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Salazar J, Garcia-Planella E, Fernández-Clotet A, Esteve M, Gisbert JP, Busquets D, Lucendo A, Márquez L, Guardiola J, Martín-Arranz MD, Iglesias E, Monfort D, Villoria A, Cañete F, Bell O, Ricart E, Zabana Y, Chaparro M, Domènech E, Gordillo J. Genetic biomarkers of methotrexate response and safety in Crohn's disease: Data from the Spanish ENEIDA registry. Br J Clin Pharmacol 2024; 90:1301-1311. [PMID: 38369687 DOI: 10.1111/bcp.16017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 01/04/2024] [Accepted: 01/18/2024] [Indexed: 02/20/2024] Open
Abstract
AIMS Methotrexate (MTX) is used to induce and maintain remission in patients with steroid-dependent Crohn's disease (CD). Despite its proven efficacy, its use is limited due to associated adverse events. Polymorphisms involving folate pathway genes might influence MTX efficacy and toxicity. We aimed to assess the impact of certain polymorphisms on the therapeutic outcomes of MTX in CD. METHODS Patients with CD who exclusively followed MTX monotherapy and fulfilled inclusion criteria were identified from the GETECCU ENEIDA registry. Variants of ATIC, DHFR, MTHFR, SLC19A1, ABCB1 and ABCC3 genes were analysed and their association with efficacy and toxicity was assessed. RESULTS A total of 129 patients were included in the analysis. MTX was used at a median weekly dose of 25 mg (interquartile range, 15-25 mg) and a median time of 14 months (interquartile range, 4-52 months). Thirty-seven percent of the patients achieved disease remission with MTX monotherapy, while 34% were nonresponders (MTX failure). MTX-related toxicity occurred in 40 patients (30%), leading to MTX discontinuation in 19%. DHFR rs408626 (odds ratio [OR] 3.12, 95% confidence interval [CI] 1.22-7.69; P = .017) and MTHFR rs1801133 (OR 2.86, 95% CI 1.23-6.68; P = .015) variants, and smoking (OR 2.61, 95% CI 1.12-6.05; P = .026) were associated with a higher risk of MTX failure. Additionally, the MTHFR rs1801131 variant was associated with a higher risk of MTX-related adverse effects (OR 2.78, 95% CI 1.26-6.13, P = .011). CONCLUSION Our study shows that variants of MTHFR and DHFR genes may be associated with MTX efficacy and adverse events in patients with CD.
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Affiliation(s)
- Juliana Salazar
- Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Institut de Recerca Sant Pau - CERCA Center, Barcelona, Spain
| | | | - Agnès Fernández-Clotet
- Gastroenterology Department, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Maria Esteve
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- Gastroenterology Department, Hospital Mútua de Terrassa, Terrassa, Spain
| | - Javier P Gisbert
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- Gastroenterology Department, Hospital Universitario de La Princesa. Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - David Busquets
- Gastroenterology Department, Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | - Alfredo Lucendo
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- Gastroenterology Department, Hospital General de Tomelloso, Ciudad Real, Spain
| | - Lucía Márquez
- Gastroenterology Department, Hospital del Mar, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Jordi Guardiola
- Gastroenterology Department, Hospital Universitari Bellvitge, IDIBELL, Barcelona, Spain
- Universitat de Barcelona, Hospitalet de Llobregat, Barcelona, Spain
| | - María Dolores Martín-Arranz
- Department of Gastroenterology of La Paz University Hospital. School of Medicine, Universidad Autónoma de Madrid. Hospital La Paz Institute for Health Research, La Paz Hospital, Madrid, Spain
| | - Eva Iglesias
- Digestive System Service, Universidad de Córdoba/Instituto Maimónides de Investigación Biomédica de Córdoba/Hospital Universitario Reina Sofía, Córdoba, Spain
| | - David Monfort
- Gastroenterology Department, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - Albert Villoria
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- Gastroenterology Department, Hospital Universitari Parc Taulí Sabadell i Departament de Medicina, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Fiorella Cañete
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Olga Bell
- Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Institut de Recerca Sant Pau - CERCA Center, Barcelona, Spain
| | - Elena Ricart
- Gastroenterology Department, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Yamile Zabana
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- Gastroenterology Department, Hospital Mútua de Terrassa, Terrassa, Spain
| | - María Chaparro
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- Gastroenterology Department, Hospital Universitario de La Princesa. Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Eugeni Domènech
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Jordi Gordillo
- Gastroenterology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Lend K, Koopman FA, Lampa J, Jansen G, Hetland ML, Uhlig T, Nordström D, Nurmohamed M, Gudbjornsson B, Rudin A, Østergaard M, Heiberg MS, Sokka-Isler T, Hørslev-Petersen K, Haavardsholm EA, Grondal G, Twisk JWR, van Vollenhoven R. Methotrexate Safety and Efficacy in Combination Therapies in Patients With Early Rheumatoid Arthritis: A Post Hoc Analysis of a Randomized Controlled Trial. Arthritis Rheumatol 2024; 76:363-376. [PMID: 37846618 DOI: 10.1002/art.42730] [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: 06/19/2023] [Revised: 09/29/2023] [Accepted: 10/11/2023] [Indexed: 10/18/2023]
Abstract
OBJECTIVE We investigated methotrexate safety and the influence of dose on efficacy outcomes in combination with three different biologic treatments and with active conventional treatment (ACT) in early rheumatoid arthritis (RA). METHODS This post hoc analysis included 812 treatment-naïve patients with early RA who were randomized (1:1:1:1) in the NORD-STAR trial to receive methotrexate in combination with ACT, certolizumab-pegol, abatacept, or tocilizumab. Methotrexate safety, doses, and dose effects on Clinical Disease Activity Index (CDAI) remission were assessed after 24 weeks of treatment. RESULTS Compared with ACT, the prevalence of methotrexate-associated side effects was higher when methotrexate was combined with tocilizumab (hazard ratio [HR] 1.48, 95% confidence interval [CI] 1.20-1.84) but not with certolizumab-pegol (HR 0.99, 95% CI 0.79-1.23) or with abatacept (HR 0.93, 95% CI 0.75-1.16). With ACT as the reference, the methotrexate dose was significantly lower when used in combination with tocilizumab (β -4.65, 95% CI -5.83 to -3.46; P < 0.001) or abatacept (β -1.15, 95% CI -2.27 to -0.03; P = 0.04), and it was numerically lower in combination with certolizumab-pegol (β -1.07, 95% CI -2.21 to 0.07; P = 0.07). Methotrexate dose reductions were not associated with decreased CDAI remission rates within any of the treatment combinations. CONCLUSION Methotrexate was generally well tolerated in combination therapies, but adverse events were a limiting factor in receiving the target dose of 25 mg/wk, and these were more frequent in combination with tocilizumab versus ACT. On the other hand, methotrexate dose reductions were not associated with decreased CDAI remission rates within any of the four treatment combinations at 24 weeks.
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Affiliation(s)
- Kristina Lend
- Amsterdam University Medical Centers, Amsterdam, the Netherlands, and Karolinska Institute, Stockholm, Sweden
| | - Frieda A Koopman
- Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Jon Lampa
- Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Gerrit Jansen
- Vrije Universiteit Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Merete L Hetland
- Copenhagen University Hospital Rigshospitalet, Glostrup, and University of Copenhagen, Copenhagen, Denmark
| | - Till Uhlig
- Diakonhjemmet Hospital and University of Oslo, Oslo, Norway
| | - Dan Nordström
- Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Michael Nurmohamed
- Amsterdam University Medical Centers, Amsterdam, and Amsterdam Rheumatology and Immunology Center, Reade, the Netherlands
| | - Bjorn Gudbjornsson
- Landspitali University Hospital and University of Iceland, Reykjavik, Iceland
| | - Anna Rudin
- Sahlgrenska University Hospital and University of Gothenburg, Gothenburg, Sweden
| | - Mikkel Østergaard
- Copenhagen University Hospital Rigshospitalet, Glostrup, and University of Copenhagen, Copenhagen, Denmark
| | | | | | - Kim Hørslev-Petersen
- University Hospital of Southern Denmark, Sønderborg, and University of Southern Denmark, Odense, Denmark
| | | | - Gerdur Grondal
- Landspitali University Hospital and University of Iceland, Reykjavik, Iceland
| | - Jos W R Twisk
- Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Ronald van Vollenhoven
- Amsterdam University Medical Centers, Amsterdam, the Netherlands, and Karolinska Institute, Stockholm, Sweden
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3
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Gehringer CK, Martin GP, Hyrich KL, Verstappen SMM, Sexton J, Kristianslund EK, Provan SA, Kvien TK, Sergeant JC. Developing and externally validating multinomial prediction models for methotrexate treatment outcomes in patients with rheumatoid arthritis: results from an international collaboration. J Clin Epidemiol 2024; 166:111239. [PMID: 38072179 DOI: 10.1016/j.jclinepi.2023.111239] [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: 10/05/2023] [Revised: 11/23/2023] [Accepted: 12/05/2023] [Indexed: 01/01/2024]
Abstract
OBJECTIVES In rheumatology, there is a clinical need to identify patients at high risk (>50%) of not responding to the first-line therapy methotrexate (MTX) due to lack of disease control or discontinuation due to adverse events (AEs). Despite this need, previous prediction models in this context are at high risk of bias and ignore AEs. Our objectives were to (i) develop a multinomial model for outcomes of low disease activity and discontinuing due to AEs 6 months after starting MTX, (ii) update prognosis 3-month following treatment initiation, and (iii) externally validate these models. STUDY DESIGN AND SETTING A multinomial model for low disease activity (submodel 1) and discontinuing due to AEs (submodel 2) was developed using data from the UK Rheumatoid Arthritis Medication Study, updated using landmarking analysis, internally validated using bootstrapping, and externally validated in the Norwegian Disease-Modifying Antirheumatic Drug register. Performance was assessed using calibration (calibration-slope and calibration-in-the-large), and discrimination (concordance-statistic and polytomous discriminatory index). RESULTS The internally validated model showed good calibration in the development setting with a calibration-slope of 1.01 (0.87, 1.14) (submodel 1) and 0.83 (0.30, 1.34) (submodel 2), and moderate discrimination with a c-statistic of 0.72 (0.69, 0.74) and 0.53 (0.48, 0.59), respectively. Predictive performance decreased after external validation (calibration-slope 0.78 (0.64, 0.93) (submodel 1) and 0.86 (0.34, 1.38) (submodel 2)), which may be due to differences in disease-specific characteristics and outcome prevalence. CONCLUSION We addressed previously identified methodological limitations of prediction models for outcomes of MTX therapy. The multinomial approach predicted outcomes of disease activity more accurately than AEs, which should be addressed in future work to aid implementation into clinical practice.
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Affiliation(s)
- Celina K Gehringer
- Division of Musculoskeletal and Dermatological Sciences, Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, Manchester, UK; Centre for Biostatistics, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.
| | - Glen P Martin
- Division of Informatics, Imaging and Data Sciences, Centre for Health Informatics, University of Manchester, Manchester, UK
| | - Kimme L Hyrich
- Division of Musculoskeletal and Dermatological Sciences, Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, Manchester, UK; NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Suzanne M M Verstappen
- Division of Musculoskeletal and Dermatological Sciences, Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, Manchester, UK; NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Joseph Sexton
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Eirik K Kristianslund
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Sella A Provan
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Tore K Kvien
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jamie C Sergeant
- Division of Musculoskeletal and Dermatological Sciences, Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, Manchester, UK; Centre for Biostatistics, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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4
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Gao S, Song H. Integrated comparison of the mRNAome in cartilage, synovium, and macrophages in osteoarthritis. Z Rheumatol 2024; 83:62-70. [PMID: 35178608 DOI: 10.1007/s00393-022-01171-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2022] [Indexed: 11/09/2022]
Abstract
The precise molecular mechanisms associated with osteoarthritis (OA), the most common musculoskeletal disorder, are poorly understood. There are currently no effective treatments to prevent the initiation and progression of the disease. In recent years, the development of mRNAome has made it possible to identify new mechanisms and therapeutic targets. However, the differentially expressed genes screened by different microarrays are not completely the same. In order to avoid this shortcoming, we integrate the different genes from different tissues and data sets, and select the commonly expressed genes for further studies.
