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Kriegbaum M, Lind BS, Grand MK, Andersen CL. The Copenhagen Primary Care Laboratory (CopLab) Database. Clin Epidemiol 2024; 16:155-163. [PMID: 38444401 PMCID: PMC10913898 DOI: 10.2147/clep.s437123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/22/2024] [Indexed: 03/07/2024] Open
Abstract
Background The Copenhagen General Practice Laboratory (CGPL) was founded in 1922 to provide paraclinical analyses to the primary health-care sector in Copenhagen. At the end of 2015, CGPL was closed and the CopLab database was established to make CGPL data available for research. Methods We isolated tests performed at the CGPL with clinically relevant test results. The database was linked to national registers containing health, social, and demographic information. Results are presented with descriptive statistics showing counts, percentages, medians, and interquartile ranges (IQR). Results The CopLab database includes 1,373,643 unique individuals from primary care with test results from laboratory analyses of blood/urine/semen as well as cardiac and lung function tests collected by CGPL from greater Copenhagen from 2000 to 2015. The CopLab database holds nearly all test results requested by general practitioners throughout years 2000 to 2015 for residents in the greater Copenhagen area. The median age of the individuals was 51 years and 59.7% were females. Each individual has a median of 4 requisitions. More than 1 million participants are currently alive and living in Denmark and may be followed in national registries such as the Danish National Patient Registry, Laboratory Database, National Prescription Database etc.
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Affiliation(s)
- Margit Kriegbaum
- The Copenhagen Primary Care Laboratory (CopLab) Database, Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Bent Struer Lind
- Department of Clinical Biochemistry, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Mia Klinten Grand
- The Copenhagen Primary Care Laboratory (CopLab) Database, Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Christen Lykkegaard Andersen
- The Copenhagen Primary Care Laboratory (CopLab) Database, Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Haematology, University Hospital Copenhagen, Rigshospitalet, Copenhagen, Denmark
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Yang TO, Floud S, Reeves GK. Rheumatoid arthritis and cancer risk in the Million Women Study. Int J Epidemiol 2024; 53:dyae006. [PMID: 38423106 PMCID: PMC10904146 DOI: 10.1093/ije/dyae006] [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: 05/09/2023] [Accepted: 01/13/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Most previous studies of rheumatoid arthritis (RA) and cancer risk have lacked information on potential confounding factors. We investigated RA-associated cancer risks in a large cohort of women in the UK, taking account of shared risk factors. METHODS In 1996-2001, women aged 50-64, who were invited for routine breast screening at 66 National Health Service (NHS) screening centres in England and Scotland, were also invited to take part in the Million Women Study. Participants provided information on sociodemographic, lifestyle and health-related factors, including RA, and were followed up for cancers and deaths. Cox regression yielded RA-associated hazard ratios (HRs) of 20 cancers, adjusted for 10 characteristics including smoking status and adiposity. RESULTS Around 1.3 million women (half of those invited) were recruited into the study. In minimally adjusted analyses, RA was associated with the risk of 13 of the 20 cancers. After additional adjustment for lifestyle factors, many of these associations were attenuated but there remained robust evidence of RA-associated increases in the risk of lung (HR 1.21, 95% confidence interval 1.15-1.26), lymphoid (1.25, 1.18-1.33), myeloid (1.12, 1.01-1.25), cervical (1.39, 1.11-1.75) and oropharyngeal (1.40, 1.21-1.61) cancers, and decreases in the risk of endometrial (0.84, 0.77-0.91) and colorectal (0.82, 0.77-0.87) cancers. CONCLUSIONS After taking account of shared risk factors, RA is positively associated with lung and certain blood and infection-related cancers, and inversely associated with colorectal cancer. These findings are consistent with existing hypotheses around immune response, susceptibility to infections, and chronic inflammation. The inverse association observed for endometrial cancer merits further investigation.
