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Sandler RD, Vital EM, Mahmoud K, Prabu A, Riddell C, Teh LS, Edwards CJ, Yee CS. Revision to the musculoskeletal domain of the BILAG-2004 index to incorporate ultrasound findings. Rheumatology (Oxford) 2024; 63:498-505. [PMID: 37225418 DOI: 10.1093/rheumatology/kead241] [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: 10/27/2022] [Revised: 04/18/2023] [Accepted: 05/16/2023] [Indexed: 05/26/2023] Open
Abstract
OBJECTIVES To improve the definitions of inflammatory arthritis within the musculoskeletal (MSK) domain of the BILAG-2004 index by incorporating imaging findings and clinical features predictive of response to treatment. METHODS The BILAG MSK Subcommittee proposed revisions to the BILAG-2004 index definitions of inflammatory arthritis, based on review of evidence in two recent studies. Data from these studies were pooled and analysed to determine the impact of the proposed changes on the severity grading of inflammatory arthritis. RESULTS The revised definition for severe inflammatory arthritis includes definition of 'basic activities of daily living'. For moderate inflammatory arthritis, it now includes synovitis, defined by either observed joint swelling or MSK US evidence of inflammation in joints and surrounding structures. For mild inflammatory arthritis, the definition now includes reference to symmetrical distribution of affected joints and guidance on how US may help re-classify patients as moderate or no inflammatory arthritis. Data from two recent SLE trials were analysed (219 patients). A total of 119 (54.3%) were graded as having mild inflammatory arthritis (BILAG-2004 Grade C). Of these, 53 (44.5%) had evidence of joint inflammation (synovitis or tenosynovitis) on US. Applying the new definition increased the number of patients classified as moderate inflammatory arthritis from 72 (32.9%) to 125 (57.1%), while patients with normal US (n = 66/119) could be recategorized as BILAG-2004 Grade D (inactive disease). CONCLUSIONS Proposed changes to the definitions of inflammatory arthritis in the BILAG-2004 index will result in more accurate classification of patients who are more or less likely to respond to treatment.
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Affiliation(s)
- Robert D Sandler
- Department of Rheumatology, Doncaster and Bassetlaw, Teaching Hospitals NHS Foundation Trust, Doncaster, UK
| | - Edward M Vital
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Khaled Mahmoud
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Athiveeraramapandian Prabu
- Department of Rheumatology, Sandwell and West, Birmingham Hospitals NHS Trust, Birmingham, UK
- Rheumatology Research Group, Institute of Inflammation and Aging, University of Birmingham, Birmingham, UK
| | - Claire Riddell
- Department of Rheumatology, Musgrave Park Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | - Lee-Suan Teh
- Department of Rheumatology, Royal Blackburn Teaching Hospital, East Lancashire Hospitals NHS Trust, Blackburn, UK
- Faculty of Clinical and Biomedical Sciences, University of Central Lancashire, Preston, UK
| | - Christopher J Edwards
- NIHR Southampton Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Chee-Seng Yee
- Department of Rheumatology, Doncaster and Bassetlaw, Teaching Hospitals NHS Foundation Trust, Doncaster, UK
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Wincup C, Dunn N, Ruetsch-Chelli C, Manouchehrinia A, Kharlamova N, Naja M, Seitz-Polski B, Isenberg DA, Fogdell-Hahn A, Ciurtin C, Jury EC. Anti-rituximab antibodies demonstrate neutralizing capacity, associate with lower circulating drug levels and earlier relapse in lupus. Rheumatology (Oxford) 2023; 62:2601-2610. [PMID: 36370065 PMCID: PMC10321108 DOI: 10.1093/rheumatology/keac608] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/21/2022] [Accepted: 10/18/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES High rates of anti-drug antibodies (ADA) to rituximab have been demonstrated in patients undergoing treatment for SLE. However, little is known with regard to their long-term dynamics, impact on drug kinetics and subsequent implications for treatment response. In this study, we aimed to evaluate ADA persistence over time, impact on circulating drug levels, assess clinical outcomes and whether they are capable of neutralizing rituximab. METHODS Patients with SLE undergoing treatment with rituximab were recruited to this study (n = 35). Serum samples were collected across a follow-up period of 36 months following treatment (n = 114). Clinical and laboratory data were collected pre-treatment and throughout follow-up. ADA were detected via electrochemiluminescent immunoassays. A complement dependent cytotoxicity assay was used to determine neutralizing capacity of ADA in a sub-cohort of positive samples (n = 38). RESULTS ADA persisted over the 36-month study period in 64.3% of patients undergoing treatment and titres peaked earlier and remained higher in those who had previously been treated with rituximab when compared with than those who were previously treatment naive. ADA-positive samples had a significantly lower median drug level until six months post rituximab infusion (P = 0.0018). Patients with persistent ADA positivity showed a significant early improvement in disease activity followed by increased rates of relapse. In vitro analysis confirmed the neutralizing capacity of ADA to rituximab. CONCLUSIONS ADA to rituximab were common and persisted over the 36-month period of this study. They associated with earlier drug elimination, an increased rate of relapse and demonstrated neutralizing capacity in vitro.
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Affiliation(s)
- Chris Wincup
- Centre for Rheumatology Research, Division of Medicine, University College London, London, UK
| | - Nicky Dunn
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Caroline Ruetsch-Chelli
- Laboratoire d’Immunologie, CHU de Nice, Université Côte d’Azur, Nice, France
- Centre Méditerranéen de Médecine Moléculaire (C3M), INSERM U1065, Université Côte d’Azur, Nice, France
- Unité de Recherche Clinique Côte d’Azur (UR2CA), Université Côte d’Azur, Nice, France
| | - Ali Manouchehrinia
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Nastya Kharlamova
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Meena Naja
- Centre for Adolescent Rheumatology Research, Division of Medicine, University College London, London, UK
| | - Barbara Seitz-Polski
- Laboratoire d’Immunologie, CHU de Nice, Université Côte d’Azur, Nice, France
- Unité de Recherche Clinique Côte d’Azur (UR2CA), Université Côte d’Azur, Nice, France
| | - David A Isenberg
- Centre for Rheumatology Research, Division of Medicine, University College London, London, UK
| | - Anna Fogdell-Hahn
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Coziana Ciurtin
- Centre for Rheumatology Research, Division of Medicine, University College London, London, UK
- Centre for Adolescent Rheumatology Research, Division of Medicine, University College London, London, UK
| | - Elizabeth C Jury
- Centre for Rheumatology Research, Division of Medicine, University College London, London, UK
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Moneta GM, Bracaglia C, Caiello I, Farroni C, Pires Marafon D, Carlomagno R, Hiraki L, Vivarelli M, Gianviti A, Carbogno S, Ferlin W, de Min C, Silverman E, Carsetti R, De Benedetti F, Marasco E. Persistently active interferon-γ pathway and expansion of T-bet + B cells in a subset of patients with childhood-onset systemic lupus erythematosus. Eur J Immunol 2023; 53:e2250319. [PMID: 37204055 DOI: 10.1002/eji.202250319] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/14/2023] [Accepted: 05/04/2023] [Indexed: 05/20/2023]
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disease causing significant morbidity and mortality, despite important improvements in its management in the last decades. The objective of this work is to investigate the role of IFN-γ in the pathogenesis of childhood-onset systemic lupus erythematosus (cSLE), evaluating the crosstalk between IFN-α and IFN-γ and the expression of T-bet, a transcription factor induced by IFN-γ, in B cells of patients with cSLE. Expression levels of both IFN-α and IFN-γ-induced genes were upregulated in patients with cSLE. We found increased serum levels of CXCL9 and CXCL10 in patients with cSLE. Type I IFN score decreased with initiation of immunosuppressive treatment; conversely, type II IFN score and levels of CXCL9 were not significantly affected by immunosuppressive treatment. Type II IFN score and CXCL9 were significantly higher in patients with lupus nephritis. We observed the expansion of a population of naïve B cells expressing T-bet in a cluster of patients with cSLE. IFN-γ, but not IFN-α, induced the expression of T-bet in B cells. Our data suggest that IFN-γ is hyperactive in cSLE, especially in patients with lupus nephritis, and it is not modulated by therapy. Our data reinforce the potential of IFN-γ as a therapeutic target in SLE.
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Affiliation(s)
- Gian Marco Moneta
- Division of Rheumatology, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy
| | - Claudia Bracaglia
- Division of Rheumatology, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy
| | - Ivan Caiello
- Division of Rheumatology, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy
| | - Chiara Farroni
- B Cell Physiopathology Unit, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | | | | | - Linda Hiraki
- Division of Rheumatology, SickKids Hospital, Toronto, Canada
| | - Marina Vivarelli
- Division of Nephrology and Dialysis, Department of Pediatric Subspecialties, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy
| | - Alessandra Gianviti
- Division of Nephrology and Dialysis, Department of Pediatric Subspecialties, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy
| | - Simone Carbogno
- Division of Rheumatology, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy
| | - Walter Ferlin
- Light Chain Bioscience - Novimmune SA, Plan-Les-Ouates Geneva, Switzerland
| | | | - Earl Silverman
- Division of Rheumatology, SickKids Hospital, Toronto, Canada
| | - Rita Carsetti
- B Cell Physiopathology Unit, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | | | - Emiliano Marasco
- Division of Rheumatology, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy
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Leosuthamas P, Narongroeknawin P, Chaiamnuay S, Asavatanabodee P, Pakchotanon R. Performance of systemic lupus erythematosus responder index for detecting clinician-rated responders in patients with active systemic lupus erythematosus. Int J Rheum Dis 2023; 26:667-672. [PMID: 36802112 DOI: 10.1111/1756-185x.14606] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 01/26/2023] [Accepted: 01/29/2023] [Indexed: 02/20/2023]
Abstract
OBJECTIVE Disease activity measures in systemic lupus erythematosus (SLE) are critical tools for trial endpoints. We aimed to evaluate the performance of current treatment outcome measures in SLE. METHODS Individuals with active SLE with a clinical SLE Disease Activity Index-2000 (SLEDAI-2K) score of at least 4 were followed up for two or more visits and classified as responders and non-responders based on a physician's judgment of improvement. The treatment outcome measures including SLEDAI-2K responder index-50 (SRI-50), SLE responder index-4 (SRI-4), substituting SLEDAI-2K with SRI-50 in SRI-4 (SRI-4(50)), SLE Disease Activity Score (SLE-DAS) responder index (Δ ≥ 1.72) and the British Isles Lupus Assessment Group (BILAG)-based Composite Lupus Assessment (BICLA) were tested. The performance of those measures was shown by sensitivity, specificity, predictive value, positive likelihood ratio, accuracy, and agreement against a physician-rated improvement. RESULTS Twenty-seven patients with active SLE were followed. The total cumulative pair of visits (baseline and follow up) was 48. The overall accuracies (95% confidence interval [CI]) of SRI-50, SRI-4, SRI-4(50), SLE-DAS, and BICLA for detecting responders in all patients were 72.9 (58.2-84.7), 75.0 (60.4-86.4), 72.9 (58.2-84.7), 75.0 (60.4-86.4), and 64.6 (49.5-77.8), respectively. Subgroup analyses of lupus nephritis (23 patients had a pair of visits) found the accuracies (95% CI) of SRI-50, SRI-4, SRI-4(50), SLE-DAS, and BICLA were 82.6 (61.2-95.0), 73.9 (51.6-89.8), 82.6 (61.2-95.0), 82.6 (61.2-95.0), and 78.3 (56.3-92.5), respectively. However, there were no significant differences between the groups (P > 0.05). CONCLUSION SRI-4, SRI-50, SRI-4(50), SLE-DAS responder index, and BICLA demonstrated comparable abilities to identify clinician-rated responders in patients with active SLE and lupus nephritis.
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Affiliation(s)
- Pornsawan Leosuthamas
- Rheumatic Disease Unit, Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Pongthorn Narongroeknawin
- Rheumatic Disease Unit, Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Sumapa Chaiamnuay
- Rheumatic Disease Unit, Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Paijit Asavatanabodee
- Rheumatic Disease Unit, Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Rattapol Pakchotanon
- Rheumatic Disease Unit, Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
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Yee CS, Gordon C, Akil M, Lanyon P, Edwards CJ, Isenberg DA, Rahman A, Teh LS, Tosounidou S, Stevens R, Prabu A, Griffiths B, McHugh N, Bruce IN, Ahmad Y, Khamashta MA, Farewell VT. The BILAG-2004 index is associated with development of new damage in SLE. Rheumatology (Oxford) 2023; 62:668-675. [PMID: 35686924 PMCID: PMC9891406 DOI: 10.1093/rheumatology/keac334] [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: 02/16/2022] [Revised: 05/06/2022] [Accepted: 05/29/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To determine whether BILAG-2004 index is associated with the development of damage in a cohort of SLE patients. Mortality and development of damage were examined. METHODS This was a multicentre longitudinal study. Patients were recruited within 12 months of achieving fourth ACR classification criterion for SLE. Data were collected on disease activity, damage, SLE-specific drug exposure, cardiovascular risk factors, antiphospholipid syndrome status and death at every visit. This study ran from 1 January 2005 to 31 December 2017. Descriptive statistics were used to analyse mortality and development of new damage. Poisson regression was used to examine potential explanatory variables for development of new damage. RESULTS A total of 273 SLE patients were recruited with total follow-up of 1767 patient-years (median 73.4 months). There were 6348 assessments with disease activity scores available for analysis. During follow-up, 13 deaths and 114 new damage items (in 83 patients) occurred. The incidence rate for development of damage was higher in the first 3 years before stabilizing at a lower rate. Overall rate for damage accrual was 61.1 per 1000 person-years (95% CI: 50.6, 73.8). Analysis showed that active disease scores according to BILAG-2004 index (systems scores of A or B, counts of systems with A and BILAG-2004 numerical score) were associated with development of new damage. Low disease activity (LDA) states [BILAG-2004 LDA and BILAG Systems Tally (BST) persistent LDA] were inversely associated with development of damage. CONCLUSIONS BILAG-2004 index is associated with new damage. BILAG-2004 LDA and BST persistent LDA can be considered as treatment targets.
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Affiliation(s)
- Chee-Seng Yee
- Department of Rheumatology, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster
| | - Caroline Gordon
- Rheumatology Research Group, Institute of Inflammation of Ageing, University of Birmingham, Birmingham
| | - Mohammed Akil
- Department of Rheumatology, Sheffield Teaching Hospitals NHS Trust, Sheffield
| | - Peter Lanyon
- Department of Rheumatology, Nottingham University Hospitals NHS Trust, Nottingham
| | - Christopher J Edwards
- Musculoskeletal Research Unit, NIHR Southampton Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton
| | - David A Isenberg
- Centre For Rheumatology, Division of Medicine, University College London, London
| | - Anisur Rahman
- Centre For Rheumatology, Division of Medicine, University College London, London
| | - Lee-Suan Teh
- Department of Rheumatology, Royal Blackburn Teaching Hospital, Blackburn.,Faculty of Clinical and Biomedical Sciences, University of Central Lancashire, Preston
| | - Sofia Tosounidou
- Department of Rheumatology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham
| | - Robert Stevens
- Department of Rheumatology, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster
| | | | - Bridget Griffiths
- Department of Rheumatology, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne
| | - Neil McHugh
- Department of Pharmacy and Pharmacology, University of Bath, Bath
| | - Ian N Bruce
- Centre for Epidemiology Versus Arthritis, The University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester
| | - Yasmeen Ahmad
- Department of Rheumatology, Betsi Cadwaladr University Health Board, Wales
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Gavan SP, Bruce IN, Payne K. Valuing Health Gain from Composite Response Endpoints for Multisystem Diseases. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:115-122. [PMID: 36008224 DOI: 10.1016/j.jval.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 06/30/2022] [Accepted: 07/11/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES This study aimed to demonstrate how to estimate the value of health gain after patients with a multisystem disease achieve a condition-specific composite response endpoint. METHODS Data from patients treated in routine practice with an exemplar multisystem disease (systemic lupus erythematosus) were extracted from a national register (British Isles Lupus Assessment Group Biologics Register). Two bespoke composite response endpoints (Major Clinical Response and Improvement) were developed in advance of this study. Difference-in-differences regression compared health utility values (3-level version of EQ-5D; UK tariff) over 6 months for responders and nonresponders. Bootstrapped regression estimated the incremental quality-adjusted life-years (QALYs), probability of QALY gain after achieving the response criteria, and population monetary benefit of response. RESULTS Within the sample (n = 171), 18.2% achieved Major Clinical Response and 49.1% achieved Improvement at 6 months. Incremental health utility values were 0.0923 for Major Clinical Response and 0.0454 for Improvement. Expected incremental QALY gain at 6 months was 0.020 for Major Clinical Response and 0.012 for Improvement. Probability of QALY gain after achieving the response criteria was 77.6% for Major Clinical Response and 72.7% for Improvement. Population monetary benefit of response was £1 106 458 for Major Clinical Response and £649 134 for Improvement. CONCLUSIONS Bespoke composite response endpoints are becoming more common to measure treatment response for multisystem diseases in trials and observational studies. Health technology assessment agencies face a growing challenge to establish whether these endpoints correspond with improved health gain. Health utility values can generate this evidence to enhance the usefulness of composite response endpoints for health technology assessment, decision making, and economic evaluation.