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Affiliation(s)
- Siming Gao
- Department of Rheumatology, Beijing Jishuitan Hospital, No. 31, Xin Jie Kou East Street, Xicheng District, 100035, Beijing, China
| | - Hui Song
- Department of Rheumatology, Beijing Jishuitan Hospital, No. 31, Xin Jie Kou East Street, Xicheng District, 100035, Beijing, China.
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5
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Nayebirad S, Javinani A, Javadi M, Yousefi-Koma H, Farahmand K, Atef Yekta R, Tamartash Z, Mohammadzadegan AM, Salehi S, Kavosi H. The effect of smoking on response to methotrexate in rheumatoid arthritis patients: A systematic review and meta-analysis. Mod Rheumatol 2023; 34:68-78. [PMID: 36688574 DOI: 10.1093/mr/road013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/03/2023] [Accepted: 01/08/2023] [Indexed: 01/24/2023]
Abstract
OBJECTIVES In the current study, we aimed to investigate the effect of smoking on inadequate response to methotrexate (MTX-IR) in rheumatoid arthritis (RA) patients. METHODS We searched PubMed, Embase, and Web of Science until 6 June 2022. Observational or interventional studies investigating MTX-IR in RA patients based on smoking status were included. Two independent reviewers assessed the risk of bias and the certainty of the evidence using the Risk of Bias in Nonrandomized Studies-of Interventions and Grades of Recommendation, Assessment, Development, and Evaluation tools, respectively. RESULTS We included 23 studies in the systematic review and 13 in the meta-analysis. Of the 13 included studies, 6 had a moderate risk, 3 had a serious risk, and 4 had a critical risk of bias. The overall random-effect meta-analysis suggested that smokers were 58% more likely to be MTX-IR when compared with nonsmokers [odds ratio (OR) 1.58, 95% confidence interval 1.21-2.06; P = .001; I2 = 69.3%]. The common-effect meta-analysis of the adjusted ORs demonstrated an overall OR of 2.69 (1.88-3.83; P < .001; I2 = 27.1%). CONCLUSIONS The current study showed that smoking is a significant predictor of MTX-IR, especially in disease-modifying antirheumatic drug-naïve early RA patients, as most of the included studies in the meta-analysis consisted of this population.
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Affiliation(s)
- Sepehr Nayebirad
- Rheumatology Research Center, Shariati Hospital, Kargar Avenue, PO-Box: 1411713137, Tehran, Iran
| | - Ali Javinani
- Rheumatology Research Center, Shariati Hospital, Kargar Avenue, PO-Box: 1411713137, Tehran, Iran
| | - Minoo Javadi
- Rheumatology Research Center, Shariati Hospital, Kargar Avenue, PO-Box: 1411713137, Tehran, Iran
| | | | - Kimia Farahmand
- Rheumatology Research Center, Shariati Hospital, Kargar Avenue, PO-Box: 1411713137, Tehran, Iran
| | - Reza Atef Yekta
- Department of Anesthesiology, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Tamartash
- Rheumatology Research Center, Shariati Hospital, Kargar Avenue, PO-Box: 1411713137, Tehran, Iran
| | | | - Samira Salehi
- Rheumatology Research Center, Shariati Hospital, Kargar Avenue, PO-Box: 1411713137, Tehran, Iran
| | - Hoda Kavosi
- Rheumatology Research Center, Shariati Hospital, Kargar Avenue, PO-Box: 1411713137, Tehran, Iran
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Janssen Bonás M, Sundaresan J, Keijsers RGM, Struys EA, Peters BJM, Kahlmann V, Wijsenbeek MS, de Rotte MCFJ, Grutters JC, Veltkamp M. Methotrexate Polyglutamate Concentrations as a Possible Predictive Marker for Effectiveness of Methotrexate Therapy in Patients with Sarcoidosis: A Pilot Study. Lung 2023; 201:617-624. [PMID: 37973683 DOI: 10.1007/s00408-023-00656-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/05/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION Methotrexate (MTX), a folate antagonist, is often used as second-line treatment in patients with sarcoidosis. Effectiveness of MTX has large inter-patient variability and at present therapeutic drug monitoring (TDM) of MTX is not possible. Upon administration, MTX is actively transported into cells and metabolized to its active forms by adding glutamate residues forming MTXPG(n=1-5) resulting in enhanced cellular retention. In this study we address the question whether different MTXPG(n) concentrations in red blood cells (RBC) of patients with sarcoidosis after 3 months of MTX therapy correlate with response to treatment. METHODS We retrospectively included patients with sarcoidosis that had started on MTX therapy and from whom blood samples and FDG-PET/CT were available 3 and 6-12 months after MTX initiation, respectively. FDG-uptake was measured by SUVmax in the heart, lungs and thoracic lymph nodes. Changes in SUVmax was used to determine anti-inflammatory response after 6-12 months of MTX therapy. MTXPG(n) concentrations were measured from whole blood RBC using an LC-MS/MS method. Pearson correlation coefficients were calculated to evaluate the relationship between changes in the SUVmax and MTXPG(n) concentrations. RESULTS We included 42 sarcoidosis patients treated with MTX (15 mg/week); 31 with cardiac sarcoidosis and 11 with pulmonary sarcoidosis. In MTXPG3 and MTXPG4 a significant negative relation between the absolute changes in SUVmax and MTXPG(n) was found r = - 0.312 (n = 42, p = 0.047) for MTXPG3 and r = - 0.336 (n = 42, p = 0.031 for MTXPG4). The other MTXPG(n) did not correlate to changes in SUVmax. CONCLUSION These results suggest a relation between MTXPG(n) concentrations and the anti-inflammatory effect in patients with sarcoidosis. Further prospective validation is warranted, but if measuring MTXPG concentrations could predict treatment effect of MTX this would be a step in the direction of personalized medicine.
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Affiliation(s)
- Montse Janssen Bonás
- Department of Pulmonology, ILD Center of Excellence, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Janani Sundaresan
- Department of Clinical Chemistry, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Ruth G M Keijsers
- Department of Nuclear Medicine, St. Antonius Hospital, Nieuwegein, Utrecht, The Netherlands
| | - Eduard A Struys
- Department of Clinical Chemistry, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Bas J M Peters
- Department of Clinical Pharmacy, St. Antonius Hospital, Nieuwegein, Utrecht, The Netherlands
| | - Vivienne Kahlmann
- Center of Excellence for ILD and Sarcoidosis, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Marlies S Wijsenbeek
- Center of Excellence for ILD and Sarcoidosis, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Maurits C F J de Rotte
- Department of Clinical Chemistry, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Jan C Grutters
- Department of Pulmonology, ILD Center of Excellence, St. Antonius Hospital, Nieuwegein, The Netherlands
- Division of Heart & Lungs, Utrecht University Medical Center, Utrecht, The Netherlands
| | - Marcel Veltkamp
- Department of Pulmonology, ILD Center of Excellence, St. Antonius Hospital, Nieuwegein, The Netherlands.
- Division of Heart & Lungs, Utrecht University Medical Center, Utrecht, The Netherlands.
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Hebing RCF, Bartelink IH, Gosselt HR, Heil SG, de Rotte MCFJ, de Jong PHP, Nurmohamed MT, de Jonge R, Mathôt RAA. Methotrexate Polyglutamates Exposure - Response Modeling in a Large Cohort of Rheumatoid Arthritis Patients Starting Methotrexate. Clin Pharmacol Ther 2023; 114:893-903. [PMID: 37313979 DOI: 10.1002/cpt.2974] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/30/2023] [Indexed: 06/15/2023]
Abstract
Methotrexate polyglutamates (MTX-PG) concentrations in red blood cells (RBCs) have been suggested as a biomarker of response in patients with rheumatoid arthritis (RA) receiving low-dose MTX therapy. We investigated the association and interpatient variability between RBC-MTX-PG3-5 -exposure and response in patients with RA starting MTX. Data of three prospective cohorts were available. The relationship between exposure and Disease Activity Score in 28 joints (DAS28) was analyzed using a population pharmacokinetic-pharmacodynamic model. Relevant covariates were tested using full covariate modeling and backward elimination. From 395 patients, 3,401 MTX-PG concentrations and 1,337 DAS28 measurements were available between 0 and 300 days after MTX treatment onset. The developed model adequately described the time course of MTX-PG3-5 and DAS28. The median MTX-PG3-5 level at month 1 was 30.9 nmol/L (interquartile range (IQR): 23.6-43.7; n = 41) and at month 3: 69.3 nmol/L (IQR: 17.9-41.2; n = 351). Clearance of MTX-PG3-5 from RBCs was 28% lower (95% confidence interval (CI): 23.6-32.8%) in a woman and 10% lower (95% CI: 7.7-12.4%) in a 65-year-old compared with a 35-year-old patient. MTX-PG3-5 concentrations associated with DAS28: half-maximal effective concentration (EC50 ) was 9.14 nmol/L (95% CI: 4.2 nmol/L-14.1 nmol/L). EF at 80% (EC80 ) above 47 nmol/L was regarded as the optimal response. Independent of the MTX-PG 3-5 - response association, co-administration of disease-modifying antirheumatic drugs and corticosteroids improved response (additive effect on maximum effect (Emax )), whereas smoking, high body mass index and low albumin decreased Emax . In patients with RA starting MTX, RBC-MTX-PG3-5 was associated with clinical response. A dose increase is suggested when MTX-PG3-5 at month 1 is below 9.15 nmol/L, continued with the same dose when the concentration is above 47 nmol/L, and consider other treatment options above 78 nmol/L from 3 months onwards.
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Affiliation(s)
- Renske C F Hebing
- Amsterdam Rheumatology and Immunology Center, Amsterdam UMC Location Reade, Amsterdam, The Netherlands
| | - Imke H Bartelink
- Department of Hospital Pharmacy and Clinical Pharmacology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Helen R Gosselt
- Department of Clinical Chemistry, Amsterdam University Medical Center - Location VUmc, Amsterdam, The Netherlands
| | - Sandra G Heil
- Department of Clinical Chemistry, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Mauritis C F J de Rotte
- Department of Clinical Chemistry, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Pascal H P de Jong
- Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Mike T Nurmohamed
- Amsterdam Rheumatology and Immunology Center, Amsterdam UMC Location Reade, Amsterdam, The Netherlands
| | - Robert de Jonge
- Department of Clinical Chemistry, Amsterdam University Medical Center - Location VUmc, Amsterdam, The Netherlands
| | - Ron A A Mathôt
- Department of Hospital Pharmacy and Clinical Pharmacology, Amsterdam UMC, Amsterdam, The Netherlands
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8
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Shao Y, Zhang H, Shi Q, Wang Y, Liang Q. Clinical prediction models of rheumatoid arthritis and its complications: focus on cardiovascular disease and interstitial lung disease. Arthritis Res Ther 2023; 25:159. [PMID: 37658422 PMCID: PMC10472585 DOI: 10.1186/s13075-023-03140-5] [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: 06/13/2023] [Accepted: 08/14/2023] [Indexed: 09/03/2023] Open
Abstract
Rheumatoid arthritis (RA) is a chronic, systemic, autoimmune disease of unknown etiology with erosive, symmetric polyarthritis as the main clinical manifestations. Its basic pathological changes are the formation of synovitis, and patients gradually develop destruction of articular cartilage destruction and bone erosion, which eventually leads to joint deformity, disability, and various extra-articular manifestations. Clinical prediction models (CPMs), also known as risk prediction models or risk scores, are mathematical formulas used to estimate the probability that a given individual will have a disease or an outcome in the future. The models are mainly divided into two categories: diagnostic models and prognostic models, which can be used to provide information on disease diagnosis or prognosis to help make better medical decisions. Currently, there is no cure for RA, but effective early diagnosis and treatment are crucial for limiting the severity of the disease and preventing the occurrence and development of complications. This paper reviews the CPMs associated with RA and its related complications, including cardiovascular disease (CVD) and interstitial lung disease (ILD), in order to provide reference and evidence for the early diagnosis and treatment of these diseases and personalized medicine for patients. In addition, the possible pathogenesis and risk factors of these comorbidities are summarized, and possible directions for future related research are prospected.
