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Pugliesi A, de Oliveira AB, Oliveira AB, Xavier R, da Mota LMH, Bertolo MB, Gonzalez-Gay MA, Citera G, de Carvalho LSF. Compared efficacy of rituximab, abatacept, and tocilizumab in patients with rheumatoid arthritis refractory to methotrexate or TNF inhibitors agents: a systematic review and network meta-analysis. Adv Rheumatol 2023; 63:30. [PMID: 37415193 DOI: 10.1186/s42358-023-00298-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 04/10/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Our aim was to compare the efficacy of rituximab, tocilizumab, and abatacept in individuals with rheumatoid arthritis (RA) refractory to treatments with MTX or TNFi agents. METHODS We searched 6 databases until January 2023 for phase 2-4 RCTs evaluating patients with RA refractory to MTX or TNFi therapy treated with rituximab, abatacept, and tocilizumab (intervention arm) compared to controls. Study data were independently assessed by two investigators. The primary outcome was considered as achieving ACR70 response. RESULTS The meta-analysis included 19 RCTs, with 7,835 patients and a mean study duration of 1.2 years. Hazard ratios for achieving an ACR70 response at six months were not different among the bDMARDs, however, we found high heterogeneity. Three factors showing a critical imbalance among the bDMARD classes were identified: baseline HAQ score, study duration, and frequency of TNFi treatment in control arm. Multivariate meta-regression adjusted to these three factors were conducted for the relative risk (RR) for ACR70. Thus, heterogeneity was attenuated (I2 = 24%) and the explanatory power of the model increased (R2 = 85%). In this model, rituximab did not modify the chance of achieving an ACR70 response compared to abatacept (RR = 1.773, 95%CI 0.113-10.21, p = 0.765). In contrast, abatacept was associated with RR = 2.217 (95%CI 1.554-3.161, p < 0.001) for ACR70 compared to tocilizumab. CONCLUSION We found high heterogeneity among studies comparing rituximab, abatacept, and tocilizumab. On multivariate metaregressions, if the conditions of the RCTs were similar, we estimate that abatacept could increase the chance of reaching an ACR70 response by 2.2-fold compared to tocilizumab.
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Affiliation(s)
- Alisson Pugliesi
- Hospital de Clínicas, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | | | - Ana Beatrice Oliveira
- Health Sciences Research and Teaching Foundation of Brasília (ESCS/FEPECS), Brasília, DF, Brazil
| | - Ricardo Xavier
- Rheumatology Service, Federal University of Rio Grande Do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Licia Maria Henrique da Mota
- Hospital Universitário de Brasília, University of Brasília (HUB-UnB-EBSERH), Brasília, DF, Brazil
- Medical Sciences at Faculty of Medicine, University of Brasília (UnB), Brasília, DF, Brazil
| | - Manoel Barros Bertolo
- Hospital de Clínicas, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Miguel Angel Gonzalez-Gay
- Division of Rheumatology, Hospital Universitário Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Gustavo Citera
- Section of Rheumatology, Instituto de Rheabilitacion Psicofisica, Buenos Aires, Argentina
| | - Luiz Sergio Fernandes de Carvalho
- Health Sciences Research and Teaching Foundation of Brasília (ESCS/FEPECS), Brasília, DF, Brazil.
- Laboratory of Data for Quality of Care and Outcomes Research (LaDaQCOR), Catholic University of Brasília (UCB), QS 07, Lote 01, Taguatinga Sul-Taguatinga, Brasília, DF, 71966-700, Brazil.
- Medical Data Analyst, Data Lab, Clarity Healthcare Intelligence, Jundiai, SP, Brazil.
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El-Tanbouly GS, Abdelrahman RS. Novel anti-arthritic mechanisms of trans-cinnamaldehyde against complete Freund's adjuvant-induced arthritis in mice: involvement of NF-кB/TNF-α and IL-6/IL-23/ IL-17 pathways in the immuno-inflammatory responses. Inflammopharmacology 2022; 30:1769-1780. [PMID: 35648328 PMCID: PMC9499911 DOI: 10.1007/s10787-022-01005-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/03/2022] [Indexed: 11/05/2022]
Abstract
Trans-cinnamaldehyde (TCA), a natural cinnamaldehyde derivative of cinnamon oil, is known for anti-inflammatory, anti-bacterial, anti-fungal, anti-diabetic, and anti-cancer activities. However, no study has examined the protective mechanisms of TCA on complete Freund's adjuvant (CFA)-induced arthritis. Chronic arthritis was induced in mice by triple dose injection of 0.1 ml CFA in the first two days, then a treatment with TCA (100 mg/kg, i.p.) and the anti-arthritic drug; methotrexate (MTX, 0.75 mg/kg, i.p., 3 times/week) started from day 10 after CFA and continued till day 35.TCA ameliorated the CFA-induced arthritis features, indicated by the decrease in serum rheumatoid factor, paw swelling, arthritis index and the arthritis changes in limb histology. Additionally, TCA treatment showed anti-inflammatory actions through downregulation of TNF-α, NF-κB and COX-2 expressions and marked reduction in IL-1β, IL-6, IL-23 and IL-17 levels in inflamed paw tissues.Consequently, TCA can decrease arthritis progression and inhibit the immune/inflammatory responses initiated by TNF-α/IL-1β/IL-6/IL-23/IL-17 signals, via NF-κB modulation, almost to the same extent accomplished by MTX. Therefore, TCA could be a promising anti-arthritic drug.
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Affiliation(s)
- Ghada S El-Tanbouly
- Department of Pharmacology, Faculty of Pharmacy, Delta University for Science and Technology, Gamasa, 11152, Egypt.
| | - Rehab S Abdelrahman
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Mansoura University, Mansoura, 35516, Egypt.,Department of Pharmacology and Toxicology, College of Pharmacy, Taibah University, Al-Madina Al-Munawwarah, 30001, Saudi Arabia
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Alten R, Mariette X, Flipo RM, Caporali R, Buch MH, Patel Y, Marsal S, Sanmartí R, Nurmohamed MT, Griffiths H, Peichl P, Bannert B, Chartier M, Connolly SE, Lozenski K, Rauch C. Retention of subcutaneous abatacept for the treatment of rheumatoid arthritis: real-world results from the ASCORE study: an international 2-year observational study. Clin Rheumatol 2022; 41:2361-2373. [PMID: 35536413 PMCID: PMC9287226 DOI: 10.1007/s10067-022-06176-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 04/01/2022] [Accepted: 04/09/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate retention, efficacy, and safety of subcutaneous (SC) abatacept over 2 years in patients with moderate-to-severe RA in the Abatacept SubCutaneOus in Routine clinical practicE (ASCORE) study. METHODS Patients with RA who initiated SC abatacept 125 mg once weekly were enrolled in the international, observational, prospective multicentre ASCORE study into biologic-naïve or ≥ 1 prior biologic failure cohorts. PRIMARY ENDPOINT abatacept retention rate at 2 years. Secondary endpoints: proportion of patients with good/moderate EULAR response rates based on DAS28 (ESR), low disease activity and/or remission according to DAS28 (ESR; ≤ 3.2/ < 2.6), SDAI (≤ 11/ ≤ 3.3), CDAI (≤ 10/ ≤ 2.8), and Boolean criteria. Retention rate by baseline serostatus was evaluated post hoc. RESULTS Overall, 47% of patients remained on abatacept for 2 years, irrespective of treatment line. Higher abatacept retention rates were associated with lower prior biologic exposure. Generally, clinical outcomes showed that the proportion of patients with low disease activity/remission was higher in biologic-naïve patients (vs biologic-failure) and similar in those with 1 and ≥ 2 prior biologic failures. In patients on treatment at 2 years, good/moderate EULAR response rates of ~ 80% were consistently noted irrespective of prior biologic exposure. Across treatment lines, retention was greater in patients with seropositive (vs seronegative) RA. Patients with rheumatoid factor/anti-citrullinated protein antibody single-positive RA who were bio-naïve had higher retention than patients who were bio-experienced. CONCLUSIONS In the ASCORE study, SC abatacept retention was 47% at 2 years with good clinical outcomes and was well-tolerated in the real-world setting. Abatacept retention and clinical response rates were higher in patients who received abatacept as an earlier- versus later-line biologic drug treatment and in those with seropositive RA. TRIAL REGISTRATION ClinicalTrials.gov, NCT02090556.
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Affiliation(s)
- Rieke Alten
- Schlosspark-Klinik, University Medicine Berlin, Heubnerweg 2, 14059, Berlin, Germany.
| | - Xavier Mariette
- Université Paris-Saclay, AP-HP, Hospital Bicêtre, INSERM UMR1184, Le Kremlin Bicêtre, France
| | | | | | - Maya H Buch
- University of Leeds, Leeds, UK
- University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester, UK
| | - Yusuf Patel
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Sara Marsal
- Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Michael T Nurmohamed
- ARC Amsterdam University Hospitals - VU University Medical & Reade, Amsterdam, Netherlands
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Simon TA, Dong L, Winthrop KL. Risk of opportunistic infections in patients with rheumatoid arthritis initiating abatacept: cumulative clinical trial data. Arthritis Res Ther 2021; 23:17. [PMID: 33430948 PMCID: PMC7798209 DOI: 10.1186/s13075-020-02399-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 12/13/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND To evaluate incidence of opportunistic infections (OIs) in patients with rheumatoid arthritis (RA) treated with abatacept in clinical trials. METHODS This pooled analysis of 16 randomized, double-blind/open-label trials, with ≥ 1 abatacept (intravenous or subcutaneous) arm, and with/without placebo control covered cumulative (controlled short-term and open-label long-term) abatacept exposure periods. OIs were analyzed separately in controlled (abatacept and placebo individually) and cumulative periods. OIs were identified using a prespecified list; events were independently adjudicated. Unadjusted incidence rates (IRs; per 100 patient-years) with 95% confidence intervals (CIs) were calculated. RESULTS In cumulative periods, 7044 patients received abatacept, with a mean (standard deviation) duration of exposure of 36.9 (26.2) months (21,274 patient-years of exposure). IRs (95% CIs) of OIs were 0.17 (0.05-0.43) for abatacept and 0.56 (0.22-1.15) for placebo during the controlled periods and 0.21 (0.15-0.28) for abatacept during the cumulative periods. There was 1 case of tuberculosis in both the abatacept (IR [95% CI] 0.04 [0.00-0.24]) and placebo (IR [95% CI] 0.08 [0.00-0.44]) groups during the controlled periods; 13 verified tuberculosis cases (IR [95% CI] 0.06 [0.03-0.10]) were reported in the cumulative period. Herpes zoster was reported numerically more often with abatacept (IR 1.9 [1.4-2.5]), versus placebo (1.7 [1.1-2.6]) in the controlled periods; within the cumulative period, herpes zoster IR (95% CI) was 1.53 (1.36-1.71) for abatacept-treated patients. CONCLUSION In controlled periods of the clinical trials, abatacept-treated patients had similarly low rates of OIs compared with placebo-treated patients. Overall, OI rates were similar among abatacept-treated patients in the controlled and cumulative periods and consistent with the ranges reported in the literature.