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Affiliation(s)
- Sean P Gavan
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, England, UK.
| | - Ian N Bruce
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, England, UK; NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, England, UK
| | - Katherine Payne
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, England, UK
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Carter LM, Gordon C, Yee CS, Bruce I, Isenberg D, Skeoch S, Vital EM. Easy-BILAG: a new tool for simplified recording of SLE disease activity using BILAG-2004 index. Rheumatology (Oxford) 2022; 61:4006-4015. [PMID: 35077529 PMCID: PMC9536795 DOI: 10.1093/rheumatology/keab883] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 11/16/2021] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE BILAG-2004 index is a comprehensive disease activity instrument for SLE but administrative burden and potential frequency of errors limits its use in routine practice. We aimed to develop a tool for more accurate, time-efficient scoring of BILAG-2004 index with full fidelity to the existing instrument. METHODS Frequency of BILAG-2004 items was collated from a BILAG-biologics registry (BILAG-BR) dataset. Easy-BILAG prototypes were developed to address known issues affecting speed and accuracy. After expert verification, accuracy and usability of the finalized Easy-BILAG was validated against standard format BILAG-2004 in a workbook exercise of 10 case vignettes. Thirty-three professionals ranging in expertise from 14 UK centres completed the validation exercise. RESULTS Easy-BILAG incorporates all items present in ≥5% BILAG-BR records, plus full constitutional and renal domains into a rapid single page assessment. An embedded glossary and colour-coding assists domain scoring. A second page captures rarer manifestations when needed. In the validation exercise, Easy-BILAG yielded higher median scoring accuracy (96.7%) than standard BILAG-2004 documentation (87.8%, P = 0.001), with better inter-rater agreement. Easy-BILAG was completed faster (59.5 min) than the standard format (80.0 min, P = 0.04) for 10 cases. An advantage in accuracy was observed with Easy-BILAG use among general hospital rheumatologists (91.3 vs 75.0, P = 0.02), leading to equivalent accuracy as tertiary centre rheumatologists. Clinicians rated Easy-BILAG as intuitive, convenient, and well adapted for routine practice. CONCLUSION Easy-BILAG facilitates more rapid and accurate scoring of BILAG-2004 across all clinical settings, which could improve patient care and biologics prescribing. Easy-BILAG should be adopted wherever BILAG-2004 assessment is required.
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Affiliation(s)
- Lucy M Carter
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds
| | - Caroline Gordon
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham
| | - Chee-Seng Yee
- Department of Rheumatology, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster
| | - Ian Bruce
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, University of Manchester, Manchester
| | - David Isenberg
- Department of Rheumatology, Division of Medicine, University College London, London and
| | - Sarah Skeoch
- Department of Rheumatology, Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath NHS Trust, Bath, UK
| | - Edward M Vital
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds
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8
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Yee CS, Khamashta M, Akil M, Kilding R, Giles I, Williams D, Bruce IN, Gordon C. The BILAG2004-Pregnancy Index is a valid disease activity outcome measure for pregnant SLE patients. Rheumatol Adv Pract 2022; 6:rkac081. [PMID: 36284526 PMCID: PMC9585949 DOI: 10.1093/rap/rkac081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/25/2022] [Indexed: 11/04/2022] Open
Abstract
Objectives This study was to determine whether the BILAG2004-Pregnancy Index (BILAG2004-P) has construct/criterion validity and is sensitive to change. Methods This was an observational multicentre study that recruited pregnant SLE patients. Data were collected on disease activity [using the BILAG2004-P and Physician Global Assessment (PGA)], investigations and therapy at each assessment. The overall BILAG2004-P score as determined by the highest score achieved by any system was used in the analysis. Cross-sectional analysis was used for construct and criterion validity. The comparison was with C3, C4 and anti-dsDNA for construct validity, while it was with change in therapy and PGA in criterion validity. Sensitivity to change was assessed by determining the relationship between the change in BILAG2004-P and the change in therapy between two consecutive visits. Results A total of 97 patients with 112 pregnancies were recruited. There were 610 assessments available for construct/criterion validity analysis (98.2% of pregnancies had more than one assessment) and 497 observations for sensitivity to change analysis. Increasing BILAG2004-P scores were associated with low C3. The active BILAG2004-P score (grade A or B) was associated with an increase in therapy and the PGA of active disease. There was an increasing likelihood of higher overall scores with an increase in therapy and the PGA of active disease. In the sensitivity to change analysis, an increase in the BILAG2004-P score was associated with an increase in therapy and inversely associated with a decrease in therapy. A decrease in the BILAG2004-P score was associated with a decrease in therapy and inversely associated with an increase in therapy. Conclusion The BILAG2004-P has criterion validity and is sensitive to change.
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Affiliation(s)
- Chee-Seng Yee
- Correspondence to: Chee-Seng Yee, Department of Rheumatology, Doncaster Royal Infirmary, Armthorpe Road, Doncaster DN2 5LT, UK. E-mail:
| | - Munther Khamashta
- Department of Women and Children’s Health, King’s College London, London, UK
| | - Mohammed Akil
- Department of Rheumatology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Rachael Kilding
- Department of Rheumatology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Ian Giles
- Centre for Rheumatology Research, University College London, London, UK
| | - David Williams
- Department of Obstetrics, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ian N Bruce
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK
| | - Caroline Gordon
- Rheumatology Research Group, University of Birmingham, Birmingham, UK
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9
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Long-Term Clinical Outcome in Systemic Lupus Erythematosus Patients Followed for More Than 20 Years: The Milan Systemic Lupus Erythematosus Consortium (SMiLE) Cohort. J Clin Med 2022; 11:jcm11133587. [PMID: 35806873 PMCID: PMC9267338 DOI: 10.3390/jcm11133587] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/31/2022] [Accepted: 06/16/2022] [Indexed: 12/14/2022] Open
Abstract
Tackling active disease to prevent damage accrual constitutes a major goal in the management of patients with systemic lupus erythematosus (SLE). Patients with early onset disease or in the early phase of the disease course are at increased risk of developing severe manifestations and subsequent damage accrual, while less is known about the course of the disease in the long term. To address this issue, we performed a multicentre retrospective observational study focused on patients living with SLE for at least 20 years and determined their disease status at 15 and 20 years after onset and at their last clinical evaluation. Disease activity was measured through the British Isles Lupus Assessment Group (BILAG) tool and late flares were defined as worsening in one or more BILAG domains after 20 years of disease. Remission was classified according to attainment of lupus low-disease-activity state (LLDAS) criteria or the Definitions Of Remission In SLE (DORIS) parameters. Damage was quantitated through the Systemic Lupus Erythematosus International Collaborating Clinics/American College of Rheumatology damage index (SLICC/ACR-DI). LLAS/DORIS remission prevalence steadily increased over time. In total, 84 patients had a late flare and 88 had late damage accrual. Lack of LLDAS/DORIS remission status at the 20 year timepoint (p = 0.0026 and p = 0.0337, respectively), prednisone dose ≥ 7.5 mg (p = 9.17 × 10−5) or active serology (either dsDNA binding, low complement or both; p = 0.001) were all associated with increased late flare risk. Late flares, in turn, heralded the development of late damage (p = 2.7 × 10−5). These data suggest that patients with longstanding SLE are frequently in remission but still at risk of disease flares and eventual damage accrual, suggesting the need for tailored monitoring and therapeutic approaches aiming at effective immunomodulation besides immunosuppression, at least by means of steroids.
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Bruce IN, Furie RA, Morand EF, Manzi S, Tanaka Y, Kalunian KC, Merrill JT, Puzio P, Maho E, Kleoudis C, Albulescu M, Hultquist M, Tummala R. Concordance and discordance in SLE clinical trial outcome measures: analysis of three anifrolumab phase 2/3 trials. Ann Rheum Dis 2022; 81:962-969. [PMID: 35580976 PMCID: PMC9213793 DOI: 10.1136/annrheumdis-2021-221847] [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: 11/12/2021] [Accepted: 03/09/2022] [Indexed: 11/16/2022]
Abstract
Objectives In the anifrolumab systemic lupus erythematosus (SLE) trial programme, there was one trial (TULIP-1) in which BILAG-based Composite Lupus Assessment (BICLA) responses favoured anifrolumab over placebo, but the SLE Responder Index (SRI(4)) treatment difference was not significant. We investigated the degree of concordance between BICLA and SRI(4) across anifrolumab trials in order to better understand drivers of discrepant SLE trial results. Methods TULIP-1, TULIP-2 (both phase 3) and MUSE (phase 2b) were randomised, 52-week trials of intravenous anifrolumab (300 mg every 4 weeks, 48 weeks; TULIP-1/TULIP-2: n=180; MUSE: n=99) or placebo (TULIP-1: n=184, TULIP-2: n=182; MUSE: n=102). Week 52 BICLA and SRI(4) outcomes were assessed for each patient. Results Most patients (78%–85%) had concordant BICLA and SRI(4) outcomes (Cohen’s Kappa 0.6–0.7, nominal p<0.001). Dual BICLA/SRI(4) response rates favoured anifrolumab over placebo in TULIP-1, TULIP-2 and MUSE (all nominal p≤0.004). A discordant TULIP-1 BICLA non-responder/SRI(4) responder subgroup was identified (40/364, 11% of TULIP-1 population), comprising more patients receiving placebo (n=28) than anifrolumab (n=12). In this subgroup, placebo-treated patients had lower baseline disease activity, joint counts and glucocorticoid tapering rates, and more placebo-treated patients had arthritis response than anifrolumab-treated patients. Conclusions Across trials, most patients had concordant BICLA/SRI(4) outcomes and dual BICLA/SRI(4) responses favoured anifrolumab. A BICLA non-responder/SRI(4) responder subgroup was identified where imbalances of key factors driving the BICLA/SRI(4) discordance (disease activity, glucocorticoid taper) disproportionately favoured the TULIP-1 placebo group. Careful attention to baseline disease activity and monitoring glucocorticoid taper variation will be essential in future SLE trials. Trial registration numbers NCT02446912 and NCT02446899.
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Affiliation(s)
- Ian N Bruce
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal & Dermatological Sciences, The University of Manchester, Manchester, UK.,NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Richard A Furie
- Division of Rheumatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York, USA
| | - Eric F Morand
- Center for Inflammatory Disease, Monash University, Melbourne, Victoria, Australia
| | - Susan Manzi
- Department of Medicine, Lupus Center of Excellence, Autoimmunity Institute, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Yoshiya Tanaka
- First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Kenneth C Kalunian
- Division of Rheumatology, Allergy, and Immunology, University of California San Diego, La Jolla, California, USA
| | - Joan T Merrill
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Patricia Puzio
- BioPharmaceuticals R&D, AstraZeneca US, Gaithersburg, Maryland, USA
| | | | - Christi Kleoudis
- BioPharmaceuticals R&D, AstraZeneca US, Durham, North Carolina, USA
| | | | - Micki Hultquist
- BioPharmaceuticals R&D, AstraZeneca US, Gaithersburg, Maryland, USA
| | - Raj Tummala
- BioPharmaceuticals R&D, AstraZeneca US, Gaithersburg, Maryland, USA
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11
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Jawahar N, Walker JK, Murray PI, Gordon C, Reynolds JA. Epidemiology of disease-activity related ophthalmological manifestations in Systemic Lupus Erythematosus: A systematic review. Lupus 2021; 30:2191-2203. [PMID: 34928721 DOI: 10.1177/09612033211050337] [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] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Ophthalmic complications in Systemic Lupus Erythematosus (SLE) are broad and can occur in up to a third of patients. The British Isles Lupus Assessment Group (BILAG) 2004 Index identifies 13 ocular manifestations of active SLE, as opposed to those related to previous disease activity and/or the consequences of therapy. We conducted a systematic review of published literature to determine the frequency of ophthalmic manifestations of active SLE. METHODS A systematic literature search of Ovid MEDLINE and EMBASE from their respective inceptions to July 2020 was conducted to identify cohort, case-control and cross-sectional studies. RESULTS 22 studies meeting eligibility criteria were included. Most studies featured small sample sizes and were judged to have a high risk of methodological bias. The number and quality of studies did not allow us to confidently estimate the incidence of the conditions. No studies reported epidemiological data for orbital inflammation/myositis/proptosis. The prevalence of each of the other ocular manifestations, with the exception of retinal vaso-occlusive disease, was consistently less than 5%. Retinal vasculitis, uveitis and isolated cotton wool spots tended to be associated with more active SLE disease. CONCLUSION The prevalence of eye disease due to SLE activity is uncommon, but clinicians should be aware that some conditions tend to be associated with more active systemic disease. Further studies to determine the incidence and risk factors for these ophthalmic manifestations are needed.
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Affiliation(s)
- Nitish Jawahar
- Department of Rheumatology, City Hospital, 1731Sandwell and West Birmingham NHS Trust, Birmingham, UK
| | - Jessica K Walker
- Department of Rheumatology, City Hospital, 1731Sandwell and West Birmingham NHS Trust, Birmingham, UK
| | - Philip I Murray
- Academic Unit of Ophthalmology, 156654Birmingham and Midland Eye Centre, City Hospital, 1731Sandwell and West Birmingham NHS Trust, Birmingham, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Caroline Gordon
- Department of Rheumatology, City Hospital, 1731Sandwell and West Birmingham NHS Trust, Birmingham, UK
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - John A Reynolds
- Department of Rheumatology, City Hospital, 1731Sandwell and West Birmingham NHS Trust, Birmingham, UK
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
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12
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Furie R, Morand EF, Bruce IN, Isenberg D, van Vollenhoven R, Abreu G, Pineda L, Tummala R. What Does It Mean to Be a British Isles Lupus Assessment Group-Based Composite Lupus Assessment Responder? Post Hoc Analysis of Two Phase III Trials. Arthritis Rheumatol 2021; 73:2059-2068. [PMID: 33913260 PMCID: PMC8596929 DOI: 10.1002/art.41778] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 04/16/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The British Isles Lupus Assessment Group-based Composite Lupus Assessment (BICLA) is a validated global measure of treatment response in systemic lupus erythematosus (SLE) clinical trials. To understand the relevance of BICLA in clinical practice, we investigated relationships between BICLA response and routine SLE assessments, patient-reported outcomes (PROs), and medical resource utilization. METHODS This was a post hoc analysis of pooled data from the phase III, randomized, placebo-controlled, 52-week TULIP-1 (ClinicalTrials.gov identifier: NCT02446912; n = 457) and TULIP-2 (ClinicalTrials.gov identifier: NCT02446899; n = 362) trials of intravenous anifrolumab (150/300 mg once every 4 weeks) in patients with moderate-to-severe SLE. Changes from baseline to week 52 in clinical assessments, PROs, and medical resource use were compared in BICLA responders versus nonresponders, regardless of treatment assignment. RESULTS BICLA responders (n = 318) achieved significantly improved outcomes compared with nonresponders (n = 501), including lower flare rates, higher rates of attainment of sustained oral glucocorticoid taper to ≤7.5 mg/day, greater improvements in PROs (Functional Assessment of Chronic Illness Therapy-Fatigue, Short Form 36 Health Survey), and fewer SLE-related hospitalizations/emergency department visits (all nominal P < 0.001). Compared with nonresponders, BICLA responders had greater improvements in global and organ-specific disease activity (Physician's Global Assessment, SLE Disease Activity Index 2000, Cutaneous Lupus Erythematosus Disease Area and Severity Index Activity, and joint counts; all nominal P < 0.001). BICLA responders had fewer lupus-related serious adverse events than nonresponders. CONCLUSION BICLA response is associated with clinical benefit in SLE assessments, PROs, and medical resource utilization, confirming its value as a clinical trial end point that is associated with measures important to patient care.
