1
|
de Almeida ALB, Guimarães MFBR, da Costa Pinto MR, Pereira LR, Reis APMG, Bonfiglioli KR, Louzada-Junior P, Giorgi RDN, de Castro GRW, Radominski SC, Brenol CV, Pugliesi A, da Mota LMH, da Rocha Castelar-Pinheiro G. Predictors of serious infections in rheumatoid arthritis-a prospective Brazilian cohort. Adv Rheumatol 2024; 64:23. [PMID: 38553751 DOI: 10.1186/s42358-024-00363-1] [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: 07/17/2023] [Accepted: 03/19/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Infections increase mortality and morbidity and often limit immunosuppressive treatment in rheumatoid arthritis patients. OBJECTIVE To analyze the occurrence of serious infections and the associated factors in a cohort of rheumatoid arthritis patients under real-life conditions. METHODS We analyzed data from the REAL, a prospective observational study, that evaluated Brazilian RA patients, with clinical and laboratory data collected over a year. Univariate and multivariate analyses were performed from the adjustment of the logistic regression model Generalized Estimating Equations (GEE), with the primary outcome being the occurrence of serious infection, defined as need for hospitalization or use of intravenous antibiotics for its treatment. RESULTS 841 patients were included with an average follow-up time of 11.2 months (SD 2.4). Eighty-nine serious infections occurred, corresponding to 13 infections per 100 patient-years. Pulmonary fibrosis, chronic kidney disease (CKD) and central nervous system disease increased the chances of serious infection by 3.2 times (95% CI: 1.5-6.9), 3.6 times (95% CI: 1.2-10.4) and 2.4 times (95% CI: 1.2-5.0), respectively. The use of corticosteroids in moderate doses increased the chances by 5.4 times (95% CI: 2.3-12.4), and for each increase of 1 unit in the health assessment questionnaire (HAQ), the chance increased 60% (95% CI: 20-120%). CONCLUSION The use of corticosteroids at moderate doses increased the risk of serious infection in RA patients. Reduced functionality assessed by the HAQ and comorbidities were other important factors associated with serious infection in this cohort.
Collapse
Affiliation(s)
| | | | | | - Leticia Rocha Pereira
- Departamento de Reumatologia, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Karina Rossi Bonfiglioli
- Departamento de Reumatologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | | | | | | | - Claiton Viegas Brenol
- Departamento de Reumatologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Alisson Pugliesi
- Departamento de Reumatologia, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | | | | |
Collapse
|
2
|
Lazaridou I, Vassilopoulos A, Vassilopoulos S, Shehadeh F, Kalligeros M, Mylonakis E, Qureshi A. Risk of infection in patients with hidradenitis suppurativa on biologics or other immunomodulators: a systematic review and meta-analysis. Int J Dermatol 2024; 63:139-149. [PMID: 37888493 DOI: 10.1111/ijd.16885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 10/01/2023] [Accepted: 10/12/2023] [Indexed: 10/28/2023]
Abstract
Hidradenitis suppurativa (HS) is a painful skin condition that significantly affects patients' quality of life. Biologic agents, including anti-TNF agents and IL-17 inhibitors, have shown promise as treatment options for HS. However, there is concern about the increased risk of infections associated with these therapies. We conducted a systematic review and meta-analysis following PRISMA and MOOSE guidelines. We searched PubMed and Embase until February 1, 2023. The primary outcome of interest was the incidence of any infectious complications. Secondary outcomes included serious and opportunistic infections in HS patients treated with biologics or other immunomodulators. Twenty-four studies met our inclusion criteria, comprising 1,696 patients. The pooled incidence rate for any infection was 24.2%, primarily consisting of mild respiratory and skin infections. Subgroup analysis based on the mechanism of action (MOA) showed a pooled incidence of 7.77% for anti-IL1, 14.24% for anti-PDE4, and 21.96% for anti-TNF. Notably, patients receiving anti-IL17 had the highest incidence rate of infection at 33.6%, but the relative risk compared to placebo was not significantly elevated (0.99, 95% CI: 0.86-1.14). Serious infections were rare, with pooled incidences of 0.39% for anti-IL17 and 0.03% for anti-TNF. Opportunistic infections were infrequent, with 10 reported cases, including eight oral candidiasis, one cryptosporidiosis, and one Blastocystis hominis infection. The use of biologic therapies in HS patients does not significantly increase the risk of infectious complications. Additionally, the occurrence of serious or opportunistic infections in HS patients treated with biologics appears to be minimal.
Collapse
Affiliation(s)
- Ingrid Lazaridou
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Stephanos Vassilopoulos
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Fadi Shehadeh
- Department of Electrical and Computer Engineering, National Technical University of Athens, Athens, Greece
| | - Markos Kalligeros
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Abrar Qureshi
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, RI, USA
| |
Collapse
|
3
|
Been Sayeed SKJ, Moniruzzaman M, Kabir AKMH, Mallik MU, Chandra Mondal B, Mahmud S, Rahman FT, Rahman M, Rahman MM. Pattern and Predictors of Infection Among Patients With Rheumatological Disease on Immunosuppressive Medications: A Retrospective Study in a Tertiary Care Hospital in Bangladesh. Cureus 2024; 16:e52817. [PMID: 38406079 PMCID: PMC10883793 DOI: 10.7759/cureus.52817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2024] [Indexed: 02/27/2024] Open
Abstract
Background Immunomodulatory therapy for chronic rheumatic disease carries a risk for infectious complications. In Bangladesh, there is limited information regarding patterns and factors associated with infections among patients receiving immunosuppressive medications. Objective The present study aimed to find out patterns and predictors associated with infection among patients who were on different immunosuppressive medications due to chronic rheumatological disease. Methodology This was a retrospective study; all confirmed cases of (new and old) different rheumatological diseases on disease-modifying agents attended at the rheumatology clinic of Dhaka Medical College Hospital from January 2019 to December 2021 were enrolled. Result Among 489 cases, 90 (18.4%) patients had documented infections. The most common rheumatological diseases were systemic lupus erythematosus (28, 31.1%), ankylosing spondylitis (26, 28.8%), and rheumatoid arthritis (20, 22.2%). COVID-19 (28, 31.1%) was the most commonly occurring infection followed by urinary tract infection (14, 15.6%), fungal infection (12, 13.3%), herpes zoster (10, 11.1%), pulmonary tuberculosis (TB) (eight, 8.8%), latent TB (seven, 7.7%), community-acquired pneumonia (six, 6.6%), and sepsis (three, 3.3%). Infection was most prevalent among patients who received steroids of more than 10 mg per day (17, 18.8%) than those less than 10 mg steroid per day (six, 6.7%), Factors associated with infections were (odds ratio, 95% CI, p-value) underweight (2.3, [1.3-2.7], 0.001), anemia (1.8, [1.1-5.7], 0.01), neutropenia (1.6, [1.1-2.9], <0.002), hypoalbuminemia (3.1, [1.6-4.9], 0.001), hypovitaminosis D (1.9, [1.3-4.5], 0.001), high blood sugar (1.5, [1.1-5.3], 0.02), inadequate counseling of steroid side effect (1.7, [1.1-3.9], 0.03), prednisolone >10mg/day (2.2, [1.19-4.10], 0.001). Conclusion COVID-19 pneumonia, urinary tract infections, fungal infection, tuberculosis, herpes zoster, and community-acquired pneumonia were commonly occurring infections among patients receiving different immunosuppressive medications. Factors like poor nutritional status, presence of anemia, leucopenia, hypoalbuminemia, hyperglycemia, and hypovitaminosis D had a significant association with infection. Moreover, inadequate counseling of steroid side effects and history of daily intake of prednisolone (>10mg/day) were also significant factors associated with infection.
Collapse
Affiliation(s)
| | - Md Moniruzzaman
- Medicine and Rheumatology, National Institute of Neurosciences and Hospital, Dhaka, BGD
| | | | | | - Bikas Chandra Mondal
- Respiratory Medicine, National Institute of Chest Diseases and Hospital, Dhaka, BGD
| | - Shahin Mahmud
- Rheumatology, National Institute of Neurosciences and Hospital, Dhaka, BGD
| | | | - Mehrin Rahman
- Medicine, Dhaka Medical College Hospital, Dhaka, BGD
| | | |
Collapse
|
4
|
Ghoreishi Amin N, Khosravi S, Atefi N, Seirafianpour F, Farhoodi S, Goodarzi A. A systematic review and meta-analysis of investigating the mutual impact of COVID-19 and psoriasis: Focusing on COVID-19 course in psoriasis and the opinion on biologics in this setting. Immun Inflamm Dis 2023; 11:e1063. [PMID: 38018599 PMCID: PMC10629237 DOI: 10.1002/iid3.1063] [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: 08/28/2023] [Revised: 10/07/2023] [Accepted: 10/16/2023] [Indexed: 11/30/2023] Open
Abstract
INTRODUCTION This systematic review and meta-analysis aims to investigate the mutual impact of COVID-19 and psoriasis to inform clinical practice and future research. METHODS We followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis protocol for systematic reviews and searched PubMed, Web of Science, Scopus, and Google Scholar until May 1, 2022. Eligibility criteria included full-text articles in English reporting COVID-19 treatment outcomes in psoriasis patients. Studies on animals, letters to editors, non-English studies, and studies with no access to full articles were excluded. Search results were screened and data were extracted by two groups of reviewers with any discrepancies resolved by the senior author. The risk of bias was assessed using ROBINS-I for nonrandomized studies. The hospitalization rate, Intensive Care Unit (ICU) admission rate, case fatality rate, odds ratios of COVID-19 infection and hospitalization rate in psoriasis patients were extracted and analyzed using random effects analysis to calculate pooled prevalence and odds ratios, as well as to explore heterogeneity. RESULTS We found 1980 records from four databases and included 20 studies after screening and removing duplicates. These studies evaluated 185,000 psoriasis patients and included eight retrospective cohort studies, one case-control study, three cross-sectional studies, and eight case series studies. The impact of the COVID-19 pandemic on psoriasis treatment and the outcome of COVID-19 infection in psoriasis patients receiving different forms of treatment were evaluated. The pooled data from included studies showed that the incidence rate of COVID-19 infection among psoriasis patients was 0.03% (confidence interval [CI]: 0.01-0.06), with a pooled odds ratio of 1.97 (CI: 0.69-5.60) compared to the general population. The hospitalization rate, ICU admission rate, and case fatality rate for psoriasis patients with COVID-19 were 0.17 (CI: 0.10-0.31), 0.06 (CI: 0.06-0.46), and 0.02 (CI: 0.01-0.04), respectively. Additionally, psoriasis patients receiving systemic nonbiologic therapy had a pooled odds ratio of 2.32 (CI: 1.18-4.57) for hospitalization compared to those using biologic agents. CONCLUSION Studies have shown that biologic therapy for psoriasis did not increase the risk of hospitalization due to COVID-19 infection and may have even offered some protection. Treatment adherence was higher in psoriasis patients receiving biologic therapies than those receiving conventional therapies. These findings suggest that psoriasis treatment did not negatively impact COVID-19 infection and that treatment could be continued on a case-by-case basis during the pandemic.