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Affiliation(s)
- TienYu Owen Yang
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Sarah Floud
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Gillian K Reeves
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Thomsen GN, Christoffersen MN, Lindegaard HM, Davidsen JR, Hartmeyer GN, Assing K, Mortz CG, Martin-Iguacel R, Møller MB, Kjeldsen AD, Havelund T, El Fassi D, Broesby-Olsen S, Maiborg M, Johansson SL, Andersen CL, Vestergaard H, Bjerrum OW. The multidisciplinary approach to eosinophilia. Front Oncol 2023; 13:1193730. [PMID: 37274287 PMCID: PMC10232806 DOI: 10.3389/fonc.2023.1193730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 04/25/2023] [Indexed: 06/06/2023] Open
Abstract
Eosinophilic granulocytes are normally present in low numbers in the bloodstream. Patients with an increased number of eosinophilic granulocytes in the differential count (eosinophilia) are common and can pose a clinical challenge because conditions with eosinophilia occur in all medical specialties. The diagnostic approach must be guided by a thorough medical history, supported by specific tests to guide individualized treatment. Neoplastic (primary) eosinophilia is identified by one of several unique acquired genetic causes. In contrast, reactive (secondary) eosinophilia is associated with a cytokine stimulus in a specific disease, while idiopathic eosinophilia is a diagnosis by exclusion. Rational treatment is disease-directed in secondary cases and has paved the way for targeted treatment against the driver in primary eosinophilia, whereas idiopathic cases are treated as needed by principles in eosinophilia originating from clonal drivers. The vast majority of patients are diagnosed with secondary eosinophilia and are managed by the relevant specialty-e.g., rheumatology, allergy, dermatology, gastroenterology, pulmonary medicine, hematology, or infectious disease. The overlap in symptoms and the risk of irreversible organ involvement in eosinophilia, irrespective of the cause, warrants that patients without a diagnostic clarification or who do not respond to adequate treatment should be referred to a multidisciplinary function anchored in a hematology department for evaluation. This review presents the pathophysiology, manifestations, differential diagnosis, diagnostic workup, and management of (adult) patients with eosinophilia. The purpose is to place eosinophilia in a clinical context, and therefore justify and inspire the establishment of a multidisciplinary team of experts from diagnostic and clinical specialties at the regional level to support the second opinion. The target patient population requires highly specialized laboratory analysis and therapy and occasionally has severe eosinophil-induced organ dysfunction. An added value of a centralized, clinical function is to serve as a platform for education and research to further improve the management of patients with eosinophilia. Primary and idiopathic eosinophilia are key topics in the review, which also address current research and discusses outstanding issues in the field.
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Affiliation(s)
| | | | - Hanne Merete Lindegaard
- Department of Rheumatology, Odense University Hospital, Denmark; Research Unit for Rheumatology, Odense University Hospital, Odense, Denmark; University of Southern Denmark, Odense, Denmark
| | - Jesper Rømhild Davidsen
- Department of Respiratory Medicine, Odense University Hospital, Denmark; Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Kristian Assing
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - Charlotte G. Mortz
- Department of Dermatology and Allergy Centre, Odense Research Centre for Anaphylaxis (ORCA), Odense University Hospital, Denmark; University of Southern Denmark, Odense, Denmark
| | | | | | - Anette Drøhse Kjeldsen
- Department of ORL- Head and Neck Surgery and Audiology, Odense University Hospital, Odense, Denmark; University of Southern Denmark, Odense, Denmark
| | - Troels Havelund
- Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark
| | - Daniel El Fassi
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Sigurd Broesby-Olsen
- Department of Dermatology and Allergy Centre, Odense Research Centre for Anaphylaxis (ORCA), Odense University Hospital, Denmark; University of Southern Denmark, Odense, Denmark
| | - Michael Maiborg
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Christen Lykkegaard Andersen
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Centre for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Hanne Vestergaard
- Department of Hematology, Odense University Hospital, Odense, Denmark
| | - Ole Weis Bjerrum
- Department of Hematology, Odense University Hospital, Odense, Denmark
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Kronzer VL, Dykhoff HJ, Stevens MA, Myasoedova E, Davis JM, Crowson CS. Racial Differences in Multimorbidity and Comorbidities in Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2023; 75:76-84. [PMID: 36094853 PMCID: PMC9797440 DOI: 10.1002/acr.25020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/18/2022] [Accepted: 09/08/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To identify differences in multimorbidity and individual comorbidities among individuals with rheumatoid arthritis (RA), separated by race and ethnicity. METHODS This case-control study within OptumLabs Data Warehouse from 2010 to 2019 matched RA cases (defined by 2 codes plus prescription of an RA drug) to non-RA controls 1:1 on age, sex, race and ethnicity, region, index date of RA, and insurance coverage duration. We defined multimorbidity as the presence of ≥2 or ≥5 validated comorbidities. Logistic regression models calculated adjusted odds of multimorbidity with 95% confidence intervals (95% CIs) within each race and ethnicity. RESULTS We identified 154,391 RA cases and 154,391 controls (mean age 59.6, 76% female). Black enrollees had the most multimorbidity ≥2/≥5 (73.1%, 34.3%); Asian enrollees had the least (52.4%, 17.3%). Adjusted odds of multimorbidity ≥2 and ≥5 in RA cases versus controls was 2.19 (95% CI 2.16-2.23) and 2.06 (95% CI 2.02-2.09), respectively. This increase was similar across race and ethnicity. However, we observed elevated occurrence of certain comorbidities by race and ethnicity versus controls (P < 0.001), including renal disease in White enrollees (4.7% versus 3.2%) and valvular heart disease in Black and White enrollees (3.2% and 2.8% versus 2.6% and 2.2%). CONCLUSION Multimorbidity is a problem for all RA patients. Targeted identification of certain comorbidities by race and ethnicity may be a helpful approach to mitigate multimorbidity.