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Affiliation(s)
- Richard Furie
- Zucker School of Medicine at Hofstra/NorthwellGreat NeckNew York
| | | | - Ian N. Bruce
- University of ManchesterNIHR Manchester Biomedical Research CentreManchester University Hospitals NHS Foundation TrustManchester Academic Health Science CentreManchesterUK
| | - David Isenberg
- University College London and University College HospitalLondonUK
| | | | | | - Lilia Pineda
- BioPharmaceuticals R&D, AstraZenecaGaithersburgMaryland
| | - Raj Tummala
- BioPharmaceuticals R&D, AstraZenecaGaithersburgMaryland
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Cleanthous S, Bongardt S, Marquis P, Stach C, Cano S, Morel T. Psychometric Analysis from EMBODY1 and 2 Clinical Trials to Help Select Suitable Fatigue PRO Scales for Future Systemic Lupus Erythematosus Studies. Rheumatol Ther 2021; 8:1287-1301. [PMID: 34244970 PMCID: PMC8380611 DOI: 10.1007/s40744-021-00338-4] [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: 04/27/2021] [Accepted: 06/14/2021] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Fatigue is one of the most important symptoms reported by patients with systemic lupus erythematosus (SLE) and a key concept of interest in SLE clinical trials. Despite this, fatigue remains poorly understood and sub-optimally measured by existing patient-reported outcome (PRO) instruments and scales. Here, we psychometrically evaluated the measurement properties of three PRO scales that purport to measure fatigue, using data from two SLE clinical trials. METHODS Data were pooled from two completed phase 3 SLE trials: EMBODY1 (NCT01262365) and EMBODY2 (NCT01261793). FACIT-F, SF-36 Vitality and LupusQoL Fatigue data were selected for post hoc Rasch Measurement Theory psychometric analysis in two stages: (1) scale-to-sample targeting, thresholds for item response options, item fit statistics, and reliability; and (2) proposal and evaluation of pooled fatigue items based on the best-performing items. Responsiveness analyses on group-level (two effect size [ES] calculations and relative efficiency) and individual level (within person statistically significant difference), were conducted to compare original scales and pooled item sets. RESULTS Scale-to-sample targeting was good for FACIT-F, but suboptimal for SF-36 Vitality and LupusQoL Fatigue. Thresholds for item response options were ordered for all three scales. Item misfit was found in all three scales (FACIT-F 10/13; SF-36 Vitality 4/4; LupusQoL Fatigue 1/4). Reliability statistics were good for FACIT-F (0.93) and LupusQoL Fatigue (0.80) but low for SF-36 Vitality (0.53). The pooled fatigue items improved some psychometric properties despite persisting misfit issues (2/10) and were more sensitive in detecting change at week 24 compared with un-pooled data (ES 0.41 vs. 0.26-0.25). CONCLUSIONS FACIT-F, SF-36 Vitality, and LupusQoL Fatigue were found to have important limitations in the EMBODY1 and EMBODY2 SLE clinical trials. Findings from pooled fatigue items support the need for further research to improve conceptual underpinnings of fatigue PROs and make them fit for purpose for drug development.
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Affiliation(s)
| | | | | | | | | | - Thomas Morel
- UCB Pharma, Allée de la Recherche 60, 1070, Anderlecht, Brussels, Belgium.
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14
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Connelly K, Golder V, Kandane-Rathnayake R, Morand EF. Clinician-reported outcome measures in lupus trials: a problem worth solving. THE LANCET. RHEUMATOLOGY 2021; 3:e595-e603. [PMID: 38287623 DOI: 10.1016/s2665-9913(21)00119-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/09/2021] [Accepted: 04/09/2021] [Indexed: 02/08/2023]
Abstract
Systemic lupus erythematosus (SLE) remains a disease of high unmet clinical need. Because of substantial patient heterogeneity, the execution of clinical trials that successfully determine the efficacy of novel therapeutics compared with placebo is a continuous challenge. Clinician-reported outcome measures of treatment response used in SLE trials have evolved from the use of individual disease activity indices, including the SLE Disease Activity Index (SLEDAI) and British Isles Lupus Assessment Group (BILAG), to composite responder definitions such as the SLE Responder Index (SRI) and BILAG-Based Composite Lupus Assessment (BICLA), which are based on these indices. However, these approaches have notable drawbacks and defining the optimal clinical trial outcome measure for SLE remains a research goal. In this Viewpoint, we explore the strengths and limitations of existing indices and composite assessments, illustrating features which should be investigated in future analysis of trial data. Further, we provide a platform from which to advance new approaches to endpoint design, which is crucial to improve the interpretability and success of subsequent clinical trials in SLE.
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Affiliation(s)
- Kathryn Connelly
- School of Clinical Sciences, Monash University, Clayton, VIC 3168, Australia; Department of Rheumatology, Monash Health, Monash University, Clayton, VIC 3168, Australia
| | - Vera Golder
- School of Clinical Sciences, Monash University, Clayton, VIC 3168, Australia; Department of Rheumatology, Monash Health, Monash University, Clayton, VIC 3168, Australia
| | | | - Eric F Morand
- School of Clinical Sciences, Monash University, Clayton, VIC 3168, Australia; Department of Rheumatology, Monash Health, Monash University, Clayton, VIC 3168, Australia.
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15
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Reynolds JA, Prattley J, Geifman N, Lunt M, Gordon C, Bruce IN. Distinct patterns of disease activity over time in patients with active SLE revealed using latent class trajectory models. Arthritis Res Ther 2021; 23:203. [PMID: 34321096 PMCID: PMC8320218 DOI: 10.1186/s13075-021-02584-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 07/10/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is a heterogeneous systemic autoimmune condition for which there are limited licensed therapies. Clinical trial design is challenging in SLE due at least in part to imperfect outcome measures. Improved understanding of how disease activity changes over time could inform future trial design. The aim of this study was to determine whether distinct trajectories of disease activity over time occur in patients with active SLE within a clinical trial setting and to identify factors associated with these trajectories. METHODS Latent class trajectory models were fitted to a clinical trial dataset of a monoclonal antibody targeting CD22 (Epratuzumab) in patients with active SLE using the numerical BILAG-2004 score (nBILAG). The baseline characteristics of patients in each class and changes in prednisolone over time were identified. Exploratory PK-PD modelling was used to examine cumulative drug exposure in relation to latent class membership. RESULTS Five trajectories of disease activity were identified, with 3 principal classes: non-responders (NR), slow responders (SR) and rapid-responders (RR). In both the SR and RR groups, significant changes in disease activity were evident within the first 90 days of the trial. The SR and RR patients had significantly higher baseline disease activity, exposure to epratuzumab and activity in specific BILAG domains, whilst NR had lower steroid use at baseline and less change in steroid dose early in the trial. CONCLUSIONS Longitudinal nBILAG scores reveal different trajectories of disease activity and may offer advantages over fixed endpoints. Corticosteroid use however remains an important confounder in lupus trials and can influence early response. Changes in disease activity and steroid dose early in the trial were associated with the overall disease activity trajectory, supporting the feasibility of performing adaptive trial designs in SLE.
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Affiliation(s)
- John A Reynolds
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Rheumatology Department, Sandwell and West Birmingham NHS Trust, Birmingham, UK
| | - Jennifer Prattley
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Stopford Building, Oxford Road, Manchester, M13 9PT, UK
| | - Nophar Geifman
- Centre for Health Informatics, Division of Informatics, Imaging & Data Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Mark Lunt
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Stopford Building, Oxford Road, Manchester, M13 9PT, UK
| | - Caroline Gordon
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Rheumatology Department, Sandwell and West Birmingham NHS Trust, Birmingham, UK
| | - Ian N Bruce
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Stopford Building, Oxford Road, Manchester, M13 9PT, UK.
- Manchester University NHS Foundation Trust, NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester, Greater Manchester, UK.
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McElhone K, Abbott J, Hurley M, Burnell J, Lanyon P, Rahman A, Yee CS, Akil M, Bruce IN, Ahmad Y, Gordon C, Teh LS. Flares in patients with systemic lupus erythematosus. Rheumatology (Oxford) 2021; 60:3262-3267. [PMID: 33325488 PMCID: PMC8517882 DOI: 10.1093/rheumatology/keaa777] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 10/14/2020] [Indexed: 11/30/2022] Open
Abstract
Objective SLE is characterized by relapses and remissions. We aimed to describe the frequency, type and time to flare in a cohort of SLE patients. Methods SLE patients with one or more ‘A’ or ‘B’ BILAG-2004 systems meeting flare criteria (‘new’ or ‘worse’ items) and requiring an increase in immunosuppression were recruited from nine UK centres and assessed at baseline and monthly for 9 months. Subsequent flares were defined as: severe (any ‘A’ irrespective of number of ‘B’ flares), moderate (two or more ‘B’ without any ‘A’ flares) and mild (one ‘B’). Results Of the 100 patients, 94% were female, 61% White Caucasians, mean age (s.d.) was 40.7 years (12.7) and mean disease duration (s.d.) was 9.3 years (8.1). A total of 195 flares re-occurred in 76 patients over 781 monthly assessments (flare rate of 0.25/patient-month). There were 37 severe flares, 32 moderate flares and 126 mild flares. By 1 month, 22% had a mild/moderate/severe flare and 22% had a severe flare by 7 months. The median time to any ‘A’ or ‘B’ flare was 4 months. Severe/moderate flares tended to be in the system(s) affected at baseline, whereas mild flares could affect any system. Conclusion . In a population with active SLE we observed an ongoing rate of flares from early in the follow-up period with moderate–severe flares being due to an inability to fully control the disease. This real-world population study demonstrates the limitations of current treatments and provides a useful reference population from which to inform future clinical trial design.
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Affiliation(s)
- Kathleen McElhone
- Department of Rheumatology, Royal Blackburn Hospital, Haslingden Road, Blackburn
| | | | - Margaret Hurley
- Faculty of Health and Wellbeing, University of Central Lancashire, Preston
| | - Jane Burnell
- Faculty of Health and Wellbeing, University of Central Lancashire, Preston
| | - Peter Lanyon
- Rheumatology, Nottingham University Hospitals NHS Trust.,Epidemiology and Public Health, University of Nottingham, Nottingham.,NIHR Nottingham Biomedical Research Centre, Nottingham
| | - Anisur Rahman
- Centre for Rheumatology Research, University College London, The Rayne Building, 4th Floor, 5 University Street, London
| | - Chee-Seng Yee
- Department of Rheumatology, Doncaster Royal Infirmary, Armthorpe Road, Doncaster
| | - Mohammed Akil
- Department of Rheumatology, Royal Hallamshire Hospital, Glossop Road, Sheffield
| | - Ian N Bruce
- Arthritis Research UK Centre for Epidemiology, Faculty of Biology, Medicine and Health, The University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester
| | - Yasmeen Ahmad
- Peter Maddison Rheumatology Centre, Betsi Cadwaldr University Health Board, Llandudno Hospital, Llandudno, Conwy
| | - Caroline Gordon
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham.,Rheumatology Department, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust.,NIHR/Wellcome Trust Birmingham Clinical Research Facility, University Hospitals Birmingham NHS Foundation Trust, Birmingham
| | - Lee-Suan Teh
- Department of Rheumatology, Royal Blackburn Hospital, Haslingden Road, Blackburn.,Faculty of Clinical and Biomedical Sciences, University of Central Lancashire, Preston PR1 2HE, UK
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Systemic Lupus Erythematosus Outcome Measures for Systemic Lupus Erythematosus Clinical Trials. Rheum Dis Clin North Am 2021; 47:415-426. [PMID: 34215371 DOI: 10.1016/j.rdc.2021.04.007] [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: 01/10/2023]
Abstract
The assessment of systemic lupus erythematosus (SLE) disease activity in clinical trials has been challenging. This is related to the wide spectrum of SLE manifestations and the heterogeneity of the disease trajectory. Currently, composite outcome measures are most commonly used as a primary endpoint while organ-specific measures are often used as secondary outcomes. In this article, we review the outcome measures and endpoints used in most recent clinical trials and explore potential avenues for further development of new measures and the refinement of existing tools.
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Yee CS, Gordon C, Isenberg DA, Griffiths B, Teh LS, Bruce IN, Ahmad Y, Rahman A, Prabu A, Akil M, McHugh N, Edwards CJ, D'Cruz D, Khamashta MA, Farewell VT. Comparison of responsiveness of BILAG-2004, SLEDAI-2000 and BILAG Systems Tally (BST). Arthritis Care Res (Hoboken) 2021; 74:1623-1630. [PMID: 33787088 DOI: 10.1002/acr.24606] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 02/08/2021] [Accepted: 03/23/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To compare the responsiveness of BILAG-2004 and SLEDAI-2000 disease activity indices and determine if there was any added value in combining BILAG-2004, BILAG System Tally (BST) or simplified BST (sBST) with SLEDAI-2000. METHODS This was a multi-centre longitudinal study of SLE patients. Data were collected on BILAG-2004, SLEDAI-2000 and therapy on consecutive assessments in routine practice. The external responsiveness of the indices was assessed by determining the relationship between change in disease activity and change in therapy between two consecutive visits. Comparison of indices and their derivatives was performed by assessing the main effects of the indices using logistic regression. ROC curves analysis was used to describe the performance of these indices individually and in various combinations and comparisons of AUC were performed. RESULTS There were 1414 observations from 347 patients. Both BILAG-2004 and SLEDAI-2000 maintained an independent relationship with change in therapy when compared. There was some improvement in responsiveness when continuous SLEDAI-2000 variables (change in score and score of previous visit) were combined with BILAG-2004 system scores. Dichotomisation of BILAG-2004 or SLEDAI-2000 resulted in poorer performance. BST and sBST had similar responsiveness as the combination of SLEDAI-2000 variables and BILAG-2004 system scores. There was little benefit in combining SLEDAI-2000 with BST or sBST. CONCLUSIONS The BILAG-2004 index had comparable responsiveness to SLEDAI-2000. There was some benefit in combining both indices. Dichotomisation of BILAG-2004 and SLEDAI-2000 leads to suboptimal performance. BST and sBST performed well on their own; sBST is recommended for its simplicity and clinical meaningfulness.