Collapse
Affiliation(s)
- Nazila Ghoreishi Amin
- Department of Radiology, Keck School of MedicineUniversity of Southern California (USC)Los AngelesCaliforniaUSA
| | - Sepehr Khosravi
- Non‐Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences InstituteTehran University of Medical SciencesTehranIran
| | - Najmolsadat Atefi
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC)Iran University of Medical SciencesTehranIran
| | | | - Sahand Farhoodi
- School of MedicineIran University of Medical SciencesTehranIran
| | - Azadeh Goodarzi
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC)Iran University of Medical SciencesTehranIran
| |
Collapse
|
5
|
Patient Preferences in the Management of Hidradenitis Suppurativa: Results of a Multinational Discrete Choice Experiment in Europe. THE PATIENT 2023; 16:153-164. [PMID: 36630078 PMCID: PMC9911507 DOI: 10.1007/s40271-022-00614-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/15/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND OBJECTIVE Hidradenitis suppurativa is a chronic inflammatory skin disease that can lead to a substantial reduction in quality of life. Recent studies revealed high levels of unmet care needs of patients with hidradenitis suppurativa, but their preferences in treatment decision making have scarcely been investigated. This study aimed to reveal which treatment attributes adult patients with HS in Europe consider most important in treatment decision-making. METHODS A discrete choice experiment was conducted with adult patients with hidradenitis suppurativa in Europe to reveal which treatment attributes are most important when making treatment decisions. Participants were presented with 15 sets of two treatment options and asked for each to choose the treatment they preferred. The treatments were characterized by six attributes informed by a prior literature review and qualitative research: effectiveness, pain reduction, duration of treatment benefit, risk of mild adverse event, risk of serious infection, and mode of administration. A random parameter logit model was used to estimate patients' preferences with additional subgroup and latent class models used to explore any differences in preferences across patient groups. RESULTS Two hundred and nineteen adult patients with hidradenitis suppurativa were included in the analysis (90% women, mean age 38 years). For all six treatment attributes, significant differences were observed between levels. Given the range of levels of each attribute, the most important treatment attributes were effectiveness (47.9%), followed by pain reduction (17.3%), annual risk of a mild adverse event (14.4%), annual risk of a serious infection (10.3%), mode of administration (5.3%), and duration of treatment benefit (4.8%). Higher levels of effectiveness, namely a 75% or 100% reduction in the abscess and inflammatory nodule count, were preferred over levels of effectiveness primarily investigated in randomized clinical trials of hidradenitis suppurativa (a 50% reduction). Results were largely consistent across subgroups and three latent class groups were identified. CONCLUSIONS This study revealed the most important treatment characteristics for patients with hidradenitis suppurativa that can help inform joint patient-physician decision making in the management of hidradenitis suppurativa. Designing future hidradenitis suppurativa treatments according to stated preferences, namely, to offer higher levels of effectiveness and pain improvement without higher risks of adverse events, may increase patients' treatment concordance and lead to improved disease management outcomes.
Collapse
|
6
|
Koltsova EN, Lukina GV, Schmidt EI, Lytkina KA, Zhilyaev EV. Predictors of biologic disease modifying antirheumatic drugs withdrawal due to the development of adverse events in patients with rheumatoid arthritis. MODERN RHEUMATOLOGY JOURNAL 2022. [DOI: 10.14412/1996-7012-2022-6-26-31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Currently, a large number of highly effective biologic disease modifying antirheumatic drugs (bDMARDs) and targeted synthetic DMARDs (tsDMARDs) are used for the treatment of rheumatoid arthritis (RA). However, in addition to effectiveness, it is necessary to evaluate the risk of adverse events (AEs) when using them.Objective: to determine the predictors of bDMARDs and tsDMARDs discontinuation due to AEs in patients with RA.Patients and methods. The study included 661 patients with RA who took bDMARDs and tsDMARDs. The search for predictors of targeted therapy discontinuation due to AEs was carried out in two stages. At the first stage, using the Kaplan-Meier method, we selected indicators that showed the greatest significant single-factor relationship with the duration of retention on therapy. At the second stage, significant independent indicators were obtained by iterative selection of variables within the multivariate proportional risk model according to Cox.Results and discussion. The presence of rheumatoid nodules (p<0.001), high doses of glucocorticoids (GC; p<0.001), low doses of methotrexate (MT; p=0.009) are significant independent factors for increasing the risk of drugs discontinuation due to the development of AEs. The type of bDMARDs/tsDMARD used also significantly correlated with the risk of discontinuation of therapy due to AEs. A relatively high risk of treatment discontinuation was observed with infliximab (IFN) and certolizumab pegol (CZP). Cancellation of IFN was associated with the occurrence of infusion reactions and infectious complications, and CZP was associated with infectious complications.Conclusion. An increase in the dose of MT and decrease in the use of GCs can help prevent the development of AEs leading to the abolition of biologics and tsDMARDs. Significant differences were found between bDMARDs in terms of the risk of their cancellation due to AEs.
Collapse
Affiliation(s)
| | - G. V. Lukina
- A.S. Loginov Moscow Clinical Scientific Center; V.A. Nasonova Research Institute of Rheumatology
| | | | | | - E. V. Zhilyaev
- European Medical Center; Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia; Pirogov Russian National Research Medical University
| |
Collapse
|
7
|
Frede N, Rieger E, Lorenzetti R, Nieters A, Venhoff AC, Hentze C, von Deimling M, Bartholomä N, Thiel J, Voll RE, Venhoff N. Respiratory tract infections and risk factors for infection in a cohort of 330 patients with axial spondyloarthritis or psoriatic arthritis. Front Immunol 2022; 13:1040725. [PMID: 36389682 PMCID: PMC9644024 DOI: 10.3389/fimmu.2022.1040725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 10/13/2022] [Indexed: 08/06/2023] Open
Abstract
Respiratory tract infections (RTIs) are the most common infections in patients with rheumatic diseases under immunosuppressive treatment and may contribute to morbidity and mortality as well as increased healthcare costs. However, to date only limited data on infection risk in spondyloarthritis (SpA) patients are available. In this study we assessed the occurrence of respiratory tract infections in a monocentric real-world cohort consisting of 330 patients (168 psoriatic arthritis and 162 axial spondyloarthritis patients) and determined factors associated with increased infection risk. Out of 330 SpA patients, 89.3% had suffered from ≥ 1 upper respiratory tract infection (URTI) and 31.1% from ≥ 1 lower respiratory tract infection (LRTI) within the last two years. The most common URTIs were rhinitis and laryngitis/pharyngitis with 87.3% and 36.1%, respectively. Bronchitis constituted the most common LRTI, reported in 29.7% of patients. In a multivariate binomial logistic regression model occurrence of LRTI was associated with chronic lung disease (OR 17.44, p=0.006), glucocorticoid therapy (OR 9.24, p=0.012), previous history of severe airway infections (OR 6.82, p=0.013), and number of previous biological therapies (OR 1.72, p=0.017), whereas HLA B27 positivity was negatively associated (OR 0.29, p=0.025). Female patients reported significantly more LRTIs than male patients (p=0.006) and had a higher rate of antibiotic therapy (p=0.009). There were no significant differences between axSpA and PsA patients regarding infection frequency or antibiotic use. 45.4% of patients had required antibiotics for respiratory tract infections. Antibiotic therapy was associated with smoking (OR 3.40, p=0.008), biological therapy (OR 3.38, p=0.004), sleep quality (OR 1.13, p<0.001) and age (OR 0.96, p=0.030). Hypogammaglobulinemia (IgG<7g/l) was rare (3.4%) in this SpA cohort despite continuous immunomodulatory treatment. Awareness of these risk factors will assist physicians to identify patients with an increased infection risk, who will benefit from additional preventive measures, such as vaccination and smoking cessation or adjustment of DMARD therapy.
