 10.21873/invivo.13344] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 08/17/2023] [Accepted: 08/19/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND/AIM A real challenge for patients with rheumatoid arthritis (RA) and rheumatologists is primary nonresponse status (PNRS) or secondary nonresponse status (SNRS) to various therapies. Despite their detrimental influence on patient life quality, PNRS and SNRS have no accurate definition and no early predictive criteria for their development exist. Patients with RA under 40 years of age are rare, hence PNRS and SNRS data for this age group are scarce. This study examined the PNRS and SNRS according to sex, age, BMI, therapy type, and duration. PATIENTS AND METHODS Retrospectively, 115 patients with RA having PNRS and/or SNRS were stratified by age (22-39, 40-59, and 60-81). The association between body mass index (BMI), proinflammatory cytokines inhibitors, JAK inhibitors, and TNF-alpha inhibitors, sex, age, and PNRS and SNRS was examined. RESULTS All three proinflammatory cytokine inhibitors (rituximab, tocilizumab, and abatacept) were associated with PNRS and SNRS in women with a high BMI aged 40-59 years. Abatacept-related PNRS and SNRS was significant in women with normal BMI aged 60-81 years. Adalimumab, infliximab, and golimumab affected SNRS differently in women with normal BMI aged 22-39 years and women with high BMI aged 60-81 years. Etanercept and infliximab were associated with SNRS status in men with high-BMI aged 40-59 years. CONCLUSION PNRS and SNRS development in patients with RA is significantly influenced by age, sex, and BMI, but most importantly is closely and differentially related to therapy type and duration.
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Affiliation(s)
- Liliana Bordean
- Department ME2/Rheumatology, Rehabilitation, Physical Medicine and Balneology, Faculty of Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureş (UMPhST), Targu Mures, Romania
- Clinic of Rheumatology, Emergency County Hospital of Târgu Mureş, Targu Mures, Romania
- Doctoral School, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - Monica Chis
- Department ME2/Rheumatology, Rehabilitation, Physical Medicine and Balneology, Faculty of Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureş (UMPhST), Targu Mures, Romania;
- Clinic of Rheumatology, Emergency County Hospital of Târgu Mureş, Targu Mures, Romania
| | - Anca Maria Cimpean
- Department of Microscopic Morphology/Histology, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania;
- Center of Expertise for Rare Vascular Disease in Children, Emergency Hospital for Children Louis Turcanu, Timisoara, Romania
| | - Alina Cristina Barb
- Doctoral School, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania
- Department of Microscopic Morphology/Histology, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania
- OncoHelp Hospital, Timisoara, Romania
| | - Andrei Alexandru Cosma
- Doctoral School, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania
- Department of Microscopic Morphology/Histology, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania
- OncoHelp Hospital, Timisoara, Romania
| | - Mihaela Pasca Fenesan
- Doctoral School, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania
- Department of Microscopic Morphology/Histology, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania
- OncoHelp Hospital, Timisoara, Romania
| | - Ovidiu Simion Cotoi
- Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Targu Mures, Romania
- Department of Pathology, County Clinical Hospital Mureș, Targu Mures, Romania
| | - Laura Nicolescu
- Department of Medicine, Faculty of Medicine, Vasile Goldiş Western University of Arad, Arad, Romania
- Department of Physical Medicine and Rehabilitation, Emergency County Hospital, Arad, Romania
| | - Cristian Mircea Nicolescu
- Department of Anesthesia and Intensive Care, Emergency County Hospital, Arad, Romania
- Department of Biology and Life Sciences, Vasile Goldiş Western University of Arad, Arad, Romania
| | - Claudiu Avram
- Department XVI/Balneology, Rehabilitation and Rheumatology, University of Medicine and Pharmacy Victor Babes Timisoara, Timisoara, Romania
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Shipa MRA, Di Cicco M, Balogh E, Nitu NA, Mainuddin MD, Bhadauria N, Mukerjee D, Roussou E. Drug-survival profiling of second-line biologic therapy in rheumatoid arthritis: Choice of another tumour necrosis factor inhibitor or a biologic of different mode of action? Mod Rheumatol 2023; 33:700-707. [PMID: 35920402 DOI: 10.1093/mr/roac086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/07/2022] [Accepted: 07/22/2022] [Indexed: 11/14/2022]