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Affiliation(s)
- Vanessa L. Kronzer
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Hayley J. Dykhoff
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery
| | - Maria A. Stevens
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery
- OptumLabs, Eden Prairie, Minnesota
- Department of Health Policy and Management, University of North Carolina at Chapel Hill
| | - Elena Myasoedova
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - John M. Davis
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Cynthia S. Crowson
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
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Solipuram V, Mohan A, Patel R, Ni R. Effect of janus kinase inhibitors and methotrexate combination on malignancy in patients with rheumatoid arthritis: a systematic review and meta-analysis of randomized controlled trials. AUTOIMMUNITY HIGHLIGHTS 2021; 12:8. [PMID: 33910632 PMCID: PMC8080865 DOI: 10.1186/s13317-021-00153-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 03/25/2021] [Indexed: 12/14/2022]
Abstract
Background Rheumatoid arthritis (RA) is a systemic autoimmune disease. The combination therapy of methotrexate (MTX) and Janus kinase inhibitor (JAKi) is commonly used. Patients with RA are at increased risk of malignancy, however, it remains unclear whether the combination therapy is associated with a higher risk. Objective To assess the malignancy risk among patients with RA receiving combination therapy of JAKi and MTX compared to MTX alone. Methods PubMed, Cochrane and Embase were thoroughly searched for randomized controlled trials (RCTs) in patients with RA receiving JAKi and MTX, from inception to July 2020. Primary endpoints were malignancy events, Non melanomatous skin cancer (NMSC) and malignancy excluding NMSC and secondary endpoints were serious adverse events (SAE), deaths. Risk ratio (RR) and 95% CI were calculated using the Mantel–Haenszel random-effect method. Results 659 publications were screened and 13 RCTs with a total of 6911 patients were included in the analysis. There was no statistically significant difference in malignancy [RR = 1.42; 95% CI (0.59, 3.41)], neither NMSC [RR = 1.44 (0.36, 5.76)] nor malignancies excluding NMSC [RR = 1.12 (0.40, 3.13)]. No statistically significant difference between the two groups for SAE [RR = 1.15 (0.90, 1.47)] and deaths [RR = 1.99 (0.75, 5.27)] was found. Conclusion The adjunction of JAKi to MTX is not associated with an increased risk of malignancy when compared to MTX alone. There is no increased risk of SAE and deaths when compared to MTX alone in patients with RA. Supplementary Information The online version contains supplementary material available at 10.1186/s13317-021-00153-5.
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Affiliation(s)
- Vinod Solipuram
- Department of Internal Medicine, Ascension Saint Agnes Healthcare, 900S Caton Ave, Baltimore, 21229, USA
| | - Akhila Mohan
- Department of Internal Medicine, Ascension Saint Agnes Healthcare, 900S Caton Ave, Baltimore, 21229, USA
| | - Roshniben Patel
- Department of Internal Medicine, Ascension Saint Agnes Healthcare, 900S Caton Ave, Baltimore, 21229, USA
| | - Ruoning Ni
- Department of Internal Medicine, Ascension Saint Agnes Healthcare, 900S Caton Ave, Baltimore, 21229, USA.