Collapse
Affiliation(s)
- Natalie Frede
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Eva Rieger
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Raquel Lorenzetti
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Alexandra Nieters
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ana C. Venhoff
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Carolin Hentze
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marcus von Deimling
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Nora Bartholomä
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jens Thiel
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Division of Rheumatology and Clinical Immunology, Medical University Graz, Graz, Austria
| | - Reinhard E. Voll
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Nils Venhoff
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| |
Collapse
|
8
|
Mayaro Virus: The State-of-the-Art for Antiviral Drug Development. Viruses 2022; 14:v14081787. [PMID: 36016409 PMCID: PMC9415492 DOI: 10.3390/v14081787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/10/2022] [Accepted: 08/11/2022] [Indexed: 12/18/2022] Open
Abstract
Mayaro virus is an emerging arbovirus that causes nonspecific febrile illness or arthralgia syndromes similar to the Chikungunya virus, a virus closely related from the Togaviridae family. MAYV outbreaks occur more frequently in the northern and central-western states of Brazil; however, in recent years, virus circulation has been spreading to other regions. Due to the undifferentiated initial clinical symptoms between MAYV and other endemic pathogenic arboviruses with geographic overlapping, identification of patients infected by MAYV might be underreported. Additionally, the lack of specific prophylactic approaches or antiviral drugs limits the pharmacological management of patients to treat symptoms like pain and inflammation, as is the case with most pathogenic alphaviruses. In this context, this review aims to present the state-of-the-art regarding the screening and development of compounds/molecules which may present anti-MAYV activity and infection inhibition.
Collapse
|
9
|
Bellan M, Scotti L, Ferrante D, Calzaducca E, Manfredi GF, Sainaghi PP, Barone-Adesi F. Risk of Severe Infection among Rheumatoid Arthritis Patients on Biological DMARDs: A Population-Based Cohort Study. J Clin Med 2022; 11:jcm11112955. [PMID: 35683344 PMCID: PMC9181346 DOI: 10.3390/jcm11112955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/14/2022] [Accepted: 05/22/2022] [Indexed: 12/15/2022] Open
Abstract
Biological disease-modifying anti-rheumatic drugs (bDMARDs) are widely used for the management of rheumatoid arthritis, although their benefits are counterweight by an increased risk of infections. In the present study, we used administrative data to compare the risk of severe infections among different classes of bDMARDs. A retrospective cohort study was conducted using Administrative Health Databases of the Piedmont Region, Italy. Relevant data were obtained from: (1) the inhabitants registry, (2) hospital discharge records, and (3) the co-payment exemption registry and (4) drug claims registry. Fine and Gray competing risk models were fitted to evaluate the association between the use of different types of bDMARDs and occurrence of severe infection accounting for treatment interruption as competing risk. A total of 1780 new users of bDMARDs were identified. Among them, 50 hospitalizations for infection occurred during the study period. The use of Tocilizumab was associated with an increased risk of infection, compared to tumor necrosis factor (TNF) inhibitor drugs (sub-distribution hazard ratios-sHR: 2.510; 95% CI: 1.279–4.926), whereas no difference in the risk of severe infection was found for abatacept (sHR: 0.584; 95% CI: 0.234–1.457). bDMARDs treatment is generally safe in clinical practice with slight but important differences among classes. The increased risk of infection associated with tocilizumab use should be taken into account when balancing the risk and benefits of starting a treatment with this drug.
Collapse
Affiliation(s)
- Mattia Bellan
- Department of Translational Medicine (DiMet), Università del Piemonte Orientale (UPO), Via Solaroli 17, 28100 Novara, Italy; (M.B.); (L.S.); (D.F.); (E.C.); (G.F.M.); (F.B.-A.)
- Department of Internal Medicine and Rheumatology Unit, Azienda Ospedaliero-Universitaria Maggiore Della Carità, 28100 Novara, Italy
- Center for Translational Research on Autoimmune and Allergic Diseases (CAAD), Università del Piemonte Orientale (UPO), 28100 Novara, Italy
| | - Lorenza Scotti
- Department of Translational Medicine (DiMet), Università del Piemonte Orientale (UPO), Via Solaroli 17, 28100 Novara, Italy; (M.B.); (L.S.); (D.F.); (E.C.); (G.F.M.); (F.B.-A.)
| | - Daniela Ferrante
- Department of Translational Medicine (DiMet), Università del Piemonte Orientale (UPO), Via Solaroli 17, 28100 Novara, Italy; (M.B.); (L.S.); (D.F.); (E.C.); (G.F.M.); (F.B.-A.)
| | - Elisa Calzaducca
- Department of Translational Medicine (DiMet), Università del Piemonte Orientale (UPO), Via Solaroli 17, 28100 Novara, Italy; (M.B.); (L.S.); (D.F.); (E.C.); (G.F.M.); (F.B.-A.)
- Department of Internal Medicine and Rheumatology Unit, Azienda Ospedaliero-Universitaria Maggiore Della Carità, 28100 Novara, Italy
| | - Giulia Francesca Manfredi
- Department of Translational Medicine (DiMet), Università del Piemonte Orientale (UPO), Via Solaroli 17, 28100 Novara, Italy; (M.B.); (L.S.); (D.F.); (E.C.); (G.F.M.); (F.B.-A.)
- Department of Internal Medicine and Rheumatology Unit, Azienda Ospedaliero-Universitaria Maggiore Della Carità, 28100 Novara, Italy
| | - Pier Paolo Sainaghi
- Department of Translational Medicine (DiMet), Università del Piemonte Orientale (UPO), Via Solaroli 17, 28100 Novara, Italy; (M.B.); (L.S.); (D.F.); (E.C.); (G.F.M.); (F.B.-A.)
- Department of Internal Medicine and Rheumatology Unit, Azienda Ospedaliero-Universitaria Maggiore Della Carità, 28100 Novara, Italy
- Center for Translational Research on Autoimmune and Allergic Diseases (CAAD), Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Correspondence: ; Tel.: +39-0321-3737512
| | - Francesco Barone-Adesi
- Department of Translational Medicine (DiMet), Università del Piemonte Orientale (UPO), Via Solaroli 17, 28100 Novara, Italy; (M.B.); (L.S.); (D.F.); (E.C.); (G.F.M.); (F.B.-A.)
| |
Collapse
|
10
|
Müller F, Heinemann S, Hummers E, Noack EM, Heesen G, Dopfer-Jablonka A, Mikuteit M, Niewolik J, Steffens S, Schröder D. [Immunosuppressed people's beliefs, expectations, and experiences with COVID-19 vaccinations : Results of a longitudinal study]. Z Rheumatol 2022; 82:342-354. [PMID: 35523964 PMCID: PMC9075708 DOI: 10.1007/s00393-022-01213-5] [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: 04/06/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Immunocompromised people are less likely to be vaccinated, despite an increased benefit of many vaccinations in terms of benefit-risk assessment, including the vaccines against SARS CoV-2 (COVID-19). Attitudes, expectations, and experiences with previous vaccinations influence the decision to get vaccinated. OBJECTIVE To explore the attitudes of immunocompromised people towards vaccinations in general and COVID-19 vaccination in particular and their experiences with COVID-19 vaccinations. MATERIAL AND METHODS As part of the CoCo Immune study, immunocompromised participants were surveyed in the spring and summer of 2021 (1 November 2021-7 September 2021) using questionnaires. Initially, they were asked about their expectations concerning a COVID-19 vaccination and followed up about their experience after COVID-19 vaccination. In addition, sociodemographic data, general attitudes toward vaccinations and experiences with previous vaccinations were collected. Analysis was performed using descriptive and bivariate statistics. RESULTS The 243 participants mostly approved vaccinations and expected the COVID-19 vaccination to be effective and well-tolerated. Women were more concerned about the safety of vaccinations and were more often worried about side effects. Older persons felt better informed than younger persons. Participants who reported subjective side effects of previous vaccinations were more skeptical about vaccinations as well as the government institutions that recommend vaccinations. They less often agreed with the statement "in retrospect, the COVID-19 vaccination has been harmless for me so far". DISCUSSION The participants mostly expressed a positive attitude and anticipation towards COVID-19 vaccinations; however, the age and sex differences found suggest that there are different information needs which should be addressed when educating individuals about vaccinations or designing vaccination campaigns.
Collapse
Affiliation(s)
- Frank Müller
- Institut für Allgemeinmedizin, Universitätsmedizin Göttingen, Humboldtallee 38, 37073, Göttingen, Deutschland.
| | - Stephanie Heinemann
- Institut für Allgemeinmedizin, Universitätsmedizin Göttingen, Humboldtallee 38, 37073, Göttingen, Deutschland
| | - Eva Hummers
- Institut für Allgemeinmedizin, Universitätsmedizin Göttingen, Humboldtallee 38, 37073, Göttingen, Deutschland
| | - Eva Maria Noack
- Institut für Allgemeinmedizin, Universitätsmedizin Göttingen, Humboldtallee 38, 37073, Göttingen, Deutschland
| | - Gloria Heesen
- Institut für Allgemeinmedizin, Universitätsmedizin Göttingen, Humboldtallee 38, 37073, Göttingen, Deutschland
| | - Alexandra Dopfer-Jablonka
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Hannover, Deutschland
- Deutsches Zentrum für Infektionsforschung, Hannover-Braunschweig, Deutschland
| | - Marie Mikuteit
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Jacqueline Niewolik
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Sandra Steffens
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Dominik Schröder
- Institut für Allgemeinmedizin, Universitätsmedizin Göttingen, Humboldtallee 38, 37073, Göttingen, Deutschland
| |
Collapse
|
11
|
Cyanidin restores Th17/Treg balance and inhibits T follicular helper cell differentiation via modulation of ROCK2 signaling in an experimental model of rheumatoid arthritis. Int Immunopharmacol 2021; 101:108359. [PMID: 34863656 DOI: 10.1016/j.intimp.2021.108359] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 10/10/2021] [Accepted: 11/07/2021] [Indexed: 01/02/2023]
Abstract
Disturbed Th17/Treg balance is a critical pathological event in the disease progression of rheumatoid arthritis (RA). Recently, emerging studies have demonstrated that CD4 + T helper follicular (Tfh) cells exacerbates the pathogenic manifestations of RA. Contrarily, our previous report has shown that cyanidin, a flavonoid compound, attenuates disease severity of RA. Howbeit, this study investigated the therapeutic efficacy of cyanidin in relation to Th17/Treg balance and pathogenic Tfh cells in RA. Onto results, cyanidin inhibited increased Th17 cell differentiation and reciprocally improved FoxP3 + Treg cells both in-vivo and in-vitro. Concomitantly, cyanidin abated the detrimental effects of IL-17 via restoration of IL-10 secretion in adjuvant induced arthritic (AIA) rats. Furthermore, cyanidin reduced Tfh cells proportion and IgG levels in AIA rats, thus rectifying Tfh and follicular regulatory T (Tfr) cell ratio. Mechanistically, the restoring effect of cyanidin was associated with blunted activation of ROCK2/STAT3 signaling axis and reciprocal increase in the level of STAT-5 activity. Notwithstanding, cyanidin therapeutic efficacy correlated with specific oral ROCK2 inhibitor KD025 in-vitro. Collectively, these results demonstrate a dual promising therapeutic role of cyanidin via regulating Th17/Treg ratio and Tfh cell differentiation in an experimental model of RA.
