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González-Álvaro I, Martínez-Fernández C, Dorantes-Calderón B, García-Vicuña R, Hernández-Cruz B, Herrero-Ambrosio A, Ibarra-Barrueta O, Martín-Mola E, Monte-Boquet E, Morell-Baladrón A, Sanmartí R, Sanz-Sanz J, de Toro-Santos FJ, Vela P, Román Ivorra JA, Poveda-Andrés JL, Muñoz-Fernández S. Spanish Rheumatology Society and Hospital Pharmacy Society Consensus on recommendations for biologics optimization in patients with rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis. Rheumatology (Oxford) 2014; 54:1200-9. [PMID: 25526976 PMCID: PMC4473767 DOI: 10.1093/rheumatology/keu461] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE The aim of this study was to establish guidelines for the optimization of biologic therapies for health professionals involved in the management of patients with RA, AS and PsA. METHODS Recommendations were established via consensus by a panel of experts in rheumatology and hospital pharmacy, based on analysis of available scientific evidence obtained from four systematic reviews and on the clinical experience of panellists. The Delphi method was used to evaluate these recommendations, both between panellists and among a wider group of rheumatologists. RESULTS Previous concepts concerning better management of RA, AS and PsA were reviewed and, more specifically, guidelines for the optimization of biologic therapies used to treat these diseases were formulated. Recommendations were made with the aim of establishing a plan for when and how to taper biologic treatment in patients with these diseases. CONCLUSION The recommendations established herein aim not only to provide advice on how to improve the risk:benefit ratio and efficiency of such treatments, but also to reduce variability in daily clinical practice in the use of biologic therapies for rheumatic diseases.
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Affiliation(s)
- Isidoro González-Álvaro
- Rheumatology Service, Instituto de Investigación Sanitaria La Princesa, Hospital Universitario de La Princesa, Madrid, Research Unit, Spanish Rheumatology Society, Madrid, Hospital Pharmacy Clinical Management Unit, Hospital de Valme, Seville, Rheumatology Clinical Management Unit, Hospital Universitario Virgen Macarena, Seville, Hospital Pharmacy Service, Hospital Universitario La Paz, IdiPaz, Madrid, Hospital Pharmacy Service, Hospital de Galdakano-Usansolo, Vizcaya, Rheumatology Service, Hospital Universitario La Paz, IdiPaz, Universidad Autónoma de Madrid, Madrid, Hospital Pharmacy Service, Hospital Universitari i Politécnic La Fe, Valencia, Hospital Pharmacy Service, Hospital Universitario de La Princesa, Madrid, Rheumatology Service, Hospital Clinic de Barcelona, Universidad de Barcelona, Barcelona, Rheumatology Service, Hospital Puerta de Hierro, Madrid, Rheumatology Service, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario A Coruña (CHUAC), Sergas. Universidade da Coruña, A Coruña, Rheumatology Section, Hospital General Universitario de Alicante, Universidad Miguel Hernández, Alicante, Rheumatology Service, Hospital Universitari i Politécnic La Fe, Valencia andRheumatology Service, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, Spain
| | - Carmen Martínez-Fernández
- Rheumatology Service, Instituto de Investigación Sanitaria La Princesa, Hospital Universitario de La Princesa, Madrid, Research Unit, Spanish Rheumatology Society, Madrid, Hospital Pharmacy Clinical Management Unit, Hospital de Valme, Seville, Rheumatology Clinical Management Unit, Hospital Universitario Virgen Macarena, Seville, Hospital Pharmacy Service, Hospital Universitario La Paz, IdiPaz, Madrid, Hospital Pharmacy Service, Hospital de Galdakano-Usansolo, Vizcaya, Rheumatology Service, Hospital Universitario La Paz, IdiPaz, Universidad Autónoma de Madrid, Madrid, Hospital Pharmacy Service, Hospital Universitari i Politécnic La Fe, Valencia, Hospital Pharmacy Service, Hospital Universitario de La Princesa, Madrid, Rheumatology Service, Hospital Clinic de Barcelona, Universidad de Barcelona, Barcelona, Rheumatology Service, Hospital Puerta de Hierro, Madrid, Rheumatology Service, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario A Coruña (CHUAC), Sergas. Universidade da Coruña, A Coruña, Rheumatology Section, Hospital General Universitario de Alicante, Universidad Miguel Hernández, Alicante, Rheumatology Service, Hospital Universitari i Politécnic La Fe, Valencia andRheumatology Service, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, Spain
