1
|
Convertino I, Cazzato M, Tillati S, Giometto S, Gini R, Valdiserra G, Cappello E, Ferraro S, Bonaso M, Bartolini C, Paoletti O, Lorenzoni V, Trieste L, Filippi M, Turchetti G, Cristofano M, Blandizzi C, Mosca M, Lucenteforte E, Tuccori M. Assessing disease activity of rheumatoid arthritis patients and drug-utilization patterns of biologic disease-modifying antirheumatic drugs in the Tuscany region, Italy. Front Pharmacol 2023; 14:1244486. [PMID: 37818193 PMCID: PMC10561246 DOI: 10.3389/fphar.2023.1244486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/04/2023] [Indexed: 10/12/2023] Open
Abstract
Introduction: The disease activity associated with the drug-utilization patterns of biologic Disease Modifying Anti-Rheumatic Drugs (DMARDs) is poorly investigated in real-world studies on rheumatoid arthritis (RA) patients. To investigate the relationship between biologic DMARD initiation/discontinuations in RA patients identified in the healthcare administrative databases of Tuscany and the Disease Activity Score 28 (DAS28) reported in the medical charts. Methods: This retrospective population-based study included RA's first-ever biologic DMARD users of the Pisa University Hospital from 2014 to 2016. Patients were followed up until 31 December 2019. We evaluated the DAS28 recorded before (T0) and after (T1) the biologic DMARD initiation and before (TD0) and after (TD1) discontinuations. Patients were classified as "off-target" (DAS28 > 3.2) or "in-target" (DAS28 ≤ 3.2). We described the disease activity trends at initiation and discontinuation. Results: Ninety-five users were included (73 women, mean age 59.6). Among 70 patients (74%) with at least three DAS28 measures, 28 (40.0%) were off-target at T0 and 38 (54.3%) in-target at T1. Thirty-three (47%) patients had at least one discontinuation, among those with at least three DAS28 assessments. In the disease activity trend, disease stability or improvement was observed in 28 out of 37 (75.7%) patients at initiation and in 24 out of 37 (64.9%) at discontinuation. Discussion: Biologic DMARD discontinuations identified in the healthcare administrative databasese of Tuscany are frequently observed in situations of controlled RA disease. Further studies are warranted to confirm that these events can be used in studies using healthcare administrative databases as proxies of treatment effectiveness.
Collapse
Affiliation(s)
- Irma Convertino
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Silvia Tillati
- Unit of Medical Statistics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sabrina Giometto
- Unit of Medical Statistics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Rosa Gini
- Tuscan Regional Healthcare Agency, Florence, Italy
| | - Giulia Valdiserra
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Emiliano Cappello
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sara Ferraro
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marco Bonaso
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | | | | | - Leopoldo Trieste
- Institute of Management, Scuola Superiore Sant’Anna, Pisa, Italy
| | - Matteo Filippi
- Direzione Medica di Presidio, University Hospital of Pisa, Pisa, Italy
| | | | | | - Corrado Blandizzi
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Unit of Adverse Drug Reactions Monitoring, University Hospital of Pisa, Pisa, Italy
| | - Marta Mosca
- Unit of Rheumatology, University Hospital of Pisa, Pisa, Italy
| | - Ersilia Lucenteforte
- Unit of Medical Statistics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marco Tuccori
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Unit of Adverse Drug Reactions Monitoring, University Hospital of Pisa, Pisa, Italy
| |
Collapse
|
2
|
Fletcher A, Lassere M, March L, Hill C, Barrett C, Carroll G, Buchbinder R. OUP accepted manuscript. Rheumatology (Oxford) 2022; 61:3939-3951. [PMID: 35094044 PMCID: PMC9536792 DOI: 10.1093/rheumatology/keac048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 01/17/2022] [Indexed: 11/14/2022] Open
Abstract
Objective The aim of this study was to describe treatment patterns in RA, including the frequency and reasons for switching or stopping biologic and targeted synthetic DMARDs (b/tsDMARDs). Methods The reasons for switching or stopping b/tsDMARDs were extracted from the Australian Rheumatology Association Database (ARAD) from 2003 to 2018 for RA participants. Switching patterns for each b/tsDMARD and time on first-, second- and third-line b/tsDMARDs were evaluated using Sankey diagrams and survival methods. Results A total of 2839 participants were included in the analysis. The first-line b/tsDMARDs were etanercept (n = 1414), adalimumab (n = 1024), infliximab (n = 155), golimumab (n = 98), abatacept (n = 66), certolizumab (n = 38), tocilizumab (n = 21) and tofacitinib (n = 23). Of those starting first-, second- and third-line biologic therapy, 24.0%, 31.8% and 24.4% switched to another b/tsDMARD within 12 months, respectively. Inefficacy or adverse effects were the most common reasons for stopping therapy, irrespective of line of treatment. Compared with first-line etanercept, participants were more likely to stop adalimumab [Hazard ratio (HR) 1.16, 95% CI: 1.04, 1.29] and infliximab (HR 1.77, 95% CI: 1.46, 2.16). No differences were seen for other b/tsDMARDs. For second-line therapies compared with etanercept, the risk of stopping was lower for tocilizumab (HR 0.41, 95% CI: 0.25, 0.70), rituximab (HR 0.51, 95% CI: 0.30, 0.85) and tofacitinib (HR 0.29, 95% CI: 0.15, 0.57). Participants taking rituximab, tocilizumab and tofacitinib were also less likely to stop third-line therapy in comparison with participants taking etanercept. Conclusions Switching between b/tsDMARDs was common among ARAD participants with RA, most commonly due to inefficacy or adverse effects. Durability of exposure and reasons for switching varied between b/tsDMARDs.