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Affiliation(s)
- Teresa A Simon
- Bristol Myers Squibb, Princeton, NJ, 08543, USA. .,Current affiliation: Physicians Research Center, LLC, Toms River, NJ, 08753, USA.
| | - Lixian Dong
- Bristol Myers Squibb, Princeton, NJ, 08543, USA
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Impact of Single-Nucleotide Polymorphisms of CTLA-4, CD80 and CD86 on the Effectiveness of Abatacept in Patients with Rheumatoid Arthritis. J Pers Med 2020; 10:jpm10040220. [PMID: 33187286 PMCID: PMC7711575 DOI: 10.3390/jpm10040220] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/11/2020] [Accepted: 11/11/2020] [Indexed: 12/24/2022] Open
Abstract
Abatacept (ABA) is used as a first-line treatment in patients diagnosed with moderate and severe rheumatoid arthritis (RA). The interindividual response to ABA therapy is very variable in these patients. The objective of our study was therefore to investigate the role of polymorphisms of the CTLA-4, CD80 and CD86 genes, as well as that of clinical factors of the disease, in the response to ABA in patients with RA. A retrospective cohort study was carried out in 109 patients receiving treatment with ABA and diagnosed with RA. The genetic variables were analyzed using real-time PCR with TaqMan® probes. The patients were classified according to the European League Against Rheumatism (EULAR) criteria at 6 and 12 months from start of treatment. The independent variables associated with higher EULAR response were lower duration of previous biologic disease-modifying anti-rheumatic drugs and lower baseline values of the disease activity score 28 after 6 months of ABA treatment; and lower baseline patient’s visual analogue scale (PVAS) after 12 months. In addition, a significant association was found between duration of ABA treatment, non-administration of concomitant glucocorticoids and lower baseline values of the number of inflamed joints and erythrocyte sedimentation rate clinical variables, with remission of the disease after 6 months’ treatment with ABA. Finally, remission of the disease after 12 months’ treatment with ABA was associated with earlier age at start of ABA therapy and lower number of previous biologic therapies (BTs). The CTLA-4rs5742909-T allele and the CTLA-4rs231775-G allele were found to be associated with satisfactory EULAR response and low disease activity (LDA) after 12 months’ treatment with ABA (CTLA-4rs5742909 T vs. CC; OR = 5.88; CI95% = 1.48–23.29 and OR = 4.75; CI95% = 1.35–17.94, respectively, and CTLA-4rs231775 G vs. AA, OR = 3.48; CI95% = 1.20–10.09 and OR = 4.68; CI95% = 1.49–17.94, respectively). In conclusion, patients with RA treated with ABA showed better EULAR response and LDA rate when they had the CTLA-4 rs5742909-T or CTLA-4 rs231775-G polymorphisms; furthermore, this remission rate increased in patients that began ABA treatment earlier, those with a lower number of previous BTs and those with a lower PVAS value.
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Hosseini A, Gharibi T, Marofi F, Babaloo Z, Baradaran B. CTLA-4: From mechanism to autoimmune therapy. Int Immunopharmacol 2020; 80:106221. [PMID: 32007707 DOI: 10.1016/j.intimp.2020.106221] [Citation(s) in RCA: 112] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 01/15/2020] [Accepted: 01/15/2020] [Indexed: 12/16/2022]
Abstract
CD28 and CTLA-4 are both important stimulatory receptors for the regulation of T cell activation. Because receptors share common ligands, B7.1 and B7.2, the expression and biological function of CTLA-4 is important for the negative regulation of T cell responses. Therefore, elimination of CTLA-4 can result in the breakdown of immune tolerance and the development of several diseases such as autoimmunity. Inhibitory signals of CTLA-4 suppress T cell responses and protect against autoimmune diseases in many ways. In this review, we summarize the structure, expression and signaling pathway of CTLA-4. We also highlight how CTLA-4 defends against potentially self-reactive T cells. Finally, we discuss how the CTLA-4 regulates a number of autoimmune diseases that indicate manipulation of this inhibitory molecule is a promise as a strategy for the immunotherapy of autoimmune diseases.
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Affiliation(s)
- Arezoo Hosseini
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Immunology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran; Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran; Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Tohid Gharibi
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Immunology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran; Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran; Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Faroogh Marofi
- Department of Immunology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zohreh Babaloo
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Immunology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Behzad Baradaran
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Immunology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
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Bird P, Bensen W, El-Zorkany B, Kaine J, Manapat-Reyes BH, Pascual-Ramos V, Witcombe D, Soma K, Zhang R, Thirunavukkarasu K. Tofacitinib 5 mg Twice Daily in Patients with Rheumatoid Arthritis and Inadequate Response to Disease-Modifying Antirheumatic Drugs: A Comprehensive Review of Phase 3 Efficacy and Safety. J Clin Rheumatol 2019; 25:115-126. [PMID: 29794874 PMCID: PMC6445596 DOI: 10.1097/rhu.0000000000000786] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Tofacitinib is an oral Janus kinase inhibitor for the treatment of rheumatoid arthritis (RA). We performed a comprehensive review of phase 3 studies of tofacitinib 5 mg twice daily (BID) (approved dose in many countries) in patients with moderate to severe RA and inadequate response to prior disease-modifying antirheumatic drugs. METHODS A search of PubMed and ClinicalTrials.gov identified 5 studies: ORAL Solo (NCT00814307), ORAL Sync (NCT00856544), ORAL Standard (included adalimumab 40 mg once every 2 weeks; NCT00853385), ORAL Scan (NCT00847613), and ORAL Step (NCT00960440). Efficacy and safety data for tofacitinib 5 mg BID, placebo, and adalimumab were analyzed. RESULTS Across the 5 studies, 1216 patients received tofacitinib 5 mg BID, 681 received placebo, and 204 received adalimumab. At month 3, tofacitinib demonstrated significantly higher 20%, 50%, and 70% improvement in American College of Rheumatology response criteria (ACR20, ACR50, and ACR70, respectively) response rates, greater improvement in Health Assessment Questionnaire-Disability Index, and a higher proportion of Disease Activity Score-defined remission than placebo. Frequencies of adverse events (AEs), serious AEs, and discontinuations due to AEs were similar for tofacitinib and placebo at month 3; serious infection events were more frequent for tofacitinib. In ORAL Standard, although not powered for formal comparisons, tofacitinib and adalimumab had numerically similar efficacy and AEs; serious AEs and serious infection events were more frequent with tofacitinib. CONCLUSIONS Tofacitinib 5 mg BID reduced RA signs and symptoms and improved physical function versus placebo in patients with inadequate response to prior disease-modifying antirheumatic drugs. Tofacitinib 5 mg BID had a consistent, manageable safety profile across studies, with no new safety signals identified.
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Affiliation(s)
- Paul Bird
- From the University of New South Wales, Sydney, New South Wales, Australia
| | - William Bensen
- St Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Bernadette Heizel Manapat-Reyes
- Section of Rheumatology, Department of Medicine, University of the Philippines–Philippine General Hospital, Manila, Philippines
| | - Virginia Pascual-Ramos
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - David Witcombe
- Pfizer Australia, Sydney, New South Wales, Australia; and
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Khan MA, Ahmed RS, Chandra N, Arora VK, Ali A. In vivo, Extract from Withania somnifera Root Ameliorates Arthritis via Regulation of Key Immune Mediators of Inflammation in Experimental Model of Arthritis. Antiinflamm Antiallergy Agents Med Chem 2019; 18:55-70. [PMID: 30444203 PMCID: PMC6446523 DOI: 10.2174/1871523017666181116092934] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 11/07/2018] [Accepted: 11/14/2018] [Indexed: 05/14/2023]
Abstract
BACKGROUND Rheumatoid Arthritis (RA) is a devastating disease characterized by continual addition of leukocytes and T cells within the articular cavity causing inflammation and cartilage destruction. Withania somnifera is one of the most precious medicinal herbs, reported to have antioxidant, anti-inflammatory, and immunomodulatory properties. OBJECTIVE The purpose of this study was to evaluate anti-inflammatory activity of aqueous extract of Withania somnifera roots (WSAq) in Collagen Induced Arthritic (CIA) rats. METHODS To achieve this, we assessed the level of inflammatory cytokines such as Tumor Necrosis Factor (TNF)-α, IL-1β, IL-6 and IL-10 in CIA rats. Further, transcription factor, oxidative stress parameters and CD+8 expressions were also analyzed in CIA rats. RESULTS Arthritic rats showed a greater increase in the levels of pro inflammatory cytokines such as TNF-α, IL-1β, IL-6, transcription factor NF-κB and a decrease in IL-10 concentration than controls rats. Oral administration of WSAq at a dose of 300mg/kg.wt. (WSAq300) appreciably attenuated the production of these pro inflammatory cytokines. This anti-inflammatory activity of WSAq300 might be partly mediated through an increase in the secretion of IL-10 and inhibition of NF-κB activity. Further, arthritic rats also show increased oxidative stress as compared to control rats. This increased oxidative stress in the arthritic rats appears to be the outcome of both an activated pro-oxidant and a poor antioxidant defense system. Treatment with WSAq300 strongly ameliorates all these ROS parameters significantly to near normal. Additional, metalloproteinase MMP-8 levels were also measured and found to be increased in CIA rats, which after treatment with WSAq300 came down to near normal. CONCLUSION From the above results, it can be concluded that the use of WSAq300 may be a valuable supplement which can improve human arthritis.
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Affiliation(s)
- Mahmood Ahmad Khan
- Address correspondence to this author at the Department of Biochemistry, University College of Medical Sciences and GTB Hospital, Dilshad Garden, Delhi, India; E-mail:
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Bray VJ, Broadwell A, Baraf HSB, Black S, Brady BL, Tkacz J, Yarngo L, DeHoratius RJ. The Effectiveness of Intravenous Golimumab Administered Directly After Infliximab in Rheumatoid Arthritis Patients. Drugs R D 2018; 18:211-219. [PMID: 30054896 PMCID: PMC6131122 DOI: 10.1007/s40268-018-0240-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Purpose For patients with rheumatoid arthritis (RA) who do not respond or lose response to anti-tumor necrosis factor (TNF) biologics, switching to a different anti-TNF can be an effective means to manage symptoms and disease progression. This study examined the utilization and effectiveness of intravenous golimumab within a real-world population of patients with RA switching directly from infliximab, a potent anti-TNF. Methods Patient charts (n = 113) were collected from five US-based rheumatology practices. Patient demographics, treatment characteristics, infliximab and intravenous golimumab utilization data, and Clinical Disease Activity Index (CDAI), Patient Global Assessment (PtGA), Physician Global Assessment (PhGA), and Routine Assessment of Patient Index Data (RAPID3) scores were extracted from charts. The effectiveness of intravenous golimumab was assessed by comparing disease activity status pre- and post-initiation of intravenous golimumab therapy. Findings Significant decreases in patient disease activity were observed following treatment with intravenous golimumab. Mean CDAI and PhGA scores significantly decreased, and a significantly increased proportion of the population exhibited low disease activity or remission in the post intravenous golimumab period (p < 0.05). Limited changes were observed through the RAPID3 and PtGA. Conclusions Findings from this study indicate that intravenous golimumab is effective in managing RA in a population of patients switching directly from infliximab (mean last dose 7.4 mg/kg).
