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Diaconu AD, Pomîrleanu C, Russu M, Strugariu G, Ancuța E, Ciortescu I, Bologa C, Morărașu BC, Constantin M, Ceasovschih A, Șorodoc V, Șorodoc L, Ancuța C. Drug Survival, Effectiveness and Safety of Secukinumab in Axial Spondyloarthritis up to 4 Years: A Real-Life Single Center Experience. J Pers Med 2024; 14:417. [PMID: 38673044 PMCID: PMC11051172 DOI: 10.3390/jpm14040417] [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: 03/15/2024] [Revised: 03/28/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
(1) Objective: The main aims of our study were to explore the drug survival and effectiveness of secukinumab in patients with axial spondyloarthritis (axSpA). (2) Methods: We underwent a retrospective analysis of consecutive axSpA treated with secukinumab as a first line of biologics or at switch in a biologic-experienced population. Efficacy data, indicating improvement in inflammation parameters (such as C-reactive protein and erythrocyte sedimentation rate) and disease activity scores (such as Ankylosing Spondylitis Disease Activity Score [ASDAS-CRP], Bath Ankylosing Spondylitis Disease Activity Index [BASDAI]), and patient-reported outcomes (pain), were assessed at 6, 12, 24, 36 and 48 months. The drug survival rate, dropout rate and discontinuation reasons (efficacy versus safety) of secukinumab were assessed in subgroup analysis (axSpA with and without exposure to biologics). (3) Results: In total, 46 patients were exposed to the IL-17A inhibitor secukinumab. The drug survival for axSpA patients 59.7% at 12 months and 31.3% at 24 months. There were no statistically significant differences in the median drug survival between biologic-naïve versus biologic-experienced subgroups. (4) Conclusions: Secukinumab has demonstrated effectiveness and safety in treating a cohort of axSpA patients in real-world settings, with a notable retention rate of the drug.
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Affiliation(s)
- Alexandra-Diana Diaconu
- Department of Internal Medicine, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (A.-D.D.); (C.B.); (B.C.M.); (M.C.); (A.C.); (V.Ș.); (L.Ș.)
- Internal Medicine 2nd Department, ‘‘Sfântul Spiridon’’ Emergency Clinical County Hospital, 700111 Iasi, Romania
| | - Cristina Pomîrleanu
- Department of Rheumatology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (C.P.); (M.R.); (C.A.)
- Rheumatoloy 2nd Department, Clinical Rehabilitation Hospital, 14 Pantelimon Halipa Street, 700661 Iasi, Romania
| | - Mara Russu
- Department of Rheumatology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (C.P.); (M.R.); (C.A.)
- Rheumatoloy 2nd Department, Clinical Rehabilitation Hospital, 14 Pantelimon Halipa Street, 700661 Iasi, Romania
| | - Georgiana Strugariu
- Department of Rheumatology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (C.P.); (M.R.); (C.A.)
- Rheumatoloy 2nd Department, Clinical Rehabilitation Hospital, 14 Pantelimon Halipa Street, 700661 Iasi, Romania
| | - Eugen Ancuța
- Research Department, Elena Doamna Clinical Hospital, 700398 Iasi, Romania;
| | - Irina Ciortescu
- Gastroenterology Department, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
- Institute of Gastroenterology and Hepatology, “Sfântul Spiridon” Emergency Clinical County Hospital, 700111 Iasi, Romania
| | - Cristina Bologa
- Department of Internal Medicine, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (A.-D.D.); (C.B.); (B.C.M.); (M.C.); (A.C.); (V.Ș.); (L.Ș.)
- Internal Medicine 2nd Department, ‘‘Sfântul Spiridon’’ Emergency Clinical County Hospital, 700111 Iasi, Romania
| | - Bianca Codrina Morărașu
- Department of Internal Medicine, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (A.-D.D.); (C.B.); (B.C.M.); (M.C.); (A.C.); (V.Ș.); (L.Ș.)
- Internal Medicine 2nd Department, ‘‘Sfântul Spiridon’’ Emergency Clinical County Hospital, 700111 Iasi, Romania
| | - Mihai Constantin
- Department of Internal Medicine, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (A.-D.D.); (C.B.); (B.C.M.); (M.C.); (A.C.); (V.Ș.); (L.Ș.)
- Internal Medicine 2nd Department, ‘‘Sfântul Spiridon’’ Emergency Clinical County Hospital, 700111 Iasi, Romania
| | - Alexandr Ceasovschih
- Department of Internal Medicine, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (A.-D.D.); (C.B.); (B.C.M.); (M.C.); (A.C.); (V.Ș.); (L.Ș.)
- Internal Medicine 2nd Department, ‘‘Sfântul Spiridon’’ Emergency Clinical County Hospital, 700111 Iasi, Romania
| | - Victorița Șorodoc
- Department of Internal Medicine, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (A.-D.D.); (C.B.); (B.C.M.); (M.C.); (A.C.); (V.Ș.); (L.Ș.)
- Internal Medicine 2nd Department, ‘‘Sfântul Spiridon’’ Emergency Clinical County Hospital, 700111 Iasi, Romania
| | - Laurențiu Șorodoc
- Department of Internal Medicine, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (A.-D.D.); (C.B.); (B.C.M.); (M.C.); (A.C.); (V.Ș.); (L.Ș.)
- Internal Medicine 2nd Department, ‘‘Sfântul Spiridon’’ Emergency Clinical County Hospital, 700111 Iasi, Romania
| | - Codrina Ancuța
- Department of Rheumatology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (C.P.); (M.R.); (C.A.)
- Rheumatoloy 2nd Department, Clinical Rehabilitation Hospital, 14 Pantelimon Halipa Street, 700661 Iasi, Romania
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Weddell J, Din NRA, Harrison SR, Michelena X, McGonagle D, Barr A, Vandevelde C, Freeston J, Marzo-Ortega H. Real-world experience of IL-17Ai drug survival in a large cohort of axial spondyloarthritis and psoriatic arthritis. Rheumatol Adv Pract 2024; 8:rkae018. [PMID: 38435412 PMCID: PMC10907062 DOI: 10.1093/rap/rkae018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/29/2024] [Indexed: 03/05/2024] Open
Abstract
Objective The aim was to assess the use and drug survival of IL-17Ai in a real-world cohort of axial SpA (axSpA) and PsA patients. Methods Patients ever commenced on an IL-17Ai (secukinumab or ixekizumab) for axSpA or PsA at the Leeds Specialist Spondyloarthritis Service were identified. Demographics, IL-17Ai treatment length and reason for cessation were collected. Drug survival data were plotted as a Kaplan-Meier curve, with log rank test of median survival compared between axSpA and PsA. Cox regression analysis was performed to investigate the relationship between diagnosis and length of drug survival. Results In total, 228 patients (91 axSpA and 137 PsA) were exposed to IL-17Ai. Drug survival for all patients at 12 months was 69% (95% Confidence Interval (CI) 63, 75%) and at 24 months 60% (95% CI 54, 67%). In axSpA and PsA, drug survival at 12 months was 63% (CI 54, 74%) and 73% (CI 66, 81%), respectively, and at 24 months it was 53% (CI 44, 65%) and 65% (CI 57, 75%), respectively. Median survival did not differ significantly between both diseases (log rank test 0.65). There was no association between diagnosis and survival (hazard ratio 0.92, 95% CI 0.63, 1.33), including when adjusting for age, previous biologic DMARD usage and sex (hazard ratio 0.89, 95% CI 0.61, 1.13). Conclusion This is the first study, to our knowledge, to analyse and compare real-world IL-17Ai drug survival in patients with axSpA and PsA from a single centre. We demonstrate that there is no difference in IL-17Ai survival rates and no relationship between diagnosis and drug survival. These results contribute to the body of real-world evidence confirming the role of IL-17Ai in the management of axSpA and PsA.