Collapse
Affiliation(s)
- Ashley Fletcher
- Correspondence to: Ashley Fletcher, 4 Drysdale Street, Malvern VIC 3144, Australia. E-mail:
| | - Marissa Lassere
- Department of Rheumatology, St George Hospital
- Department of Medicine, School of Population Health, University of New South Wales
| | - Lyn March
- Florance and Cope Professorial Department of Rheumatology, Royal North Shore Hospital
- Department of Rheumatology, Institute of Bone and Joint Research at Kolling Institute, University of Sydney, Sydney, NSW
| | - Catherine Hill
- Department of Rheumatology, The Queen Elizabeth and Royal Adelaide Hospitals
- Department of Rheumatology, Discipline of Medicine, University of Adelaide, Adelaide, SA
| | - Claire Barrett
- Department of Rheumatology, Redcliffe Hospital, Redcliffe
- Department of Medicine, School of Medicine, University of Queensland, Brisbane, QLD
| | - Graeme Carroll
- Department of Rheumatology, Fiona Stanley Hospital, Perth, WA, Australia
| | - Rachelle Buchbinder
- Monash–Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC
| |
Collapse
|
3
|
Holdsworth EA, Donaghy B, Fox KM, Desai P, Collier DH, Furst DE. Biologic and Targeted Synthetic DMARD Utilization in the United States: Adelphi Real World Disease Specific Programme for Rheumatoid Arthritis. Rheumatol Ther 2021; 8:1637-1649. [PMID: 34487340 PMCID: PMC8572299 DOI: 10.1007/s40744-021-00357-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 08/03/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction In patients with inadequate response or intolerance to first biologic disease-modifying antirheumatic drug (bDMARD), guidelines recommend switching to an agent of different mechanism of action or to another bDMARD. However, the reasons behind switching between bDMARD/targeted synthetic (ts)DMARD are not well documented in many studies. The objective of this study was to assess the rheumatologists’ perceptions and behaviors towards choice of initial b/tsDMARD treatment and reasons for switching between bDMARDs/tsDMARDs, in the context of present treatment patterns. Methods This was a retrospective analysis of data collected from the 12th Adelphi Real World Disease Specific Programme for rheumatoid arthritis (RA). Qualified rheumatologists involved in treatment decision-making for ≥ 10 patients a month completed patient record forms (PRFs). Patients aged ≥ 18 years with RA diagnosis and receiving bDMARD/tsDMARD were included. The outcomes assessed were proportion of patients receiving bDMARD/tsDMARD at molecule and class levels; rheumatologist-reported reasons for choice of therapy; proportion of patients who switched bDMARDs/tsDMARDs; and rheumatologist-reported reasons for switching therapies. Results Eighty-six rheumatologists completed PRFs for 1027 patients. Of these, 621 were receiving bDMARD/tsDMARD at data collection. The majority (73%) of patients received first-line bDMARD/tsDMARD, and at first-line, 68% received a tumor necrosis factor inhibitor (TNFi) and 21% received a Janus kinase inhibitor (JAKi). The response option of strong overall efficacy was the primary reason for selecting first-line and second-line bDMARD/tsDMARD. A total of 163 patients had switched from first-line b/tsDMARD to second-line b/tsDMARD therapy. Of these, 44, 28, and 17% had switched from TNFi to another TNFi, TNFi to non-TNF biologic, and TNFi to JAKi, respectively. Lack of efficacy and worsening disease were the most frequent reasons for switching therapies. Conclusions TNFis remain the most prescribed b/tsDMARD for first-line and second-line treatments. Strong overall efficacy was the primary reason for selecting therapy and loss of efficacy was the primary reason for switching therapy. Supplementary Information The online version contains supplementary material available at 10.1007/s40744-021-00357-1.