| | - Benito Dorantes-Calderón
- Rheumatology Service, Instituto de Investigación Sanitaria La Princesa, Hospital Universitario de La Princesa, Madrid, Research Unit, Spanish Rheumatology Society, Madrid, Hospital Pharmacy Clinical Management Unit, Hospital de Valme, Seville, Rheumatology Clinical Management Unit, Hospital Universitario Virgen Macarena, Seville, Hospital Pharmacy Service, Hospital Universitario La Paz, IdiPaz, Madrid, Hospital Pharmacy Service, Hospital de Galdakano-Usansolo, Vizcaya, Rheumatology Service, Hospital Universitario La Paz, IdiPaz, Universidad Autónoma de Madrid, Madrid, Hospital Pharmacy Service, Hospital Universitari i Politécnic La Fe, Valencia, Hospital Pharmacy Service, Hospital Universitario de La Princesa, Madrid, Rheumatology Service, Hospital Clinic de Barcelona, Universidad de Barcelona, Barcelona, Rheumatology Service, Hospital Puerta de Hierro, Madrid, Rheumatology Service, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario A Coruña (CHUAC), Sergas. Universidade da Coruña, A Coruña, Rheumatology Section, Hospital General Universitario de Alicante, Universidad Miguel Hernández, Alicante, Rheumatology Service, Hospital Universitari i Politécnic La Fe, Valencia andRheumatology Service, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, Spain
| | - Rosario García-Vicuña
- Rheumatology Service, Instituto de Investigación Sanitaria La Princesa, Hospital Universitario de La Princesa, Madrid, Research Unit, Spanish Rheumatology Society, Madrid, Hospital Pharmacy Clinical Management Unit, Hospital de Valme, Seville, Rheumatology Clinical Management Unit, Hospital Universitario Virgen Macarena, Seville, Hospital Pharmacy Service, Hospital Universitario La Paz, IdiPaz, Madrid, Hospital Pharmacy Service, Hospital de Galdakano-Usansolo, Vizcaya, Rheumatology Service, Hospital Universitario La Paz, IdiPaz, Universidad Autónoma de Madrid, Madrid, Hospital Pharmacy Service, Hospital Universitari i Politécnic La Fe, Valencia, Hospital Pharmacy Service, Hospital Universitario de La Princesa, Madrid, Rheumatology Service, Hospital Clinic de Barcelona, Universidad de Barcelona, Barcelona, Rheumatology Service, Hospital Puerta de Hierro, Madrid, Rheumatology Service, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario A Coruña (CHUAC), Sergas. Universidade da Coruña, A Coruña, Rheumatology Section, Hospital General Universitario de Alicante, Universidad Miguel Hernández, Alicante, Rheumatology Service, Hospital Universitari i Politécnic La Fe, Valencia andRheumatology Service, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, Spain
| | - Blanca Hernández-Cruz
- Rheumatology Service, Instituto de Investigación Sanitaria La Princesa, Hospital Universitario de La Princesa, Madrid, Research Unit, Spanish Rheumatology Society, Madrid, Hospital Pharmacy Clinical Management Unit, Hospital de Valme, Seville, Rheumatology Clinical Management Unit, Hospital Universitario Virgen Macarena, Seville, Hospital Pharmacy Service, Hospital Universitario La Paz, IdiPaz, Madrid, Hospital Pharmacy Service, Hospital de Galdakano-Usansolo, Vizcaya, Rheumatology Service, Hospital Universitario La Paz, IdiPaz, Universidad Autónoma de Madrid, Madrid, Hospital Pharmacy Service, Hospital Universitari i Politécnic La Fe, Valencia, Hospital Pharmacy Service, Hospital Universitario de La Princesa, Madrid, Rheumatology Service, Hospital Clinic de Barcelona, Universidad de Barcelona, Barcelona, Rheumatology Service, Hospital Puerta de Hierro, Madrid, Rheumatology Service, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario A Coruña (CHUAC), Sergas. Universidade da Coruña, A Coruña, Rheumatology Section, Hospital General Universitario de Alicante, Universidad Miguel Hernández, Alicante, Rheumatology Service, Hospital Universitari i Politécnic La Fe, Valencia andRheumatology Service, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, Spain
| | - Alicia Herrero-Ambrosio