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Affiliation(s)
- Yubo Shao
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
- Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
- School of Graduate, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
- Key Laboratory of Ministry of Education of Theory and Therapy of Muscles and Bones, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
| | - Hong Zhang
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
- Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
- Key Laboratory of Ministry of Education of Theory and Therapy of Muscles and Bones, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
| | - Qi Shi
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
- Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
- Key Laboratory of Ministry of Education of Theory and Therapy of Muscles and Bones, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
| | - Yongjun Wang
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China.
- Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China.
- Key Laboratory of Ministry of Education of Theory and Therapy of Muscles and Bones, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China.
| | - Qianqian Liang
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China.
- Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China.
- Key Laboratory of Ministry of Education of Theory and Therapy of Muscles and Bones, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China.
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9
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Duquesne J, Bouget V, Cournède PH, Fautrel B, Guillemin F, de Jong PHP, Heutz JW, Verstappen M, van der Helm-van Mil AHM, Mariette X, Bitoun S. Machine learning identifies a profile of inadequate responder to methotrexate in rheumatoid arthritis. Rheumatology (Oxford) 2023; 62:2402-2409. [PMID: 36416134 PMCID: PMC10321123 DOI: 10.1093/rheumatology/keac645] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 11/06/2022] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVES Around 30% of patients with RA have an inadequate response to MTX. We aimed to use routine clinical and biological data to build machine learning models predicting EULAR inadequate response to MTX and to identify simple predictive biomarkers. METHODS Models were trained on RA patients fulfilling the 2010 ACR/EULAR criteria from the ESPOIR and Leiden EAC cohorts to predict the EULAR response at 9 months (± 6 months). Several models were compared on the training set using the AUROC. The best model was evaluated on an external validation cohort (tREACH). The model's predictions were explained using Shapley values to extract a biomarker of inadequate response. RESULTS We included 493 therapeutic sequences from ESPOIR, 239 from EAC and 138 from tREACH. The model selected DAS28, Lymphocytes, Creatininemia, Leucocytes, AST, ALT, swollen joint count and corticosteroid co-treatment as predictors. The model reached an AUROC of 0.72 [95% CI (0.63, 0.80)] on the external validation set, where 70% of patients were responders to MTX. Patients predicted as inadequate responders had only 38% [95% CI (20%, 58%)] chance to respond and using the algorithm to decide to initiate MTX would decrease inadequate-response rate from 30% to 23% [95% CI: (17%, 29%)]. A biomarker was identified in patients with moderate or high activity (DAS28 > 3.2): patients with a lymphocyte count superior to 2000 cells/mm3 are significantly less likely to respond. CONCLUSION Our study highlights the usefulness of machine learning in unveiling subgroups of inadequate responders to MTX to guide new therapeutic strategies. Further work is needed to validate this approach.
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Affiliation(s)
| | | | - Paul Henry Cournède
- CentraleSupélec, Lab of Mathematics and Computer Science (MICS), Université Paris-Saclay, Gif-sur-Yvette, France
| | - Bruno Fautrel
- Groupe Hospitalier Pitié Salpêtrière, Service de Rhumatologie, Sorbonne Université – Assistance Publique Hôpitaux de Paris, Paris, France
- Inserm UMRS 1136, Équipe PEPITES (Pharmaco-épidémiologie et Évaluation des Soins), Institut Pierre Louis d’Épidémiologie et Santé Publique, Paris, France
| | | | - Pascal H P de Jong
- Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Judith W Heutz
- Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Marloes Verstappen
- Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands
| | | | | | - Samuel Bitoun
- Correspondence to: Samuel Bitoun, Department of Rheumatology, Université Paris Saclay, INSERM UMR 1184, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, FHU CARE, Hôpital Bicêtre 78 avenue du General Leclerc, Le Kremlin Bicêtre France. E-mail:
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10
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Ceballos FC, Chamizo-Carmona E, Mata-Martín C, Carrasco-Cubero C, Aznar-Sánchez JJ, Veroz-González R, Rojas-Herrera S, Dorado P, LLerena A. Pharmacogenetic Sex-Specific Effects of Methotrexate Response in Patients with Rheumatoid Arthritis. Pharmaceutics 2023; 15:1661. [PMID: 37376109 DOI: 10.3390/pharmaceutics15061661] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/09/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
Methotrexate (MTX) is a commonly used drug for the treatment of rheumatoid arthritis (RA), but its effectiveness can vary greatly among patients. Pharmacogenetics, the study of how genetic variations can affect drug response, has the potential to improve the personalized treatment of RA by identifying genetic markers that can predict a patient's response to MTX. However, the field of MTX pharmacogenetics is still in its early stages and there is a lack of consistency among studies. This study aimed to identify genetic markers associated with MTX efficacy and toxicity in a large sample of RA patients, and to investigate the role of clinical covariates and sex-specific effects. Our results have identified an association of ITPA rs1127354 and ABCB1 rs1045642 with response to MTX, polymorphisms of FPGS rs1544105, GGH rs1800909, and MTHFR genes with disease remission, GGH rs1800909 and MTHFR rs1801131 polymorphisms with all adverse events, and ADA rs244076 and MTHFR rs1801131 and rs1801133, However, clinical covariates were more important factors to consider when building predictive models. These findings highlight the potential of pharmacogenetics to improve personalized treatment of RA, but also emphasize the need for further research to fully understand the complex mechanisms involved.
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Affiliation(s)
| | | | - Carmen Mata-Martín
- MEPER Group-Clinical and Translational Research in Pharmacogenetics and Personalized Medicine, Biosanitary Research Institute of Extremadura (INUBE), 06080 Badajoz, Spain
- CICAB Clinical Research Center, Pharmacogenetics and Personalized Medicine Unit, Hospital Universitario de Badajoz, 06080 Badajoz, Spain
| | | | | | | | | | - Pedro Dorado
- MEPER Group-Clinical and Translational Research in Pharmacogenetics and Personalized Medicine, Biosanitary Research Institute of Extremadura (INUBE), 06080 Badajoz, Spain
- Faculty of Medicine, Universidad de Extremadura, 06071 Badajoz, Spain
| | - Adrián LLerena
- MEPER Group-Clinical and Translational Research in Pharmacogenetics and Personalized Medicine, Biosanitary Research Institute of Extremadura (INUBE), 06080 Badajoz, Spain
- CICAB Clinical Research Center, Pharmacogenetics and Personalized Medicine Unit, Hospital Universitario de Badajoz, 06080 Badajoz, Spain
- Faculty of Medicine, Universidad de Extremadura, 06071 Badajoz, Spain
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11
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Smita P, Narayan PA, J K, Gaurav P. Therapeutic drug monitoring for cytotoxic anticancer drugs: Principles and evidence-based practices. Front Oncol 2022; 12:1015200. [PMID: 36568145 PMCID: PMC9773989 DOI: 10.3389/fonc.2022.1015200] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/24/2022] [Indexed: 12/13/2022] Open
Abstract
Cytotoxic drugs are highly efficacious and also have low therapeutic index. A great degree of caution needs to be exercised in their usage. To optimize the efficacy these drugs need to be given at maximum tolerated dose which leads to significant amount of toxicity to the patient. The fine balance between efficacy and safety is the key to the success of cytotoxic chemotherapeutics. However, it is possibly more rewarding to obtain that balance for this class drugs as the frequency of drug related toxicities are higher compared to the other therapeutic class and are potentially life threatening and may cause prolonged morbidity. Significant efforts have been invested in last three to four decades in therapeutic drug monitoring (TDM) research to understand the relationship between the drug concentration and the response achieved for therapeutic efficacy as well as drug toxicity for cytotoxic drugs. TDM evolved over this period and the evidence gathered favored its routine use for certain drugs. Since, TDM is an expensive endeavor both from economic and logistic point of view, to justify its use it is necessary to demonstrate that the implementation leads to perceivable improvement in the patient outcomes. It is indeed challenging to prove the utility of TDM in randomized controlled trials and at times may be nearly impossible to generate such data in view of the obvious findings and concern of compromising patient safety. Therefore, good quality data from well-designed observational study do add immense value to the scientific knowledge base, when they are examined in totality, despite the heterogeneity amongst them. This article compiles the summary of the evidence and the best practices for TDM for the three cytotoxic drug, busulfan, 5-FU and methotrexate. Traditional use of TDM or drug concentration data for dose modification has been witnessing a sea change and model informed precision dosing is the future of cytotoxic drug therapeutic management.
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Affiliation(s)
- Pattanaik Smita
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India,*Correspondence: Pattanaik Smita,
| | - Patil Amol Narayan
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kumaravel J
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Prakash Gaurav
- Department of Clinical Hematology and Medical Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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12
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Gehringer CK, Martin GP, Hyrich KL, Verstappen SM, Sergeant JC. Clinical prediction models for methotrexate treatment outcomes in patients with rheumatoid arthritis: A systematic review and meta-analysis. Semin Arthritis Rheum 2022; 56:152076. [DOI: 10.1016/j.semarthrit.2022.152076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/22/2022] [Accepted: 07/26/2022] [Indexed: 11/24/2022]
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13
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van de Meeberg MM, Seinen ML, Fidder HH, Lin M, Oldenburg B, de Boer NK, Bouma G, de Jonge R, Bulatović Ćalasan M. Subcutaneous administration, higher age and lower renal function are associated with erythrocyte methotrexate accumulation in Crohn's disease: a cross-sectional study. BMC Gastroenterol 2022; 22:365. [PMID: 35907797 PMCID: PMC9338675 DOI: 10.1186/s12876-022-02439-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 07/20/2022] [Indexed: 11/25/2022] Open
Abstract
Background Methotrexate is an immunomodulatory drug for patients with Crohn’s disease. Erythrocyte MTX-polyglutamates (MTX-PG1-5) may be used for therapeutic drug monitoring (TDM) as MTX-PG is thought to mediate MTX’s efficacy. Information on determinants of the concentration of MTX-PG in patients with Crohn’s disease is lacking. We aim to identify clinical and biochemical determinants of the erythrocyte MTX-PG1-5 and MTX-PGtotal concentration in patients with Crohn’s disease. Methods Adults with Crohn’s disease on methotrexate treatment who visited the outpatient clinic of Amsterdam UMC were included. Erythrocyte MTX-PGs were measured by tandem mass spectrometry. Results Nineteen patients were included, with a median duration of MTX use of 77 months (range 7–202). Twelve patients received MTX monotherapy, whereas 7 patients were on concomitant TNF-α inhibitors. The mean dose of MTX was 15.5 mg (SD ± 2.8) and 12 (63%) patients used subcutaneous MTX. MTX-PG1-5 were successfully measured in 18 patients, showing substantial variability in concentrations of MTX-PGtotal and individual species. The median MTX-PGtotal was 117.1 nmol/L (range 46.4–258.7) with preferential accumulation of MTX-PG3 (43.1 nmol/L, range 15.3–96.1). Patients on subcutaneous compared to oral MTX had higher median MTX-PG(4,5) levels (55 versus 9 nmol/L, p = 0.01). Higher age (β = 0.71) and lower estimated glomerular filtration rate (β = − 0.52) were associated with a significantly higher MTX-PGtotal concentration (R2 = 0.60, p = 0.001). Conclusion MTX-PG concentrations display a considerable inter-individual variability. Higher MTX-PG accumulation is associated with subcutaneous administration, higher age, and lower renal function in Crohn’s disease patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12876-022-02439-y.