Collapse
Affiliation(s)
| | | | | | | | | | - Daniel E Furst
- Division of Rheumatology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.,University of Washington, Seattle, WA, USA.,University of Florence, Florence, Italy
| |
Collapse
|
4
|
Li KJ, Chang CL, Hsin CY, Tang CH. Switching and Discontinuation Pattern of Biologic Disease-Modifying Antirheumatic Drugs and Tofacitinib for Patients With Rheumatoid Arthritis in Taiwan. Front Pharmacol 2021; 12:628548. [PMID: 34366836 PMCID: PMC8333863 DOI: 10.3389/fphar.2021.628548] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 07/06/2021] [Indexed: 01/09/2023] Open
Abstract
Rheumatoid arthritis (RA) is a chronic inflammatory systemic disease characterized by persistent joint synovial inflammation and swelling, leading to cartilage damage and bone erosion. This retrospective, longitudinal study is to evaluate the treatment patterns of biologic-naïve RA patients receiving index biologic disease-modifying antirheumatic drug (bDMARD) and tofacitinib by the data of Taiwan National Healthcare Insurance Claims and the Death Registry between 2012 and 2017. Drug survival and treatment patterns were determined by investigating the occurrence of switching and discontinuation from index treatment. At baseline, 70.0% of patients used tumor necrosis factor inhibitors (TNFi) bDMARD with the majority taking etanercept (27.0%) or adalimumab (26.2%). During the follow-up period, 40.0% (n = 3,464) of index users switched (n = 1,479) or discontinued (n = 1,985) the treatment with an average incidence rate of 0.18 per patient-year. Among the six index treatment groups, drug survival was the lowest for adalimumab and highest for tocilizumab. When compared with etanercept, only adalimumab had a higher cumulative probability of switching/discontinuation (adjusted HR = 1.17, 95% CI: 1.08-1.28), whereas golimumab, non-TNFi bDMARDs and tofacitinib were significantly less probable to switch or discontinue. For patients switching the index treatment, tocilizumab (31.2%) and tofacitinib (23.4%) were the main regimens being switched to. In addition, 48.2% of patients who discontinued the index treatment received further retreatment, and 63.8-77.0% of them were retreated with same agent. In conclusion, this population-based study found that TNFi were the preferred agents as the index treatments during 2012-2017. Non-TNFi and tofacitinib were more common second-line agents being switched to. Nearly half of discontinued patients received retreatment, with a majority receiving the same agent.
Collapse
Affiliation(s)
- Ko-Jen Li
- Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan
| | - Chia-Li Chang
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei City, Taiwan
| | | | - Chao-Hsiun Tang
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei City, Taiwan
| |
Collapse
|
5
|
Xiao Q, Li X, Li Y, Wu Z, Xu C, Chen Z, He W. Biological drug and drug delivery-mediated immunotherapy. Acta Pharm Sin B 2021; 11:941-960. [PMID: 33996408 PMCID: PMC8105778 DOI: 10.1016/j.apsb.2020.12.018] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/03/2020] [Accepted: 11/15/2020] [Indexed: 12/11/2022] Open
Abstract
The initiation and development of major inflammatory diseases, i.e., cancer, vascular inflammation, and some autoimmune diseases are closely linked to the immune system. Biologics-based immunotherapy is exerting a critical role against these diseases, whereas the usage of the immunomodulators is always limited by various factors such as susceptibility to digestion by enzymes in vivo, poor penetration across biological barriers, and rapid clearance by the reticuloendothelial system. Drug delivery strategies are potent to promote their delivery. Herein, we reviewed the potential targets for immunotherapy against the major inflammatory diseases, discussed the biologics and drug delivery systems involved in the immunotherapy, particularly highlighted the approved therapy tactics, and finally offer perspectives in this field.