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Affiliation(s)
- Jake Weddell
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- Department of Rheumatology, Leeds Teaching Hospitals NHS Trust, Chapel Allerton Hospital, Leeds, UK
| | - Naw Ra Aung Din
- Department of Rheumatology, Leeds Teaching Hospitals NHS Trust, Chapel Allerton Hospital, Leeds, UK
| | - Stephanie R Harrison
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- Department of Rheumatology, Leeds Teaching Hospitals NHS Trust, Chapel Allerton Hospital, Leeds, UK
| | - Xabier Michelena
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- Rheumatology Unit, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Dennis McGonagle
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- Department of Rheumatology, Leeds Teaching Hospitals NHS Trust, Chapel Allerton Hospital, Leeds, UK
| | - Andrew Barr
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- Department of Rheumatology, Leeds Teaching Hospitals NHS Trust, Chapel Allerton Hospital, Leeds, UK
| | - Claire Vandevelde
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- Department of Rheumatology, Leeds Teaching Hospitals NHS Trust, Chapel Allerton Hospital, Leeds, UK
| | - Jane Freeston
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- Department of Rheumatology, Leeds Teaching Hospitals NHS Trust, Chapel Allerton Hospital, Leeds, UK
| | - Helena Marzo-Ortega
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- Department of Rheumatology, Leeds Teaching Hospitals NHS Trust, Chapel Allerton Hospital, Leeds, UK
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Larid G, Baudens G, Tiemdjo-Djimaffo G, Coquerelle P, Goeb V, Guyot MH, Marguerie L, Maury F, Veillard E, Houvenagel E, Salmon JH, Flipo RM, Gervais E. Retention rate of subcutaneous TNF inhibitors in axial spondyloarthritis in a multicentre study from the RIC-FRANCE network. Sci Rep 2024; 14:1374. [PMID: 38228719 PMCID: PMC10791989 DOI: 10.1038/s41598-024-52016-4] [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: 07/08/2022] [Accepted: 01/12/2024] [Indexed: 01/18/2024] Open
Abstract
The objectives of our study were to assess retention rate, safety, and predictive factors for retention of subcutaneous (SC) TNF inhibitors (TNFi) (adalimumab (ADA), etanercept (ETN), golimumab (GOL), and certolizumab pegol (CZP)) in axial spondyloarthritis (axSpA) depending on the line of treatment in real-life conditions. A multicentre retrospective observational study was conducted including 552 patients fulfilling the ASAS criteria for axSpA followed in the RIC-France register who began SC-TNFi between 01/01/13 and 08/31/2018 for a total of 824 prescriptions. Taking all lines of treatment into account, GOL had a significantly higher retention rate compared with ADA, ETN, and CZP with a mean retention length of 59 months. As first-line bDMARDs, GOL had a significantly higher retention rate compared with ADA and ETN. ETN had the best retention rate when prescribed as at least 3rd bDMARD. Taking all lines of treatment into account, female sex, peripheral disease, BASDAI at initiation, and line of treatment were predictive factors for treatment cessation. Primary inefficiency was the most frequent reason for treatment cessation. In conclusion, GOL showed the highest retention rate in axSpA. Male sex, absence of peripheral disease, and early line of prescription were associated with better SC-TNFi retention in axSpA.
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Affiliation(s)
- Guillaume Larid
- LITEC, Université de Poitiers, CHU Poitiers, 86000, Poitiers, France.
| | | | | | | | - Vincent Goeb
- University Hospital of Amiens-Picardie, Amiens, France
| | | | | | | | | | | | | | | | - Elisabeth Gervais
- LITEC, Université de Poitiers, CHU Poitiers, 86000, Poitiers, France
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Kwon OC, Park MC. Drug Retention Rate and Factors Associated with Discontinuation of Interleukin-17 Inhibitors in Patients with Axial Spondyloarthritis. Yonsei Med J 2023; 64:697-704. [PMID: 37992741 PMCID: PMC10681822 DOI: 10.3349/ymj.2023.0151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/17/2023] [Accepted: 08/21/2023] [Indexed: 11/24/2023] Open
Abstract
PURPOSE To assess the drug retention rate of interleukin-17 inhibitors (IL-17is) over long-term observation in patients with axial spondyloarthritis (axSpA) in whom treatment with tumor necrosis factor inhibitors (TNFis) failed and to determine baseline factors associated with discontinuation of IL-17is. MATERIALS AND METHODS This retrospective cohort study included 68 patients with axSpA started on IL-17is after an inadequate response or intolerance to ≥1 TNFis. Drug retention rates at 1, 2, and 3 years were assessed. Baseline (i.e., at initiation of IL-17is) factors associated with discontinuation of IL-17is were evaluated using multivariable Cox proportional hazard regression analysis. RESULTS Over 1933.9 person-months of observation in 68 patients, discontinuation of IL-17is occurred in 27 (39.7%) patients. Twenty (29.4%) patients discontinued IL-17is because of ineffectiveness, and 7 (10.3%) patients discontinued IL-17is because of adverse events. The 1-year, 2-year, and 3-year drug retention rates for IL-17is were 71.9%, 66.5%, and 62.0%, respectively. Current smoking was associated with a higher risk of IL-17is discontinuation [adjusted hazard ratio (HR)=2.256, 95% confidence interval (CI)=1.053-4.831, p=0.036], while previous use of ≥3 TNFis (vs. 1) was significantly associated with a lower risk of IL-17is discontinuation (adjusted HR=0.223, 95% CI=0.051-0.969, p=0.045). CONCLUSION In patients with axSpA in whom TNFis failed, the long-term drug retention rate of IL-17is appears to be acceptable, with a 3-year drug retention rate of approximately 60%. Current smoking was associated with a higher risk of discontinuing IL-17is, whereas previous use of ≥3 TNFis was associated with a lower risk of discontinuing IL-17is.