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Affiliation(s)
- Chee-Seng Yee
- Doncaster and Bassetlaw, Teaching Hospitals NHS Foundation Trust, Doncaster, UK
| | | | | | - Bridget Griffiths
- Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - Lee-Suan Teh
- Royal Blackburn Teaching Hospital, Blackburn, UK.,University of Central Lancashire, Preston, UK
| | | | | | | | | | - Mohammed Akil
- Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Neil McHugh
- Royal National Hospital for Rheumatic Diseases NHS Trust, Bath, UK
| | - Christopher J Edwards
- NIHR Southampton Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - David D'Cruz
- Louise Coote Lupus Unit, Guy's Hospital, London, UK
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Yavne Y, Edel Y, Berman J, Eviatar T, Shepshelovich D. Quality Evaluation of the Underlying Evidence in the Updated Treatment Recommendations for Systemic Lupus Erythematosus. Rheumatology (Oxford) 2021; 61:240-248. [PMID: 33764408 DOI: 10.1093/rheumatology/keab306] [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: 12/23/2022] Open
Abstract
OBJECTIVE Systemic lupus erythematosus (SLE) is a multisystem autoimmune disorder known for its broad clinical spectrum. Recently, the European, British and Latin American rheumatology professional societies (EULAR, BSR and PANLAR) published updated recommendations for SLE management. The objective of this study was to characterize the data supporting the updated recommendations, with the goal of highlighting areas which could benefit from additional high-quality research. METHODS References were compiled from the recently published EULAR, BSR and PANLAR SLE treatment recommendations. Data collected from each study included publication year, treatment regimen, study design, sample size, inclusion and exclusion criteria and relevant SLE diagnostic criteria. Studies with less than 10 patients and those which did not specify the SLE diagnostic criteria used were excluded. RESULTS Altogether 250 studies were included in this study. The majority were prospective and retrospective cohorts (72%), with only a small percentage of randomized controlled trials (28%). The median number of patients included was 37 (IQR 19-86). The revised American College of Rheumatology (ACR) 1982 criteria were the most commonly used criteria for SLE diagnosis (52%), followed by the revised ACR criteria from 1997 (27%). Only a small proportion of studies included the use of disease activity scores when defining study population (15%). CONCLUSIONS Our study has indicated a scarcity of sufficiently powered high-quality research referenced in the recently published SLE treatment guidelines. Well-designed large-scale studies utilizing the updated 2019 SLE diagnostic criteria are needed to better inform healthcare professionals caring for patients with SLE.
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Affiliation(s)
- Yarden Yavne
- Department of Medicine 'T', Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yonatan Edel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Rheumatology unit, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
| | - Julia Berman
- Department of Medicine 'T', Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Tali Eviatar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Daniel Shepshelovich
- Department of Medicine 'T', Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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20
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Amarnani R, Yeoh SA, Denneny EK, Wincup C. Lupus and the Lungs: The Assessment and Management of Pulmonary Manifestations of Systemic Lupus Erythematosus. Front Med (Lausanne) 2021; 7:610257. [PMID: 33537331 PMCID: PMC7847931 DOI: 10.3389/fmed.2020.610257] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 12/07/2020] [Indexed: 12/25/2022] Open
Abstract
Pulmonary manifestations of systemic lupus erythematosus (SLE) are wide-ranging and debilitating in nature. Previous studies suggest that anywhere between 20 and 90% of patients with SLE will be troubled by some form of respiratory involvement throughout the course of their disease. This can include disorders of the lung parenchyma (such as interstitial lung disease and acute pneumonitis), pleura (resulting in pleurisy and pleural effusion), and pulmonary vasculature [including pulmonary arterial hypertension (PAH), pulmonary embolic disease, and pulmonary vasculitis], whilst shrinking lung syndrome is a rare complication of the disease. Furthermore, the risks of respiratory infection (which often mimic acute pulmonary manifestations of SLE) are increased by the immunosuppressive treatment that is routinely used in the management of lupus. Although these conditions commonly present with a combination of dyspnea, cough and chest pain, it is important to consider that some patients may be asymptomatic with the only suggestion of the respiratory disorder being found incidentally on thoracic imaging or pulmonary function tests. Treatment decisions are often based upon evidence from case reports or small cases series given the paucity of clinical trial data specifically focused on pulmonary manifestations of SLE. Many therapeutic options are often initiated based on studies in severe manifestations of SLE affecting other organ systems or from experience drawn from the use of these therapeutics in the pulmonary manifestations of other systemic autoimmune rheumatic diseases. In this review, we describe the key features of the pulmonary manifestations of SLE and approaches to investigation and management in clinical practice.
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Affiliation(s)
- Raj Amarnani
- Department of Rheumatology, University College London Hospital, London, United Kingdom
| | - Su-Ann Yeoh
- Department of Rheumatology, University College London Hospital, London, United Kingdom.,Division of Medicine, Department of Rheumatology, University College London, London, United Kingdom
| | - Emma K Denneny
- Department of Respiratory Medicine, University College London Hospital, London, United Kingdom.,Leukocyte Trafficking Laboratory, Centre for Inflammation and Tissue Repair, UCL Respiratory, University College London, London, United Kingdom
| | - Chris Wincup
- Department of Rheumatology, University College London Hospital, London, United Kingdom.,Division of Medicine, Department of Rheumatology, University College London, London, United Kingdom
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21
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Arora S, Isenberg DA, Castrejon I. Measures of Adult Systemic Lupus Erythematosus: Disease Activity and Damage. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:27-46. [PMID: 33091256 DOI: 10.1002/acr.24221] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 04/09/2020] [Indexed: 12/30/2022]
Affiliation(s)
- Shilpa Arora
- Rush University Medical Center, Chicago, Illinois
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22
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Tanaka Y, Kondo K, Ichibori A, Yanai Y, Susuta Y, Inoue S, Takeuchi T. Amiselimod, a sphingosine 1-phosphate receptor-1 modulator, for systemic lupus erythematosus: A multicenter, open-label exploratory study. Lupus 2020; 29:1902-1913. [PMID: 33115374 DOI: 10.1177/0961203320966385] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To evaluate the safety, pharmacokinetics, pharmacodynamics, and exploratory efficacy of amiselimod, an oral selective sphingosine 1-phosphate receptor-1 modulator, in patients with systemic lupus erythematosus (SLE). METHODS A multicenter, open-label phase Ib trial was conducted in Japan. Patients in Part 1 and Part 2-B received 0.2 mg amiselimod while those in Part 2-A received 0.4 mg amiselimod for 24 weeks. RESULTS Seventeen subjects received 0.2 or 0.4 mg amiselimod. Amiselimod and amiselimod-P plasma concentrations increased dose-dependently. Peripheral blood lymphocyte count decreased in all patients after amiselimod treatment, with no clear dose response. There were no serious/severe adverse events (AEs) or clinically meaningful cardiac effects. Five subjects were withdrawn from amiselimod treatment following a decrease in lymphocyte count to <200/μl. Anti-double stranded-DNA antibody decreased from baseline to Week 24/end of treatment (EOT), with those in 2 subjects (22.2%) decreasing to within the normal range. Total SLE disease activity index 2000 score decreased by ≥4 at EOT in 7 of 17 subjects. CONCLUSIONS Amiselimod was generally well tolerated. While no serious AEs or infectious AEs led to discontinuation, low lymphocyte counts of <200/μl were observed as a laboratory abnormality. Our findings suggest the potential efficacy of amiselimod for patients with SLE.Trial registration: ClinicalTrials.gov identifier: NCT02307643.
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Affiliation(s)
- Yoshiya Tanaka
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Kazuoki Kondo
- Ikuyaku, Integrated Value Development Division, Mitsubishi Tanabe Pharma Corporation, Tokyo, Japan
| | - Ayako Ichibori
- Ikuyaku, Integrated Value Development Division, Mitsubishi Tanabe Pharma Corporation, Tokyo, Japan
| | - Yoshiari Yanai
- Ikuyaku, Integrated Value Development Division, Mitsubishi Tanabe Pharma Corporation, Tokyo, Japan
| | - Yutaka Susuta
- Ikuyaku, Integrated Value Development Division, Mitsubishi Tanabe Pharma Corporation, Tokyo, Japan
| | - Shinsuke Inoue
- Ikuyaku, Integrated Value Development Division, Mitsubishi Tanabe Pharma Corporation, Tokyo, Japan
| | - Tsutomu Takeuchi
- The Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
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23
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Abstract
Following the advent of molecular targeted drugs, a paradigm shift in treatment similar to that in rheumatoid arthritis has been expected in the treatment of systemic lupus erythematosus (SLE), but clinical trials for drugs that many specialists believed to be effective have failed repeatedly. The causes are not simple, but include the heterogeneity of SLE, inclusion criteria, lack of appropriate disease activity measures, and relapse criteria. This review outlines the disease activity indices used in SLE, discusses their advantages and disadvantages, and describes the ideal activity index.
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Affiliation(s)
- Koichiro Ohmura
- Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine, Kyoto, Japan
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24
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Mathian A, Pha M, Haroche J, Cohen-Aubart F, Hié M, Pineton de Chambrun M, Boutin THD, Miyara M, Gorochov G, Yssel H, Cherin P, Devilliers H, Amoura Z. Withdrawal of low-dose prednisone in SLE patients with a clinically quiescent disease for more than 1 year: a randomised clinical trial. Ann Rheum Dis 2019; 79:339-346. [PMID: 31852672 DOI: 10.1136/annrheumdis-2019-216303] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/12/2019] [Accepted: 11/18/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To compare the efficacy to prevent flares of maintenance versus withdrawal of 5 mg/day prednisone in systemic lupus erythematosus (SLE) patients with clinically quiescent disease. METHODS A monocentric, 12-month, superiority, open-label, randomised (1:1) controlled trial was conducted with 61 patients continuing 5 mg/day prednisone and 63 stopping it. Eligibility criteria were SLE patients who, during the year preceding the inclusion, had a clinically inactive disease and a stable SLE treatment including 5 mg/day prednisone. The primary endpoint was the proportion of patient experiencing a flare defined with the SELENA-SLEDAI flare index (SFI) at 52 weeks. Secondary endpoints included time to flare, flare severity according to SFI and British Isles Lupus Assessment Group (BILAG) index and increase in the Systemic Lupus International Collaborating Clinics (SLICC) damage index (SDI). RESULTS Proportion of patients experiencing a flare was significantly lower in the maintenance group as compared with the withdrawal group (4 patients vs 17; RR 0.2 (95% CI 0.1 to 0.7), p=0.003). Maintenance of 5 mg prednisone was superior with respect to time to first flare (HR 0.2; 95% CI 0.1 to 0.6, p=0.002), occurrence of mild/moderate flares using the SFI (3 patients vs 12; RR 0.2 (95% CI 0.1 to 0.8), p=0.012) and occurrence of moderate/severe flares using the BILAG index (1 patient vs 8; RR 0.1 (95% CI 0.1 to 0.9), p=0.013). SDI increase and adverse events were similar in the two treatment groups. Subgroup analyses of the primary endpoint by predefined baseline characteristics did not show evidence of a different clinical response. CONCLUSION Maintenance of long term 5 mg prednisone in SLE patients with inactive disease prevents relapse. TRIAL REGISTRATION NUMBER NCT02558517; Results.
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Affiliation(s)
- Alexis Mathian
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupement Hospitalier Pitié-Salpêtrière, French National Referral Center for Systemic Lupus Erythematosus, Antiphospholipid Antibody Syndrome and Other Autoimmune Disorders, Service de Médecine Interne 2, Institut E3M, Inserm UMRS, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
| | - Micheline Pha
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupement Hospitalier Pitié-Salpêtrière, French National Referral Center for Systemic Lupus Erythematosus, Antiphospholipid Antibody Syndrome and Other Autoimmune Disorders, Service de Médecine Interne 2, Institut E3M, Inserm UMRS, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
| | - Julien Haroche
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupement Hospitalier Pitié-Salpêtrière, French National Referral Center for Systemic Lupus Erythematosus, Antiphospholipid Antibody Syndrome and Other Autoimmune Disorders, Service de Médecine Interne 2, Institut E3M, Inserm UMRS, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
| | - Fleur Cohen-Aubart
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupement Hospitalier Pitié-Salpêtrière, French National Referral Center for Systemic Lupus Erythematosus, Antiphospholipid Antibody Syndrome and Other Autoimmune Disorders, Service de Médecine Interne 2, Institut E3M, Inserm UMRS, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
| | - Miguel Hié
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupement Hospitalier Pitié-Salpêtrière, French National Referral Center for Systemic Lupus Erythematosus, Antiphospholipid Antibody Syndrome and Other Autoimmune Disorders, Service de Médecine Interne 2, Institut E3M, Inserm UMRS, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
| | - Marc Pineton de Chambrun
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupement Hospitalier Pitié-Salpêtrière, French National Referral Center for Systemic Lupus Erythematosus, Antiphospholipid Antibody Syndrome and Other Autoimmune Disorders, Service de Médecine Interne 2, Institut E3M, Inserm UMRS, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
| | - Thi Huong Du Boutin
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupement Hospitalier Pitié-Salpêtrière, French National Referral Center for Systemic Lupus Erythematosus, Antiphospholipid Antibody Syndrome and Other Autoimmune Disorders, Service de Médecine Interne 2, Institut E3M, Inserm UMRS, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
| | - Makoto Miyara
- Sorbonne Université, Inserm UMR-S, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Assistance Publique-Hôpitaux de Paris, Groupement Hospitalier Pitié-Salpêtrière, Département d'Immunologie, Paris, France
| | - Guy Gorochov
- Sorbonne Université, Inserm UMR-S, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Assistance Publique-Hôpitaux de Paris, Groupement Hospitalier Pitié-Salpêtrière, Département d'Immunologie, Paris, France
| | - Hans Yssel
- Sorbonne Université, Inserm UMR-S, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Assistance Publique-Hôpitaux de Paris, Groupement Hospitalier Pitié-Salpêtrière, Département d'Immunologie, Paris, France
| | - Patrick Cherin
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupement Hospitalier Pitié-Salpêtrière, French National Referral Center for Systemic Lupus Erythematosus, Antiphospholipid Antibody Syndrome and Other Autoimmune Disorders, Service de Médecine Interne 2, Institut E3M, Inserm UMRS, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
| | - Hervé Devilliers
- Centre Hospitalier Universitaire de Dijon, Hôpital François-Mitterrand, service de médecine interne et maladies systémiques (médecine interne 2) et Centre d'Investigation Clinique, Inserm CIC-EC 1432, Dijon, France
| | - Zahir Amoura
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupement Hospitalier Pitié-Salpêtrière, French National Referral Center for Systemic Lupus Erythematosus, Antiphospholipid Antibody Syndrome and Other Autoimmune Disorders, Service de Médecine Interne 2, Institut E3M, Inserm UMRS, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
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25
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Wang H, Liu C, Chen W, Ding G. The skewed frequency of B-cell subpopulation CD19 + CD24 hi CD38 hi cells in peripheral blood mononuclear cells is correlated with the elevated serum sCD40L in patients with active systemic lupus erythematosus. J Cell Biochem 2019; 120:11490-11497. [PMID: 30771230 DOI: 10.1002/jcb.28427] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 12/13/2018] [Accepted: 01/10/2019] [Indexed: 01/24/2023]
Abstract
CD19+ CD24hi CD38hi cells play an essential role in maintaining immune homeostasis. CD40 signaling is involved in regulating the induction and function of CD19+ CD24hi CD38hi cells. Changes in B-cell subpopulations and CD19+ CD24hi CD38hi cells have been observed in systemic lupus erythematosus (SLE) patients. Whether changes in the B-cell subpopulation are related to the aberrant CD40 signaling in SLE patients remains unclear. In this study, we examined changes in the levels of CD19+ CD24hi CD38hi cells and CD19+ CD24hi CD38low cells in peripheral blood mononuclear cells and the serum level of soluble CD40 ligand (sCD40L) in 30 patients with SLE. Through routine biochemical assays and flow cytometry assay, we found that (1) the CD19+ CD24hi CD38hi cell subset was upregulated in SLE patients compared to that in healthy controls (HCs) (P < 0.05); (2) the CD19+ CD24hi CD38low cell subset was downregulated in SLE patients compared with that in HCs; and (3) CD38 expression was positively correlated with SLE manifestations and the serum sCD40L level (P < 0.05). In conclusion, the relative level of Bregs is significantly higher in SLE patients than in HCs and is positively correlated with disease activity and sCD40L level.