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Affiliation(s)
- M M van de Meeberg
- Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands. .,Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam, AGEM Research Institute, Amsterdam, The Netherlands.
| | - M L Seinen
- Department of Gastroenterology, OLVG, Amsterdam, The Netherlands
| | - H H Fidder
- Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - M Lin
- Department of Clinical Chemistry, Amsterdam UMC, Amsterdam, The Netherlands
| | - B Oldenburg
- Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - N K de Boer
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam, AGEM Research Institute, Amsterdam, The Netherlands
| | - G Bouma
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam, AGEM Research Institute, Amsterdam, The Netherlands
| | - R de Jonge
- Department of Clinical Chemistry, Amsterdam UMC, Amsterdam, The Netherlands
| | - M Bulatović Ćalasan
- Department of Clinical Chemistry, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, Utrecht, The Netherlands
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14
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Shipa MRA, Langley L, Sacks B, Yeoh SA, Mainuddin MD, Mukerjee D, Castelino M, Ehrenstein MR. Increased erythrocyte mean corpuscular volume by methotrexate predicts clinical response in psoriatic arthritis. Rheumatology (Oxford) 2022; 61:e270-e273. [PMID: 35532065 PMCID: PMC9434146 DOI: 10.1093/rheumatology/keac276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/21/2022] [Accepted: 04/24/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Lawrence Langley
- Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Benjamin Sacks
- Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Su-Ann Yeoh
- Department of Rheumatology, University College London, London, UK
| | - M D Mainuddin
- Department of Rheumatology, North Middlesex University Hospital NHS Trust, Sterling Way, London, N18 1QX, UK, London
| | - Dev Mukerjee
- Department of Rheumatology, North Middlesex University Hospital NHS Trust, Sterling Way, London, N18 1QX, UK, London
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15
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Association Study of SLCO1B3 and ABCC3 Genetic Variants in Gallstone Disease. Genes (Basel) 2022; 13:genes13030512. [PMID: 35328066 PMCID: PMC8951115 DOI: 10.3390/genes13030512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/04/2022] [Accepted: 03/09/2022] [Indexed: 12/10/2022] Open
Abstract
There is growing evidence that gallstone formation may be genetically determined. Recent studies have shown that polymorphism of genes encoding proteins involved in bile acid transport may be associated with the risk of gallstone disease. The aim of this study was to investigate the association between SLCO1B3 (rs4149117:G>T, rs7311358:A>G) and ABCC3 (rs4793665:T>C, rs11568591:G>A) genetic variants and susceptibility to cholesterol gallstone disease, as well as gallstone composition. The study included 317 patients suffering from cholelithiasis who underwent cholecystostomy and 249 controls with no evidence of stones, confirmed by ultrasound examination. There were no statistically significant differences in the distribution of studied gene polymorphisms between patients with gallstone disease and healthy controls. No significant associations were observed between studied genotypes and the content of analyzed gallstone components: total cholesterol, bilirubin, CaCO3, nor the total bile acids. There was also no association between bile acid content in gallstones and the polymorphisms studied. The results of this study suggest that polymorphisms of SLCO1B3 and ABCC3 genes are not a valuable marker of gallstone disease susceptibility and do not influence gallstone composition.
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16
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Verweij N, Zwezerijnen G, Ter Wee M, de Jongh J, Yaqub M, van Schaardenburg D, Lammertsma A, Voskuyl A, Lems W, Boers M, van der Laken C. Early prediction of treatment response in rheumatoid arthritis by quantitative macrophage PET. RMD Open 2022; 8:rmdopen-2021-002108. [PMID: 35149604 PMCID: PMC8845317 DOI: 10.1136/rmdopen-2021-002108] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 01/25/2022] [Indexed: 11/22/2022] Open
Abstract
Objective To determine whether macrophage positron emission tomography (PET)/computed tomography (CT) imaging using (R)-[11C]PK11195 at 0 and 2 weeks is associated with clinical response at 13 weeks in patients with early rheumatoid arthritis (RA). Methods Whole-body (R)-[11C]PK11195 PET/CT scans were performed at baseline and after 2 weeks of COBRA-light (combination therapy of methotrexate and prednisone) treatment in 35 patients with clinically active early RA. Clinical assessment (Disease Activity Score of 44 joints (DAS44)) was performed at 0, 2 and 13 weeks of treatment. PET/CT scans were assessed visually by two blinded, experienced readers, and by calculating standardised uptake values (SUVs) for shoulders, elbows, hips, knees, and hand and feet joints. Clinical and PET variables were compared using (multivariate) linear regression. Results 18 males and 17 females were included (baseline DAS44=3.2 ± 1.0). 171 out of 1470 joints were visually PET positive at baseline, decreasing to 100 joints after 2 weeks. In general, small feet joints showed the highest uptake at baseline, and the largest decrease after 2 weeks (Δ0-2). Neither baseline nor Δ0-2 PET measures correlated with DAS44 at 13 weeks. However, at 2 weeks, average SUV of the feet significantly correlated with DAS44 at 13 weeks (R2=0.14, p=0.04). In a multivariable model, DAS44 and average SUV of the feet at 2 weeks showed substantial combined predictive value (combined R2=0.297, p<0.01). Conclusion Quantitative macrophage PET assessment of feet joints, together with DAS44, after 2 weeks of COBRA light treatment in patients with early RA correlates with clinical response after 3 months of treatment.
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Affiliation(s)
- Nicki Verweij
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - Gerben Zwezerijnen
- Department of Radiology & Nuclear Medicine, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - Marieke Ter Wee
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands.,Department of Epidemiology and Data Science, Amsterdam Public Health, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - Jerney de Jongh
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - Maqsood Yaqub
- Department of Radiology & Nuclear Medicine, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | | | - Adriaan Lammertsma
- Department of Radiology & Nuclear Medicine, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - Alexandre Voskuyl
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - Willem Lems
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - Maarten Boers
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands.,Department of Epidemiology and Data Science, Amsterdam Public Health, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - Conny van der Laken
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
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17
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Yan H, Su R, Xue H, Gao C, Li X, Wang C. Pharmacomicrobiology of Methotrexate in Rheumatoid Arthritis: Gut Microbiome as Predictor of Therapeutic Response. Front Immunol 2022; 12:789334. [PMID: 34975886 PMCID: PMC8719371 DOI: 10.3389/fimmu.2021.789334] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 12/01/2021] [Indexed: 12/12/2022] Open
Abstract
Rheumatoid arthritis (RA) is a disabling autoimmune disease with invasive arthritis as the main manifestation and synovitis as the basic pathological change, which can cause progressive destruction of articular cartilage and bone, ultimately leading to joint deformity and loss of function. Since its introduction in the 1980s and its widespread use in the treatment of RA, low-dose methotrexate (MTX) therapy has dramatically changed the course and outcome of RA treatment. The clinical use of this drug will be more rational with a better understanding of the pharmacology, anti-inflammatory mechanisms of action and adverse reaction about it. At present, the current clinical status of newly diagnosed RA is that MTX is initiated first regardless of the patients’ suitability. But up to 50% of patients could not reach adequate clinical efficacy or have severe adverse events. Prior to drug initiation, a prognostic tool for treatment response is lacking, which is thought to be the most important cause of the situation. A growing body of studies have shown that differences in microbial metagenomes (including bacterial strains, genes, enzymes, proteins and/or metabolites) in the gastrointestinal tract of RA patients may at least partially determine their bioavailability and/or subsequent response to MTX. Based on this, some researchers established a random forest model to predict whether different RA patients (with different gut microbiome) would respond to MTX. Of course, MTX, in turn, alters the gut microbiome in a dose-dependent manner. The interaction between drugs and microorganisms is called pharmacomicrobiology. Then, the concept of precision medicine has been raised. In this view, we summarize the characteristics and anti-inflammatory mechanisms of MTX and highlight the interaction between gut microbiome and MTX aiming to find the optimal treatment for patients according to individual differences and discuss the application and prospect of precision medicine.
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Affiliation(s)
- Huanhuan Yan
- Department of Rheumatology, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Rui Su
- Department of Rheumatology, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Hongwei Xue
- Department of Rheumatology, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Chong Gao
- Pathology, Joint Program in Transfusion Medicine, Brigham and Women's Hospital/Children' s Hospital, Harvard Medical School, Boston, MA, United States
| | - Xiaofeng Li
- Department of Rheumatology, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Caihong Wang
- Department of Rheumatology, The Second Hospital of Shanxi Medical University, Taiyuan, China
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18
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Balevic SJ, Sagcal-Gironella ACP. Precision Medicine: Towards Individualized Dosing in Pediatric Rheumatology. Rheum Dis Clin North Am 2021; 48:305-330. [PMID: 34798954 DOI: 10.1016/j.rdc.2021.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Despite an increase in the number of available therapeutics, many children with rheumatic disease continue to experience active inflammatory disease and treatment failure. One reason for treatment failure is the lack of dosing paradigms to account for the wide between-patient variability in drug pharmacokinetics because of developmental changes or genetic polymorphisms that effect drug absorption, distribution, metabolism, and elimination. This review highlights several strategies to optimize dosing for biologic and nonbiologic disease-modifying antirheumatic drugs, including therapeutic drug monitoring, pharmacogenomics, and the use of pharmacokinetic/pharmacodynamic modeling.
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Affiliation(s)
- Stephen J Balevic
- Department of Pediatrics, Duke University, Durham, NC, USA; Duke Clinical Research Institute, Durham, NC, USA.
| | - Anna Carmela P Sagcal-Gironella
- Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, NJ, USA; Division of Pediatric Rheumatology, Joseph M. Sanzari Children's Hospital, 30 Prospect Avenue, WFAN 3rd Floor, Hackensack, NJ 07601, USA; K. HovnanianChildren's Hospital, Neptune, NJ, USA
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19
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Muller IB, Lin M, Lems WF, Ter Wee MM, Wojtuszkiewicz A, Nurmohamed MT, Cloos J, Assaraf YG, Jansen G, de Jonge R. Association of altered folylpolyglutamate synthetase pre-mRNA splicing with methotrexate unresponsiveness in early rheumatoid arthritis. Rheumatology (Oxford) 2021; 60:1273-1281. [PMID: 32940699 PMCID: PMC7937028 DOI: 10.1093/rheumatology/keaa428] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 05/23/2020] [Indexed: 02/06/2023] Open
Abstract
Objectives An efficient pharmacological response to MTX treatment in RA patients relies on the retention and accumulation of intracellular MTX-polyglutamates catalysed by the enzyme folylpolyglutamate synthetase (FPGS). We recently identified a partial retention of FPGS intron 8 (8PR) as a prominent splice variant conferring FPGS dysfunction and decreased MTX polyglutamylation in acute lymphoblastic leukaemia. Here, we explored the association between FPGS 8PR levels and lack of MTX responsiveness in RA patients. Methods Thirty-six patients undergoing MTX treatment were enrolled from the Combinatie behandeling Reumatoide Artritis (COBRA)-light trial. RNA was isolated from blood samples at baseline, 13 weeks and 26 weeks of therapy, from patients in either COBRA-light (n = 21) or COBRA (n = 15) treatment arms. RT-qPCR analysis was used to assess RNA levels of FPGS 8PR over wild-type FPGS (8WT). Results In the COBRA-light treatment arm, higher baseline ratios of 8PR/8WT were significantly associated with higher 44-joint disease activity score (DAS44) at 13 and 26 weeks. Higher baseline ratios of 8PR/8WT also trended towards not obtaining low disease activity (DAS <1.6) and becoming a EULAR non-responder at 13 and 26 weeks. In the COBRA-treatment arm, a significant association was observed between high baseline 8PR/8WT ratios and higher DAS44 score at 26 weeks. Higher 8PR/8WT ratios were associated with non-response at week 26 based on both low disease activity and EULAR criteria. Conclusion This study is the first to associate alterations in FPGS pre-mRNA splicing levels with reduced responsiveness to MTX treatment in RA patients. Trial registration ISRCTN55552928.
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Affiliation(s)
- Ittai B Muller
- Department of Clinical Chemistry, Amsterdam, The Netherlands
| | - Marry Lin
- Department of Clinical Chemistry, Amsterdam, The Netherlands
| | - Willem F Lems
- Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands
| | - Marieke M Ter Wee
- Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands.,Department of Epidemiology and Biostatistics, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - Anna Wojtuszkiewicz
- Department of Hematology, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - Michael T Nurmohamed
- Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, The Netherlands
| | - Jacqueline Cloos
- Department of Hematology, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - Yehuda G Assaraf
- The Fred Wyszkowski Cancer Research Laboratory, Department of Biology, Technion-Israel Institute of Technology, Haifa, Israel
| | - Gerrit Jansen
- Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands
| | - Robert de Jonge
- Department of Clinical Chemistry, Amsterdam, The Netherlands
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20
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Jansen G, de Rotte MCFJ, de Jonge R. Smoking and Methotrexate Inefficacy in Rheumatoid Arthritis: What About Underlying Molecular Mechanisms? J Rheumatol 2021; 48:1495-1497. [PMID: 34329189 DOI: 10.3899/jrheum.210217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The study by Safy-Khan, et al in the current issue of The Journal of Rheumatology 1 reports that in a methotrexate (MTX)-based treatment regimen for patients with early arthritis, current smoking was significantly associated with a smaller reduction of Disease Activity Score in 28 joints (DAS28) over time compared to noncurrent smoking. This negative effect of current smoking on DAS28 was dose-dependent: patients who smoked 10-19 cigarettes per day did worse than patients who smoked 1-9 cigarettes per day.