Collapse
Key Words
- AAs, amino acids
- ACT, adoptive T cell therapy
- AHC, Chlamydia pneumonia
- ALL, acute lymphoblastic leukemia
- AP, ascorbyl palmitate
- APCs, antigen-presenting cells
- AS, atherosclerosis
- ASIT, antigen-specific immunotherapy
- Adoptive cell transfer
- ApoA–I, apolipoprotein A–I
- ApoB LPs, apolipoprotein-B-containing lipoproteins
- Atherosclerosis
- BMPR-II, bone morphogenetic protein type II receptor
- Biologics
- Bregs, regulatory B lymphocytes
- CAR, chimeric antigen receptor
- CCR9–CCL25, CC receptor 9–CC chemokine ligand 25
- CD, Crohn's disease
- CETP, cholesterol ester transfer protein
- CTLA-4, cytotoxic T-lymphocyte-associated protein-4
- CX3CL1, CXXXC-chemokine ligand 1
- CXCL 16, CXC-chemokine ligand 16
- CXCR 2, CXC-chemokine receptor 2
- Cancer immunotherapy
- CpG ODNs, CpG oligodeoxynucleotides
- DAMPs, danger-associated molecular patterns
- DCs, dendritic cells
- DDS, drug delivery system
- DMARDs, disease-modifying antirheumatic drugs
- DMPC, 1,2-dimyristoyl-sn-glycero-3-phosphatidylcholine
- DSS, dextran sulfate sodium
- Dex, dexamethasone
- Drug delivery
- ECM, extracellular matrix
- ECs, endothelial cells
- EGFR, epidermal growth factor receptor
- EPR, enhanced permeability and retention effect
- ET-1, endothelin-1
- ETAR, endothelin-1 receptor type A
- FAO, fatty acid oxidation
- GM-CSF, granulocyte–macrophage colony-stimulating factor
- HA, hyaluronic acid
- HDL, high density lipoprotein
- HER2, human epidermal growth factor-2
- IBD, inflammatory bowel diseases
- ICOS, inducible co-stimulator
- ICP, immune checkpoint
- IFN, interferon
- IL, interleukin
- IT-hydrogel, inflammation-targeting hydrogel
- Immune targets
- Inflammatory diseases
- JAK, Janus kinase
- LAG-3, lymphocyte-activation gene 3
- LDL, low density lipoprotein
- LPS, lipopolysaccharide
- LTB4, leukotriene B4
- MCP-1, monocyte chemotactic protein-1
- MCT, monocrotaline
- MDSC, myeloid-derived suppressor cell
- MHCs, major histocompatibility complexes
- MHPC, 1-myristoyl-2-hydroxy-sn-glycero-phosphocholine
- MIF, migration inhibitory factor
- MM, multiple myeloma
- MMP, matrix metalloproteinase
- MOF, metal–organic framework
- MPO, myeloperoxidase
- MSCs, mesenchymal stem cells
- NF-κB, nuclear factor κ-B
- NK, natural killer
- NPs, nanoparticles
- NSAIDs, nonsteroidal anti-inflammatory drugs
- PAECs, pulmonary artery endothelial cells
- PAH, pulmonary arterial hypertension
- PASMCs, pulmonary arterial smooth muscle cells
- PBMCs, peripheral blood mononuclear cells
- PCSK9, proprotein convertase subtilisin kexin type 9
- PD-1, programmed death protein-1
- PD-L1, programmed cell death-ligand 1
- PLGA, poly lactic-co-glycolic acid
- Pulmonary artery hypertension
- RA, rheumatoid arthritis
- ROS, reactive oxygen species
- SHP-2, Src homology 2 domain–containing tyrosine phosphatase 2
- SLE, systemic lupus erythematosus
- SMCs, smooth muscle cells
- Src, sarcoma gene
- TCR, T cell receptor
- TGF-β, transforming growth factor β
- TILs, tumor-infiltrating lymphocytes
- TIM-3, T-cell immunoglobulin mucin 3
- TLR, Toll-like receptor
- TNF, tumor necrosis factor
- TRAF6, tumor necrosis factor receptor-associated factor 6
- Teff, effector T cell
- Th17, T helper 17
- Tph, T peripheral helper
- Tregs, regulatory T cells
- UC, ulcerative colitis
- VEC, vascular endothelial cadherin
- VEGF, vascular endothelial growth factor
- VISTA, V-domain immunoglobulin-containing suppressor of T-cell activation
- YCs, yeast-derived microcapsules
- bDMARDs, biological DMARDs
- hsCRP, high-sensitivity C-reactive protein