Abstract
OBJECTIVES To assess the best choice of second-line therapy between tumour necrosis factor-inhibitor (TNFi) and biologics of different-mode-of-action (BDMA-rituximab/tocilizumab/abatacept) in rheumatoid arthritis (RA) by evaluating drug-survival following discontinuation of the first-line TNFi. METHODS This retrospective drug-survival study was performed across two different hospitals by conventional-statistics and machine-learning approach. RESULTS From a total of 435 patients, 213 (48.9%; TNFi = 122, BDMA = 91) discontinued their second-line biologic {median drug-survival: TNFi, 27 months [95% confidence interval (95%CI) 22-32] vs BDMA, 37 months (95%CI 32-52)}. As a second-line biologic, BDMA was likely to reduce the risk of treatment-discontinuation [hazard-ratio (HR) 0.63, 95%CI 0.48-0.83] compared to TNFi, but only in seropositive-patients (HR 0.52, 95%CI 0.38-0.73), not in seronegative-RA. Drug-survival benefit of BDMA over TNFi was not observed if the seropositive-patients were previously exposed to monoclonal-TNFi (HR 0.77, 95%CI 0.49-1.22) versus soluble-TNFi (etanercept/biosimilars) or if the first-line TNFi was terminated within 23.9 months of initiation (HR 0.97, 95%CI 0.56-1.68). CONCLUSIONS BDMA, as a second-line biologic, is more likely to be sustained in seropositive-patients, particularly without prior exposure to monoclonal-TNFi. The drug-survival benefit of BDMA was not observed in seronegative-patients or if the first-line TNFi was stopped within 2 years.
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Affiliation(s)
- Muhammad R A Shipa
- Centre for Rheumatology, Division of Medicine, University College London, London, UK; Rayne Institute, 5 University St, Bloomsbury, London WC1E 6JF, UK
| | - Maria Di Cicco
- Department of Rheumatology, Barking Havering and Redbridge University Hospitals NHS Trust, London, UK
| | - Emese Balogh
- Department of Rheumatology, Barking Havering and Redbridge University Hospitals NHS Trust, London, UK
| | - Naila A Nitu
- Department of Rheumatology, North Middlesex University Trust, London, UK
| | - M D Mainuddin
- Department of Rheumatology, North Middlesex University Trust, London, UK
| | - Naveen Bhadauria
- Department of Rheumatology, North Middlesex University Trust, London, UK
| | - Dev Mukerjee
- Department of Rheumatology, North Middlesex University Trust, London, UK
| | - Euthalia Roussou
- Department of Rheumatology, Barking Havering and Redbridge University Hospitals NHS Trust, London, UK
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5
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de Klaver PAG, Keizer RJ, Ter Heine R, Smits L, Boekema PJ, Kuntzel I, Schaap T, de Vries A, Bloem K, Rispens T, Hoentjen F, Derijks LJJ. Early At-Home Measurement of Adalimumab Concentrations to Guide Anti-TNF Precision Dosing: A Pilot Study. Eur J Drug Metab Pharmacokinet 2023:10.1007/s13318-023-00835-7. [PMID: 37322238 DOI: 10.1007/s13318-023-00835-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND AND OBJECTIVE Underdosing of adalimumab can result in non-response and poor disease control in patients with rheumatic disease or inflammatory bowel disease. In this pilot study we aimed to predict adalimumab concentrations with population pharmacokinetic model-based Bayesian forecasting early in therapy. METHODS Adalimumab pharmacokinetic models were identified with a literature search. A fit-for-purpose evaluation of the model was performed for rheumatologic and inflammatory bowel disease (IBD) patients with adalimumab peak (first dose) and trough samples (first and seventh dose) obtained by a volumetric absorptive microsampling technique. Steady state adalimumab concentrations were predicted after the first adalimumab administration. Predictive performance was calculated with mean prediction error (MPE) and normalised root mean square error (RMSE). RESULTS Thirty-six patients (22 rheumatologic and 14 IBD) were analysed in our study. After stratification for absence of anti-adalimumab antibodies, the calculated MPE was -2.6% and normalised RMSE 24.0%. Concordance between predicted and measured adalimumab serum concentrations falling within or outside the therapeutic window was 75%. Three patients (8.3%) developed detectable concentrations of anti-adalimumab antibodies. CONCLUSION This prospective study demonstrates that adalimumab concentrations at steady state can be predicted from early samples during the induction phase. CLINICAL TRIAL REGISTRATION The trial was registered in the Netherlands Trial Register with trial registry number NTR 7692 ( www.trialregister.nl ).