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Affiliation(s)
- Huiming Wang
- Division of Nephrology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Changxuan Liu
- Division of Nephrology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wenli Chen
- Division of Nephrology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Guohua Ding
- Division of Nephrology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
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26
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Lu R, Guthridge JM, Chen H, Bourn RL, Kamp S, Munroe ME, Macwana SR, Bean K, Sridharan S, Merrill JT, James JA. Immunologic findings precede rapid lupus flare after transient steroid therapy. Sci Rep 2019; 9:8590. [PMID: 31197240 PMCID: PMC6565690 DOI: 10.1038/s41598-019-45135-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 05/31/2019] [Indexed: 12/19/2022] Open
Abstract
Systemic lupus erythematosus (SLE) flares elicit progressive organ damage, leading to disability and early mortality. This study evaluated clinical and immunologic factors associated with impending flare in the Biomarkers of Lupus Disease study. Autoantibodies and 32 soluble mediators were measured by multiplex assays, immune pathway activation by gene expression module scores, and immune cell subset frequencies and activation states by flow cytometry. After providing baseline samples, participants received transient steroids to suppress disease and were followed until flare. Flare occurred early (within 60 days of baseline) in 21 participants and late (90–165 days) in 13. At baseline, compared to the late flare group, the early flare group had differential gene expression in monocyte, T cell, interferon, and inflammation modules, as well as significantly higher frequencies of activated (aCD11b+) neutrophils and monocytes, and activated (CD86hi) naïve B cells. Random forest models showed three subgroups of early flare patients, distinguished by greater baseline frequencies of aCD11b+ monocytes, or CD86hi naïve B cells, or both. Increases in these cell populations were the most accurate biomarkers for early flare in this study. These results suggest that SLE flares may arise from an overlapping spectrum of lymphoid and myeloid mechanisms in different patients.
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Affiliation(s)
- Rufei Lu
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, OK, 73104, USA.,Departments of Pathology and Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Joel M Guthridge
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, OK, 73104, USA.,Departments of Pathology and Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Hua Chen
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, OK, 73104, USA
| | - Rebecka L Bourn
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, OK, 73104, USA
| | - Stan Kamp
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, OK, 73104, USA
| | - Melissa E Munroe
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, OK, 73104, USA
| | - Susan R Macwana
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, OK, 73104, USA
| | - Krista Bean
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, OK, 73104, USA
| | | | - Joan T Merrill
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, OK, 73104, USA
| | - Judith A James
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, OK, 73104, USA. .,Departments of Pathology and Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA.
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27
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Conigliaro P, Cesareo M, Chimenti MS, Triggianese P, Canofari C, Barbato C, Giannini C, Salandri AG, Nucci C, Perricone R. Take a look at the eyes in Systemic Lupus Erythematosus: A novel point of view. Autoimmun Rev 2019; 18:247-254. [DOI: 10.1016/j.autrev.2018.09.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 09/20/2018] [Indexed: 01/17/2023]
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28
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Smith EMD, Eleuteri A, Goilav B, Lewandowski L, Phuti A, Rubinstein T, Wahezi D, Jones CA, Marks SD, Corkhill R, Pilkington C, Tullus K, Putterman C, Scott C, Fisher AC, Beresford MW. A Markov Multi-State model of lupus nephritis urine biomarker panel dynamics in children: Predicting changes in disease activity. Clin Immunol 2018; 198:71-78. [PMID: 30391651 DOI: 10.1016/j.clim.2018.10.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 09/28/2018] [Accepted: 10/31/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND A urine 'biomarker panel' comprising alpha-1-acid-glycoprotein, ceruloplasmin, transferrin and lipocalin-like-prostaglandin-D synthase performs to an 'excellent' level for lupus nephritis identification in children cross-sectionally. The aim of this study was to assess if this biomarker panel predicts lupus nephritis flare/remission longitudinally. METHODS The novel urinary biomarker panel was quantified by enzyme linked immunoabsorbant assay in participants of the United Kingdom Juvenile Systemic Lupus Erythematosus (UK JSLE) Cohort Study, the Einstein Lupus Cohort, and the South African Paediatric Lupus Cohort. Monocyte chemoattractant protein-1 and vascular cell adhesion molecule-1 were also quantified in view of evidence from other longitudinal studies. Serial urine samples were collected during routine care with detailed clinical and demographic data. A Markov Multi-State model of state transitions was fitted, with predictive clinical/biomarker factors assessed by a corrected Akaike Information Criterion (AICc) score (the better the model, the lower the AICc score). RESULTS The study included 184 longitudinal observations from 80 patients. The homogeneous multi-state Markov model of lupus nephritis activity AICc score was 147.85. Alpha-1-acid-glycoprotein and ceruloplasmin were identified to be the best predictive factors, reducing the AICc score to 139.81 and 141.40 respectively. Ceruloplasmin was associated with the active-to-inactive transition (hazard ratio 0.60 (95% confidence interval [0.39, 0.93])), and alpha-1-acid-glycoprotein with the inactive-to-active transition (hazard ratio 1.49 (95% confidence interval [1.10, 2.02])). Inputting individual alpha-1-acid-glycoprotein/ceruloplasmin values provides 3, 6 and 12 months probabilities of state transition. CONCLUSIONS Alpha-1-acid-glycoprotein was predictive of active lupus nephritis flare, whereas ceruloplasmin was predictive of remission. The Markov state-space model warrants testing in a prospective clinical trial of lupus nephritis biomarker led monitoring.
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Affiliation(s)
- E M D Smith
- Department of Women's & Children's Health, University of Liverpool, Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.
| | - A Eleuteri
- Medical Physics and Clinical Engineering, and Department of Physics, University of Liverpool, Liverpool, UK.
| | - B Goilav
- Department of Paediatric Nephrology, Albert Einstein College of Medicine, New York, USA.
| | | | - A Phuti
- Paediatric Rheumatology, University of Cape Town, Cape Town, South Africa.
| | - T Rubinstein
- Department of Paediatric Rheumatology, Albert Einstein College of Medicine, New York, USA.
| | - D Wahezi
- Department of Paediatric Rheumatology, Albert Einstein College of Medicine, New York, USA.
| | - C A Jones
- Department of Paediatric Nephrology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.
| | - S D Marks
- Paediatric Nephrology, Great Ormond Street Hospital, London, UK.
| | - R Corkhill
- Department of Women's & Children's Health, University of Liverpool, Liverpool, UK.
| | - C Pilkington
- Paediatric Rheumatology, Great Ormond Street Hospital, London, UK.
| | - K Tullus
- Paediatric Nephrology, Great Ormond Street Hospital, London, UK.
| | - C Putterman
- Department of Rheumatology, Albert Einstein College of Medicine, New York, USA.
| | - C Scott
- Paediatric Rheumatology, University of Cape Town, Cape Town, South Africa.
| | - A C Fisher
- Medical Physics and Clinical Engineering, and Department of Physics, University of Liverpool, Liverpool, UK.
| | - M W Beresford
- Department of Women's & Children's Health, University of Liverpool, Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.
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29
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Gottenberg JE, Dörner T, Bootsma H, Devauchelle-Pensec V, Bowman SJ, Mariette X, Bartz H, Oortgiesen M, Shock A, Koetse W, Galateanu C, Bongardt S, Wegener WA, Goldenberg DM, Meno-Tetang G, Kosutic G, Gordon C. Efficacy of Epratuzumab, an Anti-CD22 Monoclonal IgG Antibody, in Systemic Lupus Erythematosus Patients With Associated Sjögren's Syndrome: Post Hoc Analyses From the EMBODY Trials. Arthritis Rheumatol 2018; 70:763-773. [PMID: 29381843 PMCID: PMC5947119 DOI: 10.1002/art.40425] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 01/23/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE EMBODY 1 (ClinicalTrials.gov identifier: NCT01262365) and EMBODY 2 (ClinicalTrials.gov identifier: NCT01261793) investigated the efficacy and safety of epratuzumab, a CD22-targeted humanized monoclonal IgG antibody, in patients with systemic lupus erythematosus (SLE). The studies showed no significant difference from placebo in primary or secondary clinical outcome measures but did demonstrate B cell-specific immunologic activity. The aim of this post hoc analysis was to determine whether epratuzumab had a different clinical efficacy profile in SLE patients with versus those without an associated diagnosis of Sjögren's syndrome (SS). METHODS The efficacy and safety of epratuzumab were compared between 2 patient subpopulations randomized in EMBODY 1 and 2: SLE patients with and those without a diagnosis of associated SS. British Isles Lupus Assessment Group (BILAG) total score, BILAG-based Combined Lupus Assessment (BICLA) clinical response to treatment, biologic markers (including B cells, IgG, IgM, and IgA), and safety were assessed. RESULTS A total of 1,584 patients were randomized in the EMBODY 1 and EMBODY 2 trials; 113 patients were anti-SSA positive and had a diagnosis of associated SS, and 1,375 patients (86.8%) had no diagnosis of associated SS (918 patients were randomized to receive epratuzumab and 457 to receive placebo). For patients with associated SS, but not those without associated SS, a higher proportion of patients receiving epratuzumab achieved a BICLA response and a reduction from baseline in BILAG total score. B cell reduction was faster in patients with associated SS. The sensitivity of B cells to epratuzumab as measured by the mean concentration producing 50% of the maximum B cell count depletion was lower for patients with associated SS (9.5 μg/ml) versus the total EMBODY population (87.1 μg/ml). No difference in the frequency of adverse events in those receiving placebo was reported. CONCLUSION Patients with SLE and associated SS treated with epratuzumab showed improvement in SLE disease activity, which was associated with bioactivity, such as decreases in B cell number and IgM level.
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Affiliation(s)
- Jacques-Eric Gottenberg
- Centre de Référence National Pour les Maladies Auto-Immunes Systémiques Rares, CNRS, Institut de Biologie Moléculaire et Cellulaire, Immunopathologie et Chimie Thérapeutique, Laboratory of Excellence MEDALIS, Strasbourg University Hospital, Strasbourg, France
| | | | | | | | - Simon J Bowman
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Xavier Mariette
- Université Paris-Sud, AP-HP, Hôpitaux Universitaires Paris-Sud, INSERM U1184, Le Kremlin-Bicêtre, France
| | | | | | | | | | | | | | | | | | | | | | - Caroline Gordon
- University of Birmingham and NIHR/Wellcome Trust Clinical Research Facility, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Abstract
INTRODUCTION Systemic lupus erythematosus (SLE) is a multi-system autoimmune disease. There are three drugs licensed for the treatment of lupus: corticosteroids, hydroxychloroquine and belimumab. Immunosuppressants such as azathioprine, methotrexate and mycophenolate are also used. Despite these treatments there is still considerable morbidity. New treatments are needed for the management of active lupus. Epratuzumab a humanized IgG1 monoclonal antibody that targets CD22 resulting in selective B cell modulation that has been considered a potential treatment for SLE. Areas covered: Summary of the relevant pathogenesis and disease activity measurements used in SLE patients, current treatments and unmet needs in SLE, pharmacokinetics and pharmacodynamics of epratuzumab therapy, and a summary of the 7 clinical trials that have investigated the efficacy and safety of epratuzumab in SLE. Expert commentary: It is not clear why trials have failed to demonstrate efficacy but high placebo response rates from optimisation of standard of care and a sub-optimal dosing regimen may have played a role. Post-hoc analysis suggested that there may be subgroups that did respond, such as anti-SSA positive patients with features of Sjogren's syndrome. Further research is needed to explore this and other potential sub-groups that might respond.
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Affiliation(s)
- Daniel Geh
- a Rheumatology Department , City Hospital, Sandwell and West Birmingham Hospitals NHS Trust , Birmingham , UK.,b University of Birmingham Research Labs , University Hospitals Birmingham NHS Foundation Trust , Birmingham , UK
| | - Caroline Gordon
- a Rheumatology Department , City Hospital, Sandwell and West Birmingham Hospitals NHS Trust , Birmingham , UK.,b University of Birmingham Research Labs , University Hospitals Birmingham NHS Foundation Trust , Birmingham , UK.,c Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences , University of Birmingham , Birmingham , UK
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Isenberg D, Sturgess J, Allen E, Aranow C, Askanase A, Sang-Cheol B, Bernatsky S, Bruce I, Buyon J, Cervera R, Clarke A, Dooley MA, Fortin P, Ginzler E, Gladman D, Hanly J, Inanc M, Jacobsen S, Kamen D, Khamashta M, Lim S, Manzi S, Nived O, Peschken C, Petri M, Kalunian K, Rahman A, Ramsey-Goldman R, Romero-Diaz J, Ruiz-Irastorza G, Sanchez-Guerrero J, Steinsson K, Sturfelt G, Urowitz M, van Vollenhoven R, Wallace DJ, Zoma A, Merrill J, Gordon C. Study of Flare Assessment in Systemic Lupus Erythematosus Based on Paper Patients. Arthritis Care Res (Hoboken) 2017; 70:98-103. [PMID: 28388813 PMCID: PMC5767751 DOI: 10.1002/acr.23252] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 04/04/2017] [Indexed: 12/22/2022]
Abstract
Objective To determine the level of agreement of disease flare severity (distinguishing severe, moderate, and mild flare and persistent disease activity) in a large paper‐patient exercise involving 988 individual cases of systemic lupus erythematosus. Methods A total of 988 individual lupus case histories were assessed by 3 individual physicians. Complete agreement about the degree of flare (or persistent disease activity) was obtained in 451 cases (46%), and these provided the reference standard for the second part of the study. This component used 3 flare activity instruments (the British Isles Lupus Assessment Group [BILAG] 2004, Safety of Estrogens in Lupus Erythematosus National Assessment [SELENA] flare index [SFI] and the revised SELENA flare index [rSFI]). The 451 patient case histories were distributed to 18 pairs of physicians, carefully randomized in a manner designed to ensure a fair case mix and equal distribution of flare according to severity. Results The 3‐physician assessment of flare matched the level of flare using the 3 indices, with 67% for BILAG 2004, 72% for SFI, and 70% for rSFI. The corresponding weighted kappa coefficients for each instrument were 0.82, 0.59, and 0.74, respectively. We undertook a detailed analysis of the discrepant cases and several factors emerged, including a tendency to score moderate flares as severe and persistent activity as flare, especially when the SFI and rSFI instruments were used. Overscoring was also driven by scoring treatment change as flare, even if there were no new or worsening clinical features. Conclusion Given the complexity of assessing lupus flare, we were encouraged by the overall results reported. However, the problem of capturing lupus flare accurately is not completely solved.