- Rheumatology Service, Instituto de Investigación Sanitaria La Princesa, Hospital Universitario de La Princesa, Madrid, Research Unit, Spanish Rheumatology Society, Madrid, Hospital Pharmacy Clinical Management Unit, Hospital de Valme, Seville, Rheumatology Clinical Management Unit, Hospital Universitario Virgen Macarena, Seville, Hospital Pharmacy Service, Hospital Universitario La Paz, IdiPaz, Madrid, Hospital Pharmacy Service, Hospital de Galdakano-Usansolo, Vizcaya, Rheumatology Service, Hospital Universitario La Paz, IdiPaz, Universidad Autónoma de Madrid, Madrid, Hospital Pharmacy Service, Hospital Universitari i Politécnic La Fe, Valencia, Hospital Pharmacy Service, Hospital Universitario de La Princesa, Madrid, Rheumatology Service, Hospital Clinic de Barcelona, Universidad de Barcelona, Barcelona, Rheumatology Service, Hospital Puerta de Hierro, Madrid, Rheumatology Service, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario A Coruña (CHUAC), Sergas. Universidade da Coruña, A Coruña, Rheumatology Section, Hospital General Universitario de Alicante, Universidad Miguel Hernández, Alicante, Rheumatology Service, Hospital Universitari i Politécnic La Fe, Valencia andRheumatology Service, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, Spain
| | - Olatz Ibarra-Barrueta
- Rheumatology Service, Instituto de Investigación Sanitaria La Princesa, Hospital Universitario de La Princesa, Madrid, Research Unit, Spanish Rheumatology Society, Madrid, Hospital Pharmacy Clinical Management Unit, Hospital de Valme, Seville, Rheumatology Clinical Management Unit, Hospital Universitario Virgen Macarena, Seville, Hospital Pharmacy Service, Hospital Universitario La Paz, IdiPaz, Madrid, Hospital Pharmacy Service, Hospital de Galdakano-Usansolo, Vizcaya, Rheumatology Service, Hospital Universitario La Paz, IdiPaz, Universidad Autónoma de Madrid, Madrid, Hospital Pharmacy Service, Hospital Universitari i Politécnic La Fe, Valencia, Hospital Pharmacy Service, Hospital Universitario de La Princesa, Madrid, Rheumatology Service, Hospital Clinic de Barcelona, Universidad de Barcelona, Barcelona, Rheumatology Service, Hospital Puerta de Hierro, Madrid, Rheumatology Service, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario A Coruña (CHUAC), Sergas. Universidade da Coruña, A Coruña, Rheumatology Section, Hospital General Universitario de Alicante, Universidad Miguel Hernández, Alicante, Rheumatology Service, Hospital Universitari i Politécnic La Fe, Valencia andRheumatology Service, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, Spain
| | - Emilio Martín-Mola
- Rheumatology Service, Instituto de Investigación Sanitaria La Princesa, Hospital Universitario de La Princesa, Madrid, Research Unit, Spanish Rheumatology Society, Madrid, Hospital Pharmacy Clinical Management Unit, Hospital de Valme, Seville, Rheumatology Clinical Management Unit, Hospital Universitario Virgen Macarena, Seville, Hospital Pharmacy Service, Hospital Universitario La Paz, IdiPaz, Madrid, Hospital Pharmacy Service, Hospital de Galdakano-Usansolo, Vizcaya, Rheumatology Service, Hospital Universitario La Paz, IdiPaz, Universidad Autónoma de Madrid, Madrid, Hospital Pharmacy Service, Hospital Universitari i Politécnic La Fe, Valencia, Hospital Pharmacy Service, Hospital Universitario de La Princesa, Madrid, Rheumatology Service, Hospital Clinic de Barcelona, Universidad de Barcelona, Barcelona, Rheumatology Service, Hospital Puerta de Hierro, Madrid, Rheumatology Service, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario A Coruña (CHUAC), Sergas. Universidade da Coruña, A Coruña, Rheumatology Section, Hospital General Universitario de Alicante, Universidad Miguel Hernández, Alicante, Rheumatology Service, Hospital Universitari i Politécnic La Fe, Valencia andRheumatology Service, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, Spain
| | - Emilio Monte-Boquet