Collapse
|
12
|
Bjornsson AH, Palsson O, Kristjansson M, Gunnarsson PS, Grondal G, Gudbjornsson B, Love TJ. Outpatient Use of Antimicrobials in Patients With Rheumatoid Arthritis Before and After Treatment With Tumor Necrosis Factor Inhibitors: A Nationwide Retrospective Cohort Study. ACR Open Rheumatol 2021; 4:187-194. [PMID: 34842362 PMCID: PMC8843757 DOI: 10.1002/acr2.11382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 10/12/2021] [Accepted: 10/18/2021] [Indexed: 12/01/2022] Open
Abstract
Objective The objective of this study was to investigate the effect of tumor necrosis factor α inhibitor (TNFi) initiation on the use of antimicrobials among biologic‐naïve patients with rheumatoid arthritis (RA). Methods Information on all biologic‐naïve patients with RA was extracted from ICEBIO, a nationwide registry. Each patient was matched on age, sex, and calendar time to five randomly selected individuals from the general population. All filled antimicrobial and glucocorticoid prescriptions in the 2 years before and after initiation of the first TNFi were extracted from the Prescription Medicines Register. Prescriptions were quantified by using the number of filled prescriptions (NP) and defined daily doses. Results We extracted information on 359 patients with RA and 1795 comparators. During the 24 months before initiating treatment with TNFi, patients with RA received more prescriptions for antimicrobials than their matched general population comparators (mean ± SD: 2.8 ± 3.4 vs 1.6 ± 2.7; P < 0.001). The 24‐month mean NP for patients with RA increased to 3.5 ± 3.9 (P < 0.001) after initiating TNFi: antibiotics, 2.6 ± 3.2 to 3.2 ± 3.5 (P < 0.001); antivirals, 0.06 ± 0.5 to 0.16 ± 0.7 (P = 0.004); and antimycotics, 0.14 ± 0.5 to 0.22 ± 0.9 (P = 0.06). The 12‐month mean NP was highest in the second year after TNFi initiation (1.9 ± 2.4). No association was found between NP and glucocorticoids, age, body mass index, or pre‐TNFi Disease Activity Score 28‐joint count and C‐reactive protein. Conclusion Patients with RA on TNFi are more commonly treated for infections in the outpatient settings than previously reported. Patients are prescribed more antimicrobials in the 2 years preceding TNFi initiation than the general population, and this use further increases after initiation of TNFi. In contrast to what is reported for infections requiring hospitalization, outpatient antimicrobial use remained elevated for at least 2 years.
Collapse
Affiliation(s)
- Aron H Bjornsson
- National University Hospital of Iceland and University of Iceland, Reykjavik, Iceland
| | - Olafur Palsson
- University of Iceland, Reykjavik, Iceland, and Lund University and Skåne University Hospital, Lund, Sweden
| | | | - Petur S Gunnarsson
- National University Hospital of Iceland and University of Iceland, Reykjavik, Iceland
| | - Gerdur Grondal
- National University Hospital of Iceland, Reykjavik, Iceland
| | - Bjorn Gudbjornsson
- National University Hospital of Iceland and University of Iceland, Reykjavik, Iceland
| | - Thorvardur J Love
- National University Hospital of Iceland and University of Iceland, Reykjavik, Iceland
| | | |
Collapse
|
13
|
De Simone C, Fargnoli MC, Amerio P, Bianchi L, Esposito M, Pirro F, Potenza C, Ricceri F, Rongioletti F, Stingeni L, Prignano F. Risk of infections in psoriasis: assessment and challenges in daily management. Expert Rev Clin Immunol 2021; 17:1211-1220. [PMID: 34696673 DOI: 10.1080/1744666x.2021.1997592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION In daily practice management of psoriasis, evaluation of risk factors for infections is having a growing influence. Indeed, in psoriatic patients, risk of infections may be due to psoriasis itself, immunomodulatory therapy, and comorbidities that may increase this risk and patient hospitalization. AREAS COVERED Given the greater understanding of psoriasis pathogenesis and the increasing number of treatment options, it is particularly important to customize therapy according to each, single patient; psoriasis features and comorbidities are also essential to tailor treatment goals. EXPERT OPINION In this perspective, the current knowledge on the infectious risk in psoriatic patient, related to comorbidities, such as diabetes mellitus, cardiovascular disease, and chronic obstructive pulmonary, to 'special populations,' to chronic infections, such as latent tuberculosis, chronic hepatitis B and C, and HIV, and to the most recent Covid-19 pandemic scenario, is reviewed and discussed in order to suggest the most appropriate approach and achieve the best available therapeutic option.
Collapse
Affiliation(s)
- Clara De Simone
- Institute of Dermatology, Catholic University, Rome, Italy.,Dermatology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maria Concetta Fargnoli
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Paolo Amerio
- Department of Medicine and Aging Science and Dermatologic Clinic, University "G. d'Annunzio", Chieti-Pescara, Italy
| | - Luca Bianchi
- Dermatology Unit, Department of Systems Medicine, Tor Vergata University of Rome, Italy
| | - Maria Esposito
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Federico Pirro
- Institute of Dermatology, Catholic University, Rome, Italy.,Dermatology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Concetta Potenza
- Dermatology Unit "Daniele Innocenzi", Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Federica Ricceri
- Unit of Dermatology, Department of Health Science, University of Florence, Florence, Italy
| | - Franco Rongioletti
- Dermatology Clinic, Department of Medical Sciences and Public Health, University of Cagliari, via Università 40, 09124 Cagliari, Italy, IRCCS San Raffaele Hospital, Vita Salute University, Milan, Italy
| | - Luca Stingeni
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Francesca Prignano
- Unit of Dermatology, Department of Health Science, University of Florence, Florence, Italy
| |
Collapse
|
14
|
Christensen IE, Lillegraven S, Mielnik P, Bakland G, Loli L, Sexton J, Uhlig T, Kvien TK, Provan SA. Serious infections in patients with rheumatoid arthritis and psoriatic arthritis treated with tumour necrosis factor inhibitors: data from register linkage of the NOR-DMARD study. Ann Rheum Dis 2021; 81:398-401. [PMID: 34625404 PMCID: PMC8862047 DOI: 10.1136/annrheumdis-2021-221007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 09/24/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To estimate the incidence of serious infections (SIs) in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA) treated with tumour necrosis factor inhibitor (TNFi), and compare risk of SIs between patients with RA and PsA. METHODS We included patients with RA and PsA from the NORwegian-Disease Modifying Anti-Rheumatic Drug registry starting TNFi treatment. Crude incidence rates (IRs) and IR ratio for SIs were calculated. The risk of SIs in patients with RA and PsA was compared using adjusted Cox-regression models. RESULTS A total of 3169 TNFi treatment courses (RA/PsA: 1778/1391) were identified in 2359 patients. Patients with RA were significantly older with more extensive use of co-medication. The crude IRs for SIs were 4.17 (95% CI 3.52 to 4.95) in patients with RA and 2.16 (95% CI 1.66 to 2.81) in patients with PsA. Compared with the patients with RA, patients with PsA had a lower risk of SIs (HR 0.59, 95% CI 0.41 to 0.85, p=0.004) in complete set analysis. The reduced risk in PsA versus RA remained significant after multiple adjustments and consistent across strata based on age, gender and disease status. CONCLUSIONS Compared with patients with RA, the risk of SIs was significantly lower in patients with PsA during TNFi exposure.