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Affiliation(s)
- Oh Chan Kwon
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Min-Chan Park
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
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Alegre-Sancho JJ, Núñez-Monje V, Campos-Fernández C, Balaguer-Trull I, Robustillo-Villarino M, Aguilar-Zamora M, Garijo-Bufort M, Pedraz-Penalva T, Peña-González C, de la Morena I, Bedoya-Sanchís D, Yankova-Komsalova L, Conesa-Mateos A, Martinez-Cristóbal A, Navarro-Blasco FJ, Senabre-Gallego JM, Sivera F. Real-world effectiveness and persistence of secukinumab in the treatment of patients with psoriatic arthritis. Front Med (Lausanne) 2023; 10:1294247. [PMID: 38053615 PMCID: PMC10694458 DOI: 10.3389/fmed.2023.1294247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/03/2023] [Indexed: 12/07/2023] Open
Abstract
Introduction Psoriatic arthritis (PsA) is a complex and heterogeneous inflammatory disease. Secukinumab, a biologic disease-modifying antirheumatic drug (bDMARD), has extensive clinical evidence of efficacy and safety in the treatment of PsA but data in clinical practice are still limited. This study aims to provide real-world evidence on secukinumab use, effectiveness, and persistence in PsA. Methods A retrospective, multicenter study was conducted on patients diagnosed with PsA and treated with secukinumab up to June 2021 at 12 centers in the Valencian Community (Spain). Data on DAS28-CRP, DAPSA, Tender and Swollen Joint Counts (TJC, SJC), enthesitis, dactylitis, skin and nail involvement, pain, patient and physician global assessment (ptGA, phGA) using 100-mm visual analog scale (VAS), and persistence for up to 24 months were collected. Results A total of 178 patients were included (49% men; mean [standard deviation, SD] age: 51.4 [10.5] years; 39% obese). Secukinumab was used as a first-, second-, or ≥ third-line bDMARD in 37, 21, and 42% of patients, respectively. The percentage of patients achieving at least low disease activity (DAS28-CRP ≤ 3.2) increased from 25% at baseline to 66% at month 6 (M6) and was maintained (75%) up to M24. Mean (SD) DAS28-CRP baseline values (3.9 [1.2]) decreased to 2.9 (1.1) (p < 0.001) at M6 and remained low through M24 (2.6 [1.1]) (p < 0.001). Secukinumab also improved peripheral arthritis increasing the percentage of patients with TJC = 0 (20% baseline; 57% M24) and SJC = 0 (37% baseline; 80% M24). Treatment reduced the percentage of patients with enthesitis (25% baseline; 6% M24), dactylitis (20% baseline; 4% M24), and skin (70% baseline; 17% M24), and nail (32% baseline; 2% M24) involvement. Additionally, we observed improvements in the mean pain VAS (-26.4 mm M24), ptGA (-26.2 mm M24), and phGA (-24.8 mm M24). Secukinumab showed an overall 24-month persistence rate of 67% (95% confidence interval [CI]: 60-74%). Patients receiving first-line secukinumab showed the highest 24-month persistence rate (83, 95% CI: 73-92; p = 0.024). Conclusion Secukinumab showed long-term effectiveness across the six key PsA domains thus reducing disease activity and pain, which are major treatment goals. This was accompanied by high persistence rates, especially in bDMARD naive patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Isabel de la Morena
- Rheumatology Department, Hospital Clínico Universitario De Valencia, Valencia, Spain
| | - Diego Bedoya-Sanchís
- Rheumatology Department, Hospital Clínico Universitario De Valencia, Valencia, Spain
| | | | - Arantxa Conesa-Mateos
- Rheumatology Department, Hospital General Universitario de Castellón, Castellón de la Plana, Spain
| | | | | | | | - Francisca Sivera
- Rheumatology Department, Hospital General Universitario de Elda, Elda, Spain
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García-Vicuña R, Juanola X, Navarro-Compán V, Moreno-Ramos MJ, Castillo-Gallego C, Moreno M, Galíndez E, Montoro M, Gómez I, Rebollo-Laserna FJ, Loza E. Management of Specific Clinical Profiles in Axial Spondyloarthritis: An Expert's Document Based on a Systematic Literature Review and Extended Delphi Process. Rheumatol Ther 2023; 10:1215-1240. [PMID: 37450194 PMCID: PMC10468481 DOI: 10.1007/s40744-023-00575-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 06/14/2023] [Indexed: 07/18/2023] Open
Abstract
INTRODUCTION The management of specific clinical scenarios is not adequately addressed in national and international guidelines for axial spondyloarthritis (axSpA). Expert opinions could serve as a valuable complement to these documents. METHODS Seven expert rheumatologists identified controversial areas or gaps of current recommendations for the management of patients with axSpA. A systematic literature review (SLR) was performed to analyze the efficacy and safety of non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, conventional synthetic, biologic and targeted synthetic disease-modifying antirheumatic drugs (csDMARDs, b/tsDMARDs) in axSpA regarding controversial areas or gaps. In a nominal group meeting, the results of the SLR were discussed and a set of statements were proposed. A Delphi process inviting 150 rheumatologists was followed to define the final statements. Agreement was defined as if at least 70% of the participants voted ≥ 7 (from 1, totally disagree, to 10, totally agree). RESULTS Three overarching principles and 17 recommendations were generated. All reached agreement. According to them, axSpA care should be holistic and individualized, taking into account objective findings, comorbidities, and patients' opinions and preferences. Integrating imaging and clinical assessment with biomarker analysis could also help in decision-making. Connected to treatments, in refractory enthesitis, b/tsDMARDs are recommended. If active peripheral arthritis, csDMARD might be considered before b/tsDMARDs. The presence of significant structural damage, long disease duration, or HLA-B27-negative status do not contraindicate for the use of b/tsDMARDs. CONCLUSIONS These recommendations are intended to complement guidelines by helping health professionals address and manage specific groups of patients, particular clinical scenarios, and gaps in axSpA.