- mAbs, monoclonal antibodies
- mPAP, mean pulmonary artery pressure
- nCmP, nanocomposite microparticle
- rHDL, recombinant HDL
- rhTNFRFc, recombinant human TNF-α receptor II-IgG Fc fusion protein
- scFv, single-chain variable fragment
- α1D-AR, α1D-adrenergic receptor
Collapse
Affiliation(s)
- Qingqing Xiao
- School of Pharmacy, China Pharmaceutical University, Nanjing 210009, China
| | - Xiaotong Li
- School of Pharmacy, China Pharmaceutical University, Nanjing 210009, China
| | - Yi Li
- School of Pharmacy, China Pharmaceutical University, Nanjing 210009, China
| | - Zhenfeng Wu
- Key Laboratory of Modern Preparation of TCM, Ministry of Education, Jiangxi University of Traditional Chinese Medicine, Nanchang 330004, China
| | - Chenjie Xu
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong 999077, China
| | - Zhongjian Chen
- Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai 200443, China
| | - Wei He
- School of Pharmacy, China Pharmaceutical University, Nanjing 210009, China
- Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai 200443, China
| |
Collapse
|
6
|
ARSLAN D. Romatoid artrit - tedavi prensipleri: Ne zaman geçiş yapalım? EGE TIP DERGISI 2021. [DOI: 10.19161/etd.864145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
7
|
Litzenburger T, Steffgen J, Benediktus E, Müller F, Schultz A, Klein E, Ramanujam M, Harcken C, Gupta A, Wu J, Wiebe S, Li X, Flack M, Padula SJ, Visvanathan S, Hünnemeyer A, Hui J. Safety, pharmacokinetics and pharmacodynamics of BI 705564, a highly selective, covalent inhibitor of Bruton's tyrosine kinase, in Phase I clinical trials in healthy volunteers. Br J Clin Pharmacol 2020; 87:1824-1838. [PMID: 32986868 PMCID: PMC9290462 DOI: 10.1111/bcp.14571] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/10/2020] [Accepted: 09/15/2020] [Indexed: 12/15/2022] Open
Abstract
Aims To evaluate the safety, pharmacokinetics and pharmacodynamics of single‐ and multiple‐rising doses (MRDs) of BI 705564 and establish proof of mechanism. Methods BI 705564 was studied in 2 placebo‐controlled, Phase I clinical trials testing single‐rising doses (1–160 mg) and MRDs (1–80 mg) of BI 705564 over 14 days in healthy male volunteers. Blood samples were analysed for BI 705564 plasma concentration, Bruton's tyrosine kinase (BTK) target occupancy (TO) and CD69 expression in B cells stimulated ex vivo. A substudy was conducted in allergic, otherwise healthy, MRD participants. Safety was assessed in both studies. Results All doses of BI 705564 were well tolerated. Geometric mean BI 705564 plasma terminal half‐life ranged from 10.1 to 16.9 hours across tested doses, with no relevant accumulation after multiple dosing. Doses ≥20 mg resulted in ≥85% average TO that was maintained for ≥48 hours after single‐dose administration. Functional effects of BTK signalling were demonstrated by dose‐dependent inhibition of CD69 expression. In allergic participants, BI 705564 treatment showed a trend in wheal size reduction in a skin prick test and complete inhibition of basophil activation. Mild bleeding‐related adverse events were observed with BI 705564; bleeding time increased in 1/12 participants (8.3%) who received placebo vs 26/48 (54.2%) treated with BI 705564. Conclusion BI 705564 showed efficient target engagement through durable TO and inhibition of ex vivo B‐cell activation, and proof of mechanism through effects on allergic skin responses. Mild bleeding‐related adverse events were probably related to inhibition of platelet aggregation by BTK inhibition.