- Rheumatology Service, Instituto de Investigación Sanitaria La Princesa, Hospital Universitario de La Princesa, Madrid, Research Unit, Spanish Rheumatology Society, Madrid, Hospital Pharmacy Clinical Management Unit, Hospital de Valme, Seville, Rheumatology Clinical Management Unit, Hospital Universitario Virgen Macarena, Seville, Hospital Pharmacy Service, Hospital Universitario La Paz, IdiPaz, Madrid, Hospital Pharmacy Service, Hospital de Galdakano-Usansolo, Vizcaya, Rheumatology Service, Hospital Universitario La Paz, IdiPaz, Universidad Autónoma de Madrid, Madrid, Hospital Pharmacy Service, Hospital Universitari i Politécnic La Fe, Valencia, Hospital Pharmacy Service, Hospital Universitario de La Princesa, Madrid, Rheumatology Service, Hospital Clinic de Barcelona, Universidad de Barcelona, Barcelona, Rheumatology Service, Hospital Puerta de Hierro, Madrid, Rheumatology Service, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario A Coruña (CHUAC), Sergas. Universidade da Coruña, A Coruña, Rheumatology Section, Hospital General Universitario de Alicante, Universidad Miguel Hernández, Alicante, Rheumatology Service, Hospital Universitari i Politécnic La Fe, Valencia andRheumatology Service, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, Spain
| | - Alberto Morell-Baladrón
- Rheumatology Service, Instituto de Investigación Sanitaria La Princesa, Hospital Universitario de La Princesa, Madrid, Research Unit, Spanish Rheumatology Society, Madrid, Hospital Pharmacy Clinical Management Unit, Hospital de Valme, Seville, Rheumatology Clinical Management Unit, Hospital Universitario Virgen Macarena, Seville, Hospital Pharmacy Service, Hospital Universitario La Paz, IdiPaz, Madrid, Hospital Pharmacy Service, Hospital de Galdakano-Usansolo, Vizcaya, Rheumatology Service, Hospital Universitario La Paz, IdiPaz, Universidad Autónoma de Madrid, Madrid, Hospital Pharmacy Service, Hospital Universitari i Politécnic La Fe, Valencia, Hospital Pharmacy Service, Hospital Universitario de La Princesa, Madrid, Rheumatology Service, Hospital Clinic de Barcelona, Universidad de Barcelona, Barcelona, Rheumatology Service, Hospital Puerta de Hierro, Madrid, Rheumatology Service, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario A Coruña (CHUAC), Sergas. Universidade da Coruña, A Coruña, Rheumatology Section, Hospital General Universitario de Alicante, Universidad Miguel Hernández, Alicante, Rheumatology Service, Hospital Universitari i Politécnic La Fe, Valencia andRheumatology Service, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, Spain
| | - Raimon Sanmartí
- Rheumatology Service, Instituto de Investigación Sanitaria La Princesa, Hospital Universitario de La Princesa, Madrid, Research Unit, Spanish Rheumatology Society, Madrid, Hospital Pharmacy Clinical Management Unit, Hospital de Valme, Seville, Rheumatology Clinical Management Unit, Hospital Universitario Virgen Macarena, Seville, Hospital Pharmacy Service, Hospital Universitario La Paz, IdiPaz, Madrid, Hospital Pharmacy Service, Hospital de Galdakano-Usansolo, Vizcaya, Rheumatology Service, Hospital Universitario La Paz, IdiPaz, Universidad Autónoma de Madrid, Madrid, Hospital Pharmacy Service, Hospital Universitari i Politécnic La Fe, Valencia, Hospital Pharmacy Service, Hospital Universitario de La Princesa, Madrid, Rheumatology Service, Hospital Clinic de Barcelona, Universidad de Barcelona, Barcelona, Rheumatology Service, Hospital Puerta de Hierro, Madrid, Rheumatology Service, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario A Coruña (CHUAC), Sergas. Universidade da Coruña, A Coruña, Rheumatology Section, Hospital General Universitario de Alicante, Universidad Miguel Hernández, Alicante, Rheumatology Service, Hospital Universitari i Politécnic La Fe, Valencia andRheumatology Service, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, Spain
| | - Jesús Sanz-Sanz
- Rheumatology Service, Instituto de Investigación Sanitaria La Princesa, Hospital Universitario de La Princesa, Madrid, Research Unit, Spanish Rheumatology Society, Madrid, Hospital Pharmacy Clinical Management Unit, Hospital de Valme, Seville, Rheumatology Clinical Management Unit, Hospital Universitario Virgen Macarena, Seville, Hospital Pharmacy Service, Hospital Universitario La Paz, IdiPaz, Madrid, Hospital Pharmacy Service, Hospital de Galdakano-Usansolo, Vizcaya, Rheumatology Service, Hospital Universitario La Paz, IdiPaz, Universidad Autónoma de Madrid, Madrid, Hospital Pharmacy Service, Hospital Universitari i Politécnic La Fe, Valencia, Hospital Pharmacy Service, Hospital Universitario de La Princesa, Madrid, Rheumatology Service, Hospital Clinic de Barcelona, Universidad de Barcelona, Barcelona, Rheumatology Service, Hospital Puerta de Hierro, Madrid, Rheumatology Service, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario A Coruña (CHUAC), Sergas. Universidade da Coruña, A Coruña, Rheumatology Section, Hospital General Universitario de Alicante, Universidad Miguel Hernández, Alicante, Rheumatology Service, Hospital Universitari i Politécnic La Fe, Valencia andRheumatology Service, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, Spain