Collapse
Affiliation(s)
- Ingrid Egeland Christensen
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway .,Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Siri Lillegraven
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Pawel Mielnik
- Section for Rheumatology; Department for Neurology, Rheumatology and Physical Medicine, Helse Førde, Førde, Norway
| | - Gunnstein Bakland
- Department of Rheumatology, University Hospital of Northern Norway, Tromsø, Norway
| | - Liz Loli
- Lillehammer Hospital for Rheumatic Diseases, Lillehammer, Norway
| | - Joe Sexton
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Till Uhlig
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway.,Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Tore K Kvien
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway.,Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Sella A Provan
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| |
Collapse
|
15
|
Quartuccio L, Valent F, Pasut E, Tascini C, De Vita S. [Not Available]. REVUE DU RHUMATISME (ED. FRANCAISE : 1993) 2021; 88:377-381. [PMID: 34007141 PMCID: PMC8120792 DOI: 10.1016/j.rhum.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/13/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIF Cette étude a pour objectif de déterminer la prévalence du coronavirus 2 du syndrome respiratoire aigu sévère (SARS-CoV-2) 2019 (COVID-19) chez des patients adultes traités par biothérapies ou inhibiteurs des JAK pour des rhumatismes inflammatoires chroniques, en particulier des arthrites inflammatoires chroniques. MÉTHODES Pour cela, une étude basée sur la population, dans la province d'Udine (466 700 habitants d'âge > 15 ans, région du Frioul-Vénétie-Julienne, Italie) a été planifiée. Le critère principal de jugement était la prévalence du COVID-19 durant les deux premiers mois de l'épidémie. Tous les patients de notre province atteints de maladies rhumatismales et traités par biothérapies ou inhibiteurs des JAK au cours des 6 mois précédents ont été inclus (n = 1051). RÉSULTATS Du 29 février au 25 avril 2020, 4 patients adultes (4/1051, 3,8/1000, IC 95 % 1,5-9,7/1000) ont été testés positifs au COVID-19 par RT-PCR et écouvillon. Au total, 47/1051 patients (4,5 %) ont été soumis au test COVID-19 par RT-PCR durant la même période, en raison de symptômes compatibles avec le COVID-19 pour 15 d'entre eux. Dans la population générale, la prévalence était de 937 cas/466700 (2/1000, IC 95 % 1,9-2,1/1000, valeur p = 0,33, test du Chi2), et 20 179/466 700 (4,3 %) prélèvements COVID-19 sur écouvillon ont été effectués. CONCLUSION Le risque de COVID-19 chez les patients atteints de maladies rhumatismales et traités par biothérapies ou inhibiteurs des JAK n'apparaît pas différent de celui observé dans la population générale. Les patients doivent être encouragés à poursuivre en toute sécurité leur traitement et à respecter les mesures de prévention et de protection contre le COVID-19.
Collapse
Affiliation(s)
- Luca Quartuccio
- Clinique de Rhumatologie, Service de Médecine (DAME), ASUFC, Université d'Udine, Udine, Italie
| | | | | | - Carlo Tascini
- Unité des Maladies Infectieuses, ASUFC, Udine, Italie
| | - Salvatore De Vita
- Clinique de Rhumatologie, Service de Médecine (DAME), ASUFC, Université d'Udine, Udine, Italie
| |
Collapse
|
16
|
Fagni F, Simon D, Tascilar K, Schoenau V, Sticherling M, Neurath MF, Schett G. COVID-19 and immune-mediated inflammatory diseases: effect of disease and treatment on COVID-19 outcomes and vaccine responses. THE LANCET. RHEUMATOLOGY 2021; 3:e724-e736. [PMID: 34485930 PMCID: PMC8397302 DOI: 10.1016/s2665-9913(21)00247-2] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
At the beginning of the COVID-19 pandemic, patients with immune-mediated inflammatory diseases were considered to be at high risk for SARS-CoV-2 infection and the development of severe COVID-19. Data collected over the past year, however, suggest that a diagnosis of inflammatory arthritis, psoriasis, or inflammatory bowel diseases does not increase risk for SARS-CoV-2 infection or severe COVID-19 compared with people without these diseases. Furthermore, substantial data suggest that certain medications frequently used in patients with immune-mediated inflammatory diseases, in particular cytokine inhibitors, might even lower the risk for severe COVID-19. Conversely, glucocorticoids and potentially B-cell-depleting treatments seem to worsen COVID-19 outcomes. Additionally, the first data on SARS-CoV-2 vaccination in patients with these diseases suggest that tolerability of vaccination in patients with immune-mediated inflammatory diseases is good, although the immune response to vaccination can be somewhat reduced in this patient group, particularly those taking methotrexate or CD20-targeted treatment.
Collapse
Affiliation(s)
- Filippo Fagni
- Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nuermberg, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander University Erlangen-Nuermberg, Erlangen, Germany
| | - David Simon
- Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nuermberg, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander University Erlangen-Nuermberg, Erlangen, Germany
| | - Koray Tascilar
- Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nuermberg, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander University Erlangen-Nuermberg, Erlangen, Germany
| | - Verena Schoenau
- Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nuermberg, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander University Erlangen-Nuermberg, Erlangen, Germany
| | - Michael Sticherling
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander University Erlangen-Nuermberg, Erlangen, Germany
- Department of Dermatology, Friedrich-Alexander University Erlangen-Nuermberg, Erlangen, Germany
| | - Markus F Neurath
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander University Erlangen-Nuermberg, Erlangen, Germany
- Department of Internal Medicine 1, Friedrich-Alexander University Erlangen-Nuermberg, Erlangen, Germany
| | - Georg Schett
- Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nuermberg, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander University Erlangen-Nuermberg, Erlangen, Germany
| |
Collapse
|
17
|
Barton JC, Barton JC, Bertoli LF, Acton RT. Factors associated with IgG levels in adults with IgG subclass deficiency. BMC Immunol 2021; 22:53. [PMID: 34372773 PMCID: PMC8353875 DOI: 10.1186/s12865-021-00447-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 08/04/2021] [Indexed: 12/12/2022] Open
Abstract
Background Factors associated with IgG levels in adults with IgG subclass deficiency (IgGSD) are incompletely understood. We studied adults with IgGSD with subnormal IgG1 only, subnormal IgG1/IgG3, or subnormal IgG3 only without other subnormal IgG subclasses, IgA, or IgM. We compiled: age; sex; autoimmune condition(s) (AC); atopy; IgG, IgG subclasses, IgA, IgM; IgGsum (IgG1 + IgG2 + IgG3 + IgG4); and D (percentage difference between IgGsum and IgG). We compared attributes of patients with/without subnormal IgG (< 7.00 g/L; subnormal IgG1 subclass groups only) and analyzed IgGsum and IgG relationships. We performed backward stepwise regressions on IgG using independent variables IgG subclasses, age, and sex and on D using independent variables age and sex. Results There were 39 patients with subnormal IgG1 only (89.7% women), 53 with subnormal IgG1/IgG3 (88.7% women), and 115 with subnormal IgG3 only (91.3% women). Fifteen patients (38.5%) and 32 patients (60.4%) in the respective subnormal IgG1 subclass groups had subnormal IgG. Attributes of patients with/without IgG < 7.00 g/L were similar, except that AC prevalence was lower in patients with subnormal IgG1 only and IgG < 7.00 g/L than ≥ 7.00 g/L (p = 0.0484). Mean/median IgG1 and IgG2 were significantly lower in patients with IgG < 7.00 g/L in both subnormal IgG1 subclass groups (p < 0.0001, all comparisons). Regressions on IgG in three subclass groups revealed positive associations with IgG1 and IgG2 (p < 0.0001 each association). Regressions on D revealed no significant association. IgG1 percentages of IgGsum were lower and IgG2 percentages were higher in patients with subnormal IgG1 subclass levels than subnormal IgG3 only (p < 0.0001 all comparisons). Conclusions We conclude that both IgG1 and IgG2 are major determinants of IgG in patients with subnormal IgG1, combined subnormal IgG1/IgG3, or subnormal IgG3 and that in patients with subnormal IgG1 or combined subnormal IgG1/IgG3, median IgG2 levels are significantly lower in those with IgG < 7.00 g/L than those with IgG ≥ 7.00 g/L. Supplementary Information The online version contains supplementary material available at 10.1186/s12865-021-00447-3.
Collapse
Affiliation(s)
- James C Barton
- University of Alabama at Birmingham, Birmingham, AL, USA. .,Southern Iron Disorders Center, Birmingham, AL, USA. .,Department of Medicine, Brookwood Medical Center, Birmingham, AL, USA.
| | | | - Luigi F Bertoli
- Southern Iron Disorders Center, Birmingham, AL, USA.,Department of Medicine, Brookwood Medical Center, Birmingham, AL, USA
| | - Ronald T Acton
- Southern Iron Disorders Center, Birmingham, AL, USA.,Department of Microbiology, University of Alabama At Birmingham, Birmingham, AL, USA
| |
Collapse
|
18
|
Okay G, Biberci Keskin E, Akkoyunlu Y, Bolukcu S, Betül Uslu A, Meric Koc M. Evaluation of hepatitis B vaccine efficacy and factors affecting vaccine nonresponse in patients receiving anti-tumor necrosis factor agents. Eur J Gastroenterol Hepatol 2021; 33:1091-1096. [PMID: 32675781 DOI: 10.1097/meg.0000000000001849] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The response rate of patients to hepatitis B virus (HBV) vaccination receiving anti-tumor necrosis factor (TNF) agents is quite low. We aimed to assess the efficiency of HBV vaccination in patients with chronic inflammatory diseases (CIDs) receiving anti-TNF agents as well as in healthy controls. We also evaluated the impact of different factors on the efficacy of HBV vaccination. METHODS Patients with CIDs receiving anti-TNF agents and healthy controls vaccinated for HBV were included in the study during 2018-2019. An adequate immune response and an effective immune response to HBV were defined as >10 IU/L and > 100 IU/L, respectively. RESULTS Among 274 participants, 187 were patients with CID and 87 were healthy controls. The mean age of the patients with CID (43.9 ± 11.7 years) was significantly higher than that of the healthy controls (31.4 ± 7 years) (P = 0.000). Adequate immune response was 60.8 and 94.3% in patients with CID and healthy controls (P = 0.000), respectively, whereas effective immune response was 37.9 and 75.9% (P = 0.000), respectively. In logistic regression analysis, male sex [odds ratio (OR), 0.408; 95% confidence interval (CI), 0.201-0.830; P = 0.013), use of infliximab (OR, 2.694; 95% CI, 1.203-6.035; P = 0.016) and sertoluzimab (OR, 3.307; 95% CI, 1.287-8.498; P = 0.013), vaccination after anti-TNF treatment (OR, 0.224; 95% CI, 0.083-0.602; P = 0.003) were identified as risk factors of nonresponse to HBV vaccine. CONCLUSIONS Infliximab and sertoluzimab usage, male sex, and vaccination after anti-TNF treatment were risk factors of nonresponse. HBV vaccination should be given to patients with CID before initiation of anti-TNF treatment and awareness should be spread on this subject.