Collapse
Affiliation(s)
| | | | | | - Fabian Müller
- Boehringer Ingelheim Pharma GmbH & Co. KG Biberach Germany
| | - Armin Schultz
- CRS Clinical Research Services Mannheim GmbH Mannheim Germany
| | - Elliott Klein
- Boehringer Ingelheim Pharmaceuticals Ridgefield CT USA
| | | | | | - Alpana Gupta
- Boehringer Ingelheim Pharmaceuticals Ridgefield CT USA
| | - Jing Wu
- Boehringer Ingelheim Pharmaceuticals Ridgefield CT USA
| | - Sabrina Wiebe
- Boehringer Ingelheim Pharma GmbH & Co. KG Biberach Germany
| | - Xiujiang Li
- Boehringer Ingelheim Pharmaceuticals Ridgefield CT USA
| | - Mary Flack
- Boehringer Ingelheim Pharmaceuticals Ridgefield CT USA
| | | | | | | | - Jianan Hui
- Boehringer Ingelheim Pharmaceuticals Ridgefield CT USA
| |
Collapse
|
8
|
Drug-resistance in rheumatoid arthritis: the role of p53 gene mutations, ABC family transporters and personal factors. Curr Opin Pharmacol 2020; 54:59-71. [PMID: 32942096 DOI: 10.1016/j.coph.2020.08.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/03/2020] [Accepted: 08/04/2020] [Indexed: 12/15/2022]
Abstract
Rheumatoid arthritis (RA) is an autoimmune disease that is associated with chronic inflammation in joints, which contribute to synovial membrane hyperplasia and cartilage damage. Conventional disease-modifying antirheumatic drugs (DMARDs), such as methotrexate (MTX) and leflunomide (LEF), are the common RA therapy to reduce inflammation and disease progression. Recently, drug-resistance in RA with conventional treatment has become an issue. Mutations in p53 tumor suppressor gene and overexpression of ABCB1/MDR-1/P-gp transporters may contribute to antirheumatic drug-resistance in RA. Biologic DMARDs (bDMARDs) are often prescribed, when conventional DMARDs fail to treat RA, by targeting proinflammatory mediators such as tumor necrosis factor-α (TNF-α) and interleukin (IL)-6. The efficacy of bDMARDs is affected by personal factors, for example, age, smoking, body mass index (BMI), immunogenicity, and genetic polymorphisms. This review highlights the role of p53 gene mutations, ABC family transporters and personal factors in antirheumatic drug-resistance, which may lead to new personalized therapies against RA with an increased drug-sensitivity.
Collapse
|
9
|
New era for outcomes and management of rheumatoid arthritis: Facing the individualized treatment challenge. Joint Bone Spine 2020; 88:105066. [PMID: 32952004 DOI: 10.1016/j.jbspin.2020.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 08/26/2020] [Indexed: 11/23/2022]
|
10
|
Oliveira FFBD, Bingana RD, Morais PAF, Oliveira SRBD, Barbosa ALDR, Chaves LDS, Alencar PDOC, Soares PMG, Souza MHLP, Freitas ALP, Barros FCN, Medeiros JVR, Damasceno ROS. Sulfated polysaccharide from Gracilaria caudata reduces hypernociception and inflammatory response during arthritis in rodents. Int J Biol Macromol 2020; 161:1061-1069. [PMID: 32531369 DOI: 10.1016/j.ijbiomac.2020.06.060] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/21/2020] [Accepted: 06/08/2020] [Indexed: 12/12/2022]
Abstract
Polysaccharide from marine alga Gracilaria caudata has potential health benefits, such as anti-inflammatory, gastroprotective and antidiarrheal effects. Here, we investigated the effect of a sulfated polysaccharide from G. caudata (SP-GC) on hypernociception and inflammatory response in arthritis models. The animals received SP-GC (3, 10 or 30 mg/kg) 1 h before tibio-tarsal injection of zymosan. Hypernociception, histopathology, edema, vascular permeability, myeloperoxidase (MPO) activity, cell influx, interleukin (IL)-1β and nitric oxide (NO) levels were evaluated in acute phase. In another protocol, animals received SP-GC (30 mg/kg) 2 h post-complete Freund's adjuvant (CFA). Hypernociception, edema and arthritis index were determined in acute, sub-chronic and chronic phases. Rota-rod test measured the motor performance. SP-GC significantly reduced, in a dose-dependent manner, the zymosan-induced hypernociception with maximal effect at 30 mg/kg. The microscopic inflammation, joint edema, MPO activity, cell influx, IL-1β and NO levels were also reduced by SP-GC. In the CFA-induced arthritis, SP-GC inhibits the hypernociception, edema and arthritic index in acute, sub-chronic and chronic phases. SP-GC did not alter the motor performance of animals. In conclusion, SP-GC exerts protective effect in models of arthritis due to the modulation of cell influx, IL-1β and NO levels, culminating in the reduction of hypernociception and edema.