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Affiliation(s)
- Gerrit Jansen
- G. Jansen, PhD, Biochemist, Amsterdam Rheumatology and Immunology Center, Amsterdam University Medical Center, location VUmc; M.C. de Rotte, PhD, Clinical Chemist, R. de Jonge, PhD, Professor of Clinical Chemistry, Department of Clinical Chemistry, Amsterdam University Medical Center, Amsterdam, the Netherlands. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. G. Jansen, Amsterdam Rheumatology and Immunology Center, Amsterdam University Medical Center, location VUmc, CCA - Rm 2.46, De Boelelaan 1117, 1081 HV Amsterdam, Amsterdam, the Netherlands,
| | - Maurits C F J de Rotte
- G. Jansen, PhD, Biochemist, Amsterdam Rheumatology and Immunology Center, Amsterdam University Medical Center, location VUmc; M.C. de Rotte, PhD, Clinical Chemist, R. de Jonge, PhD, Professor of Clinical Chemistry, Department of Clinical Chemistry, Amsterdam University Medical Center, Amsterdam, the Netherlands. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. G. Jansen, Amsterdam Rheumatology and Immunology Center, Amsterdam University Medical Center, location VUmc, CCA - Rm 2.46, De Boelelaan 1117, 1081 HV Amsterdam, Amsterdam, the Netherlands,
| | - Robert de Jonge
- G. Jansen, PhD, Biochemist, Amsterdam Rheumatology and Immunology Center, Amsterdam University Medical Center, location VUmc; M.C. de Rotte, PhD, Clinical Chemist, R. de Jonge, PhD, Professor of Clinical Chemistry, Department of Clinical Chemistry, Amsterdam University Medical Center, Amsterdam, the Netherlands. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. G. Jansen, Amsterdam Rheumatology and Immunology Center, Amsterdam University Medical Center, location VUmc, CCA - Rm 2.46, De Boelelaan 1117, 1081 HV Amsterdam, Amsterdam, the Netherlands,
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21
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Westerlind H, Maciejewski M, Frisell T, Jelinsky SA, Ziemek D, Askling J. What Is the Persistence to Methotrexate in Rheumatoid Arthritis, and Does Machine Learning Outperform Hypothesis-Based Approaches to Its Prediction? ACR Open Rheumatol 2021; 3:457-463. [PMID: 34085401 PMCID: PMC8280803 DOI: 10.1002/acr2.11266] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 04/01/2021] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE The objectives of this study were to assess the 1-year persistence to methotrexate (MTX) initiated as the first ever conventional synthetic disease-modifying antirheumatic drug in new-onset rheumatoid arthritis (RA) and to investigate the marginal gains and robustness of the results by increasing the number and nature of covariates and by using data-driven, instead of hypothesis-based, methods to predict this persistence. METHODS Through the Swedish Rheumatology Quality Register, linked to other data sources, we identified a cohort of 5475 patients with new-onset RA in 2006-2016 who were starting MTX monotherapy as their first disease-modifying antirheumatic drug. Data on phenotype at diagnosis and demographics were combined with increasingly detailed data on medical disease history and medication use in four increasingly complex data sets (48-4162 covariates). We performed manual model building using logistic regression. We also performed five different machine learning (ML) methods and combined the ML results into an ensemble model. We calculated the area under the receiver operating characteristic curve (AUROC) and made calibration plots. We trained on 90% of the data, and tested the models on a holdout data set. RESULTS Of the 5475 patients, 3834 (70%) remained on MTX monotherapy 1 year after treatment start. Clinical RA disease activity and baseline characteristics were most strongly associated with the outcome. The best manual model had an AUROC of 0.66 (95% confidence interval [CI] 0.60-0.71). For the ML methods, Lasso regression performed best (AUROC = 0.67; 95% CI 0.62-0.71). CONCLUSION Approximately two thirds of patients with early RA who start MTX remain on this therapy 1 year later. Predicting this persistence remains a challenge, whether using hypothesis-based or ML models, and may yet require additional types of data.
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22
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Floris A, Perra D, Cangemi I, Congia M, Chessa E, Angioni MM, Mangoni AA, Erre GL, Mathieu A, Piga M, Cauli A. Current smoking predicts inadequate response to methotrexate monotherapy in rheumatoid arthritis patients naïve to DMARDs: Results from a retrospective cohort study. Medicine (Baltimore) 2021; 100:e25481. [PMID: 33907096 PMCID: PMC8084001 DOI: 10.1097/md.0000000000025481] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 03/16/2021] [Accepted: 03/18/2021] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Identifying predictors of inadequate response to methotrexate (MTX) in rheumatoid arthritis (RA) is key to move from a "trial and error" to a "personalized medicine" treatment approach where patients less likely to adequately respond to MTX monotherapy could start combination therapy at an earlier stage. This study aimed to identify potential predictors of inadequate response to MTX in RA patients naïve to disease modifying anti-rheumatic drugs.Data from a real-life cohort of newly diagnosed RA patients starting MTX (baseline, T0) as first-line therapy were analyzed. Outcomes, assessed after 6 months (T1), were defined as failure to achieve a disease activity score 28 (DAS28) low disease activity (LDA) or a good/moderate response to MTX, according to the European League Against Rheumatism (EULAR) response criteria. Logistic regression was used to assess the associations between baseline variables and the study outcomes.Overall, 294 patients (60.5% females, median age 54.5 years) with a median disease duration of 7.9 months were recruited. At T1, 47.3% of subjects failed to achieve LDA, and 29.3% did not have any EULAR-response. In multivariate analysis, significant associations were observed between no LDA and current smoking (adjusted odds ratio [adjOR] 1.79, P = .037), female gender (adjOR 1.68, P = .048), and higher DAS28 (adjOR 1.31, P = .013); and between no EULAR-response and current smoking (adjOR: 2.04, P = .019), age (adjOR: 0.72 per 10-years increases, P = .001), and higher erythrocyte sedimentation rate (adjOR: 0.49; P = .020). By contrast, there were no associations between past smoker status and study outcomes.In summary, in our real-life cohort of disease modifying anti-rheumatic drug naïve RA patients, current smoking habit independently predicts inadequate response to MTX. This, together with other independent predictors of response to treatment identified in our study, might assist with personalized monitoring in RA patients. Further studies are required to investigate whether smoking quitting strategies enhance the therapeutic response to MTX.
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Affiliation(s)
- Alberto Floris
- Rheumatology Unit, University of Cagliari and AOU University Clinic of Cagliari, Monserrato, Italy
| | - Daniela Perra
- Rheumatology Unit, University of Cagliari and AOU University Clinic of Cagliari, Monserrato, Italy
| | - Ignazio Cangemi
- Rheumatology Unit, University of Cagliari and AOU University Clinic of Cagliari, Monserrato, Italy
| | - Mattia Congia
- Rheumatology Unit, University of Cagliari and AOU University Clinic of Cagliari, Monserrato, Italy
| | - Elisabetta Chessa
- Rheumatology Unit, University of Cagliari and AOU University Clinic of Cagliari, Monserrato, Italy
| | - Maria Maddalena Angioni
- Rheumatology Unit, University of Cagliari and AOU University Clinic of Cagliari, Monserrato, Italy
| | - Arduino Aleksander Mangoni
- Department of Clinical Pharmacology, College of Medicine and Public Health, Flinders University and Flinders Medical Centre, Adelaide, Australia
| | - Gian Luca Erre
- Rheumatology Unit, University of Sassari and AOU University of Sassari, Sassari, Italy
| | - Alessandro Mathieu
- Rheumatology Unit, University of Cagliari and AOU University Clinic of Cagliari, Monserrato, Italy
| | - Matteo Piga
- Rheumatology Unit, University of Cagliari and AOU University Clinic of Cagliari, Monserrato, Italy
| | - Alberto Cauli
- Rheumatology Unit, University of Sassari and AOU University of Sassari, Sassari, Italy
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23
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Huerta-García AP, Rodríguez-Báez AS, Medellín-Garibay SE, Portales-Pérez DP, Martínez-Martínez MU, Abud-Mendoza C, Herrera-Van Oostdam D, Romano-Moreno S, Milán-Segovia RDC. Methotrexate Triglutamate as a Determinant of Clinical Response in Mexican Patients With Rheumatoid Arthritis: Pharmacokinetics and Dose Recommendation. J Clin Pharmacol 2021; 61:1118-1130. [PMID: 33595870 DOI: 10.1002/jcph.1837] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/14/2021] [Indexed: 01/28/2023]
Abstract
Methotrexate is the gold standard treatment in rheumatoid arthritis. Once absorbed, it is internalized in cells, where glutamate residues are added to produce polyglutamated forms, which are responsible for the effect of methotrexate. The aim of the current study is to determine the relationship between methotrexate triglutamate concentrations and the clinical evolution in rheumatoid arthritis patients, as well as to characterize the variability in both features to propose strategies for low-dose methotrexate optimization. The quantification of methotrexate triglutamate concentration in red blood cells was performed through ultra-performance liquid chromatography coupled with mass spectrometry. Polymorphisms of genes involved in the formation of polyglutamates were determined by real-time polymerase chain reaction. A multivariate regression was performed to determine the covariates involved in the variability of methotrexate triglutamate concentrations and a population pharmacokinetics model was developed through nonlinear mixed-effects modeling. Disease activity score changed according to methotrexate triglutamate concentrations; patients with good response to treatment had higher concentrations than moderate or nonresponding patients. The methotrexate triglutamate concentrations were related to time under treatment, dose, red blood cells, and body mass index. A 1-compartment open model was selected to estimate the pharmacokinetic parameters; the typical total clearance (L/day) was determined as 1.45 * (body mass index/28 kg/m2 ) * (red blood cells/4.6 × 106 cells/μL) and the volume of distribution was 52.4 L, with an absorption rate of 0.0346/day and a fraction metabolized of 1.03%. Through the application of the model, the initial dose of methotrexate is proposed on the basis of stochastic simulations and considering methotrexate triglutamate concentrations found in responders patients.
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Affiliation(s)
- Ana P Huerta-García
- Faculty of Chemical Sciences, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México
| | - Ana S Rodríguez-Báez
- Faculty of Chemical Sciences, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México
| | | | - Diana P Portales-Pérez
- Faculty of Chemical Sciences, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México
| | | | - Carlos Abud-Mendoza
- Department of Rheumatology, Hospital Central "Dr. Ignacio Morones Prieto", San Luis Potosí, México
| | | | - Silvia Romano-Moreno
- Faculty of Chemical Sciences, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México
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24
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Muto S, Minamitani N, Ogura T, Nakajima A, Nakagawa K, Masaka T, Hiura S, Kobayashi H, Kato H, Kameda H. Good response to methotrexate is associated with a decrease in the gene expression of ABCG2, a drug transporter, in patients with rheumatoid arthritis. Mod Rheumatol 2021; 31:1079-1086. [PMID: 33492182 DOI: 10.1080/14397595.2021.1879429] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES Methotrexate (MTX) is used as an anchor drug in the treatment of rheumatoid arthritis (RA), although more than a half of the patients with RA require additional treatments. We designed a prospective study involving two medical centers in Japan to examine the association between the expression of MTX-related genes including a drug transporter ATP-binding cassette sub-family G member 2 (ABCG2) gene and the clinical response to MTX in MTX-naive patients with RA. METHODS The primary endpoint of this study was good response based on the European League Against Rheumatism (EULAR) response criteria by Disease Activity Score using 28-joint count (DAS28). We evaluated the association between the baseline expression of six genes involved in the intracellular pharmacokinetics of MTX, including ABCG2, as well as their temporal changes, and the clinical response at week 12 from the initiation of MTX. RESULTS Based on the clinical response at 12 weeks after the initiation of MTX, 24 patients were classified into good responders (n = 9) and non-good responders (n = 15; 10 moderate responders and 5 non-responders) groups. A univariate logistic regression analysis of the baseline gene expression levels to predict the EULAR good response at week 12 showed a significant association with ABCG2 expression alone. Furthermore, the rate of baseline expression of ABCG2 mRNA above the cut-off value determined using a receiver operating characteristic curve was higher in good responders than in non-good responders (p = .012). Moreover, ABCG2 expression decreased in almost all good responders, but not in non-good responders, after MTX treatment for 12 weeks (median -76% vs. +41% from baseline, respectively; p = .011). The ABCG2 expression level did not correlate with DAS28 at baseline or week 12. CONCLUSIONS Our study revealed that good response to MTX is associated with a decrease in the expression of ABCG2 in patients with RA.