Collapse
Affiliation(s)
- Gülay Okay
- Department of Gastroenterology, Faculty of Medicine, Istanbul, Bezmialem Vakif University, Turkey
| | | | | | - Sibel Bolukcu
- Department of Infectious Diseases and Clinical Microbiology
| | | | | |
Collapse
|
19
|
Fisher S, Ziv M. Skin and soft tissue infections in biological therapy for psoriasis-A case report and systematic review of the literature. Int J Dermatol 2021; 60:1429-1434. [PMID: 34080684 DOI: 10.1111/ijd.15679] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 04/04/2021] [Accepted: 05/02/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Biological therapies are widely used for moderate to severe chronic plaque psoriasis owing to their high efficacy and safety profile. However, skin and soft tissue infections (SSTIs) have been reported in association with biological treatment in psoriasis. METHODS We report a case of necrotizing fasciitis in an 18-year-old psoriasis patient with a history of severe combined immunodeficiency treated with secukinumab and conducted a systematic literature review of SSTIs associated with biological therapy for psoriasis. The literature review related to biological therapies for psoriasis between the years 1990 and 2020: Medline (PubMed), Embase, and CENTRAL (Cochrane Central Register of Controlled Trials) were searched for psoriasis, biological treatment, and skin and soft tissue infections. RESULTS Over 1,300 titles were found, 24 of which met the inclusion criteria for our study: nine retrospective studies, nine randomized controlled trials, and six prospective studies. The data covered 10 biological treatments. More than 40,000 patients receiving biological treatment were included, and nearly 1,000 cases of SSTIs were documented. CONCLUSIONS We present the available records regarding SSTIs among chronic plaque psoriasis patients given biological treatment. Most reported SSTIs were related to psoriasis patients treated with TNF-α inhibitors. In view of the presented data, biological treatment appears to be a safe mode of therapy for this aspect of psoriasis.
Collapse
Affiliation(s)
- Shani Fisher
- Dermatology and Venereology Department, Emek Medical Center, Afula, Israel.,Department of Nursing, Steyer School of Health Professions, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Ziv
- Dermatology and Venereology Department, Emek Medical Center, Afula, Israel
| |
Collapse
|
20
|
Dalal G, Wright SJ, Vass CM, Davison NJ, Vander Stichele G, Smith CH, Griffiths CEM, Payne K. Patient preferences for stratified medicine in psoriasis: a discrete choice experiment. Br J Dermatol 2021; 185:978-987. [PMID: 33991338 DOI: 10.1111/bjd.20482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND New technologies have enabled the potential for stratified medicine in psoriasis. It is important to understand patients' preferences to enable the informed introduction of stratified medicine, which is likely to involve a number of individual tests that could be collated into a prescribing algorithm for biological drug selection to be used in clinical practice. OBJECTIVES To quantify patient preferences for an algorithm-based approach to prescribing biologics ('biologic calculator') in psoriasis. METHODS An online survey comprising a discrete choice experiment (DCE) was conducted to elicit the preferences of two purposive samples of adults living with psoriasis in the UK, identified from a psoriasis patient organization (Psoriasis Association) and an online panel provider (Dynata). Respondents chose between two biologic calculators and conventional prescribing described using five attributes: treatment delay; positive predictive value; negative predictive value; risk of infection; and cost saving to the National Health Service. Each participant selected their preferred alternative from six hypothetical choice sets. Additional data, including sociodemographic characteristics, were collected. Choice data were analysed using conditional logit and fully correlated random parameters logit models. RESULTS Data from 212 respondents (67 from the Psoriasis Association and 145 from Dynata) were analysed. The signs of all estimated coefficients were consistent with a priori expectations. Respondents had a strong preference for a high predictive accuracy and avoiding serious infection, but there was evidence of systematic differences in preferences between the samples. CONCLUSIONS This study indicates that individuals with psoriasis would value a biologic calculator and suggested that such a biologic calculator should have sufficient accuracy to predict future response and risk of serious infection from the biologic.
Collapse
Affiliation(s)
- G Dalal
- Manchester Centre for Health Economics, The University of Manchester, Manchester, M13 9PL, UK
| | - S J Wright
- Manchester Centre for Health Economics, The University of Manchester, Manchester, M13 9PL, UK
| | - C M Vass
- Manchester Centre for Health Economics, The University of Manchester, Manchester, M13 9PL, UK.,RTI Health Solutions, Manchester, M20 2LS, UK
| | - N J Davison
- Manchester Centre for Health Economics, The University of Manchester, Manchester, M13 9PL, UK.,BresMed Health Solutions, Manchester, M1 4BT, UK
| | | | - C H Smith
- St John's Institute of Dermatology, Guy's and St. Thomas' NHS Foundation Trust and Kings College London, London, UK
| | - C E M Griffiths
- The Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, NIHR Manchester Biomedical Research Centre, Manchester, UK
| | - K Payne
- Manchester Centre for Health Economics, The University of Manchester, Manchester, M13 9PL, UK
| | | |
Collapse
|
21
|
Quartuccio L, Zabotti A, Gallo T, De Vita S, Valent F. Influenza vaccination in chronic inflammatory arthritis undergoing immunosuppressive treatments: temporal trend and factors of adherence. Rheumatology (Oxford) 2021; 60:2456-2460. [PMID: 33083815 DOI: 10.1093/rheumatology/keaa454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/24/2020] [Accepted: 06/30/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To verify the level of adherence to the influenza vaccination program in a population of patients suffering from RA, PsA or AS undergoing immunosuppressive treatment. METHODS Administrative databases from the Regional Health Information System of Friuli Venezia Giulia (FVG), Italy, were used. Subjects were residents in FVG, suffered from chronic inflammatory arthritis and had at least one prescription for a DMARD in the 9 months before the start of the vaccination season (from 1 October to 31 December). The observation ranged from 2006 to 2018. Logistic regression was used to assess the association between vaccination and the patient's characteristics in the 2018-2019 influenza season. RESULTS Overall, vaccination adherence decreased from the highest value of 35.7% (662/1853) in 2006 to the lowest value of 25.3% (926/3663) in 2014; in people ≥65 years of age it also decreased over time from 61.6% (577/936) in 2008 to 43.9% (701/1595) in the 2014. By logistic analysis on the 2018-2019 season, which included 4460 patients, older subjects were more likely to be vaccinated [people 65-74 years, odds ratio (OR) 4.58 (95% CI 3.72, 5.64); people 75-84 years, OR 6.47 (95% CI 5.04, 8.32); both vs <65] as were those with diabetes [OR 1.66 (95% CI 1.05, 2.64)]. Treatment with a biologic agent alone [OR 0.64 (95% CI 0.52, 0.80)] and RA diagnosis [OR 0.69 (95% CI 0.51, 0.93)] were associated with lower adherence. CONCLUSION Influenza vaccination adherence is alarmingly low in a population at higher risk of infectious complications, in particular in elderly patients.
Collapse
Affiliation(s)
- Luca Quartuccio
- Clinic of Rheumatology, Department of Medicine, Academic Hospital "Santa Maria della Misericordia", Azienda sanitaria universitaria Friuli Centrale, University of Udine
| | - Alen Zabotti
- Clinic of Rheumatology, Department of Medicine, Academic Hospital "Santa Maria della Misericordia", Azienda sanitaria universitaria Friuli Centrale, University of Udine
| | - Tolinda Gallo
- Department of Prevention, Azienda sanitaria universitaria Friuli Centrale
| | - Salvatore De Vita
- Clinic of Rheumatology, Department of Medicine, Academic Hospital "Santa Maria della Misericordia", Azienda sanitaria universitaria Friuli Centrale, University of Udine
| | - Francesca Valent
- Institute of Epidemiology, Academic Hospital "Santa Maria della Misericordia", Azienda sanitaria universitaria Friuli Centrale, Udine, Italy
| |
Collapse
|
22
|
The Role of Tumor Necrosis Factor Alpha (TNF-α) in Autoimmune Disease and Current TNF-α Inhibitors in Therapeutics. Int J Mol Sci 2021; 22:ijms22052719. [PMID: 33800290 PMCID: PMC7962638 DOI: 10.3390/ijms22052719] [Citation(s) in RCA: 482] [Impact Index Per Article: 160.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/25/2021] [Accepted: 03/04/2021] [Indexed: 02/06/2023] Open
Abstract
Tumor necrosis factor alpha (TNF-α) was initially recognized as a factor that causes the necrosis of tumors, but it has been recently identified to have additional important functions as a pathological component of autoimmune diseases. TNF-α binds to two different receptors, which initiate signal transduction pathways. These pathways lead to various cellular responses, including cell survival, differentiation, and proliferation. However, the inappropriate or excessive activation of TNF-α signaling is associated with chronic inflammation and can eventually lead to the development of pathological complications such as autoimmune diseases. Understanding of the TNF-α signaling mechanism has been expanded and applied for the treatment of immune diseases, which has resulted in the development of effective therapeutic tools, including TNF-α inhibitors. Currently, clinically approved TNF-α inhibitors have shown noticeable potency in a variety of autoimmune diseases, and novel TNF-α signaling inhibitors are being clinically evaluated. In this review, we briefly introduce the impact of TNF-α signaling on autoimmune diseases and its inhibitors, which are used as therapeutic agents against autoimmune diseases.