Collapse
Affiliation(s)
| | - Rudy Diavila Bingana
- Departamento de Fisiologia e Farmacologia, Universidade Federal do Ceará, 60430-275 Fortaleza, CE, Brazil
| | - Pedro Almir Feitosa Morais
- Departamento de Fisiologia e Farmacologia, Universidade Federal do Ceará, 60430-275 Fortaleza, CE, Brazil
| | | | - André Luiz Dos Reis Barbosa
- Núcleo de Pesquisa em Biodiversidade e Biotecnologia, Universidade Federal do Piauí, 64202-020 Parnaíba, PI, Brazil
| | - Luciano de Sousa Chaves
- Departamento de Bioquímica e Biologia Molecular, Universidade Federal do Ceará, 60440-900 Fortaleza, CE, Brazil
| | | | - Pedro Marcos Gomes Soares
- Departamento de Fisiologia e Farmacologia, Universidade Federal do Ceará, 60430-275 Fortaleza, CE, Brazil
| | | | - Ana Lúcia Ponte Freitas
- Departamento de Bioquímica e Biologia Molecular, Universidade Federal do Ceará, 60440-900 Fortaleza, CE, Brazil
| | - Francisco Clark Nogueira Barros
- Departamento de Bioquímica e Biologia Molecular, Universidade Federal do Ceará, 60440-900 Fortaleza, CE, Brazil; Departamento de Pesquisa, Pós-Graduação e Inovação, 63040-540, Instituto Federal de Educação, Ciência e Tecnologia - CE, Brazil
| | - Jand-Venes Rolim Medeiros
- Núcleo de Pesquisa em Biodiversidade e Biotecnologia, Universidade Federal do Piauí, 64202-020 Parnaíba, PI, Brazil
| | | |
Collapse
|
11
|
Mankia K, Di Matteo A, Emery P. Prevention and cure: The major unmet needs in the management of rheumatoid arthritis. J Autoimmun 2020; 110:102399. [DOI: 10.1016/j.jaut.2019.102399] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 12/20/2019] [Indexed: 01/01/2023]
|
12
|
Reply to the Editor. Semin Arthritis Rheum 2020; 50:e7. [DOI: 10.1016/j.semarthrit.2019.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 07/11/2019] [Indexed: 11/22/2022]
|
13
|
Deviatkin AA, Vakulenko YA, Akhmadishina LV, Tarasov VV, Beloukhova MI, Zamyatnin Jr. AA, Lukashev AN. Emerging Concepts and Challenges in Rheumatoid Arthritis Gene Therapy. Biomedicines 2020; 8:biomedicines8010009. [PMID: 31936504 PMCID: PMC7168286 DOI: 10.3390/biomedicines8010009] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/03/2020] [Accepted: 01/07/2020] [Indexed: 02/07/2023] Open
Abstract
Rheumatoid arthritis (RA) is a systemic inflammatory joint disease affecting about 1% of the population worldwide. Current treatment approaches do not ensure a cure for every patient. Moreover, classical regimens are based on nontargeted systemic immune suppression and have significant side effects. Biological treatment has advanced considerably but efficacy and specificity issues remain. Gene therapy is one of the potential future directions for RA therapy, which is rapidly developing. Several gene therapy trials done so far have been of moderate success, but experimental and genetics studies have yielded novel targets. As a result, the arsenal of gene therapy tools keeps growing. Currently, both viral and nonviral delivery systems are used for RA therapy. Herein, we review recent approaches for RA gene therapy.
Collapse
Affiliation(s)
- Andrei A. Deviatkin
- Institute of Molecular Medicine, Sechenov First Moscow State Medical University, 119048 Moscow, Russia; (M.I.B.); (A.A.Z.J.); (A.N.L.)
- Correspondence:
| | - Yulia A. Vakulenko
- Martsinovsky Institute of Medical Parasitology, Tropical and Vector Borne Diseases, Sechenov First Moscow State Medical University, 119435 Moscow, Russia; (Y.A.V.); (L.V.A.)