| | - Francisco Javier de Toro-Santos
- Rheumatology Service, Instituto de Investigación Sanitaria La Princesa, Hospital Universitario de La Princesa, Madrid, Research Unit, Spanish Rheumatology Society, Madrid, Hospital Pharmacy Clinical Management Unit, Hospital de Valme, Seville, Rheumatology Clinical Management Unit, Hospital Universitario Virgen Macarena, Seville, Hospital Pharmacy Service, Hospital Universitario La Paz, IdiPaz, Madrid, Hospital Pharmacy Service, Hospital de Galdakano-Usansolo, Vizcaya, Rheumatology Service, Hospital Universitario La Paz, IdiPaz, Universidad Autónoma de Madrid, Madrid, Hospital Pharmacy Service, Hospital Universitari i Politécnic La Fe, Valencia, Hospital Pharmacy Service, Hospital Universitario de La Princesa, Madrid, Rheumatology Service, Hospital Clinic de Barcelona, Universidad de Barcelona, Barcelona, Rheumatology Service, Hospital Puerta de Hierro, Madrid, Rheumatology Service, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario A Coruña (CHUAC), Sergas. Universidade da Coruña, A Coruña, Rheumatology Section, Hospital General Universitario de Alicante, Universidad Miguel Hernández, Alicante, Rheumatology Service, Hospital Universitari i Politécnic La Fe, Valencia andRheumatology Service, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, Spain
| | - Paloma Vela
- Rheumatology Service, Instituto de Investigación Sanitaria La Princesa, Hospital Universitario de La Princesa, Madrid, Research Unit, Spanish Rheumatology Society, Madrid, Hospital Pharmacy Clinical Management Unit, Hospital de Valme, Seville, Rheumatology Clinical Management Unit, Hospital Universitario Virgen Macarena, Seville, Hospital Pharmacy Service, Hospital Universitario La Paz, IdiPaz, Madrid, Hospital Pharmacy Service, Hospital de Galdakano-Usansolo, Vizcaya, Rheumatology Service, Hospital Universitario La Paz, IdiPaz, Universidad Autónoma de Madrid, Madrid, Hospital Pharmacy Service, Hospital Universitari i Politécnic La Fe, Valencia, Hospital Pharmacy Service, Hospital Universitario de La Princesa, Madrid, Rheumatology Service, Hospital Clinic de Barcelona, Universidad de Barcelona, Barcelona, Rheumatology Service, Hospital Puerta de Hierro, Madrid, Rheumatology Service, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario A Coruña (CHUAC), Sergas. Universidade da Coruña, A Coruña, Rheumatology Section, Hospital General Universitario de Alicante, Universidad Miguel Hernández, Alicante, Rheumatology Service, Hospital Universitari i Politécnic La Fe, Valencia andRheumatology Service, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, Spain
| | - José Andrés Román Ivorra
- Rheumatology Service, Instituto de Investigación Sanitaria La Princesa, Hospital Universitario de La Princesa, Madrid, Research Unit, Spanish Rheumatology Society, Madrid, Hospital Pharmacy Clinical Management Unit, Hospital de Valme, Seville, Rheumatology Clinical Management Unit, Hospital Universitario Virgen Macarena, Seville, Hospital Pharmacy Service, Hospital Universitario La Paz, IdiPaz, Madrid, Hospital Pharmacy Service, Hospital de Galdakano-Usansolo, Vizcaya, Rheumatology Service, Hospital Universitario La Paz, IdiPaz, Universidad Autónoma de Madrid, Madrid, Hospital Pharmacy Service, Hospital Universitari i Politécnic La Fe, Valencia, Hospital Pharmacy Service, Hospital Universitario de La Princesa, Madrid, Rheumatology Service, Hospital Clinic de Barcelona, Universidad de Barcelona, Barcelona, Rheumatology Service, Hospital Puerta de Hierro, Madrid, Rheumatology Service, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario A Coruña (CHUAC), Sergas. Universidade da Coruña, A Coruña, Rheumatology Section, Hospital General Universitario de Alicante, Universidad Miguel Hernández, Alicante, Rheumatology Service, Hospital Universitari i Politécnic La Fe, Valencia andRheumatology Service, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, Spain