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Affiliation(s)
- Rosario García-Vicuña
- Servicio de Reumatología, Hospital Universitario La Princesa, IIS-Princesa, Madrid, Spain
| | - Xavier Juanola
- Servicio de Reumatología, Hospital Universitario de Bellvitge, Universidad de Barcelona, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | | | - Manuel José Moreno-Ramos
- Servicio de Reumatología, Hospital Clínico Universitario Virgen de La Arrixaca, El Palmar, Murcia, Spain
| | | | - Mireia Moreno
- Servicio de Reumatología, Universitari Parc Taulí Hospital, Institut d’Investigació i Innovació Parc Taulí (I3PT), Sabadell, Spain
| | - Eva Galíndez
- Servicio de Reumatología, Hospital Universitario de Basurto, Bilbao, Spain
| | - María Montoro
- Pfizer Medical Department, Alcobendas, Madrid, Spain
| | - Ismael Gómez
- Pfizer Medical Department, Alcobendas, Madrid, Spain
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Queiro R, Aurrecoechea E, Alonso Castro S, Villa Blanco I, Brandy-Garcia A, Linge R. Interleukin-17-targeted treatment in patients with spondyloarthritis and associated cardiometabolic risk profile. Front Immunol 2023; 14:1203372. [PMID: 37533855 PMCID: PMC10391638 DOI: 10.3389/fimmu.2023.1203372] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/29/2023] [Indexed: 08/04/2023] Open
Abstract
Spondyloarthritis is a group of immune-mediated rheumatic disorders that significantly impact patients' physical function and quality of life. Patients with spondyloarthritis experience a greater prevalence of cardiometabolic disorders, such as obesity, hypertension, dyslipidemia and diabetes mellitus, and these comorbidities are associated with increased spondyloarthritis disease activity and risk of cardiovascular events. This narrative review summarizes the evidence for a physiological link between inflammatory status and cardiometabolic comorbidities in spondyloarthritis, as well as the impact of interleukin (IL)-17 blockade versus other molecular mechanisms in patients with cardiometabolic conditions. The IL-23/IL-17 axis plays a pivotal role in the pathophysiology of spondyloarthritis by promoting inflammation and tissue remodeling at the affected joints and entheses. The importance of the IL-23/IL-17 signaling cascade in underlying sub-clinical inflammation in common cardiometabolic disorders suggests the existence of shared pathways between these processes and spondyloarthritis pathophysiology. Thus, a bidirectional relationship exists between the effects of biologic drugs and patients' cardiometabolic profile, which must be considered during treatment decision making. Biologic therapy may induce changes in patients' cardiometabolic status and cardiometabolic conditions may conversely impact the clinical response to biologic therapy. Available evidence regarding the impact of IL-17 blockade with secukinumab on cardiometabolic parameters suggests this drug does not interfere with traditional cardiovascular risk markers and could be associated with a decreased risk of cardiovascular events. Additionally, the efficacy and retention rates of secukinumab do not appear to be negatively affected by obesity, with some studies reporting a positive impact on clinical outcomes, contrary to that described with other approaches, such as tumor necrosis factor blockade. In this article, we also review evidence for this bidirectional association with other treatments for spondyloarthritis. Current evidence suggests that IL-17-targeted therapy with secukinumab is highly effective in spondyloarthritis patients with cardiometabolic comorbidities and may provide additional cardiometabolic benefits.
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Affiliation(s)
- Rubén Queiro
- Rheumatology and Health Research Institute of the Principality of Asturias (ISPA) Translational Immunology Division, Hospital Universitario Central de Asturias, Oviedo, Spain
- Oviedo University School of Medicine, Oviedo, Spain
| | - Elena Aurrecoechea
- Rheumatology Division, Hospital de Sierrallana, Torrelavega, Spain
- Fundación Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - Sara Alonso Castro
- Rheumatology Division, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Ignacio Villa Blanco
- Rheumatology Division, Hospital de Sierrallana, Torrelavega, Spain
- Fundación Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain
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Ferrito M, Cincinelli G, Manara M, Di Taranto R, Favalli EG, Caporali R. Retention rate of tumor necrosis factor inhibitors, anti-interleukin 17, and anti-interleukin 12/23 drugs in a single-center cohort of psoriatic arthritis patients. Reumatismo 2023; 75. [PMID: 37462129 DOI: 10.4081/reumatismo.2023.1544] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 04/19/2023] [Indexed: 07/20/2023] Open
Abstract
The objective of this study was to evaluate biological disease-modifying anti-rheumatic drugs (bDMARDs) survival in several therapy courses of patients affected by psoriatic arthritis (PsA) and to compare tumor necrosis factor inhibitors (TNFi) and non-TNFi retention rates. A total of 241 bDMARD therapy courses (155 TNFi drugs, 65 anti-interleukin (IL)-17 drugs, and 21 anti-IL12/23) were analyzed. Bivariate analyses were performed to assess the presence of demographic and clinical features, as well as comorbidities, associated with bDMARD discontinuation in TNFi and non-TNFi groups. In the bivariate analyses of TNFi and non-TNFi groups, we found a lower age at the start of TNFi therapy in the former group [46 years, interquartile range (IQR) 45-54 vs 50.5 years, IQR 42-61; p=0.004] as well as a lower proportion of patients with skin psoriasis (65.8% vs 88.4%; p<0.001). Survival analysis showed no significant differences between TNFi and non-TNFi groups. Cox regression found fibromyalgia as a predictor of drug failure [hazard ratio (HR) 3.40, confidence interval (CI) 1.92-6.03; p<0.001] and first-line bDMARDs as a protective factor (HR 0.46, CI 0.25-0.88; p=0.019). Lastly, among TNFi courses, fibromyalgia was associated with drug suspension (HR 6.52, CI 3.16-13.46; p<0.001), while only a trend of significance for skin psoriasis as a risk factor for drug failure was shown (HR 2.38, CI 1.00-5.66, p=0.05). This study provides information about clinical and demographic factors associated with retention rates of bDMARDs from a real-life, single-center cohort of PsA patients.
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Affiliation(s)
- M Ferrito
- Department of Clinical Sciences and Community Health, University of Milan; Clinical Rheumatology Unit, ASST Gaetano Pini-CTO, Milan .
| | - G Cincinelli
- Department of Clinical Sciences and Community Health, University of Milan; Clinical Rheumatology Unit, ASST Gaetano Pini-CTO, Milan .
| | - M Manara
- Department of Clinical Sciences and Community Health, University of Milan; Clinical Rheumatology Unit, ASST Gaetano Pini-CTO, Milan .
| | - R Di Taranto
- Department of Clinical Sciences and Community Health, University of Milan; Clinical Rheumatology Unit, ASST Gaetano Pini-CTO, Milan .
| | - E G Favalli
- Department of Clinical Sciences and Community Health, University of Milan; Clinical Rheumatology Unit, ASST Gaetano Pini-CTO, Milan .
| | - R Caporali
- Department of Clinical Sciences and Community Health, University of Milan; Clinical Rheumatology Unit, ASST Gaetano Pini-CTO, Milan .