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Affiliation(s)
- Vance J Bray
- Denver Arthritis Clinic, 200 Spruce Street, Suite 100, Denver, CO, 80230, USA
| | - Aaron Broadwell
- Rheumatology and Osteoporosis Specialists, 820 Jordan Street Suite 201, Shreveport, LA, 71101-4616, USA
| | - Herbert S B Baraf
- Arthritis and Rheumatism Associates, P.C, 2730 University Blvd West, Suite 306, Wheaton, MD, 20902, USA
| | - Shawn Black
- Janssen Medical Affairs, 800 Ridgeview Dr, Horsham, PA, 19044, USA.
| | - Brenna L Brady
- Health Analytics, LLC 9200 Rumsey Rd, Suite 215, Columbia, MD, 21045, USA
| | - Joseph Tkacz
- Health Analytics, LLC 9200 Rumsey Rd, Suite 215, Columbia, MD, 21045, USA
| | - Lorraine Yarngo
- Health Analytics, LLC 9200 Rumsey Rd, Suite 215, Columbia, MD, 21045, USA
| | - Raphael J DeHoratius
- Janssen Medical Affairs, 800 Ridgeview Dr, Horsham, PA, 19044, USA.,Sidney Kimmel School of Medicine, Thomas Jefferson University, Philadelphia, PA, 19107, USA
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Mori S, Yoshitama T, Ueki Y. Tofacitinib Therapy for Rheumatoid Arthritis: A Direct Comparison Study between Biologic-naïve and Experienced Patients. Intern Med 2018; 57:663-670. [PMID: 29151519 PMCID: PMC5874336 DOI: 10.2169/internalmedicine.9341-17] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Objective This study was designed to directly compare the outcomes of tofacitinib therapy for methotrexate-refractory rheumatoid arthritis (RA) between biologic-naïve patients and patients who had experienced an inadequate response to biological agents. Methods We prospectively enrolled and followed 113 patients who had a high or moderate clinical disease activity index (CDAI) (36 biologic-naïve patients and 77 biologic-experienced patients). Patients received 5 mg of tofacitinib twice daily. Effectiveness and adverse events were examined at month 6 of treatment. Results At month 6, 65 patients (57.5%) reached CDAI50, which is defined as achieving ≥50% improvement. The number of previous biological agents was twice as high in CDAI50 non-responders as in responders (2.2 versus 1.1, p<0.001), but there was no significant difference in the type of previous agents or the reason for discontinuation. According to a multivariate logistic regression analysis, the previous use of biological agents [odds ratio (OR) 4.48, p=0.002] and the concurrent use of prednisolone (OR 2.40, p=0.047) were associated with a failure to achieve a CDAI 50 response. Biologic-naïve patients were more likely to achieve CDAI50 than biologic-experienced patients (80.6% versus 46.8%, p=0.001). Mean CDAI values were higher in biologic-experienced patients (11.4 versus 4.8, p=0.001), and remission rates were higher in biologic-naïve patients (41.7% versus 11.7%, p=0.001). Biologic-naïve patients more rapidly achieved remission. Rates of discontinuation resulting from adverse events were similar in both groups. Conclusion Although tofacitinib can provide an effective treatment option for intractable RA patients, its impact on outcomes is lower in patients with previous biologic failure.
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Affiliation(s)
- Shunsuke Mori
- Department of Rheumatology, Clinical Research Center for Rheumatic Diseases, NHO Kumamoto Saishunsou National Hospital, Japan
| | | | - Yukitaka Ueki
- Rheumatic and Collagen Disease Center, Sasebo Chuo Hospital, Japan
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Antiarthritic Activity of Qi-Wu Rheumatism Granule (a Chinese Herbal Compound) on Complete Freund's Adjuvant-Induced Arthritis in Rats. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 2017:1960517. [PMID: 29238384 PMCID: PMC5697382 DOI: 10.1155/2017/1960517] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 09/12/2017] [Accepted: 09/28/2017] [Indexed: 12/14/2022]
Abstract
Objective The aim was to study the therapeutic effects and mechanisms of QWRG on adjuvant-induced RA in rats. Methods The RA rat models were manipulated and subsequently divided into five experimental groups: AIA, DEX, and QWRG groups. The paw volume, body weight, arthritic score, and mechanical nociceptive threshold were assessed. The serum levels of the RF, MDA, ALP, AST, ALT, IL-1β, IL-2, IL-16, and TNF-α were measured. The proliferative capacity of lymphocytes was evaluated, and the synovial tissue was histopathologically examined. Results The paw swelling and arthritic scores were relieved, and the variation of relative body weight and mechanical nociceptive threshold had improved in the AIA rats. The serum levels of RF, MDA, ALP, AST, and ALT were alleviated, and the inflammation and cartilage damage were effectively attenuated in the AIA rats. Simultaneously, the inflammation of the synovial cavity was alleviated, and the grading of synovitis reduced by inhibiting the expressions of IL-1β, TNF-α, and IL-16 in the serum and synovium tissue. Conclusion Our results suggested that the antiarthritic properties of QWRG may be due to immunodepression and downregulation of inflammatory cytokines, which may be a potential candidate for the treatment of RA.
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Abstract
The biological DMARD (bDMARD) abatacept (Orencia®), a recombinant fusion protein, selectively modulates a co-stimulatory signal necessary for T-cell activation. In the EU, abatacept is approved for use in patients with highly active and progressive rheumatoid arthritis (RA) not previously treated with methotrexate. Abatacept is also approved for the treatment of moderate to severe active RA in patients with an inadequate response to previous therapy with at least one conventional DMARD (cDMARD), including methotrexate or a TNF inhibitor. In phase III trials, beneficial effects on RA signs and symptoms, disease activity, structural damage progression and physical function were seen with intravenous (IV) or subcutaneous (SC) abatacept regimens, including abatacept plus methotrexate in methotrexate-naive patients with early RA and poor prognostic factors, and abatacept plus methotrexate or other cDMARDs in patients with inadequate response to methotrexate or TNF inhibitors. Benefits were generally maintained during longer-term follow-up. Absolute drug-free remission rates following withdrawal of all RA treatments were significantly higher with abatacept plus methotrexate than with methotrexate alone. Both IV and SC abatacept were generally well tolerated, with low rates of immunogenicity. Current evidence therefore suggests that abatacept is a useful treatment option for patients with RA.
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Affiliation(s)
- Hannah A Blair
- Springer, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand.
| | - Emma D Deeks
- Springer, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand
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Henrickson SE, Ruffner MA, Kwan M. Unintended Immunological Consequences of Biologic Therapy. Curr Allergy Asthma Rep 2017; 16:46. [PMID: 27324478 DOI: 10.1007/s11882-016-0624-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Recent advances in the understanding of immune dysregulation in autoimmune diseases have enabled the development of new monoclonal antibody-based drugs called biologics. Biologics have been used to target aberrant immune responses in many diseases, but patients with rheumatologic and other autoimmune diseases have benefited the most and improvements in outcomes have been significant. The use of biologics is not without hazard, however, as these agents block immune pathways adapted to protect the host. This has been borne out by increased rates of infections as well as induction of new autoimmune and hematologic adverse effects. As new drugs for the treatment of autoimmune conditions are entering the pipeline, it is incumbent on the practicing immunologist to understand the mechanism of these biologics and the implications of clinical use.
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Affiliation(s)
- Sarah E Henrickson
- Division of Allergy and Immunology, The Children's Hospital of Philadelphia, 3550 Market St. 3rd floor, Philadelphia, PA, 19104, USA
| | - Melanie A Ruffner
- Division of Allergy and Immunology, The Children's Hospital of Philadelphia, 3550 Market St. 3rd floor, Philadelphia, PA, 19104, USA
| | - Mildred Kwan
- Department of Internal Medicine, Division of Rheumatology, Allergy & Immunology, University of North Carolina School of Medicine, 3300 Thurston, CB #7280, Chapel Hill, NC, 27599, USA.
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15
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Davis BP, Ballas ZK. Biologic response modifiers: Indications, implications, and insights. J Allergy Clin Immunol 2017; 139:1445-1456. [PMID: 28263774 DOI: 10.1016/j.jaci.2017.02.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 02/03/2017] [Accepted: 02/09/2017] [Indexed: 12/27/2022]
Abstract
The field of biologic immune modulators is currently mushrooming at a dizzying pace. Although most of these biologics are tested and approved for one or a few indications, their unanticipated side effects and off-label use have contributed significantly to our understanding of basic immune mechanisms, the involvement of cytokines in several apparently nonimmunologic diseases, and the importance of compartmentalized immune responses. In this review we attempt to give a bird's-eye view of the major biologics and to highlight insights and implications derived from their secondary effects and adverse reactions.
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Affiliation(s)
- Benjamin P Davis
- Department of Internal Medicine, Division of Immunology, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
| | - Zuhair K Ballas
- Department of Internal Medicine, Division of Immunology, University of Iowa and the Iowa City Veterans Administration, Iowa City, Iowa
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16
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Chen Y, Wang QW, Zuo J, Chen JW, Li X. Anti-arthritic activity of ethanol extract of Claoxylon indicum on Freund's complete adjuvant-induced arthritis in mice. Altern Ther Health Med 2017; 17:11. [PMID: 28056924 PMCID: PMC5216541 DOI: 10.1186/s12906-016-1500-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 12/06/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Claoxylon indicum Hassk. (Euphorbiaceae), named Diu Le Bang, have functions of dehumidification and relieving swelling pain, and is used as a folk medicine to treat Rheumatoid arthritis (RA), lumbocrural pain and foot edema in the south of China. The aim of the present study was to investigate the anti-arthritic activity of the ethanol extract of Claoxylon indicum (CIE) on mice with adjuvant induced joint arthritis. METHODS Adjuvant arthritis was induced in mice by subcutaneous injection of complete Freund's adjuvant into the plantar surface of right hind paw. Arthritis severity was evaluated by arthritic score, hind paws oedema and spleen index, and histological examinations. Serum samples were collected for determination of malondialdehyde (MDA) and alkaline phosphatase (ALP) levels. The expression of interleukin-1 beta (IL-1β) and tumor necrosis factor alpha (TNF-α) in the specimens of knee joints was determined by standard immunohistochemical techniques. RESULTS CIE administration (0.4 and 0.8 g/kg) suppressed the inflammatory responses in the joints of adjuvant-induced arthritis (AIA) mice, suggested by the modulatory effects on paw swelling, hyperplasia of lymphatic tissues and synovial membrane. It also decreased the levels of MDA and ALP in serum and downregulated the expression of IL-1β and TNF-α in the arthritic joints of AIA mice. CONCLUSION These results suggested that CIE possessed substantial anti-arthritic activity due to immumodepression and regulation of cytokines. CIE may be a potential candidate for the treatment of RA.