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Affiliation(s)
- Satoshi Muto
- Center of Pharmaceutical Health Care and Sciences, Faculty of Pharmaceutical Sciences, Toho University, Chiba, Japan
| | - Nana Minamitani
- Center of Pharmaceutical Health Care and Sciences, Faculty of Pharmaceutical Sciences, Toho University, Chiba, Japan
| | - Takehisa Ogura
- Division of Rheumatology, Department of Internal Medicine, Toho University (Ohashi Medical Center), Tokyo, Japan
| | - Arata Nakajima
- Department of Orthopaedic Surgery, Toho University (Sakura Medical Center), Chiba, Japan
| | - Koichi Nakagawa
- Department of Orthopaedic Surgery, Toho University (Sakura Medical Center), Chiba, Japan
| | - Toru Masaka
- Center of Pharmaceutical Health Care and Sciences, Faculty of Pharmaceutical Sciences, Toho University, Chiba, Japan.,Department of Pharmacy, Toho University Sakura Medical Center, Chiba, Japan
| | - Sumiko Hiura
- Department of Pharmacy, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Hideki Kobayashi
- Department of Pharmacy, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Hiroyoshi Kato
- Center of Pharmaceutical Health Care and Sciences, Faculty of Pharmaceutical Sciences, Toho University, Chiba, Japan
| | - Hideto Kameda
- Division of Rheumatology, Department of Internal Medicine, Toho University (Ohashi Medical Center), Tokyo, Japan
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25
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Bruckmueller H, Cascorbi I. ABCB1, ABCG2, ABCC1, ABCC2, and ABCC3 drug transporter polymorphisms and their impact on drug bioavailability: what is our current understanding? Expert Opin Drug Metab Toxicol 2021; 17:369-396. [PMID: 33459081 DOI: 10.1080/17425255.2021.1876661] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Interindividual differences in drug response are a frequent clinical challenge partly due to variation in pharmacokinetics. ATP-binding cassette (ABC) transporters are crucial determinants of drug disposition. They are subject of gene regulation and drug-interaction; however, it is still under debate to which extend genetic variants in these transporters contribute to interindividual variability of a wide range of drugs. AREAS COVERED This review discusses the current literature on the impact of genetic variants in ABCB1, ABCG2 as well as ABCC1, ABCC2, and ABCC3 on pharmacokinetics and drug response. The aim was to evaluate if results from recent studies would increase the evidence for potential clinically relevant pharmacogenetic effects. EXPERT OPINION Although enormous efforts have been made to investigate effects of ABC transporter genotypes on drug pharmacokinetics and response, the majority of studies showed only weak if any associations. Despite few unique results, studies mostly failed to confirm earlier findings or still remained inconsistent. The impact of genetic variants on drug bioavailability is only minor and other factors regulating the transporter expression and function seem to be more critical. In our opinion, the findings on the so far investigated genetic variants in ABC efflux transporters are not suitable as predictive biomarkers.
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Affiliation(s)
- Henrike Bruckmueller
- Institute of Experimental and Clinical Pharmacology, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
| | - Ingolf Cascorbi
- Institute of Experimental and Clinical Pharmacology, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
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26
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Factors predicting addition of disease-modifying antirheumatic drugs after initial methotrexate monotherapy in patients with rheumatoid arthritis. Clin Rheumatol 2021; 40:2657-2663. [PMID: 33483918 DOI: 10.1007/s10067-021-05599-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/13/2021] [Accepted: 01/17/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION We investigated factors predicting the addition of disease-modifying antirheumatic drugs (DMARDs) after an initial methotrexate (MTX) monotherapy in rheumatoid arthritis (RA) patients to support an early decision on the DMARDs addition. METHODS This retrospective cohort study included 311 patients who were diagnosed with RA and started on MTX monotherapy at Showa University Hospital, Japan. The outcome was addition of DMARDs after an initial MTX monotherapy at 6 months. Baseline patient characteristics were compared between the DMARDs addition and MTX monotherapy continuation groups, and significant independent predictive factors for the addition of DMARDs were selected using multivariate analysis. RESULTS The median age of patients was 62 years (range 24-90), 170 patients (73%) were women, the median swollen 28-joint count (SJC28) was 3 (0-28), and the median tender 28-joint count (TJC28) was 5 (0-28). DMARDs were added in 65 (27.9%) patients. In the univariate analysis, higher TJC28 and SJC28, concomitant use of nonsteroidal anti-inflammatory drugs, and intra-articular glucocorticoid (GC) injection history were significantly associated with the DMARDs addition. In the multivariate analysis, by adding covariates to the variables identified in the univariate analysis, SJC28 (odds ratio [OR] 1.390 per 5 joints increase; 95% confidence interval [CI], 1.036-1.866) and intra-articular GC injection history (OR 3.678; 95% CI, 1.170-11.557) were independent predictors of DMARDs addition. CONCLUSION A higher SJC28 and intra-articular GC injection history may be useful predictors of DMARDs addition after the initial MTX monotherapy. We expect that using these predictors will enable an earlier shift to a more aggressive treatment. Key Points ・We performed a retrospective cohort study with the addition of DMARDs as the outcome in patients with RA who were started on MTX monotherapy. ・A higher SJC28 (OR 1.390; 95% CI, 1.036-1.866) and an intra-articular GC injection history (OR 3.678; 95% CI, 1.170-11.557) may be useful predictors for the addition of DMARDs of initiating MTX monotherapy at 6 months. ・The use of such indicators may support an early decision on the addition of DMARDs after the initial MTX monotherapy.
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Gosselt HR, Verhoeven MMA, Bulatović-Ćalasan M, Welsing PM, de Rotte MCFJ, Hazes JMW, Lafeber FPJG, Hoogendoorn M, de Jonge R. Complex Machine-Learning Algorithms and Multivariable Logistic Regression on Par in the Prediction of Insufficient Clinical Response to Methotrexate in Rheumatoid Arthritis. J Pers Med 2021; 11:jpm11010044. [PMID: 33466633 PMCID: PMC7828730 DOI: 10.3390/jpm11010044] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/24/2020] [Accepted: 01/11/2021] [Indexed: 12/16/2022] Open
Abstract
The goals of this study were to examine whether machine-learning algorithms outperform multivariable logistic regression in the prediction of insufficient response to methotrexate (MTX); secondly, to examine which features are essential for correct prediction; and finally, to investigate whether the best performing model specifically identifies insufficient responders to MTX (combination) therapy. The prediction of insufficient response (3-month Disease Activity Score 28-Erythrocyte-sedimentation rate (DAS28-ESR) > 3.2) was assessed using logistic regression, least absolute shrinkage and selection operator (LASSO), random forest, and extreme gradient boosting (XGBoost). The baseline features of 355 rheumatoid arthritis (RA) patients from the “treatment in the Rotterdam Early Arthritis CoHort” (tREACH) and the U-Act-Early trial were combined for analyses. The model performances were compared using area under the curve (AUC) of receiver operating characteristic (ROC) curves, 95% confidence intervals (95% CI), and sensitivity and specificity. Finally, the best performing model following feature selection was tested on 101 RA patients starting tocilizumab (TCZ)-monotherapy. Logistic regression (AUC = 0.77 95% CI: 0.68–0.86) performed as well as LASSO (AUC = 0.76, 95% CI: 0.67–0.85), random forest (AUC = 0.71, 95% CI: 0.61 = 0.81), and XGBoost (AUC = 0.70, 95% CI: 0.61–0.81), yet logistic regression reached the highest sensitivity (81%). The most important features were baseline DAS28 (components). For all algorithms, models with six features performed similarly to those with 16. When applied to the TCZ-monotherapy group, logistic regression’s sensitivity significantly dropped from 83% to 69% (p = 0.03). In the current dataset, logistic regression performed equally well compared to machine-learning algorithms in the prediction of insufficient response to MTX. Models could be reduced to six features, which are more conducive for clinical implementation. Interestingly, the prediction model was specific to MTX (combination) therapy response.
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Affiliation(s)
- Helen R. Gosselt
- Department of Clinical Chemistry, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, VUmc, 1081 HV Amsterdam, The Netherlands;
- Department of Clinical Chemistry, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
- Correspondence: ; Tel.: +31-20-4443029
| | - Maxime M. A. Verhoeven
- Department of Rheumatology & Clinical Immunology, UMC Utrecht, 3508 GA Utrecht, The Netherlands; (M.M.A.V.); (M.B.-Ć.); (P.M.W.); (F.P.J.G.L.)
| | - Maja Bulatović-Ćalasan
- Department of Rheumatology & Clinical Immunology, UMC Utrecht, 3508 GA Utrecht, The Netherlands; (M.M.A.V.); (M.B.-Ć.); (P.M.W.); (F.P.J.G.L.)
- Department of Internal Medicine, UMC Utrecht, 3508 GA Utrecht, The Netherlands
| | - Paco M. Welsing
- Department of Rheumatology & Clinical Immunology, UMC Utrecht, 3508 GA Utrecht, The Netherlands; (M.M.A.V.); (M.B.-Ć.); (P.M.W.); (F.P.J.G.L.)
| | - Maurits C. F. J. de Rotte
- Department of Clinical Chemistry, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, Univ of Amsterdam, 1105 AZ Amsterdam, The Netherlands;
| | - Johanna M. W. Hazes
- Department of Rheumatology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands;
| | - Floris P. J. G. Lafeber
- Department of Rheumatology & Clinical Immunology, UMC Utrecht, 3508 GA Utrecht, The Netherlands; (M.M.A.V.); (M.B.-Ć.); (P.M.W.); (F.P.J.G.L.)
| | - Mark Hoogendoorn
- Department of Computer Science, Quantitative Data Analytics Group, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands;
| | - Robert de Jonge
- Department of Clinical Chemistry, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, VUmc, 1081 HV Amsterdam, The Netherlands;
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28
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Gosselt HR, Muller IB, Jansen G, van Weeghel M, Vaz FM, Hazes JMW, Heil SG, de Jonge R. Identification of Metabolic Biomarkers in Relation to Methotrexate Response in Early Rheumatoid Arthritis. J Pers Med 2020; 10:jpm10040271. [PMID: 33321888 PMCID: PMC7768454 DOI: 10.3390/jpm10040271] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/03/2020] [Accepted: 12/08/2020] [Indexed: 12/11/2022] Open
Abstract
This study aimed to identify baseline metabolic biomarkers for response to methotrexate (MTX) therapy in rheumatoid arthritis (RA) using an untargeted method. In total, 82 baseline plasma samples (41 insufficient responders and 41 sufficient responders to MTX) were selected from the Treatment in the Rotterdam Early Arthritis Cohort (tREACH, trial number: ISRCTN26791028) based on patients' EULAR response at 3 months. Metabolites were assessed using high-performance liquid chromatography-quadrupole time of flight mass spectrometry. Differences in metabolite concentrations between insufficient and sufficient responders were assessed using partial least square regression discriminant analysis (PLS-DA) and Welch's t-test. The predictive performance of the most significant findings was assessed in a receiver operating characteristic plot with area under the curve (AUC), sensitivity and specificity. Finally, overrepresentation analysis was performed to assess if the best discriminating metabolites were enriched in specific metabolic events. Baseline concentrations of homocystine, taurine, adenosine triphosphate, guanosine diphosphate and uric acid were significantly lower in plasma of insufficient responders versus sufficient responders, while glycolytic intermediates 1,3-/2,3-diphosphoglyceric acid, glycerol-3-phosphate and phosphoenolpyruvate were significantly higher in insufficient responders. Homocystine, glycerol-3-phosphate and 1,3-/2,3-diphosphoglyceric acid were independent predictors and together showed a high AUC of 0.81 (95% CI: 0.72-0.91) for the prediction of insufficient response, with corresponding sensitivity of 0.78 and specificity of 0.76. The Warburg effect, glycolysis and amino acid metabolism were identified as underlying metabolic events playing a role in clinical response to MTX in early RA. New metabolites and potential underlying metabolic events correlating with MTX response in early RA were identified, which warrant validation in external cohorts.