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9
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Sivera F, Núñez-Monje V, Campos-Fernández C, Balaguer-Trull I, Robustillo-Villarino M, Aguilar-Zamora M, Garijo-Bufort M, López-Gómez JM, Peña-González C, de la Morena I, Bedoya-Sanchís D, Yankova-Komsalova L, Conesa-Mateos A, Martínez-Cristóbal A, Navarro-Blasco FJ, Senabre-Gallego JM, Alegre-Sancho JJ. Real-world experience with secukinumab in the entire axial spondyloarthritis spectrum. Front Med (Lausanne) 2023; 10:1156557. [PMID: 37250652 PMCID: PMC10213893 DOI: 10.3389/fmed.2023.1156557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/18/2023] [Indexed: 05/31/2023] Open
Abstract
Background Secukinumab is a biologic disease-modifying antirheumatic drug (bDMARD) that has demonstrated efficacy in the treatment of axial spondyloarthritis (axSpA, i.e., ankylosing spondylitis and non-radiographic axSpA) across various clinical trials. However, data of secukinumab in clinical practice is still limited. Here, we aimed to provide real-world data on secukinumab use, effectiveness, and persistence in axSpA. Patients and methods Retrospective, multicenter study of patients with a diagnosis of axSpA treated with secukinumab at 12 centers up to June 2021 in the Valencian Community (Spain). Information was gathered on BASDAI measurement, pain, patient and physician global assessment (ptGA, phGA) using a 100-mm visual analog scale (VAS), persistence and other secondary variables by treatment line (first, second, and ≥ third) for up to 24 months. Results 221 patients were included (69% men; mean age [standard deviation, SD]: 46.7 [12.1] years old). Secukinumab was used as a first-line bDMARD in 38% of patients, as a second-line in 34% and as a ≥ hird-line in 28%. The percentage of patients achieving low disease activity (BASDAI<4) increased from 9% at baseline to 48% at month 6 and was maintained (49%) up to month 24. The greatest improvement in BASDAI was observed in naïve patients (month 6: -2.6; month 24: -3.7), followed by second-line (month 6: -1.9; month 24: -3.1) and ≥ third-line (month 6: -1.3; month 24: -2.3) patients. Reductions in mean pain VAS (-23.3; -31.9), ptGA (-25.1; -31.9) and phGA (-25.1; -31) were also observed at 6 and 24 months. Secukinumab showed an overall 12-months persistence rate of 70% (95% confidence interval [CI]: 63-77%) and a 24-months persistence rate of 58% (95% CI, 51-66%). Patients receiving first-line secukinumab had the highest 24-months persistence rate (p = 0.05). Conclusion Secukinumab improved disease activity in axSpA patients, especially in naive, and second-line patients, which was accompanied by high persistence rates up to 24 months.
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Affiliation(s)
- Francisca Sivera
- Rheumatology Department, Hospital General Universitario de Elda, Alicante, Spain
- Departament of Clinical Medicine, Universidad Miguel Hernandez, Elche, Spain
| | | | | | | | | | | | | | | | | | - Isabel de la Morena
- Rheumatology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Diego Bedoya-Sanchís
- Rheumatology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | | | - Arantxa Conesa-Mateos
- Rheumatology Department, Hospital General Universitari de Castelló, Castellón, Spain
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10
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Adami G, Idolazzi L, Benini C, Fracassi E, Carletto A, Viapiana O, Gatti D, Rossini M, Fassio A. Secukinumab retention rate is greater in patients with psoriatic arthritis presenting with axial involvement. Reumatismo 2023; 75. [PMID: 37154254 DOI: 10.4081/reumatismo.2023.1559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 04/14/2023] [Indexed: 05/10/2023] Open
Abstract
Psoriatic arthritis (PsA) is an inflammatory disease characterized by peripheral and axial involvement. Biological disease-modifying antirheumatic drugs (bDMARDs) are the mainstream treatment for PsA and bDMARDs retention rate is a proxy for the drug's overall effectiveness. However, it is unclear whether IL-17 inhibitors can have a higher retention rate than tumor necrosis factor (TNF) inhibitors, in particular in axial or peripheral PsA. A real-life observational study was conducted on bDMARD naïve PsA patients initiating TNF inhibitors or secukinumab. Time-to-switch analysis was carried out with Kaplan-Meyer curves (log-rank test) truncated at 3 years (1095 days). Sub-analyses of Kaplan-Meyer curves between patients presenting with prevalent peripheral PsA or prevalent axial PsA were also conducted. Cox regression models were employed to describe predictors of treatment switch/swap. Data on 269 patients with PsA naïve to bDMARD starting either TNF inhibitors (n=220) or secukinumab (n=48) were retrieved. The overall treatment retention at 1 and 2 years was similar for secukinumab and TNF inhibitors (log-rank test p NS). We found a trend towards significance in the Kaplan-Meyer at 3 years in favor of secukinumab (log-rank test p 0.081). Predominant axial disease was significantly associated with a higher chance of drug survival in secukinumab users (adjusted hazard ratio 0.15, 95% confidence interval = 0.04-0.54) but not in TNF inhibitor users. In this real-life, single-center, study on bDMARD naïve PsA patients, axial involvement was associated with longer survival of secukinumab but not of TNF inhibitors. Drug retention of secukinumab and TNF inhibitors were similar in predominantly peripheral PsA.
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Affiliation(s)
- G Adami
- Rheumatology Unit, University of Verona.
| | - L Idolazzi
- Rheumatology Unit, University of Verona.
| | - C Benini
- Rheumatology Unit, University of Verona.
| | - E Fracassi
- Rheumatology Unit, University of Verona.
| | - A Carletto
- Rheumatology Unit, University of Verona.
| | - O Viapiana
- Rheumatology Unit, University of Verona.
| | - D Gatti
- Rheumatology Unit, University of Verona.
| | - M Rossini
- Rheumatology Unit, University of Verona.
| | - A Fassio
- Rheumatology Unit, University of Verona.
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11
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Gialouri CG, Pappa M, Evangelatos G, Nikiphorou E, Fragoulis GE. Effect of body mass index on treatment response of biologic-/targeted synthetic-DMARDs in patients with rheumatoid arthritis, psoriatic arthritis and axial spondyloarthritis. A systematic review. Autoimmun Rev 2023; 22:103357. [PMID: 37150489 DOI: 10.1016/j.autrev.2023.103357] [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: 04/26/2023] [Accepted: 05/04/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND Overweight and/or obese patients with inflammatory arthritis (IA) have higher disease activity and lower chances of achieving and/or maintaining the treatment targets. Weight/obesity also appears to negatively affect the response to tumor necrosis factor (TNF) inhibitors in patients with IA, including rheumatoid arthritis -RA, psoriatic arthritis -PsA, axial spondyloarthritis -AxSpA. We conducted a systematic literature review (SLR) for the effect of weight/body-mass-index (BMI) in the efficacy of all approved b- and targeted-synthetic (ts)- DMARDs for the treatment of IA. METHODS For this PROSPERO-registered SLR, we searched PubMed, Scopus and Cohrane-Library from inception up to June 21st 2022. Clinical-trials (randomized and non-randomized) and observational studies of RA, PsA or AxSpA patients that reported the effect of weight/BMI on response (all possible outcomes) to b/ts-DMARDs were included. Risk-of-bias was assessed via RoB2-Cochrane-tool and Newcastle-Ottawa-scale for randomized and non-randomized studies, respectively. FINDINGS Out of 996 references, 75 eventually fulfilled the inclusion criteria (of which 10 studies were retrieved through manual-search). Among the included studies (TNF-inhibitors: 34, IL-12/23 inhibitors: 4, IL-23 inhibitor: 1, IL-17 inhibitors: 7, tocilizumab: 18, abatacept: 8, rituximab: 3, JAK-inhibitors: 5), most had medium RoB. Efficacy of TNF-inhibitors was affected by BMI in all forms of IA. Data are not robust to compare the effect among various TNF-inhibitors. In contrast, favorable results of IL-23 and IL-17 inhibitors did not appear to be influenced by increased BMI in PsA or AxSpA patients. Similar evidence exists for tocilizumab (in RA) and for abatacept (in RA and PsA), while no conclusion can be drawn for rituximab. More data are needed for JAK-inhibitors, although the effect of weight/BMI does not seem to be significant so far. INTERPRETATION Weight/BMI should be considered in the treatment-plan of patients with IA, with its effect being more pronounced for TNF-inhibitors compared to other b/ts-DMARDs.