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Affiliation(s)
| | - J Sturgess
- The Hospital For Tropical Diseases, London, UK
| | - E Allen
- The Hospital For Tropical Diseases, London, UK
| | - C Aranow
- Feinstein Institute for Medical Research, Manhasset, New York
| | | | - B Sang-Cheol
- Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea
| | | | - I Bruce
- The University of Manchester, Central Manchester University Hospitals NHS Foundation Trust and Manchester Academic Health Science Centre, Manchester, UK
| | - J Buyon
- New York School of Medicine, New York
| | - R Cervera
- Universitat de Barcelona, Barcelona, Spain
| | - A Clarke
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - P Fortin
- Université Laval, Quebec City, Québec, Canada
| | - E Ginzler
- Downstate Medical Center Rheumatology, Brooklyn, New York
| | - D Gladman
- Krembil Research Institute, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - J Hanly
- Nova Scotia Rehabiliation Center, Halifax, Nova Scotia, Canada
| | - M Inanc
- Istanbul University, Istanbul, Turkey
| | | | - D Kamen
- Medical University of South Carolina, Charleston, UK
| | | | - S Lim
- Emory University, Atlanta, Georgia
| | - S Manzi
- Allegheny Health Network, Pittsburgh, Pennsylvania
| | - O Nived
- Lund University, Lund, Sweden
| | - C Peschken
- University of Manitoba, Winnipeg, Manitoba, Canada
| | - M Petri
- Johns Hopkins University, Baltimore, Maryland
| | - K Kalunian
- University of California at San Diego, Chicago, Illinois
| | - A Rahman
- University College London, London, UK
| | - R Ramsey-Goldman
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - J Romero-Diaz
- Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico
| | - G Ruiz-Irastorza
- Hospital Universitario Cruces and University of the Basque Country, Barakaldo, Spain
| | - J Sanchez-Guerrero
- Mount Sinai Hospital and University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - K Steinsson
- Landspitali University Hospital, Reykjavik, Iceland
| | | | - M Urowitz
- Krembil Research Institute, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - D J Wallace
- University of California at Los Angeles, Scotland, UK
| | - A Zoma
- Hairmyres Hospital, East Kilbride, Scotland, UK
| | - J Merrill
- Oklahoma Medical Research Foundation, Oklahoma City, UK
| | - C Gordon
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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Shimizu Y, Yasuda S, Kimura T, Nishio S, Kono M, Ohmura K, Shimamura S, Kono M, Fujieda Y, Kato M, Oku K, Bohgaki T, Fukasawa Y, Tanaka S, Atsumi T. Interferon-inducible Mx1 protein is highly expressed in renal tissues from treatment-naïve lupus nephritis, but not in those under immunosuppressive treatment. Mod Rheumatol 2017; 28:661-669. [PMID: 29189089 DOI: 10.1080/14397595.2017.1404711] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The aim of this study was to clarify the consequences of Mx1, one of the IFN-inducible proteins, in the peripheral blood as well as in renal tissues in patients with systemic lupus erythematosus (SLE). PATIENTS AND METHODS Mx1 protein concentrations in (PBMCs) from 18 SLE patients mostly in their stable disease status, 11 IgA nephropathy (IgAN) patients, 5 ANCA-associated vasculitis (AAV) patients and 16 healthy controls were measured using enzyme-linked immunosorbent assay (ELISA). Mx1 expression in renal specimens from 18 patients with lupus nephritis (LN), 18 with IgAN and 10 with AAV were evaluated using immunohistochemistry. RESULTS Mx1 protein concentrations in lysates of PBMCs were significantly higher in SLE patients compared with those in other three groups. Mx1-positive area in renal tissues was significantly dominant in both glomeruli and renal tubules of LN compared with other renal diseases. Renal Mx1 protein levels were lower in LN after immunosuppressive treatment, compared with those from immunosuppressant-naïve patients. CONCLUSION Mx1 levels were upregulated in lupus peripheral blood even when their disease activities were stable. On the other hand, Mx1 was highly expressed in kidneys from patients with LN before treatment, which was decreased after immunosuppressive treatment. These results suggest that Mx1 is a potential marker for the diagnosis of SLE in the peripheral blood and also for the activity of lupus nephritis in the kidney.
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Affiliation(s)
- Yuka Shimizu
- a Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine , Hokkaido University , Sapporo , Japan
| | - Shinsuke Yasuda
- a Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine , Hokkaido University , Sapporo , Japan
| | - Taichi Kimura
- b Department of Translational Pathology, Faculty of Medicine , Hokkaido University , Sapporo , Japan.,c Department of Pathology , Hokkaido Medical Center , Sapporo , Japan
| | - Saori Nishio
- a Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine , Hokkaido University , Sapporo , Japan
| | - Michihiro Kono
- a Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine , Hokkaido University , Sapporo , Japan
| | - Kazumasa Ohmura
- a Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine , Hokkaido University , Sapporo , Japan
| | - Sanae Shimamura
- a Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine , Hokkaido University , Sapporo , Japan
| | - Michihito Kono
- a Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine , Hokkaido University , Sapporo , Japan
| | - Yuichiro Fujieda
- a Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine , Hokkaido University , Sapporo , Japan
| | - Masaru Kato
- a Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine , Hokkaido University , Sapporo , Japan
| | - Kenji Oku
- a Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine , Hokkaido University , Sapporo , Japan
| | - Toshiyuki Bohgaki
- a Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine , Hokkaido University , Sapporo , Japan
| | - Yuichiro Fukasawa
- d Department of Pathology , Sapporo City General Hospital , Sapporo , Japan
| | - Shinya Tanaka
- b Department of Translational Pathology, Faculty of Medicine , Hokkaido University , Sapporo , Japan.,e Department of Cancer Pathology, Faculty of Medicine , Hokkaido University , Sapporo , Japan
| | - Tatsuya Atsumi
- a Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine , Hokkaido University , Sapporo , Japan
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Gordon C, Amissah-Arthur MB, Gayed M, Brown S, Bruce IN, D’Cruz D, Empson B, Griffiths B, Jayne D, Khamashta M, Lightstone L, Norton P, Norton Y, Schreiber K, Isenberg D. The British Society for Rheumatology guideline for the management of systemic lupus erythematosus in adults. Rheumatology (Oxford) 2017; 57:e1-e45. [DOI: 10.1093/rheumatology/kex286] [Citation(s) in RCA: 172] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Indexed: 12/15/2022] Open
Affiliation(s)
- Caroline Gordon
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham,
- Rheumatology Department, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust,
- Rheumatology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham,
| | - Maame-Boatemaa Amissah-Arthur
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham,
| | - Mary Gayed
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham,
- Rheumatology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham,
| | - Sue Brown
- Royal National Hospital for Rheumatic Diseases, Bath,
| | - Ian N. Bruce
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute for Inflammation and Repair, University of Manchester, Manchester Academic Health Sciences Centre,
- The Kellgren Centre for Rheumatology, NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester,
| | - David D’Cruz
- Louise Coote Lupus Unit, Guy’s Hospital, London,
| | - Benjamin Empson
- Laurie Pike Health Centre, Modality Partnership, Birmingham,
| | | | - David Jayne
- Department of Medicine, University of Cambridge,
- Lupus and Vasculitis Unit, Addenbrooke’s Hospital, Cambridge,
| | - Munther Khamashta
- Lupus Research Unit, The Rayne Institute, St Thomas’ Hospital,
- Division of Women’s Health, King’s College London,
| | - Liz Lightstone
- Section of Renal Medicine and Vascular Inflammation, Division of Immunology and Inflammation, Department of Medicine, Imperial College London, London,
| | | | | | | | - David Isenberg
- Centre for Rheumatology, University College London, London, UK
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Merrill JT, Immermann F, Whitley M, Zhou T, Hill A, O'Toole M, Reddy P, Honczarenko M, Thanou A, Rawdon J, Guthridge JM, James JA, Sridharan S. The Biomarkers of Lupus Disease Study: A Bold Approach May Mitigate Interference of Background Immunosuppressants in Clinical Trials. Arthritis Rheumatol 2017; 69:1257-1266. [PMID: 28257602 DOI: 10.1002/art.40086] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 02/28/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Molecular medicine raised expectations for strategically targeted biologic agents in systemic lupus erythematosus (SLE), but clinical trial results have been disappointing and difficult to interpret. Most studies add investigational agents to various, often effective, standard therapy immunosuppressants used at baseline, with unknown treatment interactions. Eliminating polypharmacy in trials of active lupus remains controversial. We undertook the Biomarkers of Lupus Disease study to test withdrawal of immunosuppressants as a novel approach to rendering SLE trials interpretable. METHODS In 41 patients with active, non-organ-threatening SLE flare (group A), temporary steroids were given while background immunosuppressants were withdrawn. Time to loss of disease suppression (time to disease flare) and safety were evaluated; standard therapy was immediately resumed when symptoms recurred. Immunologic impacts of standard therapy were studied at baseline by multiplex assay, enzyme-linked immunosorbent assay, and messenger RNA array in group A patients plus 62 additional patients donating a single sample (group B). RESULTS Patients with lower or higher baseline disease activity had median times to flare of 71 or 45 days, respectively; 40 of 41 patients (98%) had disease flares by 6 months. All flares were treated and resolved within 6 weeks. No serious adverse events occurred from flare or infection. Type I interferon (IFN), Th17, and B lymphocyte stimulator pathways tracked together. Baseline immunosuppressants had distinct impacts on Th17 and B lymphocyte stimulator, depending on IFN signature. CONCLUSION Trials in active, non-organ-threatening SLE can safely withdraw background treatments if patients who have disease flares are designated nonresponders and returned to standard therapy. Immunologic effects of standard therapy vary between IFN-defined subsets. These findings provide a strategy for minimizing or optimizing treatment combinations in lupus trials and clinical care.
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Affiliation(s)
- Joan T Merrill
- Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center, Oklahoma City
| | | | | | | | | | | | | | | | - Aikaterini Thanou
- Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center, Oklahoma City
| | - Joe Rawdon
- Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center, Oklahoma City
| | - Joel M Guthridge
- Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center, Oklahoma City
| | - Judith A James
- Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center, Oklahoma City
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Smith EMD, Jorgensen AL, Beresford MW. Do classic blood biomarkers of JSLE identify active lupus nephritis? Evidence from the UK JSLE Cohort Study. Lupus 2017; 26:1212-1217. [PMID: 28385126 DOI: 10.1177/0961203317702253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Lupus nephritis (LN) affects up to 80% of juvenile-onset systemic lupus erythematosus (JSLE) patients. The value of commonly available biomarkers, such as anti-dsDNA antibodies, complement (C3/C4), ESR and full blood count parameters in the identification of active LN remains uncertain. Methods Participants from the UK JSLE Cohort Study, aged <16 years at diagnosis, were categorized as having active or inactive LN according to the renal domain of the British Isles Lupus Assessment Group score. Classic biomarkers: anti-dsDNA, C3, C4, ESR, CRP, haemoglobin, total white cells, neutrophils, lymphocytes, platelets and immunoglobulins were assessed for their ability to identify active LN using binary logistic regression modeling, with stepAIC function applied to select a final model. Receiver-operating curve analysis was used to assess diagnostic accuracy. Results A total of 370 patients were recruited; 191 (52%) had active LN and 179 (48%) had inactive LN. Binary logistic regression modeling demonstrated a combination of ESR, C3, white cell count, neutrophils, lymphocytes and IgG to be best for the identification of active LN (area under the curve 0.724). Conclusions At best, combining common classic blood biomarkers of lupus activity using multivariate analysis provides a 'fair' ability to identify active LN. Urine biomarkers were not included in these analyses. These results add to the concern that classic blood biomarkers are limited in monitoring discrete JSLE manifestations such as LN.
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Affiliation(s)
- E M D Smith
- 1 Department of Women's and Children's Health, University of Liverpool, UK
| | - A L Jorgensen
- 2 Department of Biostatistics, University of Liverpool, UK
| | - M W Beresford
- 1 Department of Women's and Children's Health, University of Liverpool, UK.,3 Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, UK
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Clowse MEB, Wallace DJ, Furie RA, Petri MA, Pike MC, Leszczyński P, Neuwelt CM, Hobbs K, Keiserman M, Duca L, Kalunian KC, Galateanu C, Bongardt S, Stach C, Beaudot C, Kilgallen B, Gordon C. Efficacy and Safety of Epratuzumab in Moderately to Severely Active Systemic Lupus Erythematosus: Results From Two Phase III Randomized, Double-Blind, Placebo-Controlled Trials. Arthritis Rheumatol 2017; 69:362-375. [PMID: 27598855 PMCID: PMC5299488 DOI: 10.1002/art.39856] [Citation(s) in RCA: 146] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 08/23/2016] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Epratuzumab, a monoclonal antibody that targets CD22, modulates B cell signaling without substantial reductions in the number of B cells. The aim of this study was to report the results of 2 phase III multicenter randomized, double-blind, placebo-controlled trials, the EMBODY 1 and EMBODY 2 trials, assessing the efficacy and safety of epratuzumab in patients with moderately to severely active systemic lupus erythematosus (SLE). METHODS Patients met ≥4 of the American College of Rheumatology revised classification criteria for SLE, were positive for antinuclear antibodies and/or anti-double-stranded DNA antibodies, had an SLE Disease Activity Index 2000 (SLEDAI-2K) score of ≥6 (increased disease activity), had British Isles Lupus Assessment Group 2004 index (BILAG-2004) scores of grade A (severe disease activity) in ≥1 body system or grade B (moderate disease activity) in ≥2 body systems (in the mucocutaneous, musculoskeletal, or cardiorespiratory domains), and were receiving standard therapy, including mandatory treatment with corticosteroids (5-60 mg/day). BILAG-2004 grade A scores in the renal and central nervous system domains were excluded. Patients were randomized 1:1:1 to receive either placebo, epratuzumab 600 mg every week, or epratuzumab 1,200 mg every other week, with infusions delivered for the first 4 weeks of each 12-week dosing cycle, for 4 cycles. Patients across all 3 treatment groups also continued with their standard therapy. The primary end point was the response rate at week 48 according to the BILAG-based Combined Lupus Assessment (BICLA) definition, requiring improvement in the BILAG-2004 score, no worsening in the BILAG-2004 score, SLEDAI-2K score, or physician's global assessment of disease activity, and no disallowed changes in concomitant medications. Patients who discontinued the study medication were classified as nonresponders. RESULTS In the EMBODY 1 and EMBODY 2 trials of epratuzumab, 793 patients and 791 patients, respectively, were randomized, 786 (99.1%) and 788 (99.6%), respectively, received study medication, and 528 (66.6%) and 533 (67.4%), respectively, completed the study. There was no statistically significant difference in the primary end point between the groups, with the week 48 BICLA response rates being similar between the epratuzumab groups and the placebo group (response rates ranging from 33.5% to 39.8%). No new safety signals were identified. CONCLUSION In patients with moderate or severely active SLE, treatment with epratuzumab + standard therapy did not result in improvements in response rates over that observed in the placebo + standard therapy group.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Caroline Gordon
- University of Birmingham and University Hospital Birmingham NHS Foundation TrustBirminghamUK
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Piga M, Gabba A, Congia M, Figus F, Cauli A, Mathieu A. Predictors of musculoskeletal flares and Jaccoud׳s arthropathy in patients with systemic lupus erythematosus: A 5-year prospective study. Semin Arthritis Rheum 2016; 46:217-224. [DOI: 10.1016/j.semarthrit.2016.04.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Revised: 03/14/2016] [Accepted: 04/25/2016] [Indexed: 01/15/2023]
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Buyon J, Furie R, Putterman C, Ramsey-Goldman R, Kalunian K, Barken D, Conklin J, Dervieux T. Reduction in erythrocyte-bound complement activation products and titres of anti-C1q antibodies associate with clinical improvement in systemic lupus erythematosus. Lupus Sci Med 2016; 3:e000165. [PMID: 27752336 PMCID: PMC5051407 DOI: 10.1136/lupus-2016-000165] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 08/17/2016] [Accepted: 09/01/2016] [Indexed: 11/16/2022]
Abstract
Background The relationship between cell-bound complement activation products (CB-CAPs: EC4d, EC3d), anti-C1q, soluble complement C3/C4 and disease activity in systemic lupus erythematosus (SLE) was evaluated. Methods Per protocol, at baseline all SLE subjects enrolled in this longitudinal study presented with active disease and elevated CB-CAPs. At each monthly visit, the non-serological (ns) Safety of Estrogens in Lupus Erythematosus: National Assessment (SELENA-SLEDAI) and the British Isles Lupus Assessment Group (BILAG)-2004 index scores were determined as was a random urinary protein to creatinine ratio (uPCR). Short-form 36 (SF-36) questionnaires were also collected. All soluble markers were determined using immunoassays, while EC4d and EC3d were determined using flow cytometry. Statistical analysis consisted of linear mixed models with random intercept and fixed slopes. Results A total of 36 SLE subjects (mean age 34 years; 94% female) were enrolled and evaluated monthly for an average 11 visits per subject. Clinical improvements were observed during the study, with significant decreases in ns-SELENA-SLEDAI scores, BILAG-2004 index scores and uPCR, and increases in all domains of SF-36 (p<0.01). The longitudinal decrease in ns-SELENA-SLEDAI and BILAG-2004 index scores was significantly associated with reduced EC4d and EC3d levels, reduced anti-C1q titres and increased serum complement C3/C4 (p<0.05). The changes in uPCR significantly correlated with C3, C4, anti-C1q and EC4d, with EC4d outperforming C3/C4 by a multivariate analysis. The reduced EC4d or EC3d was associated with improvements in at least six out of the eight domains of SF-36 and outperformed C3/C4. Anti-dsDNA titres did not correlate with changes in disease activity. Conclusions These data indicate that CB-CAPs and anti-C1q are helpful in monitoring patients with SLE.