| | - José Luis Poveda-Andrés
- Rheumatology Service, Instituto de Investigación Sanitaria La Princesa, Hospital Universitario de La Princesa, Madrid, Research Unit, Spanish Rheumatology Society, Madrid, Hospital Pharmacy Clinical Management Unit, Hospital de Valme, Seville, Rheumatology Clinical Management Unit, Hospital Universitario Virgen Macarena, Seville, Hospital Pharmacy Service, Hospital Universitario La Paz, IdiPaz, Madrid, Hospital Pharmacy Service, Hospital de Galdakano-Usansolo, Vizcaya, Rheumatology Service, Hospital Universitario La Paz, IdiPaz, Universidad Autónoma de Madrid, Madrid, Hospital Pharmacy Service, Hospital Universitari i Politécnic La Fe, Valencia, Hospital Pharmacy Service, Hospital Universitario de La Princesa, Madrid, Rheumatology Service, Hospital Clinic de Barcelona, Universidad de Barcelona, Barcelona, Rheumatology Service, Hospital Puerta de Hierro, Madrid, Rheumatology Service, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario A Coruña (CHUAC), Sergas. Universidade da Coruña, A Coruña, Rheumatology Section, Hospital General Universitario de Alicante, Universidad Miguel Hernández, Alicante, Rheumatology Service, Hospital Universitari i Politécnic La Fe, Valencia andRheumatology Service, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, Spain
| | - Santiago Muñoz-Fernández
- Rheumatology Service, Instituto de Investigación Sanitaria La Princesa, Hospital Universitario de La Princesa, Madrid, Research Unit, Spanish Rheumatology Society, Madrid, Hospital Pharmacy Clinical Management Unit, Hospital de Valme, Seville, Rheumatology Clinical Management Unit, Hospital Universitario Virgen Macarena, Seville, Hospital Pharmacy Service, Hospital Universitario La Paz, IdiPaz, Madrid, Hospital Pharmacy Service, Hospital de Galdakano-Usansolo, Vizcaya, Rheumatology Service, Hospital Universitario La Paz, IdiPaz, Universidad Autónoma de Madrid, Madrid, Hospital Pharmacy Service, Hospital Universitari i Politécnic La Fe, Valencia, Hospital Pharmacy Service, Hospital Universitario de La Princesa, Madrid, Rheumatology Service, Hospital Clinic de Barcelona, Universidad de Barcelona, Barcelona, Rheumatology Service, Hospital Puerta de Hierro, Madrid, Rheumatology Service, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario A Coruña (CHUAC), Sergas. Universidade da Coruña, A Coruña, Rheumatology Section, Hospital General Universitario de Alicante, Universidad Miguel Hernández, Alicante, Rheumatology Service, Hospital Universitari i Politécnic La Fe, Valencia andRheumatology Service, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, Spain
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Tony HP, Burmester G, Schulze-Koops H, Grunke M, Henes J, Kötter I, Haas J, Unger L, Lovric S, Haubitz M, Fischer-Betz R, Chehab G, Rubbert-Roth A, Specker C, Weinerth J, Holle J, Müller-Ladner U, König R, Fiehn C, Burgwinkel P, Budde K, Sörensen H, Meurer M, Aringer M, Kieseier B, Erfurt-Berge C, Sticherling M, Veelken R, Ziemann U, Strutz F, von Wussow P, Meier FMP, Hunzelmann N, Schmidt E, Bergner R, Schwarting A, Eming R, Hertl M, Stadler R, Schwarz-Eywill M, Wassenberg S, Fleck M, Metzler C, Zettl U, Westphal J, Heitmann S, Herzog AL, Wiendl H, Jakob W, Schmidt E, Freivogel K, Dörner T. Safety and clinical outcomes of rituximab therapy in patients with different autoimmune diseases: experience from a national registry (GRAID). Arthritis Res Ther 2011; 13:R75. [PMID: 21569519 PMCID: PMC3218885 DOI: 10.1186/ar3337] [Citation(s) in RCA: 139] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Revised: 03/28/2011] [Accepted: 05/13/2011] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Evidence from a number of open-label, uncontrolled studies has suggested that rituximab may benefit patients with autoimmune diseases who are refractory to standard-of-care. The objective of this study was to evaluate the safety and clinical outcomes of rituximab in several standard-of-care-refractory autoimmune diseases (within rheumatology, nephrology, dermatology