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Affiliation(s)
- Chrysoula G Gialouri
- Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Greece; Clinical Immunology-Rheumatology Unit, 2nd Department of Medicine and Laboratory, Medical School, National and Kapodistrian University of Athens, "Hippocration" General Hospital, Athens, Greece
| | - Maria Pappa
- Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Greece; Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, "Laiko" General Hospital, Athens, Greece
| | - Gerasimos Evangelatos
- Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Greece; Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, "Laiko" General Hospital, Athens, Greece
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases, King's College London, London, UK; Rheumatology Department, King's College Hospital, London, UK
| | - George E Fragoulis
- Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Greece; Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, "Laiko" General Hospital, Athens, Greece.; Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK..
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12
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Dougados M, Lucas J, Desfleurs E, Claudepierre P, Goupille P, Ruyssen-Witrand A, Saraux A, Tournadre A, Wendling D, Lukas C. Factors associated with the retention of secukinumab in patients with axial spondyloarthritis in real-world practice: results from a retrospective study (FORSYA). RMD Open 2023; 9:rmdopen-2022-002802. [PMID: 36921980 PMCID: PMC10030893 DOI: 10.1136/rmdopen-2022-002802] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 02/12/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND Secukinumab efficacy and retention data are emerging in patients with axial spondyloarthritis (axSpA) in real-world settings. However, limited data are available on the predictive factors that affect the retention rate. The key objective was to determine whether objective signs of inflammation (OSI) were predictive of secukinumab retention at 1 year. METHODS FORSYA is a French, multicentric, non-interventional, retrospective study in adult axSpA patients who received secukinumab treatment between its launch (11 August 2016) and 31 August 2018. The time to secukinumab discontinuation and retention were analysed using a Kaplan-Meier (KM) analysis. OSI was predefined by at least one of the criteria: C reactive protein ≥5 mg/L or erythrocyte sedimentation rate ≥28 mm/hour at secukinumab initiation or MRI inflammation at the sacroiliac or spine level. RESULTS In total, 906 patients from 48 centres were included in the analysis, 42.2% of whom were men, with a mean age of 46.2±11.7 years and a mean disease duration of 9.3±9.1 years. The 1-year KM retention rate (95% CI) for secukinumab was 59% (55%-62%), whereas for patients with and without OSI, it was 58% (54%-62%) and 63% (53%-73%), respectively. In multivariate analysis, lack of prior exposure to tumour necrosis factor inhibitor (TNFi), absence of OSI and inflammatory bowel disease (IBD) were associated with a better retention of secukinumab at 1 year. CONCLUSION Following its approval in France, ~59% of axSpA patients retained secukinumab in daily practice, at 1 year. Prior exposure to TNFi, OSI and IBD were identified as risk factors for secukinumab discontinuation.
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Affiliation(s)
- Maxime Dougados
- Rheumatology, University of Paris, Hopital Cochin, Paris, France
| | | | | | | | | | - Adeline Ruyssen-Witrand
- Centre d'Investigation Clinique de Toulouse CIC1436, Inserm, University of Toulouse 3, Rheumatology Center, Toulouse University Hospital, Toulouse, France
| | - Alain Saraux
- Rheumatology, Université de Bretagne Occidentale, Brest, France
| | - Anne Tournadre
- Rheumatology, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Daniel Wendling
- Rheumatology, CHRU de Besançon, Besançon, France
- Rheumatology, Université de Franche-Comté, Besancon, France
| | - Cédric Lukas
- Rheumatology, University of Montpellier, Montpellier, France
- University Hospital Centre Montpellier, Montpellier, France
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13
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Glintborg B, Di Giuseppe D, Wallman JK, Provan SA, Nordström D, Hokkanen AM, Österlund J, Kristianslund E, Kvien TK, Gudbjornsson B, Hetland ML, Michelsen B, Jacobsson L, Askling J, Lindström U. Is the risk of infection higher during treatment with secukinumab than with TNF inhibitors? An observational study from the Nordic countries. Rheumatology (Oxford) 2023; 62:647-658. [PMID: 35723604 PMCID: PMC9891432 DOI: 10.1093/rheumatology/keac358] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/13/2022] [Accepted: 06/13/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES The positioning of secukinumab in the treatment of axial SpA (axSpA) and PsA is debated, partly due to a limited understanding of the comparative safety of the available treatments. We aimed to assess the risk of the key safety outcome infections during treatment with secukinumab and TNF inhibitors (TNFi). METHODS Patients with SpA and PsA starting secukinumab or TNFi year 2015 through 2018 were identified in four Nordic rheumatology registers. The first hospitalized infection during the first year of treatment was identified through linkage to national registers. Incidence rates (IRs) with 95% CIs per 100 patient-years were calculated. Adjusted hazard ratios were estimated through Cox regression, with secukinumab as the reference. Several sensitivity analyses were performed to investigate confounding by indication. RESULTS Among 7708 patients with SpA and 5760 patients with PsA, we identified 16 229 treatment courses of TNFi (53% bionaïve) and 1948 with secukinumab (11% bionaïve). For secukinumab, the first-year risk of hospitalized infection was 3.5% (IR 5.0; 3.9-6.3), compared with 1.7% (IR 2.3; 1.7-3.0) during 3201 courses with adalimumab, with the IRs for other TNFi lying in between these values. The adjusted HR for adalimumab, compared with secukinumab, was 0.58 (0.39-0.85). In sensitivity analyses, the difference from secukinumab was somewhat attenuated and in some analyses no longer statistically significant. CONCLUSION When used according to clinical practice in the Nordic countries, the observed first-year absolute risk of hospitalized infection was doubled for secukinumab compared with adalimumab. This excess risk seemed largely explained by confounding by indication.