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Affiliation(s)
- Jill Buyon
- NYU School of Medicine , New York, New York , USA
| | - Richard Furie
- Hofstra Northwell School of Medicine , New York, New York , USA
| | - Chaim Putterman
- Albert Einstein College of Medicine and Montefiore Medical Center , Bronx, New York , USA
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McElhone K, Abbott J, Sutton C, Mullen M, Lanyon P, Rahman A, Yee CS, Akil M, Bruce IN, Ahmad Y, Gordon C, Teh LS. Sensitivity to Change and Minimal Important Differences of the LupusQoL in Patients With Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2016; 68:1505-13. [PMID: 26816223 PMCID: PMC5053261 DOI: 10.1002/acr.22850] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 01/07/2016] [Accepted: 01/19/2016] [Indexed: 12/13/2022]
Abstract
Objective As a health‐related quality of life (HRQOL) measure, the LupusQoL is a reliable and valid measure for adults with systemic lupus erythematosus (SLE). This study evaluates the responsiveness and minimal important differences (MIDs) for the 8 LupusQoL domains. Methods Patients experiencing a flare were recruited from 9 UK centers. At each of the 10 monthly visits, HRQOL (LupusQoL, Short Form 36 health survey [SF‐36]), global rating of change (GRC), and disease activity using the British Isles Lupus Assessment Group 2004 index were assessed. The responsiveness of the LupusQoL and the SF‐36 was evaluated primarily when patients reported an improvement or deterioration on the GRC scale and additionally with changes in physician‐reported disease activity. MIDs were estimated as mean changes when minimal change was reported on the GRC scale. Results A total of 101 patients were recruited. For all LupusQoL domains, mean HRQOL worsened when patients reported deterioration and improved when patients reported an improvement in GRC; SF‐36 domains showed comparable responsiveness. Improvement in some domains of the LupusQoL/SF‐36 was observed with a decrease in disease activity, but when disease activity worsened, there was no significant change. LupusQoL MID estimates for deterioration ranged from −2.4 to −8.7, and for improvement from 3.5 to 7.3; for the SF‐36, the same MID estimates were −2.0 to −11.1 and 2.8 to 10.9, respectively. Conclusion All LupusQoL domains are sensitive to change with patient‐reported deterioration or improvement in health status. For disease activity, some LupusQoL domains showed responsiveness when there was improvement but none for deterioration. LupusQoL items were derived from SLE patients and provide the advantage of disease‐specific domains, important to the patients, not captured by the SF‐36.
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Affiliation(s)
| | | | | | | | - Peter Lanyon
- Queen's Medical Centre Campus, Nottingham University Hospitals, Nottingham, UK
| | | | | | | | - Ian N Bruce
- The Kellgren Centre for Rheumatology, National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals National Health Service Foundation Trust and Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Yasmeen Ahmad
- Peter Maddison Rheumatology Centre, Betsi Cadwaladr University Health Board, Llandudno Hospital, Llandudno, UK
| | - Caroline Gordon
- University of Birmingham, National Institute for Health Research Wellcome Trust Clinical Research Facility, University Hospital Birmingham National Health Service Foundation Trust, and West Birmingham Hospitals National Health Service Trust, Birmingham, UK
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Thanou A, Stavrakis S, Dyer JW, Munroe ME, James JA, Merrill JT. Impact of heart rate variability, a marker for cardiac health, on lupus disease activity. Arthritis Res Ther 2016; 18:197. [PMID: 27590046 PMCID: PMC5010705 DOI: 10.1186/s13075-016-1087-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 08/02/2016] [Indexed: 01/17/2023] Open
Abstract
Background Decreased heart rate variability (HRV) is associated with adverse outcomes in cardiovascular diseases and has been observed in patients with systemic lupus erythematosus (SLE). We examined the relationship of HRV with SLE disease activity and selected cytokine pathways. Methods Fifty-three patients from the Oklahoma Lupus Cohort were evaluated at two visits each. Clinical assessments included the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), British Isles Lupus Assessment Group (BILAG) index, physician global assessment (PGA), and Safety of Estrogens in Lupus Erythematosus National Assessment-SLEDAI Flare Index. HRV was assessed with a 5-minute electrocardiogram, and the following HRV parameters were calculated: square root of the mean of the squares of differences between adjacent NN intervals (RMSSD), percentage of pairs of adjacent NN intervals differing by more than 50 milliseconds (pNN50), high-frequency power (HF power), and low frequency to high frequency (LF/HF) ratio, which reflects sympathetic/vagal balance. Plasma cytokine levels were measured with a multiplex, bead-based immunoassay. Serum B lymphocyte stimulator (BLyS) and a proliferation-inducing ligand (APRIL) were measured with an enzyme-linked immunosorbent assay. Linear regression analysis was applied. Results Baseline HRV (pNN50, HF power, LF/HF ratio) was inversely related to disease activity (BILAG, PGA) and flare. Changes in RMSSD between visits were inversely related to changes in SLEDAI (p = 0.007). Age, caffeine, tobacco and medication use had no impact on HRV. Plasma soluble tumor necrosis factor receptor II (sTNFRII) and monokine induced by interferon gamma (MIG) were inversely related with all baseline measures of HRV (p = 0.039 to <0.001). Plasma stem cell factor (SCF), interleukin (IL)-1 receptor antagonist (IL-1RA), and IL-15 showed similar inverse relationships with baseline HRV, and weaker trends were observed for interferon (IFN)-α, interferon gamma-induced protein (IP)-10, and serum BLyS. Changes in the LF/HF ratio between visits were also associated with changes in sTNFRII (p = 0.021), MIG (p = 0.003), IFN-α (p = 0.012), SCF (p = 0.001), IL-1RA (p = 0.023), and IL-15 (p = 0.010). On the basis of multivariate linear regression, MIG was an independent predictor of baseline HRV after adjusting for plasma IL-1RA, SCF, IFN-α, IP-10, and serum BLyS. In a similar model, the sTNFRII impact remained significant after adjusting for the same variables. Conclusions Impaired HRV, particularly the LF/HF ratio, is associated with lupus disease activity and several cytokines related to IFN type II and TNF pathways. The strongest association was with MIG and sTNFRII, expanding previous immune connections of vagal signaling. Electronic supplementary material The online version of this article (doi:10.1186/s13075-016-1087-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Aikaterini Thanou
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, 825 N.E. 13th Street, Oklahoma City, OK, 73104, USA.
| | - Stavros Stavrakis
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, 1200 Mark Everett Drive, TCH 6E103, Oklahoma City, OK, 73104, USA
| | - John W Dyer
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, 1200 Mark Everett Drive, TCH 6E103, Oklahoma City, OK, 73104, USA
| | - Melissa E Munroe
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, 825 N.E. 13th Street, Oklahoma City, OK, 73104, USA
| | - Judith A James
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, 825 N.E. 13th Street, Oklahoma City, OK, 73104, USA.,Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Joan T Merrill
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, 825 N.E. 13th Street, Oklahoma City, OK, 73104, USA
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Choi CB, Liang MH, Bae SC. Progress in defining clinically meaningful changes for clinical trials in nonrenal manifestations of SLE disease activity. Arthritis Res Ther 2016; 18:1. [PMID: 26732314 PMCID: PMC4718037 DOI: 10.1186/s13075-015-0906-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Since the 2002 Dusseldorf meeting, one new agent, Benlysta, has been approved by the US Food and Drug Administration for systemic lupus erythematosus. Experiences from the field in conducting trials of all the agents tested during this period have provided valuable practical insights. There has been incremental progress in defining the minimal clinically important difference (MCID) of key disease manifestations and the view is largely that of the health care providers and not that of the person suffering the disease. This basic methodological work on the MCID should improve the efficiency and the clinical relevance of future trials and their design.
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Affiliation(s)
- Chan-Bum Choi
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea.,Department of Aging, Brigham and Women's Hospital, Section of Rheumatology, 75 Francis St., Boston, MA, 02115, USA.,VA Healthcare System, 150 S Huntington Ave, Jamaica Plain, MA, 02130, USA
| | - Matthew H Liang
- Department of Aging, Brigham and Women's Hospital, Section of Rheumatology, 75 Francis St., Boston, MA, 02115, USA. .,Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
| | - Sang-Cheol Bae
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
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Murphy CL, Yee CS, Gordon C, Isenberg D. From BILAG to BILAG-based combined lupus assessment—30 years on. Rheumatology (Oxford) 2015; 55:1357-63. [DOI: 10.1093/rheumatology/kev387] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Indexed: 11/13/2022] Open
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Hui-Yuen JS, Reddy A, Taylor J, Li X, Eichenfield AH, Bermudez LM, Starr AJ, Imundo LF, Buyon J, Furie RA, Kamen DL, Manzi S, Petri M, Ramsey-Goldman R, van Vollenhoven RF, Wallace DJ, Askanase A. Safety and Efficacy of Belimumab to Treat Systemic Lupus Erythematosus in Academic Clinical Practices. J Rheumatol 2015; 42:2288-95. [PMID: 26523030 DOI: 10.3899/jrheum.150470] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To evaluate the use and efficacy of belimumab in academic practices. Belimumab is a human monoclonal antibody that inhibits soluble B lymphocyte stimulator and has been approved for the treatment of adults with systemic lupus erythematosus (SLE). METHODS Invitations to participate and complete a 1-page questionnaire for each patient prescribed belimumab were sent to 16 physicians experienced in SLE phase III clinical trials. The outcome was defined as the physician's impression of improvement in the initial manifestation(s) being treated without worsening in other organ systems. RESULTS Of 195 patients treated with belimumab at 10 academic centers, 96% were taking background medications for SLE at initiation of belimumab, with 74% taking corticosteroids. The main indications for initiation of belimumab were arthritis, rash, and/or worsening serologic activity, with 30% of patients unable to taper corticosteroids. Of the 120 patients taking belimumab for at least 6 months, 51% responded clinically and 67% had ≥ 25% improvement in laboratory values. While numbers are limited, black patients showed improvement at 6 months. In a subset of 39 patients with childhood-onset SLE, 65% responded favorably at 6 months, and 35% discontinued corticosteroids. CONCLUSION Our data demonstrate favorable clinical and laboratory outcomes in patients with SLE at 6 months across all racial and ethnic groups, with similar improvement seen among patients with childhood-onset SLE.
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Affiliation(s)
- Joyce S Hui-Yuen
- From the Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; New York University Langone Medical Center; Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center, New York; Hofstra North Shore-LIJ School of Medicine, Hempstead, New York; Medical University of South Carolina, Charleston, South Carolina; Temple University School of Medicine, Philadelphia, Pennsylvania; Johns Hopkins University School of Medicine, Baltimore, Maryland; Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Karolinska University Hospital, Stockholm, Sweden; Cedars-Sinai Medical Center, Los Angeles, California, USA.J.S. Hui-Yuen, MD, MSc, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A. Reddy, BSc, Research Assistant, New York University Langone Medical Center; J. Taylor, MD, Pediatric Resident, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; X. Li, BSc, Research Assistant, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; A.H. Eichenfield, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.M. Bermudez, MD, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A.J. Starr, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.F. Imundo, MD, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; J. Buyon, MD, Professor, New York University Langone Medical
| | - Arthi Reddy
- From the Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; New York University Langone Medical Center; Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center, New York; Hofstra North Shore-LIJ School of Medicine, Hempstead, New York; Medical University of South Carolina, Charleston, South Carolina; Temple University School of Medicine, Philadelphia, Pennsylvania; Johns Hopkins University School of Medicine, Baltimore, Maryland; Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Karolinska University Hospital, Stockholm, Sweden; Cedars-Sinai Medical Center, Los Angeles, California, USA.J.S. Hui-Yuen, MD, MSc, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A. Reddy, BSc, Research Assistant, New York University Langone Medical Center; J. Taylor, MD, Pediatric Resident, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; X. Li, BSc, Research Assistant, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; A.H. Eichenfield, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.M. Bermudez, MD, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A.J. Starr, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.F. Imundo, MD, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; J. Buyon, MD, Professor, New York University Langone Medical
| | - Jennifer Taylor
- From the Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; New York University Langone Medical Center; Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center, New York; Hofstra North Shore-LIJ School of Medicine, Hempstead, New York; Medical University of South Carolina, Charleston, South Carolina; Temple University School of Medicine, Philadelphia, Pennsylvania; Johns Hopkins University School of Medicine, Baltimore, Maryland; Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Karolinska University Hospital, Stockholm, Sweden; Cedars-Sinai Medical Center, Los Angeles, California, USA.J.S. Hui-Yuen, MD, MSc, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A. Reddy, BSc, Research Assistant, New York University Langone Medical Center; J. Taylor, MD, Pediatric Resident, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; X. Li, BSc, Research Assistant, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; A.H. Eichenfield, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.M. Bermudez, MD, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A.J. Starr, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.F. Imundo, MD, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; J. Buyon, MD, Professor, New York University Langone Medical
| | - Xiaoqing Li
- From the Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; New York University Langone Medical Center; Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center, New York; Hofstra North Shore-LIJ School of Medicine, Hempstead, New York; Medical University of South Carolina, Charleston, South Carolina; Temple University School of Medicine, Philadelphia, Pennsylvania; Johns Hopkins University School of Medicine, Baltimore, Maryland; Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Karolinska University Hospital, Stockholm, Sweden; Cedars-Sinai Medical Center, Los Angeles, California, USA.J.S. Hui-Yuen, MD, MSc, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A. Reddy, BSc, Research Assistant, New York University Langone Medical Center; J. Taylor, MD, Pediatric Resident, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; X. Li, BSc, Research Assistant, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; A.H. Eichenfield, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.M. Bermudez, MD, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A.J. Starr, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.F. Imundo, MD, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; J. Buyon, MD, Professor, New York University Langone Medical
| | - Andrew H Eichenfield
- From the Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; New York University Langone Medical Center; Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center, New York; Hofstra North Shore-LIJ School of Medicine, Hempstead, New York; Medical University of South Carolina, Charleston, South Carolina; Temple University School of Medicine, Philadelphia, Pennsylvania; Johns Hopkins University School of Medicine, Baltimore, Maryland; Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Karolinska University Hospital, Stockholm, Sweden; Cedars-Sinai Medical Center, Los Angeles, California, USA.J.S. Hui-Yuen, MD, MSc, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A. Reddy, BSc, Research Assistant, New York University Langone Medical Center; J. Taylor, MD, Pediatric Resident, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; X. Li, BSc, Research Assistant, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; A.H. Eichenfield, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.M. Bermudez, MD, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A.J. Starr, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.F. Imundo, MD, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; J. Buyon, MD, Professor, New York University Langone Medical
| | - Liza M Bermudez
- From the Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; New York University Langone Medical Center; Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center, New York; Hofstra North Shore-LIJ School of Medicine, Hempstead, New York; Medical University of South Carolina, Charleston, South Carolina; Temple University School of Medicine, Philadelphia, Pennsylvania; Johns Hopkins University School of Medicine, Baltimore, Maryland; Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Karolinska University Hospital, Stockholm, Sweden; Cedars-Sinai Medical Center, Los Angeles, California, USA.J.S. Hui-Yuen, MD, MSc, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A. Reddy, BSc, Research Assistant, New York University Langone Medical Center; J. Taylor, MD, Pediatric Resident, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; X. Li, BSc, Research Assistant, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; A.H. Eichenfield, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.M. Bermudez, MD, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A.J. Starr, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.F. Imundo, MD, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; J. Buyon, MD, Professor, New York University Langone Medical
| | - Amy J Starr
- From the Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; New York University Langone Medical Center; Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center, New York; Hofstra North Shore-LIJ School of Medicine, Hempstead, New York; Medical University of South Carolina, Charleston, South Carolina; Temple University School of Medicine, Philadelphia, Pennsylvania; Johns Hopkins University School of Medicine, Baltimore, Maryland; Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Karolinska University Hospital, Stockholm, Sweden; Cedars-Sinai Medical Center, Los Angeles, California, USA.J.S. Hui-Yuen, MD, MSc, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A. Reddy, BSc, Research Assistant, New York University Langone Medical Center; J. Taylor, MD, Pediatric Resident, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; X. Li, BSc, Research Assistant, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; A.H. Eichenfield, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.M. Bermudez, MD, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A.J. Starr, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.F. Imundo, MD, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; J. Buyon, MD, Professor, New York University Langone Medical
| | - Lisa F Imundo