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The link “Cancer and autoimmune diseases” in the light of microbiota: Evidence of a potential culprit. Immunol Lett 2020; 222:12-28. [DOI: 10.1016/j.imlet.2020.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 02/20/2020] [Accepted: 03/03/2020] [Indexed: 12/15/2022]
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McFarlane IM, Bhamra MS, Amarnani A, Zhaz SY, Kolla S, Alvarez MR, Mo G, Srinivasan M, Hevroni G, Meisel T, Hasan A, Baguidy MS, Hadaddin M, Melamed A, Koci K, Taklalsingh N, Pathiparampil J, Freeman L, Kaplan I, Kabani N, Ozeri DJ, Watler E, Frefer M, Vaitkus V, Matthew K, Arroyo-Mercado F, Lyo H, Feoktistov A, Sanchez R, Soliman F, Valdez FR, Dronamraju V, Trevisonno M, Grant C, Clerger G, Sun K, Amin K, Dawkins M, Green J, Fahmy S, Jayarangaiah A, Waite SA, Burza A. Prevalence of Malignancy Among Urban Black Rheumatoid Arthritis Patients. INTERNATIONAL JOURNAL OF CLINICAL RESEARCH & TRIALS 2020; 5. [PMID: 32661506 DOI: 10.15344/2456-8007/2020/145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Rheumatoid arthritis (RA) patients have an increased risk of malignancy with postulated risk factors that include chronic inflammation, smoking and the use of immunosuppressants have been postulated as drivers of higher malignancies rates. Our study aimed to describe the prevalence and type of malignancies encountered in an urban, predominantly Black RA patient population. METHODS Cross sectional analysis of 1142 patients with RA diagnosis by ICD-codes of which 501 cases met the inclusion criteria for the study. Blacks accounted for 88.4% of the study population. Fifty-six patients had cancer recorded in their medical records and these cases were further reviewed for tumor type, timing of diagnosis and patient clinical characteristics. RESULTS The cancer prevalence was 11.2% (56/501) in our Black RA population being studied. Mean age at cancer diagnosis was 59.9 ± 5.2 for the patients who developed cancer before RA diagnosis and 58.25 ± 16.02 for those who developed malignancy after RA diagnosis. There were 18 breast cancers, 4 colon and 4 cervical cancers; for lung, multiple myeloma, thyroid, squamous cell carcinoma and pancreas there were 3 cases each; for endometrial, Non-Hodgkin's lymphoma, meningioma and prostate, 2 cases each and 1 each for urinary bladder, esophageal adenocarcinoma, lymphoma, glioblastoma, liver, Hodgkin's lymphoma, sarcoma, ovary and renal cell carcinoma. No differences were found in years of RA duration, joint erosion, joint space narrowing or SENS score except for significantly higher ESR among the cancer group and RF seropositivity in the non-cancer group.Therapeutic modalities were not significantly different between the cancer and no cancer groups. CONCLUSION Breast cancer was the most prevalent malignancy among our Black RA population. Further studies are needed to identify the contributing factors to the malignancy risk of breast cancer in our Black RA population and whether it is gender-related since RA is more prevalence in women.
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Affiliation(s)
- Isabel M McFarlane
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Manjeet S Bhamra
- Department of Medicine, Division of Rheumatology SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Abhimnayu Amarnani
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Su Yien Zhaz
- NCH Healthcare System Department of Rheumatology, Naples, FL 34110, USA
| | - Srinivas Kolla
- Department of Radiology SUNY Downstate Medical Center/Health and Hospitals Kings County, Brooklyn, NY 11203, USA
| | - Milena Rodriguez Alvarez
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - George Mo
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Maya Srinivasan
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Gil Hevroni
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Talia Meisel
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Abida Hasan
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Marie S Baguidy
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Michael Hadaddin
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Adielle Melamed
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Kristaq Koci
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Nicholas Taklalsingh
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Joshy Pathiparampil
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Latoya Freeman
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Ian Kaplan
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Naureen Kabani
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | | | - Elsie Watler
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Mosab Frefer
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Vytas Vaitkus
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Keron Matthew
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Fray Arroyo-Mercado
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Helen Lyo
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Aleksander Feoktistov
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Randolph Sanchez
- Department of Rheumatology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Faisal Soliman
- Department of Internal Medicine, Baptist Memorial Hospital-Tipton, 1995 Highway 51, South Covington, TN 38019, USA
| | - Felix Reyes Valdez
- Department of Pulmonary and Critical Care, Montefiore Medical Center Albert Einstein College of Medicine, Bronx, NY 10468, USA
| | - Veena Dronamraju
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Michael Trevisonno
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Christon Grant
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Guerrier Clerger
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Kunfeng Sun
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Khabbab Amin
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Makeda Dawkins
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Jason Green
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Samir Fahmy
- NCH Healthcare System Department of Rheumatology, Naples, FL 34110, USA
| | - Apoorva Jayarangaiah
- Department of Internal Medicine, NYC Health and Hospitals/Jacobi Medical Center, Bronx, NY, USA
| | - Stephen Anthony Waite
- Department of Radiology SUNY Downstate Medical Center/Health and Hospitals Kings County, Brooklyn, NY 11203, USA
| | - Aaliya Burza
- Department of Medicine, Division of Pulmonary and Critical Care State, SUNY Downstate Medical Center/Health and Hospitals Kings County, Brooklyn, NY 11203, USA
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Giat E, Ehrenfeld M, Shoenfeld Y. Cancer and autoimmune diseases. Autoimmun Rev 2017; 16:1049-1057. [DOI: 10.1016/j.autrev.2017.07.022] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 07/12/2017] [Indexed: 02/06/2023]
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Malignancy Incidence, Management, and Prevention in Patients with Rheumatoid Arthritis. Rheumatol Ther 2017; 4:333-347. [PMID: 28508282 PMCID: PMC5696277 DOI: 10.1007/s40744-017-0064-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Indexed: 12/17/2022] Open
Abstract
Traditional and biologic disease-modifying antirheumatic drugs (DMARDs) are effective medications for the management of rheumatoid arthritis (RA). However, the effects of these medications on immune function raises concern that they may increase long-term cancer risk. The baseline risk for some cancers appears to differ in patients with RA compared to the general population, with the former having an increased risk of lymphoma, lung cancer and renal cancer, but a decreased risk of colorectal and breast cancer. Some DMARDs appear to increase the rate of specific cancer types (such as bladder cancer with cyclophosphamide), but few appear to increase the overall cancer risk. Studying the link between lymphoma and disease severity in RA is complicated because patients with persistently active disease are at increased risk for lymphoma, and disease severity correlates with more intense use of immunosuppressive medications. Overall, cancer risk in patients with RA is slightly above that of the general population, with the increased risk likely secondary to an increased risk of lymphomas in those with high disease activity. Risk mitigation includes management of RA disease activity as well as age- and sex-appropriate cancer screening.