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Affiliation(s)
- Paul A G de Klaver
- Department of Clinical Pharmacy and Pharmacology, Máxima Medical Center, 5504 DB, Veldhoven, The Netherlands.
| | | | - Rob Ter Heine
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lisa Smits
- Department of Gastroenterology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Paul J Boekema
- Department of Gastroenterology, Máxima Medical Center, Veldhoven, The Netherlands
| | - Inge Kuntzel
- Department of Rheumatology, Máxima Medical Center, Eindhoven, The Netherlands
| | - Tiny Schaap
- Biologics Laboratory, Sanquin Diagnostic Services, Amsterdam, The Netherlands
| | - Annick de Vries
- Biologics Laboratory, Sanquin Diagnostic Services, Amsterdam, The Netherlands
| | - Karien Bloem
- Biologics Laboratory, Sanquin Diagnostic Services, Amsterdam, The Netherlands
| | - Theo Rispens
- Biologics Laboratory, Sanquin Diagnostic Services, Amsterdam, The Netherlands
- Department of Immunopathology, Sanquin Research, Amsterdam, The Netherlands
- Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Frank Hoentjen
- Department of Gastroenterology, Radboud University Medical Center, Nijmegen, The Netherlands
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Luc J J Derijks
- Department of Clinical Pharmacy and Pharmacology, Máxima Medical Center, 5504 DB, Veldhoven, The Netherlands
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center, Maastricht, The Netherlands
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Ouardi NE, Maghraoui AE, Djossou HJ, Taoubane L, Ghassem AM, Toufik H, Majjad A, Sadni S, Mounach A, Hmamouchi I, Abouqal R, Bahiri R, Allali F, Bouchti IE, Ghozlani I, Hassikou H, Harzy T, Ichchou L, Mkinsi O, Niamane R, Bezza A. Discontinuation of biologic therapy in patients with rheumatoid arthritis and ankylosing spondylitis: analysis from multicenter cohort study. Rheumatol Int 2023; 43:79-87. [PMID: 36334121 DOI: 10.1007/s00296-022-05237-7] [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: 06/07/2022] [Accepted: 10/16/2022] [Indexed: 11/07/2022]
Abstract
Despite of the availability of several effective bDMARDs, a significant proportion of rheumatoid arthritis (RA) and ankylosing spondylitis (AS) patients discontinued bDMARDs. The aims of this study were to analyze causes of bDMARDs discontinuation in RA and AS included in the Moroccan registry RBSMR. A historical prospective multicenter cohort study based on the RBSMR database at 12 months of follow-up, which included 225 RA and 170 AS. Using T student, Mann-Whitney U, chi-squared or Fischer exact tests, baseline demographic and clinical features were compared between patients discontinuing bDMARDs and patients remaining on initiated bDMARDs or switching bDMARDs. Logistic regression models were used to identify factors associated with drugs discontinuation. 61 RA discontinued bDMARDs and 47 AS interrupted anti-TNF. The most common reasons for drugs discontinuation were adverse events (7.5%) in RA patients and social security reimbursement problems (16.8%) in AS. RA patients discontinuing bDMARDs were more frequently first-line biological drugs users, more frequently female and had more comorbidities and lower DAS28 CRP than RA patients remaining on initiated bDMARDs or switching bDMARDs (p < 0.001, p = 0.01, p < 0.001 and p < 0.001 respectively). Female sex and comorbidities were the significant predictors of bDMARDs discontinuation in RA patients. Higher baseline BASDAI had a protective role on anti-TNF interruption in AS patients. Adverse events and social security reimbursement problems were the main reasons for drugs discontinuation in RA and AS patients respectively. Female sex and comorbidities in RA patients, baseline BASDAI in AS patients impacted bDMARDs discontinuation in real-life settings.