- From the Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; New York University Langone Medical Center; Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center, New York; Hofstra North Shore-LIJ School of Medicine, Hempstead, New York; Medical University of South Carolina, Charleston, South Carolina; Temple University School of Medicine, Philadelphia, Pennsylvania; Johns Hopkins University School of Medicine, Baltimore, Maryland; Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Karolinska University Hospital, Stockholm, Sweden; Cedars-Sinai Medical Center, Los Angeles, California, USA.J.S. Hui-Yuen, MD, MSc, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A. Reddy, BSc, Research Assistant, New York University Langone Medical Center; J. Taylor, MD, Pediatric Resident, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; X. Li, BSc, Research Assistant, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; A.H. Eichenfield, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.M. Bermudez, MD, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A.J. Starr, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.F. Imundo, MD, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; J. Buyon, MD, Professor, New York University Langone Medical
| | - Jill Buyon
- From the Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; New York University Langone Medical Center; Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center, New York; Hofstra North Shore-LIJ School of Medicine, Hempstead, New York; Medical University of South Carolina, Charleston, South Carolina; Temple University School of Medicine, Philadelphia, Pennsylvania; Johns Hopkins University School of Medicine, Baltimore, Maryland; Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Karolinska University Hospital, Stockholm, Sweden; Cedars-Sinai Medical Center, Los Angeles, California, USA.J.S. Hui-Yuen, MD, MSc, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A. Reddy, BSc, Research Assistant, New York University Langone Medical Center; J. Taylor, MD, Pediatric Resident, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; X. Li, BSc, Research Assistant, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; A.H. Eichenfield, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.M. Bermudez, MD, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A.J. Starr, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.F. Imundo, MD, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; J. Buyon, MD, Professor, New York University Langone Medical
| | - Richard A Furie
- From the Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; New York University Langone Medical Center; Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center, New York; Hofstra North Shore-LIJ School of Medicine, Hempstead, New York; Medical University of South Carolina, Charleston, South Carolina; Temple University School of Medicine, Philadelphia, Pennsylvania; Johns Hopkins University School of Medicine, Baltimore, Maryland; Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Karolinska University Hospital, Stockholm, Sweden; Cedars-Sinai Medical Center, Los Angeles, California, USA.J.S. Hui-Yuen, MD, MSc, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A. Reddy, BSc, Research Assistant, New York University Langone Medical Center; J. Taylor, MD, Pediatric Resident, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; X. Li, BSc, Research Assistant, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; A.H. Eichenfield, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.M. Bermudez, MD, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A.J. Starr, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.F. Imundo, MD, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; J. Buyon, MD, Professor, New York University Langone Medical
| | - Diane L Kamen
- From the Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; New York University Langone Medical Center; Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center, New York; Hofstra North Shore-LIJ School of Medicine, Hempstead, New York; Medical University of South Carolina, Charleston, South Carolina; Temple University School of Medicine, Philadelphia, Pennsylvania; Johns Hopkins University School of Medicine, Baltimore, Maryland; Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Karolinska University Hospital, Stockholm, Sweden; Cedars-Sinai Medical Center, Los Angeles, California, USA.J.S. Hui-Yuen, MD, MSc, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A. Reddy, BSc, Research Assistant, New York University Langone Medical Center; J. Taylor, MD, Pediatric Resident, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; X. Li, BSc, Research Assistant, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; A.H. Eichenfield, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.M. Bermudez, MD, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A.J. Starr, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.F. Imundo, MD, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; J. Buyon, MD, Professor, New York University Langone Medical
| | - Susan Manzi
- From the Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; New York University Langone Medical Center; Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center, New York; Hofstra North Shore-LIJ School of Medicine, Hempstead, New York; Medical University of South Carolina, Charleston, South Carolina; Temple University School of Medicine, Philadelphia, Pennsylvania; Johns Hopkins University School of Medicine, Baltimore, Maryland; Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Karolinska University Hospital, Stockholm, Sweden; Cedars-Sinai Medical Center, Los Angeles, California, USA.J.S. Hui-Yuen, MD, MSc, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A. Reddy, BSc, Research Assistant, New York University Langone Medical Center; J. Taylor, MD, Pediatric Resident, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; X. Li, BSc, Research Assistant, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; A.H. Eichenfield, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.M. Bermudez, MD, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A.J. Starr, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.F. Imundo, MD, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; J. Buyon, MD, Professor, New York University Langone Medical
| | - Michelle Petri
- From the Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; New York University Langone Medical Center; Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center, New York; Hofstra North Shore-LIJ School of Medicine, Hempstead, New York; Medical University of South Carolina, Charleston, South Carolina; Temple University School of Medicine, Philadelphia, Pennsylvania; Johns Hopkins University School of Medicine, Baltimore, Maryland; Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Karolinska University Hospital, Stockholm, Sweden; Cedars-Sinai Medical Center, Los Angeles, California, USA.J.S. Hui-Yuen, MD, MSc, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A. Reddy, BSc, Research Assistant, New York University Langone Medical Center; J. Taylor, MD, Pediatric Resident, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; X. Li, BSc, Research Assistant, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; A.H. Eichenfield, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.M. Bermudez, MD, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A.J. Starr, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.F. Imundo, MD, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; J. Buyon, MD, Professor, New York University Langone Medical
| | - Rosalind Ramsey-Goldman
- From the Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; New York University Langone Medical Center; Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center, New York; Hofstra North Shore-LIJ School of Medicine, Hempstead, New York; Medical University of South Carolina, Charleston, South Carolina; Temple University School of Medicine, Philadelphia, Pennsylvania; Johns Hopkins University School of Medicine, Baltimore, Maryland; Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Karolinska University Hospital, Stockholm, Sweden; Cedars-Sinai Medical Center, Los Angeles, California, USA.J.S. Hui-Yuen, MD, MSc, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A. Reddy, BSc, Research Assistant, New York University Langone Medical Center; J. Taylor, MD, Pediatric Resident, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; X. Li, BSc, Research Assistant, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; A.H. Eichenfield, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.M. Bermudez, MD, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A.J. Starr, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.F. Imundo, MD, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; J. Buyon, MD, Professor, New York University Langone Medical
| | - Ronald F van Vollenhoven
- From the Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; New York University Langone Medical Center; Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center, New York; Hofstra North Shore-LIJ School of Medicine, Hempstead, New York; Medical University of South Carolina, Charleston, South Carolina; Temple University School of Medicine, Philadelphia, Pennsylvania; Johns Hopkins University School of Medicine, Baltimore, Maryland; Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Karolinska University Hospital, Stockholm, Sweden; Cedars-Sinai Medical Center, Los Angeles, California, USA.J.S. Hui-Yuen, MD, MSc, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A. Reddy, BSc, Research Assistant, New York University Langone Medical Center; J. Taylor, MD, Pediatric Resident, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; X. Li, BSc, Research Assistant, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; A.H. Eichenfield, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.M. Bermudez, MD, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A.J. Starr, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.F. Imundo, MD, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; J. Buyon, MD, Professor, New York University Langone Medical
| | - Daniel J Wallace
- From the Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; New York University Langone Medical Center; Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center, New York; Hofstra North Shore-LIJ School of Medicine, Hempstead, New York; Medical University of South Carolina, Charleston, South Carolina; Temple University School of Medicine, Philadelphia, Pennsylvania; Johns Hopkins University School of Medicine, Baltimore, Maryland; Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Karolinska University Hospital, Stockholm, Sweden; Cedars-Sinai Medical Center, Los Angeles, California, USA.J.S. Hui-Yuen, MD, MSc, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A. Reddy, BSc, Research Assistant, New York University Langone Medical Center; J. Taylor, MD, Pediatric Resident, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; X. Li, BSc, Research Assistant, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; A.H. Eichenfield, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.M. Bermudez, MD, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A.J. Starr, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.F. Imundo, MD, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; J. Buyon, MD, Professor, New York University Langone Medical
| | - Anca Askanase
- From the Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; New York University Langone Medical Center; Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center, New York; Hofstra North Shore-LIJ School of Medicine, Hempstead, New York; Medical University of South Carolina, Charleston, South Carolina; Temple University School of Medicine, Philadelphia, Pennsylvania; Johns Hopkins University School of Medicine, Baltimore, Maryland; Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Karolinska University Hospital, Stockholm, Sweden; Cedars-Sinai Medical Center, Los Angeles, California, USA.J.S. Hui-Yuen, MD, MSc, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A. Reddy, BSc, Research Assistant, New York University Langone Medical Center; J. Taylor, MD, Pediatric Resident, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; X. Li, BSc, Research Assistant, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; A.H. Eichenfield, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.M. Bermudez, MD, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A.J. Starr, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.F. Imundo, MD, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; J. Buyon, MD, Professor, New York University Langone Medical
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Mikdashi J, Nived O. Measuring disease activity in adults with systemic lupus erythematosus: the challenges of administrative burden and responsiveness to patient concerns in clinical research. Arthritis Res Ther 2015; 17:183. [PMID: 26189728 PMCID: PMC4507322 DOI: 10.1186/s13075-015-0702-6] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Measuring lupus disease activity accurately remains a challenging and demanding task given the complex multi-system nature of lupus, an illness known for its variability between patients and within the same patient over time. Many have attempted to define what disease activity means and how it should be measured, and several instruments were devised for a standardized assessment of disease activity and outcome domains in clinical research. Several of these measuring tools have been able to detect clinical improvement and have demonstrated adequate reliability, validity, and sensitivity to change in observational studies, and some were found to be useful in randomized controlled trials. However, several failed clinical trials have confronted these metrics, as they were not intended for clinical trials. The Outcome Measures Rheumatology group and the US Food and Drug Administration have recommended using measures of disease activity, cumulative organ damage, health-related quality of life, and adverse events as outcomes of interest. Composite responder indices that determine disease global improvement, ensure no significant worsening in unaffected organ systems, and include a physician’s global assessment have been used in randomized clinical trials. Yet unmet therapeutic needs were further challenged by the complex content and psychometric information of the updated instruments, including increased administrative burden associated with demanding training and cost of instruments, and small effect size associated with responsiveness to patient concerns. Nevertheless, with the progress of novel targeted therapy, refining the disease activity metrics is essential. Selection of the disease activity endpoints which is a defining aspect of clinical trial design must be tailored to the outcome of interest and measured by a reliably rated scale characterized by minimal administrative burden. An optimal scale should be simple and practical and incorporate elements of patient concerns.
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Affiliation(s)
- Jamal Mikdashi
- Division of Rheumatology and Clinical Immunology, University of Maryland School of Medicine, 10 South Pine Street, Suite 834, Baltimore, MD, 21201, USA.
| | - Ola Nived
- Department of Rheumatology, Institution of Clinical Sciences, Lund University Hosptial, SE-221 85, Lund, Sweden
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Abstract
Systemic lupus erythematosus (SLE) is a life-threatening multisystem inflammatory condition that may affect almost any part of the eye. We provide an update for the practicing ophthalmologist comprising a systematic review of the recent literature presented in the context of current knowledge of the pathogenesis, diagnosis, and treatment of this condition. We review recent advances in the understanding of the influence of genetic and environmental factors on the development of SLE. Recent changes in the diagnostic criteria for SLE are considered. We assess the potential for novel molecular biomarkers to find a clinical application in disease diagnosis and stratification and in the development of therapeutic agents. We discuss limited forms of SLE and their differentiation from other collagen vascular disorders and review recent evidence underlying the use of established and novel therapeutics in this condition, including specific implications regarding monitoring for ocular toxicity associated with antimalarials.
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Abstract
PURPOSE OF REVIEW To provide an update on the advances in the assessment of disease activity and damage in systemic lupus erythematosus. RECENT FINDINGS Over the last couple of years, the development of composite responder indices has led to better description of the changes in disease activity, especially for clinical trials. It has been recognized that newer composite responder indices such as Systemic Lupus Erythematosus Responder Index (SRI) and BILAG-based Combined Lupus Assessment (BICLA) capture more comprehensive clinical response as they integrate global lupus assessment, system-based assessment, physician's global assessment and treatment failure defined as an increase in the dose of steroid and/or immunosuppressant. The Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) Responder Index 50 (SRI-50) may be more practical for capturing response in clinical practice. British Isles Lupus Assessment Group 2004 (BILAG 2004) Index may capture flare slightly better than the other available flare indices whilst also capturing response. SUMMARY This review will provide an insight into the various tools available to assess disease activity and damage in lupus, with a particular focus on the new responder indices currently in use.
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Hickman RA, Hira-Kazal R, Yee CS, Toescu V, Gordon C. The efficacy and safety of rituximab in a chart review study of 15 patients with systemic lupus erythematosus. Clin Rheumatol 2015; 34:263-71. [PMID: 25564308 DOI: 10.1007/s10067-014-2839-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 12/01/2014] [Accepted: 12/02/2014] [Indexed: 01/21/2023]
Abstract
In contrast to randomised clinical trials, open-label studies have suggested that B cell depletion by a course of rituximab is associated with a significant clinical benefit. Our aim was to assess the safety and efficacy of rituximab in 15 refractory lupus patients, particularly those with more than one course of therapy. Disease activity was measured by the classic British Isles Lupus Assessment Group (BILAG) index, anti-DNA antibodies and complement levels. We assessed immunoglobulin levels, functional antibodies and serious adverse events. The mean patient age ± SD was 37.9 ± 7.2 years and mean disease duration was 8.5 ± 3.3 years; 46% were Afro-Caribbean, 27% South Asian, 20% Caucasian and 7% others. Twelve patients responded by 6 months; six avoided major flare for >1 year. Complete absence of disease activity (BILAG D/E) lasted for 5.5 (SD 3.8) months and 4.8 (SD 3.6) months after the first (n = 15) and second (n = 9) rituximab course, respectively. The mean 6-month reduction in daily prednisolone was 10.4 (SD 11.4) mg/day and 10.7 (SD 9.3) mg/day from baseline after the first and second course, respectively. Patients with low C3/C4 normalised their C3 by 6 months. Most patients with raised anti-dsDNA normalised after rituximab courses. Serious adverse events only occurred after more than four courses of rituximab. Rituximab was safe and efficacious for treating patients with refractory systemic lupus erythematosus (SLE) and was associated with significant steroid reduction, but more than four courses of rituximab was associated with an increased risk of serious infection in two patients.
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Affiliation(s)
- R A Hickman
- Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
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Castrejón I, Rúa-Figueroa I, Rosario MP, Carmona L. Índices compuestos para evaluar la actividad de la enfermedad y el daño estructural en pacientes con lupus eritematoso: revisión sistemática de la literatura. ACTA ACUST UNITED AC 2014; 10:309-20. [DOI: 10.1016/j.reuma.2014.01.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 12/09/2013] [Accepted: 01/31/2014] [Indexed: 11/26/2022]
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Feld J, Isenberg D. Why and how should we measure disease activity and damage in lupus? Presse Med 2014; 43:e151-6. [DOI: 10.1016/j.lpm.2014.03.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 03/04/2014] [Indexed: 11/25/2022] Open
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Watanabe H, Hirase N, Goda H, Nishikawa H, Ikuyama S. Oral low-dose tacrolimus therapy for refractory hemophagocytic syndrome associated with systemic lupus erythematosus. Mod Rheumatol 2014. [DOI: 10.3109/s10165-011-0491-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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