and neurology) other than rheumatoid arthritis or non-Hodgkin's lymphoma in a real-life clinical setting. METHODS Patients who received rituximab having shown an inadequate response to standard-of-care had their safety and clinical outcomes data retrospectively analysed as part of the German Registry of Autoimmune Diseases. The main outcome measures were safety and clinical response, as judged at the discretion of the investigators. RESULTS A total of 370 patients (299 patient-years) with various autoimmune diseases (23.0% with systemic lupus erythematosus, 15.7% antineutrophil cytoplasmic antibody-associated granulomatous vasculitides, 15.1% multiple sclerosis and 10.0% pemphigus) from 42 centres received a mean dose of 2,440 mg of rituximab over a median (range) of 194 (180 to 1,407) days. The overall rate of serious infections was 5.3 per 100 patient-years during rituximab therapy. Opportunistic infections were infrequent across the whole study population, and mostly occurred in patients with systemic lupus erythematosus. There were 11 deaths (3.0% of patients) after rituximab treatment (mean 11.6 months after first infusion, range 0.8 to 31.3 months), with most of the deaths caused by infections. Overall (n = 293), 13.3% of patients showed no response, 45.1% showed a partial response and 41.6% showed a complete response. Responses were also reflected by reduced use of glucocorticoids and various immunosuppressives during rituximab therapy and follow-up compared with before rituximab. Rituximab generally had a positive effect on patient well-being (physician's visual analogue scale; mean improvement from baseline of 12.1 mm). CONCLUSIONS Data from this registry indicate that rituximab is a commonly employed, well-tolerated therapy with potential beneficial effects in standard of care-refractory autoimmune diseases, and support the results from other open-label, uncontrolled studies.
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Affiliation(s)
- Hans-Peter Tony
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Klinikstr 6-8, 97070 Würzburg, Germany
| | - Gerd Burmester
- Department Medicine/Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Schumannstr 20/21, 10098 Berlin, Germany
| | - Hendrik Schulze-Koops
- Medizinische Poliklinik, Klinikum der Universität München, Pettenkoferstr. 8a, 80336 München, Germany
| | - Mathias Grunke
- Medizinische Poliklinik, Klinikum der Universität München, Pettenkoferstr. 8a, 80336 München, Germany
| | - Joerg Henes
- Department of Internal Medicine II, Universitätsklinikum Tübingen, Otfried-Müller-Str. 10, 72 076 Tübingen, Germany
| | - Ina Kötter
- Department of Internal Medicine II, Universitätsklinikum Tübingen, Otfried-Müller-Str. 10, 72 076 Tübingen, Germany
| | - Judith Haas
- Department of Neurology, Jüdisches Krankenhaus Berlin, Heinz-Galinski-Strasse 1, 13347 Berlin, Germany
| | - Leonore Unger
- Internal Medicine Rheumatology, Krankenhaus Dresden-Friedrichstadt, Friedrich Strasse 41, 01067 Dresden, Germany
| | - Svjetlana Lovric
- Internal Medicine ICU, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Marion Haubitz
- Internal Medicine ICU, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Rebecca Fischer-Betz
- Endokrinologie, Diabetologie und Rheumatologie, Heinrich Heine-Universität Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Gamal Chehab
- Endokrinologie, Diabetologie und Rheumatologie, Heinrich Heine-Universität Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Andrea Rubbert-Roth
- Klinik für Innere Medizin I, Uniklinik Köln, Josef-Stelzmann-Str 9, 50931 Köln, Germany
| | - Christof Specker
- Department of Rheumatology and Clinical Immunology, Kliniken Essen-Süd, Propsteistr. 2, 45239 Essen, Germany
| | - Jutta Weinerth
- Klinikum Augsburg, Stenglinstr., 86156 Augsburg, Germany
| | - Julia Holle
- University Hospital Schleswig-Holstein Campus Lübeck, Universität Lübeck/Klinikum Bad Bramstedt, Oskar-Alexander-Straße 26, 24576 Bad Bramstedt, Germany
| | - Ulf Müller-Ladner
- Department of Internal Medicine and Rheumatology, Universität Giessen/Kerckhoff-Klinik, 61231 Bad Nauheim, Germany
| | - Ramona König
- Department of Internal Medicine and Rheumatology, Universität Giessen/Kerckhoff-Klinik, 61231 Bad Nauheim, Germany