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Affiliation(s)
| | | | - Johan K Wallman
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Skane University Hospital, Lund, Sweden
| | - Sella A Provan
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Dan Nordström
- Department of Medicine and Rheumatology, Helsinki University and Helsinki University Hospital, Helsinki
| | | | - Jenny Österlund
- Division of Medicine, Helsinki University, Helsinki, Finland
| | | | - Tore K Kvien
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Bjorn Gudbjornsson
- Centre for Rheumatology Research, Landspitali University Hospital and Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Merete Lund Hetland
- DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Copenhagen University Hospital, Rigshospitalet, Glostrup
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Brigitte Michelsen
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
- Division of Rheumatology, Department of Medicine, Hospital of Southern Norway Trust, Kristiansand, Norway
| | - Lennart Jacobsson
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Johan Askling
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm
| | - Ulf Lindström
- Correspondence to: Ulf Lindström, Department of Rheumatology and Inflammation Research, University of Gothenburg, Box 115, Gothenburg, Sweden. E-mail:
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14
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Alonso-Castro S, García-Valle A, Morante-Bolado I, Braña I, Pardo E, Queiro R. Differentiated Effect of Smoking on Disease Activity and Quality of Life among Different Spondyloarthritis Phenotypes. J Clin Med 2023; 12:jcm12020551. [PMID: 36675480 PMCID: PMC9865976 DOI: 10.3390/jcm12020551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 12/30/2022] [Accepted: 01/06/2023] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND AND AIMS The effect of smoking on disease activity and quality of life (QoL) in spondyloarthritis (SpA) is far from clear. We aimed to evaluate the relationship between smoking and these outcomes in patients with axial SpA (axSpA) and psoriatic arthritis (PsA). PATIENTS AND METHODS This cross-sectional observational multicenter study included 242 patients with axSpA and 90 with PsA. The association between conventional cardiovascular risk factors and disease activity as well as QoL, in both SpA phenotypes was evaluated. For this, univariate and multivariate regression analyses were performed, as well as confirmatory meta-analyses. RESULTS Regardless of age, sex, or disease duration, patients with axSpA showed significantly less association with obesity (OR 0.50 (0.26-0.96), p = 0.03) and hypertension (OR 0.33 (0.18-0.62), p = 0.0005). However, axSpA was significantly associated with smoking (OR 2.62 (1.36-5.04), p = 0.004). Patients with axSpA were more likely to be in a category of high disease activity compared with PsA (OR 2.86, p = 0.0006). Regardless of sex, age, disease duration, and education level, smoking was significantly associated with higher disease activity in axSpA (OR 1.88, p = 0.027). A fixed-effects model meta-analysis (OR 1.70, p = 0.038) confirmed the association between tobacco and disease activity. No relationship was found between smoking (or other cardiometabolic risk factors) and structural damage or worse QoL in either disease. CONCLUSIONS Although the cardiometabolic risk profile is clearly different between both SpA phenotypes, the only clear link between these factors and increased disease activity was observed between smoking and axSpA. Our findings need further confirmation.
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Affiliation(s)
- Sara Alonso-Castro
- Rheumatology Division, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | - Andrea García-Valle
- Rheumatology Division, Complejo Hospitalario de Palencia, 34004 Palencia, Spain
| | | | - Ignacio Braña
- Rheumatology Division, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | - Estefanía Pardo
- Rheumatology Division, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | - Rubén Queiro
- Rheumatology Division, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
- ISPA Translational Immunology Division, 33011 Oviedo, Spain
- School of Medicine, Oviedo University, 33011 Oviedo, Spain
- Correspondence: ; Tel.: +34-985-108000
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15
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Braña I, Pardo E, Burger S, González del Pozo P, Alperi M, Queiro R. Treatment Retention and Safety of Ixekizumab in Psoriatic Arthritis: A Real Life Single-Center Experience. J Clin Med 2023; 12:jcm12020467. [PMID: 36675395 PMCID: PMC9861177 DOI: 10.3390/jcm12020467] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 12/28/2022] [Accepted: 01/04/2023] [Indexed: 01/09/2023] Open
Abstract
Background and objectives: Information on the performance of ixekizumab (IXE) in patients with psoriatic arthritis (PsA) in clinical practice is scarce. We aimed to analyze the retention rate and safety of IXE in patients with PsA in routine clinical practice. Methods: A retrospective longitudinal observational single-center study of all patients with PsA who had received at least one dose of IXE. Adverse events (AEs) and drug retention rate were the main study focus. Survival was analyzed using Kaplan−Meier curves and predictive factors using multivariate Cox regression analysis. The hazard ratio (HR) was used as a measure of the association. Results: Seventy-two patients were included (52 women and 20 men). Median disease duration was 5 years (IQR 3−9). More than 90% received ≥2 biologic and/or targeted synthetic disease-modifying anti-rheumatic drugs (DMARDs) prior to IXE. Ixekizumab showed a 1-year retention rate of 65% and a 2-year retention rate of 57%. Regarding discontinuation due to AEs, 0.18 AEs per person-year were identified. The number of previous biologics did not influence drug survival but prior use of methotrexate (HR 2.31 (95% CI 1.05−5.10), p < 0.05) and depression (HR 2.40 (95% CI 1.07−5.41), p < 0.05) increased the risk of IXE discontinuation. Conclusions: Ixekizumab showed a good retention rate in a PsA population mostly refractory to biologic and targeted synthetic DMARDs. Drug survival was consistently good regardless of age, gender, metabolic comorbidities, smoking status, or prior number of biologic therapies. This information may be of interest to better position this drug in the PsA treatment algorithms.
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Affiliation(s)
- Ignacio Braña
- Rheumatology Division, Hospital Universitario Central de Asturias (HUCA), 33011 Oviedo, Spain
| | - Estefanía Pardo
- Rheumatology Division, Hospital Universitario Central de Asturias (HUCA), 33011 Oviedo, Spain
| | - Stefanie Burger
- Rheumatology Division, Hospital Universitario Central de Asturias (HUCA), 33011 Oviedo, Spain
| | - Pablo González del Pozo
- Rheumatology Division, Hospital Universitario Central de Asturias (HUCA), 33011 Oviedo, Spain
| | - Mercedes Alperi
- Rheumatology Division, Hospital Universitario Central de Asturias (HUCA), 33011 Oviedo, Spain
| | - Rubén Queiro
- Rheumatology Division, Hospital Universitario Central de Asturias (HUCA), 33011 Oviedo, Spain
- ISPA Translational Immunology Division & Oviedo University School of Medicine, 33011 Oviedo, Spain
- Correspondence: ; Tel.: +34-985-108000
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16
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Fernández-Carballido C, Sanchez-Piedra C, Valls R, Garg K, Sánchez-Alonso F, Artigas L, Mas JM, Jovaní V, Manrique S, Campos C, Freire M, Martínez-González O, Castrejón I, Perella C, Coma M, van der Horst-Bruinsma IE. Female Sex, Age, and Unfavorable Response to Tumor Necrosis Factor Inhibitors in Patients With Axial Spondyloarthritis: Results of Statistical and Artificial Intelligence-Based Data Analyses of a National Multicenter Prospective Registry. Arthritis Care Res (Hoboken) 2023; 75:115-124. [PMID: 36278846 DOI: 10.1002/acr.25048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 10/17/2022] [Accepted: 10/20/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Real-world studies are needed to identify factors associated with response to biologic therapies in patients with axial spondyloarthritis (SpA). The objective was to assess sex differences in response to tumor necrosis factor inhibitors (TNFi) and to explore possible risk factors associated with TNFi efficacy. METHODS A total of 969 patients with axial SpA (315 females, 654 males) enrolled in the BIOBADASER registry (2000-2019) who initiated a TNFi (first, second, or further lines) were studied. Statistical and artificial intelligence (AI)-based data analyses were used to explore the association of sex differences and other factors to TNFi response, using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), to calculate the BASDAI50, with an improvement of at least 50% of the BASDAI score, and using the Ankylosing Spondylitis Disease Activity Score, calculated using the C-reactive protein level (ASDAS-CRP). RESULTS Females had a lower probability of reaching a BASDAI50 response with a first line TNFi treatment at the second year of follow-up (P = 0.018) and a lesser reduction of the ASDAS-CRP at this time point. The logistic regression model showed lower BASDAI50 responses to TNFi in females (P = 0.05). Other factors, such as older age (P = 0.004), were associated with unfavorable responses. The AI data analyses reinforced the idea that age at the beginning of the treatment was the main factor associated with an unfavorable response. The combination of age with other clinical characteristics (female sex or cardiovascular risk factors and events) potentially contributed to an unfavorable response to TNFi. CONCLUSION In this national multicenter registry, female sex was associated with less response to a first-line TNFi by the second year of follow-up. A higher age at the start of the TNFi was the main factor associated with an unfavorable response to TNFi.