Collapse
|
23
|
Impact of COVID-19 on rheumatology practice in the UK-a pan-regional rheumatology survey. Clin Rheumatol 2021; 40:2499-2504. [PMID: 33495972 PMCID: PMC7832421 DOI: 10.1007/s10067-021-05601-1] [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: 12/12/2020] [Revised: 01/17/2021] [Accepted: 01/18/2021] [Indexed: 12/01/2022]
Abstract
The COVID-19 pandemic has disrupted healthcare services and rheumatology staff were redeployed to the frontline. The purpose of this survey was to evaluate the impact of the COVID-19 pandemic on the provision of rheumatology services as viewed by rheumatologists in the UK. Survey monkey questionnaire weblink was sent to 804 clinicians including consultant rheumatologists, speciality trainees, nurse specialists, and allied health professionals in 4 regions of the UK to evaluate personal effects of COVID-19 and redeployment, impact on current out-patient clinic activity, immunosuppressive drug use, and future rheumatology care. Response rate was 21%. One-fifth of the responders reported that their rheumatology departments were functioning less than 50% capacity during the pandemic. Two-third of responders felt anxious about the ill-effects of COVID-19 on their health and well-being, and one-third of them were redeployed. During the peak of the pandemic, 75% of clinicians stopped intravenous biologics. Although access to video consultation was available for up to three-fourths of the clinicians, the majority (90%) used this modality in less than 1 in 4 consultations. This survey highlights rheumatologists’ perception in the delivery of future care and anxiety they faced. As demonstrated by this survey, the National Institute for Health and Care Excellence (NICE) guidance did not influence clinician decision making in some aspects of patient care. Underutilization of tele-rheumatology in this survey should be considered whilst planning the restoration of rheumatology services in the post-COVID era.Key points • COVID-19 has generated significant concerns among rheumatology community about their mental well-being. • In over 50% of cases, rheumatologists stopped IV biologic drugs as per patients’ wishes during the first wave of the pandemic. • Tele-rheumatology has been used more widely during the pandemic, but the extent of its use in the post-COVID era is less clear. Evolving evidence will determine its future wider use. |
Collapse
|
24
|
Bjornsson AH, Grondal G, Kristjansson M, Jonsdottir T, Love TJ, Gudbjornsson B. Prevalence, admission rates and hypoxia due to COVID-19 in patients with rheumatic disorders treated with targeted synthetic or biologic disease modifying antirheumatic drugs or methotrexate: a nationwide study from Iceland. Ann Rheum Dis 2021; 80:671-672. [PMID: 33402343 DOI: 10.1136/annrheumdis-2020-219564] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/27/2020] [Accepted: 12/29/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Aron Hjalti Bjornsson
- Medicine, National University Hospital of Iceland, Reykjavik, Iceland .,Faculty of Medicine, University of Iceland School of Health Sciences, Reykjavik, Iceland
| | - Gerdur Grondal
- Rheumatology, National University Hospital of Iceland, Reykjavik, Capital, Iceland
| | - Mar Kristjansson
- Medicine, National University Hospital of Iceland, Reykjavik, Iceland
| | | | - Thorvardur Jon Love
- Faculty of Medicine, University of Iceland School of Health Sciences, Reykjavik, Iceland
| | - Bjorn Gudbjornsson
- Faculty of Medicine, University of Iceland School of Health Sciences, Reykjavik, Iceland.,Centre for Rheumatology Research, National University Hospital of Iceland, Reykjavik, Iceland
| | | |
Collapse
|
25
|
Valent F, Mazzilis G, Doimo A, Pipan C. Frequency of nasopharyngeal swab collection and positivity for SARS-CoV-2 infection in the population of the Italian province of Udine with and without chronic conditions. Health Policy 2020; 125:155-159. [PMID: 33384183 PMCID: PMC7752027 DOI: 10.1016/j.healthpol.2020.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 11/16/2022]
Abstract
This is a prevalence study in the Italian province of Udine. We study SARS-CoV-2 tests in persons with and without comorbidities. Patients with comorbidities are tested more than the others. Prevalence of positive test is not increased in patients with most chronic conditions.
Severity of SARS-CoV-2 infection is associated with comorbidities. However, no information is available on the frequency of nasopharyngeal swab collection and positivity depending on comorbidities. Using a cross-sectional design, we assessed the prevalence of SARS-CoV-2 tests and of positivity in the general population of the 530,000-inhabitant Italian province of Udine and in subgroups affected by chronic conditions in the first weeks of SARS-CoV-2 epidemic. Anonymous health databases were used as source of information to identify persons with 14 chronic conditions. From laboratory records we assessed the likelihood of real‐time reverse‐transcriptase polymerase chain reaction for SARS-CoV-2 and the frequency of positivity from February 29 to April 19, 2020, i.e., 7 weeks from the first case detected in the study area. Sex and age-stratified proportions were calculated in comorbidity subgroups. Multivariate regression was used to adjust for confounders. In the province, 236,623 persons had ≥1 chronic condition; 869 had positive tests. Persons with comorbidities were tested more than the others. However, most chronic conditions were not significantly associated with the prevalence of positivity, except psychiatric and neurological diseases and diabetes. In conclusion, despite more frequent testing, patients with most chronic diseases where equally likely to be diagnosed with SARS-CoV-2 as the general population. Chronic patients should adhere to general recommendations for preventing SARS-CoV-2 infection, but ad hoc restrictions do not seem necessary.
Collapse
Affiliation(s)
- Francesca Valent
- Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Italy.
| | - Giada Mazzilis
- Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Italy
| | - Anna Doimo
- Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Italy
| | - Corrado Pipan
- Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Italy
| |
Collapse
|
26
|
Dysregulation of leukocyte trafficking in ageing: Causal factors and possible corrective therapies. Pharmacol Res 2020; 163:105323. [PMID: 33276099 DOI: 10.1016/j.phrs.2020.105323] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/24/2020] [Accepted: 11/27/2020] [Indexed: 02/07/2023]
Abstract
Ageing is a universal biological phenomenon that is accompanied by the development of chronic, low-grade inflammation and remodelling of the immune system resulting in compromised immune function. In this review, we explore how the trafficking of innate and adaptive immune cells under homeostatic and inflammatory conditions is dysregulated in ageing. We particularly highlight the age-related changes in the expression of adhesion molecules and chemokine receptor/ligands, and the accumulation of senescent cells that drive modulated leukocyte trafficking. These age-related changes to leukocyte trafficking are multifactorial and specific to leukocyte subset, tissue, type of vascular bed, and inflammatory status. However, dysregulated leukocyte trafficking ultimately affects immune responses in older adults. We therefore go on to discuss approved drugs, including anti-integrins, anti-chemokines and statins, as well as novel therapeutics that may be used to target dysregulated leukocyte trafficking in ageing, improve immune responses and delay the onset of age-related diseases.
Collapse
|
27
|
Aziz M, Haghbin H, Sharma S, Fatima R, Ishtiaq R, Chandan S, Mohan BP, Lee-Smith W, Hassan M, Nawras A. Safety of bariatric surgery in patients with inflammatory bowel disease: A systematic review and meta-analysis. Clin Obes 2020; 10:e12405. [PMID: 32877572 DOI: 10.1111/cob.12405] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 07/30/2020] [Accepted: 08/07/2020] [Indexed: 12/18/2022]
Abstract
The efficacy of bariatric surgery in achieving weight loss and preventing long-term comorbidities such as cardiovascular diseases, diabetes mellitus and osteoarthritis is well established. Data regarding safety of bariatric surgery in patients with inflammatory bowel disease (IBD) is scarce. We attempted a systematic review and meta-analysis to evaluate the complications following bariatric surgery in patients with IBD. The primary outcomes evaluated were wound infection, Clavien-Dindo grade > II complications and IBD exacerbation (within 1 year). Secondary outcomes evaluated included overall mortality, stricture, small bowel obstruction, acute kidney injury (AKI) and thromboembolism. Pooled outcomes (event rate) with 95% confidence interval (CI) were calculated using random effects model. A total of 14 studies (all observational) with 2608 patients were included. The rates of primary outcomes were: wound infection (4.1%, 95% CI: 0.9-7.2), Clavien-Dindo grade > II complications (2.0%, 95%: CI 0.6-3.5) and IBD exacerbation (4.3%, 95% CI: 0.7-7.9). The pooled rate for other outcomes was: mortality 0.1%, stricture 6.5%, small bowel obstruction 6.7%, AKI 2.2% and thromboembolism 0.1%. Bariatric surgery is relatively safe in patients with IBD and should be pursued to reduce comorbidities associated with obesity. Future comparative studies are needed to further assess the safety of bariatric surgery in population with and without IBD.