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Affiliation(s)
- Helen R. Gosselt
- Amsterdam Gastroenterology and Metabolism, Department of Clinical Chemistry, Amsterdam UMC, VUmc, 1081 HV Amsterdam, The Netherlands; (I.B.M.); (R.d.J.)
- Department of Clinical Chemistry, Erasmus MC University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands;
- Correspondence: ; Tel.: +31-20-4443029
| | - Ittai B. Muller
- Amsterdam Gastroenterology and Metabolism, Department of Clinical Chemistry, Amsterdam UMC, VUmc, 1081 HV Amsterdam, The Netherlands; (I.B.M.); (R.d.J.)
| | - Gerrit Jansen
- Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, VUmc, 1081 HV Amsterdam, The Netherlands;
| | - Michel van Weeghel
- Amsterdam Gastroenterology Endocrinology Metabolism, Laboratory Genetic Metabolic Diseases, Departments of Clinical Chemistry and Pediatrics, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (M.v.W.); (F.M.V.)
- Core Facility Metabolomics, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Frédéric M. Vaz
- Amsterdam Gastroenterology Endocrinology Metabolism, Laboratory Genetic Metabolic Diseases, Departments of Clinical Chemistry and Pediatrics, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (M.v.W.); (F.M.V.)
- Core Facility Metabolomics, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Johanna M. W. Hazes
- Department of Rheumatology, Erasmus MC University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands;
- Academic Center of Excellence−Inflammunity, Erasmus MC University Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Sandra G. Heil
- Department of Clinical Chemistry, Erasmus MC University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands;
- Academic Center of Excellence−Inflammunity, Erasmus MC University Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Robert de Jonge
- Amsterdam Gastroenterology and Metabolism, Department of Clinical Chemistry, Amsterdam UMC, VUmc, 1081 HV Amsterdam, The Netherlands; (I.B.M.); (R.d.J.)
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Gosselt HR, Verhoeven MMA, de Rotte MCFJ, Pluijm SMF, Muller IB, Jansen G, Tekstra J, Bulatović-Ćalasan M, Heil SG, Lafeber FPJG, Hazes JMW, de Jonge R. Validation of a Prognostic Multivariable Prediction Model for Insufficient Clinical Response to Methotrexate in Early Rheumatoid Arthritis and Its Clinical Application in Evidencio. Rheumatol Ther 2020; 7:837-850. [PMID: 32926395 PMCID: PMC7695780 DOI: 10.1007/s40744-020-00230-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Methotrexate (MTX) constitutes the first-line therapy in rheumatoid arthritis (RA), yet approximately 30% of the patients do not benefit from MTX. Recently, we reported a prognostic multivariable prediction model for insufficient clinical response to MTX at 3 months of treatment in the treatment in the Rotterdam Early Arthritis Cohort (tREACH), including baseline predictors: Disease activity score 28 (DAS28), Health Assessment Questionnaire (HAQ), erythrocyte folate, single-nucleotide polymorphisms (SNPs; ABCB1, ABCC3), smoking, and BMI. The purpose of the current study was (1) to externally validate the model and (2) to enhance the model's clinical applicability. METHODS Erythrocyte folate and SNPs were assessed in 91 early disease-modifying antirheumatic drug (DMARD)-naïve RA patients starting MTX in the external validation cohort (U-Act-Early). Insufficient response (DAS28 > 3.2) was determined after 3 months and non-response after 6 months of therapy. The previously developed prediction model was considered successfully validated in the U-Act-Early (validation cohort) if the area under the curve (AUC) of the receiver operating characteristic (ROC) was not significantly lower than in the tREACH (derivation cohort). RESULTS The AUCs in U-Act-Early at three and 6 months were 0.75 (95% CI 0.64-0.85) and 0.71 (95% CI 0.60-0.82) respectively, similar to the tREACH. Baseline DAS28 > 5.1 and HAQ > 0.6 were the strongest predictors. The model was simplified by excluding the SNPs, while still classifying 73% correctly. Furthermore, interaction terms between BMI and HAQ and BMI and erythrocyte folate significantly improved the model increasing correct classification to 75%. Results were successfully implemented in Evidencio online platform assisting clinicians in shared decision-making to intensify treatment when appropriate. CONCLUSIONS We successfully externally validated our recently reported prediction model for MTX non-response and enhanced its clinical application thus enabling its evaluation in a clinical trial. TRIAL REGISTRATION The U-Act-Early is registered at ClinicalTrials.gov. number: NCT01034137. tREACH is registered retrospectively at ISRCTN registry, number: ISRCTN26791028 at 23 August 2007.
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Affiliation(s)
- Helen R Gosselt
- Amsterdam Gastroenterology and Metabolism, Department of Clinical Chemistry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
- Department of Clinical Chemistry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | - Maxime M A Verhoeven
- Department of Rheumatology and Clinical Immunology, UMC Utrecht, Utrecht, The Netherlands
| | - Maurits C F J de Rotte
- Amsterdam Gastroenterology and Metabolism, Department of Clinical Chemistry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology and Metabolism, Department of Clinical Chemistry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Saskia M F Pluijm
- Department of Paediatric Oncology, Prinses Máxima Centre for Paediatric Oncology, Utrecht, The Netherlands
| | - Ittai B Muller
- Amsterdam Gastroenterology and Metabolism, Department of Clinical Chemistry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Gerrit Jansen
- Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Janneke Tekstra
- Department of Rheumatology and Clinical Immunology, UMC Utrecht, Utrecht, The Netherlands
| | | | - Sandra G Heil
- Department of Clinical Chemistry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Floris P J G Lafeber
- Department of Rheumatology and Clinical Immunology, UMC Utrecht, Utrecht, The Netherlands
| | - Johanna M W Hazes
- Department of Rheumatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Robert de Jonge
- Amsterdam Gastroenterology and Metabolism, Department of Clinical Chemistry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Ling SF, Bluett J. Pharmacogenetics of methotrexate response in rheumatoid arthritis: an update. Pharmacogenomics 2020; 21:3-6. [PMID: 31849277 DOI: 10.2217/pgs-2019-0154] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Stephanie F Ling
- Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, Oxford Road, Manchester, M13 9PT, UK.,The Nowgen Centre, 29 Grafton Street, Mancheser, M13 9WL, UK
| | - James Bluett
- Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, Oxford Road, Manchester, M13 9PT, UK.,The Nowgen Centre, 29 Grafton Street, Mancheser, M13 9WL, UK
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Luedders BA, Johnson TM, Sayles H, Thiele GM, Mikuls TR, O'Dell JR, England BR. Predictive ability, validity, and responsiveness of the multi-biomarker disease activity score in patients with rheumatoid arthritis initiating methotrexate. Semin Arthritis Rheum 2020; 50:1058-1063. [PMID: 32911284 DOI: 10.1016/j.semarthrit.2020.05.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 05/01/2020] [Accepted: 05/27/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND/OBJECTIVE We assessed the predictive value, validity, and responsiveness of the multi-biomarker disease activity (MBDA) score in rheumatoid arthritis (RA) patients initiating methotrexate. METHODS We examined data from a 16-week, open-label study of methotrexate in RA. Disease activity was assessed and the MBDA score was calculated using serum that was collected and banked from baseline and week 16. Multivariable logistic regression models assessed whether MBDA scores predicted treatment response. Pearson correlations assessed the convergent validity and external responsiveness of the MBDA score with other measures of RA disease activity. Internal responsiveness was assessed by calculating standardized response means (SRMs). RESULTS A total of 130 patients initiated the study, with follow-up MBDA scores available on 95 patients. Baseline MBDA scores did not predict ACR response or achieving low disease activity. Higher baseline DAS28-ESR scores were significantly associated with an ACR20 response (odds ratio 1.89 per unit, 95% CI 1.20-2.96) but not ACR50, ACR70, or low disease activity. The MBDA score moderate-to-weakly correlated with the DAS28-ESR and ESR at baseline and week 16, with weak-to-very weak correlations with patient global and function. Change in MBDA scores moderately correlated with changes in DAS28-ESR and ESR, while weakly correlating with changes in patient global and function. The DAS28-ESR (SRM 1.31) demonstrated greater responsiveness following methotrexate treatment than the MBDA score (SRM 0.71). CONCLUSIONS MBDA scores did not predict treatment response to methotrexate. The MBDA score weak-to-moderately correlated with baseline and post-treatment disease activity measures and was less responsive to methotrexate-related improvement than the DAS28-ESR.
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Affiliation(s)
- Brent A Luedders
- Division of Rheumatology & Immunology, Department of Internal Medicine, University of Nebraska Medical Center (UNMC), Omaha, NE, United States; VA Nebraska-Western IA Health Care System, Omaha, NE, United States
| | - Tate M Johnson
- Division of Rheumatology & Immunology, Department of Internal Medicine, University of Nebraska Medical Center (UNMC), Omaha, NE, United States; VA Nebraska-Western IA Health Care System, Omaha, NE, United States
| | - Harlan Sayles
- Division of Rheumatology & Immunology, Department of Internal Medicine, University of Nebraska Medical Center (UNMC), Omaha, NE, United States; Department of Biostatistics, College of Public Health, UNMC, Omaha, NE, United States
| | - Geoffrey M Thiele
- Division of Rheumatology & Immunology, Department of Internal Medicine, University of Nebraska Medical Center (UNMC), Omaha, NE, United States; VA Nebraska-Western IA Health Care System, Omaha, NE, United States
| | - Ted R Mikuls
- Division of Rheumatology & Immunology, Department of Internal Medicine, University of Nebraska Medical Center (UNMC), Omaha, NE, United States; VA Nebraska-Western IA Health Care System, Omaha, NE, United States
| | - James R O'Dell
- Division of Rheumatology & Immunology, Department of Internal Medicine, University of Nebraska Medical Center (UNMC), Omaha, NE, United States; VA Nebraska-Western IA Health Care System, Omaha, NE, United States
| | - Bryant R England
- Division of Rheumatology & Immunology, Department of Internal Medicine, University of Nebraska Medical Center (UNMC), Omaha, NE, United States; VA Nebraska-Western IA Health Care System, Omaha, NE, United States.
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Esperon P, Giletti A. Genetic markers that could influence clinical decision making during treatment with methotrexate. Pharmacogenomics 2020; 21:505-507. [DOI: 10.2217/pgs-2019-0188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Patricia Esperon
- Molecular Genetics Laboratory, Clinical Biochemistry Department, School of Chemistry, Universidad de la República, Montevideo, 11200, Uruguay
| | - Andrea Giletti
- Molecular Genetics Laboratory, Clinical Biochemistry Department, School of Chemistry, Universidad de la República, Montevideo, 11200, Uruguay
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Scher JU, Nayak RR, Ubeda C, Turnbaugh PJ, Abramson SB. Pharmacomicrobiomics in inflammatory arthritis: gut microbiome as modulator of therapeutic response. Nat Rev Rheumatol 2020; 16:282-292. [PMID: 32157196 DOI: 10.1038/s41584-020-0395-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2020] [Indexed: 02/07/2023]
Abstract
In the past three decades, extraordinary advances have been made in the understanding of the pathogenesis of, and treatment options for, inflammatory arthritides, including rheumatoid arthritis and spondyloarthritis. The use of methotrexate and subsequently biologic therapies (such as TNF inhibitors, among others) and oral small molecules have substantially improved clinical outcomes for many patients with inflammatory arthritis; for others, however, these agents do not substantially improve their symptoms. The emerging field of pharmacomicrobiomics, which investigates the effect of variations within the human gut microbiome on drugs, has already provided important insights into these therapeutics. Pharmacomicrobiomic studies have demonstrated that human gut microorganisms and their enzymatic products can affect the bioavailability, clinical efficacy and toxicity of a wide array of drugs through direct and indirect mechanisms. This discipline promises to facilitate the advent of microbiome-based precision medicine approaches in inflammatory arthritis, including strategies for predicting response to treatment and for modulating the microbiome to improve response to therapy or reduce drug toxicity.