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Monitoring of Epstein-Barr virus (EBV)/cytomegalovirus (CMV)/varicella-zoster virus (VZV) load in patients receiving tocilizumab for rheumatoid arthritis. Joint Bone Spine 2016; 83:412-5. [DOI: 10.1016/j.jbspin.2015.07.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 07/25/2015] [Indexed: 01/17/2023]
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Abstract
Rituximab is a chimeric monoclonal antibody that selectively binds to the CD20 molecule on B cells, resulting in their lysis. In autoimmune blistering diseases, the auto-antibody-producing B cells are destroyed and auto-antibody levels are reduced or eliminated. In the majority of patients, rituximab produces rapid clinical response and early resolution. In part, this accounts for the increased use of rituximab. Rituximab does not distinguish normal from pathologic B cells. Hence, shortly after its use, B-cell levels are zero and remain so for several months. In most patients, the use of systemic corticosteroids and immunosuppressive agents are continued after rituximab therapy, while their dosages are significantly decreased. In the majority of patients rituximab is used according to the protocol used in treating lymphoma patients or patients with rheumatoid arthritis. Approximately 50% of patients experience a relapse, requiring additional therapy. Serious adverse events and fatal outcomes have been reported, although their incidence is less than that observed with conventional therapy. Nonetheless, the causes, i.e. infections and septicemia, are similar. Several gaps exist in our understanding of how to optimally benefit from the use of this valuable biological agent. Future studies need to be targeted in designing and implanting protocols that maximize the benefit of rituximab and result in producing sustained prolonged remissions with minimal adverse events and a high quality of life.
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Selmi C, Ceribelli A, Naguwa SM, Cantarini L, Shoenfeld Y. Safety issues and concerns of new immunomodulators in rheumatology. Expert Opin Drug Saf 2014; 14:389-99. [PMID: 25518908 DOI: 10.1517/14740338.2015.993605] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION The development of biologic therapies has been an enormous leap in the management of patients with rheumatoid and psoriatic arthritis. Since the first anti-TNF-α therapies, numerous molecules have been identified as targets of immunomodulatory therapies, such as IL-1 (anakinra, canakinumab), IL-6 (tocilizumab), CD20(+) B cells (rituximab), CTLA4 (abatacept) and two additional anti-TNF-α therapies (certolizumab pegol, golimumab). AREAS COVERED In the present review, we will describe the safety issues related to the immunosuppressive action of these biologic drugs that are mainly represented by infection and malignancy. The risk of infection should be identified before initiating a biologic treatment and markers checked over time, in particular for tuberculosis and hepatitis B and C viruses. Other infections (bacterial, viral, parasitic; opportunistic; surgery-related) and safety issues may require temporary interruption of the treatment until complete resolution. No significantly increased risk of malignancy, both hematological and solid, has been associated with the use of biologic agents. In all cases, it is difficult to dissect the risks related to biologics from those related to baseline treatments. EXPERT OPINION Detailed medical history and laboratory screening should be performed before starting biologic therapies. Clinicians should be aware of the different safety profiles associated with different molecules and they should follow up data coming out of the existing registries for biologics in regard to new or old side effects.
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Affiliation(s)
- Carlo Selmi
- Humanitas Research Hospital, Division of Rheumatology and Clinical Immunology , Rozzano, Milan , Italy
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