Collapse
Affiliation(s)
- Muhammad Aziz
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Hossein Haghbin
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Sachit Sharma
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Rawish Fatima
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Rizwan Ishtiaq
- Department of Internal Medicine, Mercy St. Vincent Medical Center, Toledo, Ohio, USA
| | - Saurabh Chandan
- Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Babu P Mohan
- Department of Internal Medicine, University of Arizona, Banner University Medical Center, Tucson, Arizona, USA
| | - Wade Lee-Smith
- University of Toledo Libraries, University of Toledo, Toledo, Ohio, USA
| | - Mona Hassan
- Division of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Ali Nawras
- Division of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, Ohio, USA
| |
Collapse
|
28
|
Abstract
OBJECTIVES Immunomodulatory drugs (IMDs) are crucial for treating autoimmune, inflammatory, and oncologic conditions. Data regarding the safety of IMDs in people living with HIV (PLWH) are limited. We describe outcomes in all PLWH prescribed these agents from 2000--2019 at two academic medical centers. DESIGN Retrospective cohort study. METHODS We systematically identified and reviewed charts of all PLWH receiving IMDs. We defined a treatment episode as an uninterrupted period on an IMD regimen. We quantified infections, blips (detectable plasma HIV RNA following an undetectable result), and virologic failure (progression from plasma HIV RNA <200 copies/ml to two consecutive values >200 copies/ml despite ART). RESULTS Seventy-seven patients contributed 110 treatment episodes. Rheumatologic comorbidities were the most frequent indication. The most common IMD classes were TNF inhibitors, antimetabolites, and checkpoint inhibitors. Ninety percent of treatment episodes involved concomitant ART. Median pretreatment CD4 T-cell count was 609 cells/μl (IQR 375--861). Among 51 treatment episodes on ART with undetectable pretreatment plasma HIV RNA, HIV became detectable within 1 year in 21 of 51 cases (41.2%); there were no instances of virologic failure. Compared with other agents, treatment episodes involving checkpoint inhibitors were more likely to involve a blip (77.8 vs. 33.3%, P = 0.015). Thirteen treatment episodes (11.8%) were associated with concomitant infection; none was attributed to IMDs by the treating clinician. CONCLUSION PLWH treated with IMDs should be monitored carefully for virologic blips and incident infections. Checkpoint inhibitors may be associated with a higher rate of viral blips, although the clinical significance is unclear.
Collapse
|
29
|
Chao WC, Wang CY, Hsu BC, Lin CH, Huang WN, Chen YH, Wu CL, Chen HH. Factors associated with sepsis risk in immune-mediated inflammatory diseases receiving tumor necrosis factor inhibitors: a nationwide study. Ther Adv Musculoskelet Dis 2020; 12:1759720X20929208. [PMID: 32595776 PMCID: PMC7298427 DOI: 10.1177/1759720x20929208] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 04/30/2020] [Indexed: 01/03/2023] Open
Abstract
Background: Risk factors for sepsis have not been assessed in patients receiving tumor
necrosis factor-alpha inhibitors (TNFi) for immune-mediated inflammatory
diseases (IMIDs) who are vulnerable to serious/hospitalized infections. Methods: Data from 2003–2017 were obtained from Taiwan’s National Health Insurance
Research Database to identify patients receiving TNFi, including etanercept,
adalimumab, and golimumab, for IMIDs including rheumatoid arthritis (RA),
ankylosing spondylitis (AS), psoriasis (PsO), psoriatic arthritis (PsA),
Crohn’s disease (CD), and ulcerative colitis (UC). To investigate risk
factors for sepsis, we used the Sepsis-3 definition and calculated hazard
ratios (HRs) with 95% confidence intervals (CIs) using Cox regression
analysis. Results: There were 17,764 patients (mean age 49.3 ± 14.3 years; females, 57.6%)
receiving TNFi for IMIDs, including RA (58.6%), AS (19.1%), PsO (15.1%), PsA
(2.5%), CD (3.0%), and UC (1.7%). The overall incidence rate of sepsis was
1088 per 100,000 person-years. After adjustment for potential confounders,
recent sepsis within 3 months before TNFi initiation (HR, 2.35; 95% CI,
1.73–3.20), CD (HR, 3.36; 95% CI 2.11–5.34; reference group: AS) and
glucocorticoid use (prednisolone-equivalent dose, mg/day HR, 1.05; 95% CI,
1.05–1.06) were associated with the risk of sepsis. Intriguingly, golimumab
users appeared to have a lower risk of sepsis compared with etanercept users
(HR, 0.56; 95% CI, 0.38–0.83). In addition, socioeconomic status, including
urbanization level and insured amount, was associated with sepsis in a
dose-response manner. Conclusions: Recent sepsis, CD, concomitant glucocorticoid use, and low socioeconomic
status, which were associated with an increased risk of sepsis, are crucial
for individualized risk management plans.
Collapse
Affiliation(s)
- Wen-Cheng Chao
- Department of Critical Care Medicine, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, ROC
| | - Chen-Yu Wang
- Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung
| | - Bo-Chueh Hsu
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung
| | - Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung
| | - Wen-Nan Huang
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung
| | - Yi-Hsing Chen
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung
| | - Chieh-Liang Wu
- Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung
| | - Hsin-Hua Chen
- Department of Medical Research, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, ROC
| |
Collapse
|
30
|
Novel Coronavirus Disease (COVID-19) and Biologic Therapy for Psoriasis: Successful Recovery in Two Patients After Infection with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Dermatol Ther (Heidelb) 2020; 10:881-885. [PMID: 32468230 PMCID: PMC7255969 DOI: 10.1007/s13555-020-00394-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Indexed: 12/17/2022] Open
Abstract
The outbreak of the novel coronavirus known as SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) causing COVID-19 was first reported in late December 2019. Many patients with psoriasis on biologic therapy have asked their medical providers about the effect of biologics on COVID-19. However, it is currently unknown how biologic therapy for psoriasis might impact patients with psoriasis and COVID-19. In this article, we report on the clinical course of two patients on biologic medication for psoriasis who developed COVID-19 and successfully recovered from SARS-CoV-2 infection. Both patients presented with fever and respiratory symptoms, but neither patient required hospitalization. While more research is needed, it is reassuring to know that successful recovery is possible after COVID-19 infection in patients on biologic therapy for psoriasis.
Collapse
|
31
|
Quartuccio L, Valent F, Pasut E, Tascini C, De Vita S. Prevalence of COVID-19 among patients with chronic inflammatory rheumatic diseases treated with biologic agents or small molecules: A population-based study in the first two months of COVID-19 outbreak in Italy. Joint Bone Spine 2020; 87:439-443. [PMID: 32445935 PMCID: PMC7239017 DOI: 10.1016/j.jbspin.2020.05.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/13/2020] [Indexed: 12/22/2022]
Abstract
Objective The aim of this study is to determine the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease 2019 (COVID-19) among adult patients treated with biologic agents or small molecules for chronic inflammatory rheumatic diseases, in particular for chronic inflammatory arthritides. Methods To this end, a population-based study, in the province of Udine (466,700 inhabitants, with age > 15 years old, Friuli Venezia Giulia region, Italy) was planned. The primary outcome was the prevalence of COVID-19 in the first two months of the outbreak. All the rheumatic patients treated with biologic agents or small molecules in the last 6 months in our province were included (N = 1051). Results From February 29 to April 25, 2020, 4 adult patients (4/1051, i.e. 3.8/1000, 95% Confidence Interval 1.5–9.7/1000) were registered as swab test positive by PCR for COVID-19. Overall, a total of 47/1051 (4.5%) cases were tested for COVID-19 by PCR in the same period, and 15 of them due to symptoms compatible with COVID-19. In the general population, the prevalence was 937 cases/466700 (2/1000, 95% Confidence Interval 1.9–2.1/1000, P-value = 0.33, chi square test), and 20,179/466,700 (4.3%) swab tests for COVID-19 were performed. Conclusion The risk of COVID-19 in rheumatic patients under biologic agents or small molecules does not appear different from that observed in the general population. Patients should be informed to safely proceed with their treatment and follow the rules for self-protection to COVID-19.
Collapse
Affiliation(s)
- Luca Quartuccio
- Clinic of Rheumatology, Department of Medicine (DAME), ASUFC, University of Udine, Udine, Italy.
| | | | | | | | - Salvatore De Vita
- Clinic of Rheumatology, Department of Medicine (DAME), ASUFC, University of Udine, Udine, Italy
| |
Collapse
|
32
|
Zabotti A, Goletti D, Lubrano E, Cantini F. The impact of the interleukin 12/23 inhibitor ustekinumab on the risk of infections in patients with psoriatic arthritis. Expert Opin Drug Saf 2019; 19:69-82. [PMID: 31847608 DOI: 10.1080/14740338.2020.1703946] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction: Psoriatic arthritis (PsA) is characterized by chronic inflammation mediated by pro-inflammatory cytokines, with clinical features resulting from dysfunctional integrated signaling pathways affecting different constituents of the immune system. Increased understanding of the processes responsible for enthesitis, synovial inflammation, joint erosion, and new bone formation during PsA has led to development of biologic therapies targeting these cytokines. There is an increased risk of opportunistic infections in patients with PsA, and this risk is increased further with targeted biologic therapy.Areas covered: This paper reviews the role of the interleukin (IL)-12, IL-23 and IL-17 axis in the pathogenesis of PsA. The data suggest that ustekinumab is associated with a low risk of infections in patients with PsA, including tuberculosis or hepatitis reactivation. No live vaccines can be safely administered; ustekinumab is contraindicated/cannot be given with live vaccines. However, long-term treatment with ustekinumab does not impair the immune response to these vaccines when administered after an appropriate interval.Expert opinion: Ustekinumab is associated with a low risk of serious and opportunistic infections. More research is needed to confirm these findings specifically in patients with PsA, and comparative studies are needed to investigate the relative risk of infection with different biologics.
Collapse
Affiliation(s)
- Alen Zabotti
- Department of Medical and Biological Sciences, Rheumatology Clinic, University of Udine, Udine, Italy
| | - Delia Goletti
- Translational Research Unit, Epidemiology and Preclinical Research Department, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Ennio Lubrano
- Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio", Università degli Studi del Molise, Campobasso, Italy
| | | |
Collapse
|
33
|
Incidence of infection other than tuberculosis in patients with autoimmune rheumatic diseases treated with bDMARDs: a real-time clinical experience from India. Rheumatol Int 2019; 39:497-507. [DOI: 10.1007/s00296-019-04245-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 01/21/2019] [Indexed: 12/15/2022]
|