- Faculty of Biology, Lomonosov Moscow State University, 119234 Moscow, Russia
| | - Ludmila V. Akhmadishina
- Martsinovsky Institute of Medical Parasitology, Tropical and Vector Borne Diseases, Sechenov First Moscow State Medical University, 119435 Moscow, Russia; (Y.A.V.); (L.V.A.)
| | - Vadim V. Tarasov
- Department of Pharmacology and Pharmacy, Sechenov First Moscow State Medical University, 119991 Moscow, Russia;
| | - Marina I. Beloukhova
- Institute of Molecular Medicine, Sechenov First Moscow State Medical University, 119048 Moscow, Russia; (M.I.B.); (A.A.Z.J.); (A.N.L.)
| | - Andrey A. Zamyatnin Jr.
- Institute of Molecular Medicine, Sechenov First Moscow State Medical University, 119048 Moscow, Russia; (M.I.B.); (A.A.Z.J.); (A.N.L.)
- Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, 119992 Moscow, Russia
| | - Alexander N. Lukashev
- Institute of Molecular Medicine, Sechenov First Moscow State Medical University, 119048 Moscow, Russia; (M.I.B.); (A.A.Z.J.); (A.N.L.)
- Martsinovsky Institute of Medical Parasitology, Tropical and Vector Borne Diseases, Sechenov First Moscow State Medical University, 119435 Moscow, Russia; (Y.A.V.); (L.V.A.)
| |
Collapse
|
14
|
Can we wean patients with inflammatory arthritis from biological therapies? Autoimmun Rev 2019; 18:102399. [PMID: 31639516 DOI: 10.1016/j.autrev.2019.102399] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 05/30/2019] [Indexed: 12/17/2022]
Abstract
Biological therapies have represented a cornerstone in the treatment of immune-mediated inflammatory diseases. Their advent combined with implementation of a treat-to-target approach has meant that remission or low disease activity are now realistic targets for treatment achieved by a significant number of patients. However, biologicals are not risk free and their elevated costs continue to present an important economic burden to national healthcare services. "Can we wean patients with inflammatory arthritis from biological therapies?" Over the last decade this question has become increasingly important as to define the best management strategies in terms of efficacy, safety and economic outcomes. Not surprisingly this has generated an interesting debate as to whether reasons to taper biologics outweigh reasons not to taper and evidence in support of either of these schools of thought is persistently growing. AIM: In this article we reviewed the contents of the relevant session from the 2019 Controversies in Rheumatology and Autoimmunity meeting in Florence.
Collapse
|
15
|
Rheumatoid Arthritis Treatment. A Back to the Drawing Board Project or High Expectations for Low Unmet Needs? J Clin Med 2019; 8:jcm8081237. [PMID: 31426398 PMCID: PMC6722985 DOI: 10.3390/jcm8081237] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 08/15/2019] [Indexed: 02/07/2023] Open
Abstract
Despite the significant progress in Rheumatoid Arthritis (RA) therapeutics, there are several reports in the literature claiming that the size of unmet needs in RA is large. In the era before biologics, there was indeed a significant number of patients who did not achieve low disease activity (LDA) or disease remission due to limited therapeutic choices in the doctors’ armamentarium. Treatment wise, great progress has been achieved over the last decades with the discovery and introduction in therapeutics of new molecules, such as the biological (b) disease-modifying anti-rheumatic drugs (DMARDs), and the targeted synthetic (ts) DMARDs. Today, with such a plethora of conventional synthetic (cs) DMARDs, tsDMARDs, and bDMARDs, why are we unable to successfully treat RA patients? What is wrong? However, a new drug for RA does not mean it is necessary to switch to a new treatment. It is very easy to change and switch therapies when the patient complains about pain and stiffness. In this setting, it is obligatory to rule out other comorbidities and disorders that may be the cause of the pain first. Thus, clinicians must have a deep knowledge of the drug therapy and be able to adjust the treatment when needed. A minute clinical examination must be carried out on every visit with close monitoring of the patient. A treat-to-target (T2T) approach and the application of the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) recommendations and strategies should minimize the unmet needs.
Collapse
|
16
|
Kaltsonoudis E, Pelechas E, Voulgari PV, Drosos AA. Comment on: Assessments of the unmet need in the management of patients with rheumatoid arthritis: analyses from the NOR-DMARD registry. Rheumatology (Oxford) 2019; 58:1883-1884. [DOI: 10.1093/rheumatology/kez206] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2019] [Indexed: 01/24/2023] Open
Affiliation(s)
- Evripidis Kaltsonoudis
- Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | - Eleftherios Pelechas
- Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | - Paraskevi V Voulgari
- Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | - Alexandros A Drosos
- Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| |
Collapse
|