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Courvoisier DS, Alpizar-Rodriguez D, Gottenberg JE, Hernandez MV, Iannone F, Lie E, Santos MJ, Pavelka K, Turesson C, Mariette X, Choquette D, Hetland ML, Finckh A. Rheumatoid Arthritis Patients after Initiation of a New Biologic Agent: Trajectories of Disease Activity in a Large Multinational Cohort Study. EBioMedicine 2016; 11:302-306. [PMID: 27558858 PMCID: PMC5049989 DOI: 10.1016/j.ebiom.2016.08.024] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 08/15/2016] [Accepted: 08/16/2016] [Indexed: 12/25/2022] Open
Abstract
Background Response to disease modifying antirheumatic drugs (DMARDs) in rheumatoid arthritis (RA) is often heterogeneous. We aimed to identify types of disease activity trajectories following the initiation of a new biologic DMARD (bDMARD). Methods Pooled analysis of nine national registries of patients with diagnosis of RA, who initiated Abatacept and had at least two measures of disease activity (DAS28). We used growth mixture models to identify groups of patients with similar courses of treatment response, and examined these patients' characteristics and effectiveness outcomes. Findings We identified three types of treatment response trajectories: ‘gradual responders’ (GR; 3576 patients, 91·7%) had a baseline mean DAS28 of 4·1 and progressive improvement over time; ‘rapid responders’ (RR; 219 patients, 5·6%) had higher baseline DAS28 and rapid improvement in disease activity; ‘inadequate responders’ (IR; 103 patients, 2·6%) had high DAS28 at baseline (5·1) and progressive worsening in disease activity. They were similar in baseline characteristics. Drug discontinuation for ineffectiveness was shorter among inadequate responders (p = 0.03), and EULAR good or moderate responses at 1 year was much higher among ‘rapid responders’ (p < 0.001). Interpretation Clinical information and baseline clinical characteristics do not allow a reliable prediction of which trajectory the patients will follow after bDMARD initiation. This study examined disease activity trajectories in a multinational cohort of 3898 rheumatoid arthritis patients. Growth mixture models identified three groups: gradual, rapid, and inadequate responders (GR: 91·7%, RR: 5·6%, IR: 2·6%). At baseline, groups were similar in demographic and clinical characteristics, and moderately different in function and disease activity. The groups had large difference in drug retention and in good or moderate response rate. Using nine national registries, this study of 3898 established RA patients initiating a new bDMARD identified distinct types of responders: gradual, rapid and inadequate responders. Neither socio-demographic nor clinical characteristics at baseline allowed the prediction of the type of response trajectory after treatment initiation, but effectiveness outcomes strongly differed, suggesting that these empirically derived subgroups have clinical relevance. As a major aim of precision medicine is to make anti-rheumatic therapy more personalized, the detection of responder types following initiation of a specific bDMARD underscores the need to find reliable predictors of trajectories to identify patients needing a distinct treatment strategy.
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Affiliation(s)
| | | | | | | | - F Iannone
- Rheumatology Unit, University Hospital, Bari, Italy
| | - E Lie
- Diakonhjemmet Hospital, Oslo, Norway
| | - M J Santos
- Rheumatology Research Unit, Instituto de Medicina Molecular, Lisbon, Portugal
| | - K Pavelka
- Institute of Rheumatology, Prague, Czech Republic
| | - C Turesson
- Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden; Department of Rheumatology, Skåne University Hospital, Malmö, Sweden
| | - X Mariette
- Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, France
| | - D Choquette
- Institut de Rhumatologie de Montréal, CHUM, Canada
| | - M L Hetland
- The DANBIO registry Rigshospitalet, Glostrup, University of Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark
| | - A Finckh
- University Hospitals Geneva, Switzerland
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Yamaoka K. Benefit and Risk of Tofacitinib in the Treatment of Rheumatoid Arthritis: A Focus on Herpes Zoster. Drug Saf 2016; 39:823-40. [DOI: 10.1007/s40264-016-0430-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Yamaoka K. [Relation between disease modifying anti-rheumatic drugs and herpes zoster in rheumatoid arthritis]. NIHON RINSHO MEN'EKI GAKKAI KAISHI = JAPANESE JOURNAL OF CLINICAL IMMUNOLOGY 2016; 39:181-189. [PMID: 27320933 DOI: 10.2177/jsci.39.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Biologics have revolutionized the treatment of rheumatoid arthritis (RA). However certain amount of the patients cannot achieve goal of therapy. Recently, compounds targeting the intracellular kinase, Janus kinase (JAK) have demonstrated therapeutic effects resembling biologics. Tofacitinib is the only JAK inhibitor approved for RA and during the clinical trial, increased events of herpes zoster (HZ) was observed. Incidence rate was twice as much as patients treated with conventional anti-rheumatic drug and was especially increased in Japan that was four times as much. The risk factors were age and glucocorticoid that is identical to that of common RA patients and there was nothing specific for tofacitinib. Mechanism of increased incidence of HZ and the difference in ethnicity remains unknown. Analysis of clinical trials have identified that HZ do not correlate with further adverse events. Therefore, it is extremely important to accumulate clinical data with considerable amount of patients with long term follow up including the post marketing surveillance in Japan to reveal the significance of increased HZ in RA patients.
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Affiliation(s)
- Kunihiro Yamaoka
- Keio University School of Medicine, Department of Internal Medicine, Division of Rheumatology
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20
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Schiotis RE, Buzoianu AD, Mureșanu DF, Suciu S. New pharmacological strategies in rheumatic diseases. J Med Life 2016; 9:227-234. [PMID: 27974925 PMCID: PMC5154305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Targeting the pathogenic pathway of chronic inflammation represents an unmet challenge for controlling disease activity, preventing functional disability, and maintaining an adequate quality of life in patients with rheumatic diseases. Abatacept, a novel molecule that inhibits co-stimulation signal, induces an inhibitory effect on the T-cells. This will further interfere with the activity of several cell lines, leading to the normalization of the immune response. In the latest years, abatacept has been extensively investigated in studies of rheumatoid arthritis for which it was recently approved as a second line biologic treatment in Romania. This review presents the clinical efficacy of abatacept in several rheumatic diseases and highlights the safety profile of this biological agent. Abbreviations: ACR = American College of Rheumatology, ADR = Adverse drug reaction, APC = antigen presenting cell, ApS = psoriatic arthritis, CRP = C reactive protein, CTLA-4 = Cytotoxic T-Cell Lymphocyte Antigen-4, DAS = Disease activity score, DMARDs = Disease modifying antirheumatic drugs, EMA = European Medicine Agency, EULAR = European League Against Rheumatism, FDA = Food and Drugs Administration, HBV = Hepatitis B virus, JIA = Juvenile Idiopathic Arthritis, LDA = low disease activity (LDA), MRI = magnetic resonance imaging (MRI), MTX = methotrexate, RA = rheumatoid arthritis, RCT = randomized controlled trial, SS = Sjogren's syndrome, TCR = T cell receptor.
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Affiliation(s)
- RE Schiotis
- Department of Pharmacology, Toxicology, and Clinical Pharmacology,
“Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
,Department of Rheumatology, Clinical Hospital of Infectious Diseases, Cluj-Napoca, Romania
| | - AD Buzoianu
- Department of Pharmacology, Toxicology, and Clinical Pharmacology,
“Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - DF Mureșanu
- Department of Neurosciences, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - S Suciu
- Department of Physiology “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Holvoet B, Quattrocelli M, Belderbos S, Pollaris L, Wolfs E, Gheysens O, Gijsbers R, Vanoirbeek J, Verfaillie CM, Sampaolesi M, Deroose CM. Sodium Iodide Symporter PET and BLI Noninvasively Reveal Mesoangioblast Survival in Dystrophic Mice. Stem Cell Reports 2015; 5:1183-1195. [PMID: 26626179 PMCID: PMC4682284 DOI: 10.1016/j.stemcr.2015.10.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 10/29/2015] [Accepted: 10/29/2015] [Indexed: 01/27/2023] Open
Abstract
Muscular dystrophies are a heterogeneous group of myopathies, characterized by muscle weakness and degeneration, without curative treatment. Mesoangioblasts (MABs) have been proposed as a potential regenerative therapy. To improve our understanding of the in vivo behavior of MABs and the effect of different immunosuppressive therapies, like cyclosporine A or co-stimulation-adhesion blockade therapy, on cell survival noninvasive cell monitoring is required. Therefore, cells were transduced with a lentiviral vector encoding firefly luciferase (Fluc) and the human sodium iodide transporter (hNIS) to allow cell monitoring via bioluminescence imaging (BLI) and small-animal positron emission tomography (PET). Non-H2 matched mMABs were injected in the femoral artery of dystrophic mice and were clearly visible via small-animal PET and BLI. Based on noninvasive imaging data, we were able to show that co-stim was clearly superior to CsA in reducing cell rejection and this was mediated via a reduction in cytotoxic T cells and upregulation of regulatory T cells. Longitudinal monitoring of murine mesoangioblasts with BLI and small-animal PET Noninvasive evaluation of immune suppressant efficacy Inhibition of co-stimulation outperformed cyclosporin Inhibition of co-stimulation reduced cytotoxic and upregulated regulatory T cells
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Affiliation(s)
- Bryan Holvoet
- Department of Imaging and Pathology, Nuclear Medicine and Molecular Imaging, KU Leuven, Leuven 3000, Belgium
| | - Mattia Quattrocelli
- Department of Development and Regeneration, Translational Cardiomyology Lab, KU Leuven, Leuven 3000, Belgium
| | - Sarah Belderbos
- Department of Imaging and Pathology, Nuclear Medicine and Molecular Imaging, KU Leuven, Leuven 3000, Belgium
| | - Lore Pollaris
- Department of Public Health and Primary Care, Centre for Environment and Health, KU Leuven, Leuven 3000, Belgium
| | - Esther Wolfs
- Department of Morphology, Biomedical Research Institute, Lab of Histology, Universiteit Hasselt, Diepenbeek 3590, Belgium
| | - Olivier Gheysens
- Department of Imaging and Pathology, Nuclear Medicine and Molecular Imaging, KU Leuven, Leuven 3000, Belgium
| | - Rik Gijsbers
- Department of Pharmaceutical and Pharmacological Sciences, Laboratory of Molecular Virology and Gene Therapy, Leuven Viral Vector Core, KU Leuven, Leuven 3000, Belgium
| | - Jeroen Vanoirbeek
- Department of Public Health and Primary Care, Centre for Environment and Health, KU Leuven, Leuven 3000, Belgium
| | - Catherine M Verfaillie
- Department of Development and Regeneration, Stem Cell Institute Leuven, KU Leuven, Leuven 3000, Belgium
| | - Maurilio Sampaolesi
- Department of Development and Regeneration, Translational Cardiomyology Lab, KU Leuven, Leuven 3000, Belgium
| | - Christophe M Deroose
- Department of Imaging and Pathology, Nuclear Medicine and Molecular Imaging, KU Leuven, Leuven 3000, Belgium.