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Affiliation(s)
- N El Ouardi
- Department of Rheumatology, Military Hospital Mohammed V, Ibn Sina University Hospital, Rabat, Morocco.
| | | | - H J Djossou
- Department of Rheumatology, Military Hospital Mohammed V, Ibn Sina University Hospital, Rabat, Morocco
| | - L Taoubane
- Department of Rheumatology, Military Hospital Mohammed V, Ibn Sina University Hospital, Rabat, Morocco
| | - A M Ghassem
- Department of Rheumatology, Military Hospital Mohammed V, Ibn Sina University Hospital, Rabat, Morocco
| | - H Toufik
- Department of Rheumatology, Military Hospital Mohammed V, Ibn Sina University Hospital, Rabat, Morocco
| | - A Majjad
- Department of Rheumatology, Military Hospital Mohammed V, Ibn Sina University Hospital, Rabat, Morocco
| | - S Sadni
- Department of Rheumatology, Military Hospital Mohammed V, Ibn Sina University Hospital, Rabat, Morocco
| | - A Mounach
- Department of Rheumatology, Military Hospital Mohammed V, Ibn Sina University Hospital, Rabat, Morocco
| | - I Hmamouchi
- Laboratory of Biostatistical, Clinical and Epidemiological Research, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco.,Department of Rheumatology, Provincial Hospital of Temara, Temara, Morocco
| | - R Abouqal
- Laboratory of Biostatistical, Clinical and Epidemiological Research, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - R Bahiri
- Department of Rheumatology A, El Ayachi Hospital, Ibn Sina University Hospital, Salé, Morocco
| | - F Allali
- Department of Rheumatology B, El Ayachi Hospital, Ibn Sina University Hospital, Salé, Morocco
| | - I El Bouchti
- Department of Rheumatology, Arrazi University Hospital, Marrakech, Morocco
| | - I Ghozlani
- Department of Rheumatology, University Hospital of Agadir, Agadir, Morocco
| | - H Hassikou
- Department of Rheumatology, Military Hospital Moulay Ismail, Hassan II University Hospital, Meknès, Morocco
| | - T Harzy
- Department of Rheumatology, Hassan II University Hospital, Fès, Morocco
| | - L Ichchou
- Department of Rheumatology, Mohammed VI University Hospital, Oujda, Morocco
| | - O Mkinsi
- Department of Rheumatology, Ibn Rochd University Hospital, Casablanca, Morocco
| | - R Niamane
- Department of Rheumatology, Military Hospital Avicenne, Mohammed VI University Hospital, Marrakech, Morocco
| | - A Bezza
- Department of Rheumatology, Military Hospital Mohammed V, Ibn Sina University Hospital, Rabat, Morocco
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Lin HC, Huang HY, Lin CY, Fang YF, Lin CH, Huang YT, Chang CH, Wang CH, Huang JL, Liao TW, Hsieh MH. Clinical outcomes and prognostic factors of bronchiectasis rheumatoid overlap syndrome: A multi-institution cohort study. Front Med (Lausanne) 2022; 9:1004550. [PMID: 36314020 PMCID: PMC9606566 DOI: 10.3389/fmed.2022.1004550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/29/2022] [Indexed: 11/21/2022] Open
Abstract
The information regarding bronchiectasis with RA (BROS) is limited in Asia. The objective of this study was to investigate the clinical characteristics and outcomes of BROS in Taiwan. This multi-institute cohort study included patients with BROS from January 2006 to December 2017. The clinical, functional and microbiological data of these patients were retrieved from the Chang Gung Research Database. Respiratory failure and mortality were the primary outcomes. Severe exacerbation was defined as bronchiectasis- related hospitalizations or emergency department visits. A total of 343 patients with BROS were identified. One hundred and eight patients had severe exacerbation and exhibited significantly more previous exacerbations, a lower FEV1 and higher BACI score (11.1 vs. 7.5) than patients without severe exacerbation. The most prevalent species in sputum were Non-tuberculous mycobacteria (NTM) (14.8 %), Pseudomonas aeruginosa (14.2 %), and fungus (5.9%). 68.8% of BROS patients used disease modifying antirheumatic drugs (DMARD), 7.9% used biological DMARD. NTM and tuberculosis infection rates were higher in bDMARD group compared with nbDMARD group and others. Overall, the 3-year respiratory failure rate and mortality rate were 14.6 and 25.7% respectively. Patients with RA diagnosed before bronchiectasis had a significantly higher cumulative incidence of mortality in a 3-year follow-up than those with RA diagnosed after bronchiectasis. In Cox regression, age, higher RF value and systemic steroid use were independent risk factors for mortality in BROS. BROS patients with severe exacerbation had a high mortality rate in Taiwan. bDMARD is associated with a trend of increased risk of NTM and TB infections.