| | - Christoph Fiehn
- ACURA Rheumazentrum Baden-Baden, Red River Valley Road 5, 76530 Baden-Baden, Germany
| | - Philip Burgwinkel
- Department Medicine/Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Schumannstr 20/21, 10098 Berlin, Germany
| | - Klemens Budde
- Department Medicine/Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Schumannstr 20/21, 10098 Berlin, Germany
| | - Helmut Sörensen
- Ambulantes Rheumazentrum, Argentinische Allee 42, 14163 Berlin, Germany
| | - Michael Meurer
- Department of Dermatology, Technische Universität Dresden, Haus 105 auf der Blasewitzer Str. 86, 01304 Dresden, Germany
| | - Martin Aringer
- Department of Dermatology, Technische Universität Dresden, Haus 105 auf der Blasewitzer Str. 86, 01304 Dresden, Germany
| | - Bernd Kieseier
- Endokrinologie, Diabetologie und Rheumatologie, Heinrich Heine-Universität Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Cornelia Erfurt-Berge
- Department of Dermatology, Universitätsklinikum Erlangen, Hartmannstrasse 14, 91054 Erlangen, Germany
| | - Michael Sticherling
- Department of Dermatology, Universitätsklinikum Erlangen, Hartmannstrasse 14, 91054 Erlangen, Germany
| | - Roland Veelken
- Department of Dermatology, Universitätsklinikum Erlangen, Hartmannstrasse 14, 91054 Erlangen, Germany
| | - Ulf Ziemann
- Klinik für Neurologie, Klinikum der Johann Wolfgang Goethe-Universität, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Frank Strutz
- Zentrum Innere Medizin Abt. Nephrologie/Rheumatologie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Praxis von Wussow
- Praxis für Hämatologie und Internistische Onkologie, Rösebeckstr. 15, 30449 Hannover, Germany
| | - Florian MP Meier
- Rheumapraxis Hofheim, Reifenberger Strasse 6, 65719 Hofheim, Germany
| | - Nico Hunzelmann
- Klinik und Poliklinik für Dermatologie und Venerologie, Universität zu Köln, Kerpener Straße 62, 50937 Köln, Germany
| | - Enno Schmidt
- Klinik für Dermatologie, Allergologie und Venerologie, Universität, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Raoul Bergner
- Medizinische Klinik A, Klinikum der Stadt Ludwigshafen, Bremserstr. 79, 67063 Ludwigshafen, Germany
| | - Andreas Schwarting
- Medizinische Klinik, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Rüdiger Eming
- Abteilung von Dermatologien und Allergology, Philipps Universität Marburg, Deutschhausstrasse 9, 35033 Marburg, Germany
| | - Michael Hertl
- Abteilung von Dermatologien und Allergology, Philipps Universität Marburg, Deutschhausstrasse 9, 35033 Marburg, Germany
| | - Rudolf Stadler
- Department of Dermatology, Johannes Wesling Klinikum Minden, Hans-Nolte-Straße 1, 32429 Minden, Germany
| | - Michael Schwarz-Eywill
- Facharzt f. Innere Medizin-Rheumatologie, Evangelisches Krankenhaus, Marienstr. 11, 26121 Oldenburg, Germany
| | - Siegfried Wassenberg
- Rheumatologe, Ev. Fachkrankenhaus Ratingen, Rosenstr. 2, 40882 Ratingen, Germany
| | - Martin Fleck
- Rheumatologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Claudia Metzler
- Medizinische Klinik II, Krankenhaus der Barmherzigen Brüder, Prüfeninger Str. 86, 93049 Regensburg, Germany
| | - Uwe Zettl
- Klinik für Neurologie und Poliklinik, Universitätsklinikum Rostock, Gehlsheimer Straße 20, 18147 Rostock, Germany
| | - Jens Westphal
- Praxis für Allgemeinmedizin, Goethestr. 35, 78669 Schramberg-Sulgen, Germany
| | - Stefan Heitmann
- Schwerpunkt Rheumatologie und klinische Immunologie, Marienhospital Stuttgart, Böheimstr. 37, 70199 Stuttgart, Germany
| | - Anna L Herzog
- Abteilung der Neurologie, Universität Würzburg, Josef-Schneider-Str. 11, 97080 Würzburg, Germany
| | - Heinz Wiendl
- Abteilung der Neurologie, Universität Würzburg, Josef-Schneider-Str. 11, 97080 Würzburg, Germany
| | - Waltraud Jakob
- Analytica International GmbH, Untere Herrenstr. 25, 79539 Lörrach, Germany
| | - Elvira Schmidt
- Analytica International GmbH, Untere Herrenstr. 25, 79539 Lörrach, Germany
| | - Klaus Freivogel
- Analytica International GmbH, Untere Herrenstr. 25, 79539 Lörrach, Germany
| | - Thomas Dörner
- Department Medicine/Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Schumannstr 20/21, 10098 Berlin, Germany
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