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Iwahashi C, Fujimoto M, Nomura S, Serada S, Nakai K, Ohguro N, Nishida K, Naka T. CTLA4-Ig suppresses development of experimental autoimmune uveitis in the induction and effector phases: Comparison with blockade of interleukin-6. Exp Eye Res 2015; 140:53-64. [DOI: 10.1016/j.exer.2015.08.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 07/04/2015] [Accepted: 08/17/2015] [Indexed: 12/14/2022]
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Zampeli E, Vlachoyiannopoulos PG, Tzioufas AG. Treatment of rheumatoid arthritis: Unraveling the conundrum. J Autoimmun 2015; 65:1-18. [PMID: 26515757 DOI: 10.1016/j.jaut.2015.10.003] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 10/09/2015] [Indexed: 11/28/2022]
Abstract
Rheumatoid arthritis (RA) is a heterogeneous disease with a complex and yet not fully understood pathophysiology, where numerous different cell-types contribute to a destructive process of the joints. This complexity results into a considerable interpatient variability in clinical course and severity, which may additionally involve genetics and/or environmental factors. After three decades of focused efforts scientists have now achieved to apply in clinical practice, for patients with RA, the "treat to target" approach with initiation of aggressive therapy soon after diagnosis and escalation of the therapy in pursuit of clinical remission. In addition to the conventional synthetic disease modifying anti-rheumatic drugs, biologics have greatly improved the management of RA, demonstrating efficacy and safety in alleviating symptoms, inhibiting bone erosion, and preventing loss of function. Nonetheless, despite the plethora of therapeutic options and their combinations, unmet therapeutic needs in RA remain, as current therapies sometimes fail or produce only partial responses and/or develop unwanted side-effects. Unfortunately the mechanisms of 'nonresponse' remain unknown and most probable lie in the unrevealed heterogeneity of the RA pathophysiology. In this review, through the effort of unraveling the complex pathophysiological pathways, we will depict drugs used throughout the years for the treatment of RA, the current and future biological therapies and their molecular or cellular targets and finally will suggest therapeutic algorithms for RA management. With multiple biologic options, there is still a need for strong predictive biomarkers to determine which drug is most likely to be effective, safe, and durable in a given individual. The fact that available biologics are not effective in all patients attests to the heterogeneity of RA, yet over the long term, as research and treatment become more aggressive, efficacy, toxicity, and costs must be balanced within the therapeutic equation to enhance the quality of life in patients with RA.
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Affiliation(s)
- Evangelia Zampeli
- Department of Pathophysiology, School of Medicine, University of Athens, Athens, Greece
| | | | - Athanasios G Tzioufas
- Department of Pathophysiology, School of Medicine, University of Athens, Athens, Greece.
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Risk of infection with biologic antirheumatic therapies in patients with rheumatoid arthritis. Best Pract Res Clin Rheumatol 2015; 29:290-305. [PMID: 26362745 DOI: 10.1016/j.berh.2015.05.009] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 05/08/2015] [Indexed: 12/11/2022]
Abstract
There are currently 10 licensed biologic therapies for the treatment of rheumatoid arthritis in 2014. In this article, we review the risk of serious infection (SI) for biologic therapies. This risk has been closely studied over the last 15 years within randomised controlled trials, long-term extension studies and observational drug registers, especially for the first three antitumour necrosis factor (TNF) drugs, namely infliximab, etanercept and adalimumab. The risk of SI with the newer biologics rituximab, tocilizumab, abatacept and tofacitinib is also reviewed, although further data from long-term observational studies are awaited. Beyond all-site SI, we review the risk of tuberculosis, other opportunistic infections and herpes zoster, and the effect of screening on TB rates. Lastly, we review emerging opportunities for stratifying the risk. Patients can be risk-stratified based on both modifiable and non-modifiable patient characteristics such as age, co-morbidity, glucocorticoid use, functional status and recent previous SI.
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Cohen S, Radominski SC, Gomez-Reino JJ, Wang L, Krishnaswami S, Wood SP, Soma K, Nduaka CI, Kwok K, Valdez H, Benda B, Riese R. Analysis of infections and all-cause mortality in phase II, phase III, and long-term extension studies of tofacitinib in patients with rheumatoid arthritis. Arthritis Rheumatol 2015; 66:2924-37. [PMID: 25047021 DOI: 10.1002/art.38779] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 07/03/2014] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To determine the rate of infection and all-cause mortality across tofacitinib phase II, phase III, and long-term extension (LTE) studies in patients with moderately to severely active rheumatoid arthritis (RA). METHODS Pooled data from studies of tofacitinib in patients with RA were analyzed. In these studies, tofacitinib was administered as monotherapy or in combination with methotrexate or other nonbiologic disease-modifying antirheumatic drugs. The cutoff date for inclusion of data was April 19, 2012. RESULTS Across phase II, phase III, and LTE studies, 4,789 patients received tofacitinib (8,460 patient-years of exposure). The overall rate of serious infection was 3.09 events per 100 patient-years (95% confidence interval [95% CI] 2.73-3.49), and rates were stable over time. A Cox proportional hazards model showed that age, corticosteroid dose, diabetes, and tofacitinib dose were independently linked to the risk of serious infection. Lymphocyte counts of <0.5 × 10(3) /mm(3) were rare but were associated with an increased risk of treated and/or serious infection. Overall, all-cause mortality rates were 0.30 events per 100 patient-years (95% CI 0.20-0.44). CONCLUSION The overall risk of infection (including serious infection) and mortality rates in RA patients treated with tofacitinib appear to be similar to those observed in RA patients treated with biologic agents. The rates of serious infection were stable over time.
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Pope JE, Rampakakis E, Sampalis J. The durability of abatacept as a first and subsequent biologic and improvement in HAQ from a large multi-site real-world study. Semin Arthritis Rheum 2014; 44:499-505. [PMID: 25440158 DOI: 10.1016/j.semarthrit.2014.09.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Revised: 09/14/2014] [Accepted: 09/19/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Assessment of the effectiveness of newer biologics such as abatacept is essential in real-world practice. METHODS RA patients administered infusions of abatacept via the Orencia Response Program network with at least one follow-up evaluation were included. The number needed to treat (NNT) to improve HAQ by at least the minimal clinically important difference (MID ≥ 0.22) and abatacept survival and differences between biologic-naïve and TNFi-experienced patients were assessed. RESULTS Among 2929 patients enrolled, 1771 (60.5%) were eligible for analysis (mean age was 57.6 years, disease duration was 16.5 ± 11.0 (SD) years, 77.2% were female, and 79.2% had past TNFi), with mean follow-up of 13.8 ± 12.3 (SD) months. Half had comorbidities including hypertension (17%), diabetes (8.4%), asthma (6.0%), hypothyroidism (5.7%), and hyperlipidemia (4.0%). Mean (SE) durability of treatment was 26.8 (0.53) months, where 66% were receiving abatacept at 12 months and 53% at 24 months. Patient survival was longer where abatacept was the first biologic vs. post-TNFi (P = 0.0001). In the use of abatacept as a first biologic, 70% achieved MID in HAQ vs. 71% if post-TNFi (P = 0.65) with NNT to improve one patient with at least MID of HAQ was 1.4. CONCLUSIONS Abatacept is effective in improving HAQ in RA both pre and post first biologic in real-world patients with comorbidities. For those still on abatacept, HAQ continued to improve over the first 2 years. The durability of abatacept is better as a first biologic, but NNT to improve HAQ patients on treatment is the same post-DMARDs and post-TNFi. For treatment durability and HAQ MID achievement, abatacept use as a first biologic is better.
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Affiliation(s)
- Janet E Pope
- Division of Rheumatology, Department of Medicine, St Joseph׳s Health Care, University of Western Ontario, 268 Grosvenor St, London, Ontario, Canada N6A 4V2.
| | | | - John Sampalis
- Department of Surgical Epidemiology, JSS Research, St Laurent, Quebec, Canada; Department of Experimental Surgery, McGill University, Montreal, Quebec, Canada
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Tanaka Y, Kubo S, Yamanaka H, Amano K, Hirata S, Tanaka E, Nagasawa H, Yasuoka H, Takeuchi T. Efficacy and safety of abatacept in routine care of patients with rheumatoid arthritis: Orencia®as Biological Intensive Treatment for RA (ORBIT) study. Mod Rheumatol 2014; 24:754-62. [DOI: 10.3109/14397595.2013.872862] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Souto A, Maneiro JR, Salgado E, Carmona L, Gomez-Reino JJ. Risk of tuberculosis in patients with chronic immune-mediated inflammatory diseases treated with biologics and tofacitinib: a systematic review and meta-analysis of randomized controlled trials and long-term extension studies. Rheumatology (Oxford) 2014; 53:1872-85. [DOI: 10.1093/rheumatology/keu172] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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Kremer JM, Peterfy C, Russell AS, Emery P, Abud-Mendoza C, Sibilia J, Becker JC, Westhovens R, Genant HK. Longterm safety, efficacy, and inhibition of structural damage progression over 5 years of treatment with abatacept in patients with rheumatoid arthritis in the abatacept in inadequate responders to methotrexate trial. J Rheumatol 2014; 41:1077-87. [PMID: 24786925 DOI: 10.3899/jrheum.130263] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Evaluate the safety and efficacy of longterm abatacept (ABA) treatment over 5 years in methotrexate (MTX)-refractory patients with rheumatoid arthritis (RA). METHODS Patients from the 1-year, double-blind Abatacept in Inadequate Responders to Methotrexate (AIM) study (NCT00048568) received open-label ABA (∼10 mg/kg) in the longterm extension (LTE). Safety was assessed for patients who received ≥ 1 ABA dose, and efficacy for patients randomized to ABA and treated in the LTE. Radiographs were evaluated for changes in Genant-modified Sharp scores. RESULTS Out of 652 patients, 539 entered the LTE (ABA, n = 378; placebo, n = 161). At Year 5, 72.4% were ongoing; discontinuation rates declined over time. Incidence rates of serious adverse events, serious infections, malignancies, and autoimmune events were 13.87, 2.84, 1.45, and 0.99 events/100 patient-years exposure, respectively. American College of Rheumatology 20 response was 82.3% (n = 373) and 83.6% (n = 268) at years 1 and 5, respectively. Disease Activity Score 28 C-reactive protein (DAS28-CRP) < 2.6 and ≤ 3.2 were achieved by 25.4% and 44.1% of patients at Year 1 (n = 370), and 33.7% and 54.7% at Year 5 (n = 267), respectively. Mean changes in DAS28-CRP and Health Assessment Questionnaire-Disability Index at Year 1 [-2.83 (n = 365) and -0.68 (n = 369)] were maintained at Year 5 [-3.14 (n = 264) and -0.77 (n = 271)] for patients continuing treatment. Of them, 59.5% (n = 291) and 45.1% (n = 235) remained free from radiographic progression at years 1 and 5, respectively. CONCLUSION In MTX-refractory patients with RA, longterm ABA treatment was well tolerated and provided consistent safety and sustained efficacy, with high patient retention. Radiographic progression continued to be inhibited with ongoing treatment.