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Affiliation(s)
- Horng-Chyuan Lin
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hung-Yu Huang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan,College of Medicine, Chang Gung University, Taoyuan, Taiwan,Department of Thoracic Medicine, New Taipei City Municipal Tucheng Hospital, Chang Gung Medical Foundation, New Taipei City, Taiwan
| | - Chun-Yu Lin
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yueh-Fu Fang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chiung-Hung Lin
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Tung Huang
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chiung-Hsin Chang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Hua Wang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jhen-Ling Huang
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ting-Wei Liao
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Meng-Heng Hsieh
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan,College of Medicine, Chang Gung University, Taoyuan, Taiwan,*Correspondence: Meng-Heng Hsieh
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KARATAŞ B, YILMAZER B. FACTORS AFFECTING BIOLOGICAL DRUG SURVIVAL IN PATIENTS DIAGNOSED OF RHEUMATOİD ARTHRİTİS: A SINGLE-CENTER STUDY FROM TURKEY. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2022. [DOI: 10.17517/ksutfd.1068756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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9
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Tahmasian H, Smeele HTW, de Jong PHP, Dolhain RJEM, van Mulligen E. Biological and Methotrexate Survival after Pregnancy in Patients With a Rheumatic Disease. Front Pharmacol 2022; 13:826034. [PMID: 35355725 PMCID: PMC8959570 DOI: 10.3389/fphar.2022.826034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/31/2022] [Indexed: 11/23/2022] Open
Abstract
Objective: Patients with a rheumatic disease who discontinue their disease-modifying anti-rheumatic drug (DMARD) due to pregnancy often wonder if treatment will be as effective after pregnancy. This study investigates the effect of a temporary discontinuation of DMARDs due to pregnancy on the effectiveness of the same DMARD postpartum in patients with a rheumatic disease. Methods: Pregnant, rheumatic patients were derived from the Preconceptional Counseling in Active Rheumatoid Arthritis (PreCARA) cohort. DMARD-survival after pregnancy, for biological and methotrexate (MTX) therapy, was analyzed and compared to controls with stable DMARD-treatment from a retrospective cohort. Results: In total, 234 patients were included, of whom 114 patients had stable biological or MTX treatment before their pregnancy. After pregnancy, 40 out of 56 (71%) patients restarted their biological, for MTX this was 49%. One year after restart, and censoring for a following pregnancy, 88.9% of patients were still using their biological, and 85% still used their MTX (p = 0.92). Compared to the matched controls the survival after pregnancy was significantly lower 1 year after restart for both biologicals (98.3%) and MTX (99.6%); p = 0.002 and p < 0.001 respectively; 3 years after restart this significant difference was no longer observed (p = 0.50 and p = 0.33, respectively). Conclusion: Effective DMARD (biological or MTX) treatment before pregnancy that was discontinued due to pregnancy seems effective after pregnancy. Although DMARD-survival was higher in the control group 1 year after restart, the percentage of patients with effective treatment was still very good (>85%). In addition, this difference was no longer observed after 3 years.
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Affiliation(s)
- Helena Tahmasian
- Department of Rheumatology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Hieronymus T W Smeele
- Department of Rheumatology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Pascal H P de Jong
- Department of Rheumatology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Radboud J E M Dolhain
- Department of Rheumatology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Elise van Mulligen
- Department of Rheumatology, Erasmus University Medical Center, Rotterdam, Netherlands.,Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
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Heutz J, de Jong PHP. Possibilities for personalised medicine in rheumatoid arthritis: hype or hope. RMD Open 2021; 7:rmdopen-2021-001653. [PMID: 34649986 PMCID: PMC8522666 DOI: 10.1136/rmdopen-2021-001653] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 09/29/2021] [Indexed: 12/26/2022] Open
Abstract
Knowledge of pathophysiology of rheumatoid arthritis (RA) has improved over the past decades, which resulted in new treatment options and strategies that led to better clinical outcomes. At the same time, we have come to understand that RA is a heterogeneous disease on a clinical as well as a pathophysiological level. Despite this heterogeneity, current management recommendations still adopt a ‘one-size-fits-all’ treatment approach, where ideally individualised treatment, or personalised medicine, is preferred. The first step towards personalised medicine in RA would be to designate different treatment strategies to distinct clinical or molecular phenotypes of patients. This viewpoint discusses current evidence and elaborates on future possibilities for personalised medicine in RA.
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Affiliation(s)
- Judith Heutz
- Rheumatology, Erasmus MC, Rotterdam, The Netherlands
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