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Affiliation(s)
- Jose U Scher
- Department of Medicine, Division of Rheumatology, New York University Langone Health, New York, NY, USA.
| | - Renuka R Nayak
- Rheumatology Division, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.,Department of Microbiology & Immunology, University of California, San Francisco, CA, USA
| | - Carles Ubeda
- Centro Superior de Investigacion en Salud Publica - FISABIO, Valencia, Spain.,CIBER en Epidemiologia y Salud Publica, Madrid, Spain
| | - Peter J Turnbaugh
- Department of Microbiology & Immunology, University of California, San Francisco, CA, USA.,Chan Zuckerberg Biohub, San Francisco, CA, USA
| | - Steven B Abramson
- Department of Medicine, Division of Rheumatology, New York University Langone Health, New York, NY, USA
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Methotrexate and its mechanisms of action in inflammatory arthritis. Nat Rev Rheumatol 2020; 16:145-154. [PMID: 32066940 DOI: 10.1038/s41584-020-0373-9] [Citation(s) in RCA: 274] [Impact Index Per Article: 68.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2020] [Indexed: 11/08/2022]
Abstract
Despite the introduction of numerous biologic agents for the treatment of rheumatoid arthritis (RA) and other forms of inflammatory arthritis, low-dose methotrexate therapy remains the gold standard in RA therapy. Methotrexate is generally the first-line drug for the treatment of RA, psoriatic arthritis and other forms of inflammatory arthritis, and it enhances the effect of most biologic agents in RA. Understanding the mechanism of action of methotrexate could be instructive in the appropriate use of the drug and in the design of new regimens for the treatment of RA. Although methotrexate is one of the first examples of intelligent drug design, multiple mechanisms potentially contribute to the anti-inflammatory actions of methotrexate, including the inhibition of purine and pyrimidine synthesis, transmethylation reactions, translocation of nuclear factor-κB (NF-κB) to the nucleus, signalling via the Janus kinase (JAK)-signal transducer and activator of transcription (STAT) pathway and nitric oxide production, as well as the promotion of adenosine release and expression of certain long non-coding RNAs.
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Jekic B, Maksimovic N, Damnjanovic T. Methotrexate pharmacogenetics in the treatment of rheumatoid arthritis. Pharmacogenomics 2019; 20:1235-1245. [DOI: 10.2217/pgs-2019-0121] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
For many decades, methotrexate (MXT) has remained the drug of choice in the treatment of rheumatoid arthritis (RA). Unfortunately, a considerable number of patients do not achieve an appropriate therapeutic response. Pharmacogenetics studies do not give usable results regarding differences in MTX response among RA patients. The mechanism of MTX action in RA is not completely understood. We present and discuss data regarding the molecular basis of folate and adenosine pathways, the most obvious MTX targets, to explain possible causes of therapy failure. The molecular basis of the disease could also have an impact on therapy outcomes and in this review we explore this. Finally, we make a short review of available pharmacogenetics study results.
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Affiliation(s)
- Biljana Jekic
- Institute of Human Genetics, Faculty of Medicine, University of Belgrade,11000 Belgrade, Serbia
| | - Nela Maksimovic
- Institute of Human Genetics, Faculty of Medicine, University of Belgrade,11000 Belgrade, Serbia
| | - Tatjana Damnjanovic
- Institute of Human Genetics, Faculty of Medicine, University of Belgrade,11000 Belgrade, Serbia
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36
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Boire G, Allard-Chamard H. The 4-H of Biomarkers in Arthritis: A Lot of Help, Occasional Harm, Some Hype, Increasing Hope. J Rheumatol 2019; 46:758-763. [DOI: 10.3899/jrheum.190375] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
(Gilles Boire): It was both a pleasure and an honor to present the 2019 Dunlop-Dottridge Lecture. My co-author and I will now discuss benefits and pitfalls of biomarkers developed through emerging techniques, evaluated through the experiential perspective of a seasoned clinician, as they apply to the quest for biomarker identification in rheumatic diseases.
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Gosselt HR, van Zelst BD, de Rotte MCFJ, Hazes JMW, de Jonge R, Heil SG. Higher baseline global leukocyte DNA methylation is associated with MTX non-response in early RA patients. Arthritis Res Ther 2019; 21:157. [PMID: 31242943 PMCID: PMC6595617 DOI: 10.1186/s13075-019-1936-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 06/06/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low-dose methotrexate (MTX) is the first-line therapy in early rheumatoid arthritis (eRA). Up to 40% of eRA patients do not benefit from MTX therapy. MTX has been shown to inhibit one-carbon metabolism, which is involved in the donation of methyl groups. In this study, we investigate baseline global DNA methylation and changes in DNA methylation during treatment in relation to clinical non-response after 3 months of MTX treatment. METHODS Two hundred ninety-four blood samples were collected from the Treatment in the Rotterdam Early Arthritis Cohort (tREACH, ISRCTN26791028), a multicenter, stratified single-blind clinical trial of eRA patients. Global DNA (hydroxy)methylation was quantified using liquid chromatography-electrospray ionization-tandem mass spectrometry (LC-ESI-MS/MS) and validated with a global DNA LINE-1 methylation technique. MTX response was determined as ΔDAS28. Additionally, patients were stratified into two response groups according to the European League Against Rheumatism (EULAR) response criteria. Associations between global DNA methylation and response were examined using univariate regression models adjusted for baseline DAS28, baseline erythrocyte folate levels, and body mass index (BMI). RESULTS Higher baseline global DNA methylation was associated with less decrease of DAS28 (β = 0.15, p = 0.013) and with MTX non-response (OR = 0.010, 95% CI = 0.001-0.188). This result was validated in LINE-1 elements (β = 0.22, p = 0.026). Changes in global DNA (hydroxy)methylation were not associated with MTX response over 3 months. CONCLUSIONS These results show that higher baseline global DNA methylation in treatment naïve eRA patients is associated with decreased clinical response after 3 months of treatment of eRA patients and can be further evaluated as a predictor for MTX therapy non-response. TRIAL REGISTRATION ISRCTN, ISRCTN26791028 , registered 23 August 2007-retrospectively registered.
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Affiliation(s)
- Helen R Gosselt
- Department of Clinical Chemistry, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Clinical Chemistry, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Bertrand D van Zelst
- Department of Clinical Chemistry, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Maurits C F J de Rotte
- Department of Clinical Chemistry, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, Univ of Amsterdam, Amsterdam, The Netherlands
| | - Johanna M W Hazes
- Department of Rheumatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Academic Center of Excellence - Inflammunity, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Robert de Jonge
- Department of Clinical Chemistry, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Sandra G Heil
- Department of Clinical Chemistry, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands. .,Academic Center of Excellence - Inflammunity, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
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Roodenrijs NMT, van der Goes MC, Welsing PMJ, Tekstra J, van Laar JM, Lafeber FPJG, Bijlsma JWJ, Jacobs JWG. Is prediction of clinical response to methotrexate in individual rheumatoid arthritis patients possible? A systematic literature review. Joint Bone Spine 2019; 87:13-23. [PMID: 30981868 DOI: 10.1016/j.jbspin.2019.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 04/02/2019] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To identify, by a systematic literature review, predictors of clinical response to methotrexate treatment in rheumatoid arthritis patients, which would facilitate personalised treatment. METHODS PubMed and Embase databases were searched for original articles. Additionally, congress abstracts of European League Against Rheumatism and American College of Rheumatology annual meetings of the past 2 years were screened. Articles describing predictors of clinical response to methotrexate after 3 to 6 months were included, since this reflects the time span used to determine treatment effectiveness and decide on treatment changes in treat-to-target recommendations. RESULTS Thirty articles were included, containing 100 different predictors and 11 predictive models. Nineteen predictors and 2 predictive models were studied in multiple cohorts. Female gender was found to be a predictor of non-response in two studies (odds ratios 0.55 and 0.54), but these findings could not be replicated in two other studies. In two studies, smoking predicted non-response (adjusted odds ratios 0.35 and 0.60), although this was inconsistent over all response criteria assessed. Rheumatoid factor positivity predicted non-response in two studies (adjusted hazard ratio 0.61, adjusted odds ratio 0.4), but this was not found in three other studies. Heterogeneity in studies prohibited further comparison of predictive values between studies. Additionally, a validated epigenetic model was found (area under the curve 0.90 and 0.91). CONCLUSIONS No predictors were identified reliably predicting clinical response to methotrexate after 3 to 6 months in the individual patient: clinical predictors were weak. However, a promising epigenetic model was found that needs further validation.
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Affiliation(s)
- Nadia M T Roodenrijs
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands.
| | - Marlies C van der Goes
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Paco M J Welsing
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Janneke Tekstra
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Jacob M van Laar
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Floris P J G Lafeber
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Johannes W J Bijlsma
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Johannes W G Jacobs
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
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Frigerio B, Bizzoni C, Jansen G, Leamon CP, Peters GJ, Low PS, Matherly LH, Figini M. Folate receptors and transporters: biological role and diagnostic/therapeutic targets in cancer and other diseases. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2019; 38:125. [PMID: 30867007 PMCID: PMC6417013 DOI: 10.1186/s13046-019-1123-1] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 02/28/2019] [Indexed: 01/28/2023]
Abstract
Folate receptors and transporters and one-carbon metabolism continue to be important areas of study given their essential roles in an assortment of diseases and as targets for treatment of cancer and inflammation. Reflecting this, every 2 years, the Folate Receptor Society organizes an international meeting, alternating between North America and Europe, where basic and translational scientists, clinical oncologists and rheumatologists from both academia and industry convene in an informal setting. The 7th International Symposium on Folate Receptors and Transporters was held in Sant’Alessio Siculo (ME), Taormina, Italy from 1st to 5th of October 2018, organized by Dr. Mariangela Figini from Fondazione IRCCS Istituto Nazionale dei Tumori, Milan. Following the format of previous meetings, more than 50 scientists from 9 different countries attended the 2018 meeting to share ongoing developments, discuss current research challenges and identify new avenues in basic and translational research. An important feature of this meeting was the participation of young investigators and trainees in this area, two (A. Dekhne and N. Verweij) of whom were awarded fellowships to attend this meeting as a recognition of the high scientific quality of their work. This report provides a synopsis of the highlights presented in the following sessions: Barton Kamen Lecture; Targeting one-carbon metabolism in cytosol and mitochondria; Structure and biology of the one-carbon solute transporters; Physiology and pathophysiology of folate receptors and transporters; Folate receptors for targeting tumors and inflammatory diseases; Conventional and new anti-folate drugs for treating inflammatory diseases and cancer; Imaging; Ongoing clinical trials; and Chimeric Antigen Receptor cell therapies of cancer.
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Affiliation(s)
- Barbara Frigerio
- Dipartimento di Ricerca Applicata e Sviluppo Tecnologico, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Claudia Bizzoni
- Dipartimento di Ricerca Applicata e Sviluppo Tecnologico, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,Present address: ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Gerrit Jansen
- Amsterdam Rheumatology and Immunology Center, Amsterdam University Medical Center, location Vrije Universiteit, Amsterdam, The Netherlands
| | | | - Godefridus J Peters
- Department of Medical Oncology, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Philip S Low
- Purdue University Institute for Drug Discovery, West Lafayette, Indiana, USA
| | - Larry H Matherly
- Barbara Ann Karmanos Cancer Institute and Wayne State University School of Medicine, Detroit, MI, USA
| | - Mariangela Figini
- Dipartimento di Ricerca Applicata e Sviluppo Tecnologico, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
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