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Affiliation(s)
- Joel M Kremer
- From the Center for Rheumatology, Albany Medical College, Albany, New York; Spire Sciences Inc., Boca Raton, Florida, USA; Division of Rheumatology, University of Alberta Hospital, Edmonton, Alberta, Canada; Division of Rheumatic and Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, UK; Regional Unit of Rheumatology, Faculty of Medicine and Central Hospital, University of San Luis Potosí, San Luis Potosí, México; Service de Rhumatologie, CHU de Strasbourg, Hôpital de Hautepierre, Strasbourg, France; Bristol-Myers Squibb, Princeton, New Jersey, USA; Department of Rheumatology, Universitaire Ziekenhuizenn Leuven, Leuven, Belgium; UCSF/Synarc, San Francisco, California, USA.Professional medical writing and editorial assistance funded by Bristol-Myers Squibb, Princeton, New Jersey, USA, and provided by Eve Guichard BSc (hons) of Caudex Medical, Oxford, UK.J.M. Kremer, MD, Center for Rheumatology, Albany Medical College; C. Peterfy, MD, PhD, FRCPC, Spire Sciences Inc.; A.S. Russell, FRCP, FRCPC, Division of Rheumatology, University of Alberta Hospital; P. Emery, MA, MD, FRCP, FRCPE, Division of Rheumatic and Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust; C. Abud-Mendoza, MD, Regional Unit of Rheumatology, Faculty of Medicine and Central Hospital, University of San Luis Potosí; J. Sibilia, MD, Service de Rhumatologie, CHU de Strasbourg, Hôpital de Hautepierre; J-C. Becker, MD, Bristol-Myers Squibb*; R. Westhovens, MD, Department of Rheumatology, Universitaire Ziekenhuizenn Leuven; H.K. Genant, MD, UCSF/Synarc.
| | - Charles Peterfy
- From the Center for Rheumatology, Albany Medical College, Albany, New York; Spire Sciences Inc., Boca Raton, Florida, USA; Division of Rheumatology, University of Alberta Hospital, Edmonton, Alberta, Canada; Division of Rheumatic and Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, UK; Regional Unit of Rheumatology, Faculty of Medicine and Central Hospital, University of San Luis Potosí, San Luis Potosí, México; Service de Rhumatologie, CHU de Strasbourg, Hôpital de Hautepierre, Strasbourg, France; Bristol-Myers Squibb, Princeton, New Jersey, USA; Department of Rheumatology, Universitaire Ziekenhuizenn Leuven, Leuven, Belgium; UCSF/Synarc, San Francisco, California, USA.Professional medical writing and editorial assistance funded by Bristol-Myers Squibb, Princeton, New Jersey, USA, and provided by Eve Guichard BSc (hons) of Caudex Medical, Oxford, UK.J.M. Kremer, MD, Center for Rheumatology, Albany Medical College; C. Peterfy, MD, PhD, FRCPC, Spire Sciences Inc.; A.S. Russell, FRCP, FRCPC, Division of Rheumatology, University of Alberta Hospital; P. Emery, MA, MD, FRCP, FRCPE, Division of Rheumatic and Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust; C. Abud-Mendoza, MD, Regional Unit of Rheumatology, Faculty of Medicine and Central Hospital, University of San Luis Potosí; J. Sibilia, MD, Service de Rhumatologie, CHU de Strasbourg, Hôpital de Hautepierre; J-C. Becker, MD, Bristol-Myers Squibb*; R. Westhovens, MD, Department of Rheumatology, Universitaire Ziekenhuizenn Leuven; H.K. Genant, MD, UCSF/Synarc
| | - Anthony S Russell
- From the Center for Rheumatology, Albany Medical College, Albany, New York; Spire Sciences Inc., Boca Raton, Florida, USA; Division of Rheumatology, University of Alberta Hospital, Edmonton, Alberta, Canada; Division of Rheumatic and Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, UK; Regional Unit of Rheumatology, Faculty of Medicine and Central Hospital, University of San Luis Potosí, San Luis Potosí, México; Service de Rhumatologie, CHU de Strasbourg, Hôpital de Hautepierre, Strasbourg, France; Bristol-Myers Squibb, Princeton, New Jersey, USA; Department of Rheumatology, Universitaire Ziekenhuizenn Leuven, Leuven, Belgium; UCSF/Synarc, San Francisco, California, USA.Professional medical writing and editorial assistance funded by Bristol-Myers Squibb, Princeton, New Jersey, USA, and provided by Eve Guichard BSc (hons) of Caudex Medical, Oxford, UK.J.M. Kremer, MD, Center for Rheumatology, Albany Medical College; C. Peterfy, MD, PhD, FRCPC, Spire Sciences Inc.; A.S. Russell, FRCP, FRCPC, Division of Rheumatology, University of Alberta Hospital; P. Emery, MA, MD, FRCP, FRCPE, Division of Rheumatic and Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust; C. Abud-Mendoza, MD, Regional Unit of Rheumatology, Faculty of Medicine and Central Hospital, University of San Luis Potosí; J. Sibilia, MD, Service de Rhumatologie, CHU de Strasbourg, Hôpital de Hautepierre; J-C. Becker, MD, Bristol-Myers Squibb*; R. Westhovens, MD, Department of Rheumatology, Universitaire Ziekenhuizenn Leuven; H.K. Genant, MD, UCSF/Synarc
| | - Paul Emery
- From the Center for Rheumatology, Albany Medical College, Albany, New York; Spire Sciences Inc., Boca Raton, Florida, USA; Division of Rheumatology, University of Alberta Hospital, Edmonton, Alberta, Canada; Division of Rheumatic and Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, UK; Regional Unit of Rheumatology, Faculty of Medicine and Central Hospital, University of San Luis Potosí, San Luis Potosí, México; Service de Rhumatologie, CHU de Strasbourg, Hôpital de Hautepierre, Strasbourg, France; Bristol-Myers Squibb, Princeton, New Jersey, USA; Department of Rheumatology, Universitaire Ziekenhuizenn Leuven, Leuven, Belgium; UCSF/Synarc, San Francisco, California, USA.Professional medical writing and editorial assistance funded by Bristol-Myers Squibb, Princeton, New Jersey, USA, and provided by Eve Guichard BSc (hons) of Caudex Medical, Oxford, UK.J.M. Kremer, MD, Center for Rheumatology, Albany Medical College; C. Peterfy, MD, PhD, FRCPC, Spire Sciences Inc.; A.S. Russell, FRCP, FRCPC, Division of Rheumatology, University of Alberta Hospital; P. Emery, MA, MD, FRCP, FRCPE, Division of Rheumatic and Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust; C. Abud-Mendoza, MD, Regional Unit of Rheumatology, Faculty of Medicine and Central Hospital, University of San Luis Potosí; J. Sibilia, MD, Service de Rhumatologie, CHU de Strasbourg, Hôpital de Hautepierre; J-C. Becker, MD, Bristol-Myers Squibb*; R. Westhovens, MD, Department of Rheumatology, Universitaire Ziekenhuizenn Leuven; H.K. Genant, MD, UCSF/Synarc
| | - Carlos Abud-Mendoza
- From the Center for Rheumatology, Albany Medical College, Albany, New York; Spire Sciences Inc., Boca Raton, Florida, USA; Division of Rheumatology, University of Alberta Hospital, Edmonton, Alberta, Canada; Division of Rheumatic and Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, UK; Regional Unit of Rheumatology, Faculty of Medicine and Central Hospital, University of San Luis Potosí, San Luis Potosí, México; Service de Rhumatologie, CHU de Strasbourg, Hôpital de Hautepierre, Strasbourg, France; Bristol-Myers Squibb, Princeton, New Jersey, USA; Department of Rheumatology, Universitaire Ziekenhuizenn Leuven, Leuven, Belgium; UCSF/Synarc, San Francisco, California, USA.Professional medical writing and editorial assistance funded by Bristol-Myers Squibb, Princeton, New Jersey, USA, and provided by Eve Guichard BSc (hons) of Caudex Medical, Oxford, UK.J.M. Kremer, MD, Center for Rheumatology, Albany Medical College; C. Peterfy, MD, PhD, FRCPC, Spire Sciences Inc.; A.S. Russell, FRCP, FRCPC, Division of Rheumatology, University of Alberta Hospital; P. Emery, MA, MD, FRCP, FRCPE, Division of Rheumatic and Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust; C. Abud-Mendoza, MD, Regional Unit of Rheumatology, Faculty of Medicine and Central Hospital, University of San Luis Potosí; J. Sibilia, MD, Service de Rhumatologie, CHU de Strasbourg, Hôpital de Hautepierre; J-C. Becker, MD, Bristol-Myers Squibb*; R. Westhovens, MD, Department of Rheumatology, Universitaire Ziekenhuizenn Leuven; H.K. Genant, MD, UCSF/Synarc
| | - Jean Sibilia
- From the Center for Rheumatology, Albany Medical College, Albany, New York; Spire Sciences Inc., Boca Raton, Florida, USA; Division of Rheumatology, University of Alberta Hospital, Edmonton, Alberta, Canada; Division of Rheumatic and Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, UK; Regional Unit of Rheumatology, Faculty of Medicine and Central Hospital, University of San Luis Potosí, San Luis Potosí, México; Service de Rhumatologie, CHU de Strasbourg, Hôpital de Hautepierre, Strasbourg, France; Bristol-Myers Squibb, Princeton, New Jersey, USA; Department of Rheumatology, Universitaire Ziekenhuizenn Leuven, Leuven, Belgium; UCSF/Synarc, San Francisco, California, USA.Professional medical writing and editorial assistance funded by Bristol-Myers Squibb, Princeton, New Jersey, USA, and provided by Eve Guichard BSc (hons) of Caudex Medical, Oxford, UK.J.M. Kremer, MD, Center for Rheumatology, Albany Medical College; C. Peterfy, MD, PhD, FRCPC, Spire Sciences Inc.; A.S. Russell, FRCP, FRCPC, Division of Rheumatology, University of Alberta Hospital; P. Emery, MA, MD, FRCP, FRCPE, Division of Rheumatic and Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust; C. Abud-Mendoza, MD, Regional Unit of Rheumatology, Faculty of Medicine and Central Hospital, University of San Luis Potosí; J. Sibilia, MD, Service de Rhumatologie, CHU de Strasbourg, Hôpital de Hautepierre; J-C. Becker, MD, Bristol-Myers Squibb*; R. Westhovens, MD, Department of Rheumatology, Universitaire Ziekenhuizenn Leuven; H.K. Genant, MD, UCSF/Synarc
| | - Jean-Claude Becker
- From the Center for Rheumatology, Albany Medical College, Albany, New York; Spire Sciences Inc., Boca Raton, Florida, USA; Division of Rheumatology, University of Alberta Hospital, Edmonton, Alberta, Canada; Division of Rheumatic and Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, UK; Regional Unit of Rheumatology, Faculty of Medicine and Central Hospital, University of San Luis Potosí, San Luis Potosí, México; Service de Rhumatologie, CHU de Strasbourg, Hôpital de Hautepierre, Strasbourg, France; Bristol-Myers Squibb, Princeton, New Jersey, USA; Department of Rheumatology, Universitaire Ziekenhuizenn Leuven, Leuven, Belgium; UCSF/Synarc, San Francisco, California, USA.Professional medical writing and editorial assistance funded by Bristol-Myers Squibb, Princeton, New Jersey, USA, and provided by Eve Guichard BSc (hons) of Caudex Medical, Oxford, UK.J.M. Kremer, MD, Center for Rheumatology, Albany Medical College; C. Peterfy, MD, PhD, FRCPC, Spire Sciences Inc.; A.S. Russell, FRCP, FRCPC, Division of Rheumatology, University of Alberta Hospital; P. Emery, MA, MD, FRCP, FRCPE, Division of Rheumatic and Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust; C. Abud-Mendoza, MD, Regional Unit of Rheumatology, Faculty of Medicine and Central Hospital, University of San Luis Potosí; J. Sibilia, MD, Service de Rhumatologie, CHU de Strasbourg, Hôpital de Hautepierre; J-C. Becker, MD, Bristol-Myers Squibb*; R. Westhovens, MD, Department of Rheumatology, Universitaire Ziekenhuizenn Leuven; H.K. Genant, MD, UCSF/Synarc
| | - Rene Westhovens
- From the Center for Rheumatology, Albany Medical College, Albany, New York; Spire Sciences Inc., Boca Raton, Florida, USA; Division of Rheumatology, University of Alberta Hospital, Edmonton, Alberta, Canada; Division of Rheumatic and Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, UK; Regional Unit of Rheumatology, Faculty of Medicine and Central Hospital, University of San Luis Potosí, San Luis Potosí, México; Service de Rhumatologie, CHU de Strasbourg, Hôpital de Hautepierre, Strasbourg, France; Bristol-Myers Squibb, Princeton, New Jersey, USA; Department of Rheumatology, Universitaire Ziekenhuizenn Leuven, Leuven, Belgium; UCSF/Synarc, San Francisco, California, USA.Professional medical writing and editorial assistance funded by Bristol-Myers Squibb, Princeton, New Jersey, USA, and provided by Eve Guichard BSc (hons) of Caudex Medical, Oxford, UK.J.M. Kremer, MD, Center for Rheumatology, Albany Medical College; C. Peterfy, MD, PhD, FRCPC, Spire Sciences Inc.; A.S. Russell, FRCP, FRCPC, Division of Rheumatology, University of Alberta Hospital; P. Emery, MA, MD, FRCP, FRCPE, Division of Rheumatic and Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust; C. Abud-Mendoza, MD, Regional Unit of Rheumatology, Faculty of Medicine and Central Hospital, University of San Luis Potosí; J. Sibilia, MD, Service de Rhumatologie, CHU de Strasbourg, Hôpital de Hautepierre; J-C. Becker, MD, Bristol-Myers Squibb*; R. Westhovens, MD, Department of Rheumatology, Universitaire Ziekenhuizenn Leuven; H.K. Genant, MD, UCSF/Synarc
| | - Harry K Genant
- From the Center for Rheumatology, Albany Medical College, Albany, New York; Spire Sciences Inc., Boca Raton, Florida, USA; Division of Rheumatology, University of Alberta Hospital, Edmonton, Alberta, Canada; Division of Rheumatic and Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, UK; Regional Unit of Rheumatology, Faculty of Medicine and Central Hospital, University of San Luis Potosí, San Luis Potosí, México; Service de Rhumatologie, CHU de Strasbourg, Hôpital de Hautepierre, Strasbourg, France; Bristol-Myers Squibb, Princeton, New Jersey, USA; Department of Rheumatology, Universitaire Ziekenhuizenn Leuven, Leuven, Belgium; UCSF/Synarc, San Francisco, California, USA.Professional medical writing and editorial assistance funded by Bristol-Myers Squibb, Princeton, New Jersey, USA, and provided by Eve Guichard BSc (hons) of Caudex Medical, Oxford, UK.J.M. Kremer, MD, Center for Rheumatology, Albany Medical College; C. Peterfy, MD, PhD, FRCPC, Spire Sciences Inc.; A.S. Russell, FRCP, FRCPC, Division of Rheumatology, University of Alberta Hospital; P. Emery, MA, MD, FRCP, FRCPE, Division of Rheumatic and Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust; C. Abud-Mendoza, MD, Regional Unit of Rheumatology, Faculty of Medicine and Central Hospital, University of San Luis Potosí; J. Sibilia, MD, Service de Rhumatologie, CHU de Strasbourg, Hôpital de Hautepierre; J-C. Becker, MD, Bristol-Myers Squibb*; R. Westhovens, MD, Department of Rheumatology, Universitaire Ziekenhuizenn Leuven; H.K. Genant, MD, UCSF/Synarc
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Vicente Rabaneda EF, Herrero-Beaumont G, Castañeda S. Update on the use of abatacept for the treatment of rheumatoid arthritis. Expert Rev Clin Immunol 2014; 9:599-621. [PMID: 23899231 DOI: 10.1586/1744666x.2013.811192] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Abatacept is approved for the treatment of moderate-to-severe active rheumatoid arthritis (RA) patients with inadequate response to one or more disease-modifying antirheumatic drugs (DMARDs), including methotrexate or a TNF antagonist, and can be used either as monotherapy or concomitantly with nonbiologic DMARDs. It can be administered either intravenously or subcutaneously. It has demonstrated to improve signs and symptoms of RA, physical function and health-related quality of life, and it inhibits radiographic progression of structural damage across a wide range of early and long-standing RA populations. The safety profile appears good and close to RA patients treated with nonbiologic DMARDs. Meta-analysis and real-world studies support these findings. This article reviews published data on clinical and radiographic efficacy as well as the safety of this drug, incorporating recent relevant information reported at scientific meetings.
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Affiliation(s)
- Esther F Vicente Rabaneda
- Rheumatology Department, Hospital Universitario de La Princesa, IIS-Princesa, Universidad Autónoma de Madrid, C/ Diego de León 62, 28006 Madrid, Spain
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Iwanaga N, Origuchi T, Terada K, Ueki Y, Kamo Y, Kinoshita N, Yonemitsu N, Kawashiri SY, Ichinose K, Tamai M, Nakamura H, Kawakami A. Rheumatoid arthritis complicated with severe liver injury during treatment with abatacept. Mod Rheumatol 2014; 24:874-6. [PMID: 24611764 DOI: 10.3109/14397595.2013.844399] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Nozomi Iwanaga
- Department of Rheumatology, Sasebo Chuo Hospital , Sasebo , Japan
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Genovese MC, Tena CP, Covarrubias A, Leon G, Mysler E, Keiserman M, Valente R, Nash P, Simon-Campos JA, Box J, Legerton CW, Nasonov E, Durez P, Delaet I, Teng J, Alten R. Subcutaneous abatacept for the treatment of rheumatoid arthritis: longterm data from the ACQUIRE trial. J Rheumatol 2014; 41:629-39. [PMID: 24584926 DOI: 10.3899/jrheum.130112] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Assess longterm tolerability, safety, and efficacy of subcutaneous (SC) abatacept (ABA) in methotrexate-refractory patients with rheumatoid arthritis (RA). METHODS The phase III, multinational Abatacept Comparison of Sub[QU]cutaneous Versus Intravenous in Inadequate Responders to MethotrexatE (ACQUIRE) trial comprised a 6-month, randomized, double-blind (DB) period, in which patients received intravenous (IV) or SC ABA, plus MTX, followed by an open-label, longterm extension (LTE), in which patients received SC ABA, 125 mg/week. Safety and efficacy from the LTE (∼3.5 yrs of exposure) are reported. RESULTS Patients who completed the DB period (1372/1385, 99.1%) entered the LTE; 1134 patients (82.7%) kept taking the treatment at time of reporting. Mean (SD) was 31.9 months (6.8); median (range) exposure was 33.0 (8-44) months. Patients entering the LTE had longstanding, moderate-to-severe disease [mean 7.6 (7.9) yrs and DAS28 (C-reactive protein) 6.2 (0.9)]. Incidence rates (events/100 patient-yrs) were reported for serious adverse events (8.76, 95% CI 7.71, 9.95), infections (44.80, 95% CI 41.76, 48.01), serious infections (1.72, 95% CI 1.30, 2.27), malignancies (1.19, 95% CI 0.86, 1.66), and autoimmune events (1.31, 95% CI 0.95, 1.79). Twenty-seven patients (2%) experienced injection-site reactions; all except 1 were mild. American College of Rheumatology 20, 50, and 70 responses achieved during the DB period were maintained through the LTE, and on Day 981 were 80.2% (95% CI 77.2, 83.2), 63.5% (95% CI 58.2, 68.9), and 39.5% (95% CI 34.0, 44.9) for patients who kept taking SC ABA, and 80.0% (95% CI 77.0, 83.0), 63.2% (95% CI 57.8, 68.7), and 39.2% (95% CI 33.7, 44.7) for those who switched from IV to SC ABA. CONCLUSION These findings support SC ABA as a well-tolerated and efficacious longterm treatment for patients with RA and inadequate response to MTX (ClinicalTrials.gov identifier NCT00559585).
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Affiliation(s)
- Mark C Genovese
- From Stanford University, Palo Alto, California, USA; Universidad Autónoma de Chihuahua, Chihuahua; Unidad Reumatologica Las Americas S.C.P., Mérida, Mexico; Instituto De Ginecologia Y Reproduccion, Lima, Peru; Organización Médica de Investigación, Buenos Aires, Argentina; Pontificial Catholic University School of Medicine, Porto Alegre, Brazil; Physician Research Collaboration, Lincoln, Nebraska, USA; University of Queensland, Brisbane, Queensland, Australia; Centro De Especialidades Médicas/Universidad Marista, Mérida, Mexico; Box Arthritis and Rheumatology of the Carolinas, Charlotte, North Carolina; Low Country Rheumatology, Charleston, South Carolina, USA; Institute of Rheumatology, Moscow, Russia; Service et Pôle de Rhumatologie, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium; Bristol-Myers Squibb, Princeton, New Jersey, USA; and Schlosspark-Klinik, Teaching Hospital of the Charité University Medicine Berlin, Berlin, Germany
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Abstract
The biological disease-modifying antirheumatic drug abatacept (Orencia) has a novel mechanism of action; its activity is mediated via the selective modulation of T cell co-stimulation. This article reviews the clinical efficacy and tolerability of intravenous and subcutaneous abatacept in patients with rheumatoid arthritis (RA) and intravenous abatacept in patients with juvenile idiopathic arthritis (JIA), as well as summarizing its pharmacological properties. In patients with RA, the beneficial effects of intravenous or subcutaneous abatacept on signs and symptoms, disease activity, the progression of structural damage, physical function and/or health-related quality of life were seen in a number of well-designed trials, including in methotrexate-naive patients with early RA and poor prognostic factors and in patients with established RA and an inadequate response to either methotrexate or anti-tumour necrosis factor therapy. Subcutaneous abatacept plus methotrexate was also noninferior to subcutaneous adalimumab plus methotrexate in patients with active RA who were naive to biological therapy and had an inadequate response to methotrexate. In paediatric patients with JIA, intravenous abatacept improved signs and symptoms and delayed the time to flare. Abatacept was generally well tolerated in RA and JIA and was associated with low rates of immunogenicity. In conclusion, abatacept is an important option for use in the treatment of RA and JIA.
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Affiliation(s)
- Gillian M Keating
- Adis, 41 Centorian Drive, Private Bag 65901, Mairangi Bay, North Shore, 0754 Auckland, New Zealand.
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Dastiridou A, Kalogeropoulos C, Brazitikos P, Symeonidis C, Androudi S. New biologic-response modifiers in ocular inflammatory disease: beyond anti-TNF treatment. Expert Rev Clin Pharmacol 2014; 5:543-55. [DOI: 10.1586/ecp.12.37] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Jani M, Hyrich KL. Abatacept in the long-term treatment of rheumatoid arthritis. Expert Rev Clin Immunol 2014; 8:231-4. [DOI: 10.1586/eci.11.98] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Reeve R, Pang L, Ferguson B, O'Kelly M, Berry S, Xiao W. Rheumatoid Arthritis Disease Progression Modeling. Ther Innov Regul Sci 2013; 47:641-650. [PMID: 30235560 DOI: 10.1177/2168479013499571] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Time progression models provide a significant advantage in developing clinical trials and can also be used to elicit comparisons among therapeutic agents. The authors performed a meta-analysis to construct a time progression model for rheumatoid arthritis (RA), an area of significant interest for pharmaceutical development, using the ACR20 end point. Compounds studied were chiefly monoclonal antibodies that were used in conjunction with methotrexate. The study shows that an exponential time response model adequately fits the data. From the modeling, a distribution of effects for biological RA therapies can be provided.
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Affiliation(s)
| | - Lei Pang
- 2 Merck, Rahway, NJ, USA
- Dr Pang was at Quintiles, Durham, NC, USA, when this study was performed
| | - Bradley Ferguson
- 3 Department of Statistics, North Carolina State University, Raleigh, NC, USA
| | | | | | - Wei Xiao
- 3 Department of Statistics, North Carolina State University, Raleigh, NC, USA
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Paula FS, Alves JD. Non-tumor necrosis factor-based biologic therapies for rheumatoid arthritis: present, future, and insights into pathogenesis. Biologics 2013; 8:1-12. [PMID: 24353404 PMCID: PMC3861294 DOI: 10.2147/btt.s35475] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The way rheumatoid arthritis is treated has changed dramatically with the introduction of anti-tumor necrosis factor (anti-TNF) biologics. Nevertheless, many patients still have less than adequate control of their disease activity even with these therapeutic regimens, and current knowledge fails to explain all the data already gathered. There is now a wide range of drugs from different classes of biologic disease-modifying anti-rheumatic drugs available (and soon this number will increase significantly), that provides the opportunity to address each patient as a particular case and thereby optimize medical intervention. Currently available biologics for the treatment of rheumatoid arthritis apart from anti-TNF-based therapies are reviewed, along with an analysis of the new insights they provide into the pathogenesis of the disease and a discussion of future prospects in the area.
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Affiliation(s)
- Filipe Seguro Paula
- Immunomediated Systemic Diseases Unit, Department of Medicine 4, Fernando Fonseca Hospital, Amadora, Portugal
| | - José Delgado Alves
- Immunomediated Systemic Diseases Unit, Department of Medicine 4, Fernando Fonseca Hospital, Amadora, Portugal ; Center for the Study of Chronic Diseases, Department of Pharmacology, Faculty of Medical Sciences, Lisbon, Portugal
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Long-term safety of abatacept in patients with rheumatoid arthritis. Autoimmun Rev 2013; 12:1115-7. [DOI: 10.1016/j.autrev.2013.06.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 01/21/2013] [Indexed: 12/20/2022]
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Newest clinical trial results with antitumor necrosis factor and nonantitumor necrosis factor biologics for rheumatoid arthritis. Curr Opin Rheumatol 2013; 25:384-90. [PMID: 23511719 DOI: 10.1097/bor.0b013e32835fc62e] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW To highlight recent evidence from the clinical trials of anti-tumor necrosis factor (TNF) and non anti-TNF biologics for rheumatoid arthritis (RA) focused on comparative clinical efficacy including safety outcomes and medication discontinuation. RECENT FINDINGS Patients with RA are sometimes able to attain low disease activity or remission since the introduction of biologic therapy for RA. Biologics like anti-TNF, anti-interleukin-6 (IL-6), anti-CD20 and those that modulate T-cell co-stimulation have consistently shown good efficacy in patients with RA. Preliminary data from comparative efficacy studies to evaluate the potential differences between anti-TNF and non anti-TNF biologics have shown little differences among these. There is ongoing work in comparative efficacy to answer this question further. SUMMARY Biologic therapy in RA has significantly changed the course of RA in the last decade. Recently published clinical trials have been focused on comparative efficacy, cardiovascular safety of biologics and potential anti-TNF therapy discontinuation in patients with RA.
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Caporali R, Bugatti S, Cavagna L, Antivalle M, Atzeni F, Puttini PS. WITHDRAWN: Abatacept as a first-line biological therapy. Autoimmun Rev 2013:S1568-9972(13)00114-6. [PMID: 23806564 DOI: 10.1016/j.autrev.2013.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 01/21/2013] [Indexed: 12/16/2022]
Abstract
The Publisher regrets that this article is an accidental duplication of an article that has already been published, http://dx.doi.org/10.1016/j.autrev.2013.06.008. The duplicate article has therefore been withdrawn.
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Affiliation(s)
- Roberto Caporali
- Division of Rheumatology, University of Pavia, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy.
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Caporali R, Bugatti S, Cavagna L, Antivalle M, Sarzi-Puttini P. Modulating the co-stimulatory signal for T cell activation in rheumatoid arthritis: could it be the first step of the treatment? Autoimmun Rev 2013; 13:49-53. [PMID: 23777823 DOI: 10.1016/j.autrev.2013.06.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Advances in our understanding of the key mediators of chronic inflammation and tissue damage in rheumatoid arthritis (RA) have fostered the development of targeted therapies and greatly expanded the available treatment options. Abatacept, a soluble human fusion protein that selectively modulates the co-stimulatory signal required for full T-cell activation, is approved for the treatment of moderate to severe RA in the United States, Canada, and the European Union. This review summarises the data on efficacy (disease activity, quality of life, prevention of structural damage) and safety from randomised clinical trials of abatacept plus methotrexate in patients with: i) active RA and an inadequate response to methotrexate who are naïve to biological disease-modifying anti-rheumatic drugs; and ii) methotrexate-naïve early RA with poor prognostic factors. Novel imaging outcomes and biological changes induced by abatacept treatment are also briefly reviewed. Optimal use of abatacept as a first-line biological therapy is discussed in light of the current recommendations and guidelines.
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Affiliation(s)
- Roberto Caporali
- Division of Rheumatology, University of Pavia, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy.
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KEYSTONE EDWARDC, COHEN STANLEYB, EMERY PAUL, KREMER JOELM, DOUGADOS MAXIME, LOVELESS JAMESE, CHUNG CAROL, WONG PAMELA, LEHANE PATRICIAB, TYRRELL HELEN. Dr. Keystone, et al, reply. J Rheumatol 2013; 40:732-733. [PMID: 23767071 DOI: 10.3899/jrheum.130175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Tran TN, Caspard H, Magrini F. Incidence density of serious infection, opportunistic infection, and tuberculosis associated with biologic treatment in patients with rheumatoid arthritis - a systematic evaluation of the literature. Open Access Rheumatol 2013; 5:21-32. [PMID: 27790021 PMCID: PMC5074790 DOI: 10.2147/oarrr.s40526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Summary data on the incidence density (ie, incidence per person-year [PY]) of serious infection, opportunistic infection, and tuberculosis associated with each of the nine biologic therapies currently indicated in rheumatoid arthritis patients are not available. To summarize these data, a systematic review was conducted with searches on PubMed and Embase of literature ranging from January 1998 to November 2011. Incidence density was extracted and reported using the definitions from the respective publications. If the incidence density was not reported, estimation was made using available information. A total of 72 published studies met the inclusion criteria and were reviewed, including 44 clinical trials, open-label extension studies, or meta-analyses, and 28 observational studies. Additional calculation of the incidence density was performed in 12 studies for serious infection and in 13 studies for opportunistic infection or tuberculosis. The incidence of serious infection was consistent across studies and biologic therapies, ranging from 0 to 11/100 PY but mainly clustered from 2 to 6/100 PY. Fewer incidence data were available for opportunistic infection and tuberculosis. The incidence of opportunistic infection and tuberculosis ranged widely, from 0.01 to 3.0/100 PY and 0.01 to 2.6/100 PY, respectively. The data on serious infection may be used to evaluate the public health risk and benefit of biologic treatment. They may also serve as a point of reference for future studies. The limited data on opportunistic infection and the lack of a consistent definition of opportunistic infection invite caution for a benchmark rate for opportunistic infection as a composite category.
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Affiliation(s)
- Trung N Tran
- Clinical Development, MedImmune, Gaithersburg, MD, USA
| | - Herve Caspard
- Clinical Development, MedImmune, Gaithersburg, MD, USA
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Keystone EC, Cohen SB, Emery P, Kremer JM, Dougados M, Loveless JE, Chung C, Wong P, Lehane PB, Tyrrell H. Multiple courses of rituximab produce sustained clinical and radiographic efficacy and safety in patients with rheumatoid arthritis and an inadequate response to 1 or more tumor necrosis factor inhibitors: 5-year data from the REFLEX study. J Rheumatol 2012; 39:2238-46. [PMID: 23027887 DOI: 10.3899/jrheum.120573] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE This 5-year observational posthoc analysis of the REFLEX study and its open-label extension assessed clinical efficacy, radiographic response, and safety of rituximab (RTX) in patients with rheumatoid arthritis (RA) who had an inadequate response to tumor necrosis factor (TNF) inhibitors. METHODS Patients in REFLEX were originally randomized to placebo (PBO) + methotrexate (MTX; PBO-randomized) or RTX + MTX (RTX-randomized). PBO-randomized patients were rescued with RTX as appropriate. Patients responding to initial RTX treatment could receive further RTX courses. For clinical efficacy and safety analyses, PBO-randomized patients were re-baselined prior to first RTX treatment and the data were pooled with RTX-randomized patient data. Efficacy outcomes 24 weeks after each course were calculated relative to first RTX pretreatment baseline. Radiographic outcomes were assessed relative to randomization baseline for both PBO-randomized and RTX-randomized groups. RESULTS A total of 480 patients received ≥ 1 RTX course. At 24 weeks, American College of Rheumatology 20/50/70 responses were 62.0%, 30.8%, and 13.0%, respectively at course 1 (n = 400) and 70.3%, 41.8%, and 22.0% at course 5 (n = 91). European League Against Rheumatism good/moderate responses were 77.2% and 84.4% at courses 1 (n = 390) and 5 (n = 90). Rates of adverse events (AE), serious AE, and infections generally remained stable. Rate of progressive joint damage (PJD; change in mean Total Sharp Score) decreased over time in both PBO-randomized (n = 79) and RTX-randomized (n = 105) groups. Mean change from baseline in PJD over 5 years was greater in PBO-randomized versus RTX-randomized patients (5.51 vs 3.21). CONCLUSION RTX re-treatment over 5 years is associated with maintained or improved efficacy, continued inhibition of PJD, and a safety profile consistent with that previously reported. A delay in initiating RTX treatment may result in increased PJD.
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Affiliation(s)
- Edward C Keystone
- Mount Sinai Hospital and the University of Toronto, Toronto, Ontario, Canada.
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Martín Mola E, Balsa A, Martínez Taboada V, Sanmartí R, Marenco JL, Navarro Sarabia F, Gómez-Reino J, Alvaro-Gracia JM, Román Ivorra JA, Lojo L, Plasencia C, Carmona L. Abatacept use in rheumatoid arthritis: evidence review and recommendations. ACTA ACUST UNITED AC 2012; 9:5-17. [PMID: 22766432 DOI: 10.1016/j.reuma.2012.05.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Revised: 04/29/2012] [Accepted: 05/02/2012] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To review the clinical evidence on abatacept and to formulate recommendations in order to clear up points related to its use in rheumatology. METHOD An expert panel of rheumatologists objectively summarized the evidence on the mechanism of action, practicalities, effectiveness and safety of abatacept, and formulated recommendations following a literature review. The level of evidence and degree of recommendation was established. RESULTS The document presents 21 statements focused on evidence or recommendations on abatacept (14 evidence summaries and 9 recommendations). The level of evidence was 2b or higher according to the Oxford Centre for Evidence-Based Medicine scale on 14 occasions. The degree of the recommendation was A in two recommendations, C in one, and D in the rest. It was considered important to make recommendations on aspects with lower levels of evidence. CONCLUSIONS This is a practical document to supplement the summary of product characteristics.
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Affiliation(s)
- Emilio Martín Mola
- Servicio de Reumatología, Hospital Universitario La Paz, IdiPAZ, Madrid, España.
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