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Affiliation(s)
| | - Carlos Sanchez-Piedra
- Health Technology Assessment Agency of Carlos III Institute of Health, Madrid, Spain
| | | | | | | | | | | | - Vega Jovaní
- Hospital General Universitario Dr. Balmis, Alicante, Spain
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17
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Fernández-Carballido C, Jovaní V, Catalán EB, Moreno-Ramos MJ, Sanz Sanz J, Gallego A, García Vivar ML, Rodríguez-Heredia JM, Sanabra C, Sastré C. Disease activity indexes might not capture the same disease aspects in males and females with ankylosing spondylitis: A real-world nationwide analysis. Front Med (Lausanne) 2022; 9:1078325. [PMID: 36619648 PMCID: PMC9811117 DOI: 10.3389/fmed.2022.1078325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
Background To evaluate gender differences in disease activity and health status (HS) in patients with radiographic axial spondyloarthritis (r-axSpA)/ankylosing spondylitis (AS). Methods Ancillary analysis of the MIDAS study, an observational, non-interventional, cross-sectional and retrospective multicenter nationwide study to assess disease activity and its relationship with HS in clinical practice. Adult patients with AS diagnosis, fulfilling ASAS and modified New York criteria, treated for ≥3 months upon study inclusion according to clinical practice were included. The primary outcome was "disease control" assessed by the percentage of patients in remission and low disease activity (BASDAI and ASDAS-CRP scores). HS was evaluated using the ASAS health index (ASAS-HI). Patients' responses and characteristics were analyzed by gender. Results We analyzed 313 patients with AS, 237 (75.7%) males and 76 (24.3%) females. A total of 202 (64.5%) patients had adequate disease control (BASDAI < 4); 69.2% of males [mean (SD) BASDAI 2.9 (2.1)] and 50.0% of females [mean (SD) BASDAI 3.8 (2.4); p = 0.01]. According to ASDAS-CRP, 57.5% of patients were adequately controlled (ASDAS-ID +ASDAS-LDA); 138 (58.2%) males and 42 (55.3%) females. The mean (SD) ASDAS-CRP was 1.9 (1.1); being 1.9 (1.0) in males and 2.0 (1.1) in females. Overall, the impact of AS on HS was low to moderate [mean (SD) ASAS-HI 5.8 (4.4)]; being 5.5 (4.4) for males and 6.8 (4.2) for females (p = 0.02). Conclusion This study showed a higher proportion of females with AS and active disease using the BASDAI definition. When using the ASDAS-CRP definition these differences by gender were less pronounced. The impact of disease activity on HS appears to be higher in females than males.
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Affiliation(s)
- Cristina Fernández-Carballido
- Department of Rheumatology, Hospital Universitario San Juan de Alicante, Alicante, Spain,*Correspondence: Cristina Fernández-Carballido ✉
| | - Vega Jovaní
- Department of Rheumatology, Hospital General Universitario Dr. Balmis, Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
| | | | | | - Jesús Sanz Sanz
- Department of Rheumatology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Adela Gallego
- Department of Rheumatology, Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain
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Venerito V, Lopalco G, Abbruzzese A, Colella S, Morrone M, Tangaro S, Iannone F. A Machine Learning Approach to Predict Remission in Patients With Psoriatic Arthritis on Treatment With Secukinumab. Front Immunol 2022; 13:917939. [PMID: 35833126 PMCID: PMC9271870 DOI: 10.3389/fimmu.2022.917939] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPsoriatic Arthritis (PsA) is a multifactorial disease, and predicting remission is challenging. Machine learning (ML) is a promising tool for building multi-parametric models to predict clinical outcomes. We aimed at developing a ML algorithm to predict the probability of remission in PsA patients on treatment with Secukinumab (SEC).MethodsPsA patients undergoing SEC treatment between September 2017 and September 2020 were retrospectively analyzed. At baseline and 12-month follow-up, we retrieved demographic and clinical characteristics, including Body Mass Index (BMI), disease phenotypes, Disease Activity in PsA (DAPSA), Leeds Enthesitis Index (LEI) and presence/absence of comorbidities, including fibromyalgia and metabolic syndrome. Two random feature elimination wrappers, based on an eXtreme Gradient Boosting (XGBoost) and Logistic Regression (LR), were trained and validated with 10-fold cross-validation for predicting 12-month DAPSA remission with an attribute core set with the least number of predictors. The performance of each algorithm was assessed in terms of accuracy, precision, recall and area under receiver operating characteristic curve (AUROC).ResultsOne-hundred-nineteen patients were selected. At 12 months, 20 out of 119 patients (25.21%) achieved DAPSA remission. Accuracy and AUROC of XGBoost was of 0.97 ± 0.06 and 0.97 ± 0.07, overtaking LR (accuracy 0.73 ± 0.09, AUROC 0.78 ± 0.14). Baseline DAPSA, fibromyalgia and axial disease were the most important attributes for the algorithm and were negatively associated with 12-month DAPSA remission.ConclusionsA ML approach may identify SEC good responders. Patients with a high disease burden and axial disease with comorbid fibromyalgia seem challenging to treat.
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Affiliation(s)
- Vincenzo Venerito
- Rheumatology Unit, Department of Emergency and Organ Transplantations, University of Bari “Aldo Moro”, Bari, Italy
| | - Giuseppe Lopalco
- Rheumatology Unit, Department of Emergency and Organ Transplantations, University of Bari “Aldo Moro”, Bari, Italy
| | - Anna Abbruzzese
- Rheumatology Unit, Department of Emergency and Organ Transplantations, University of Bari “Aldo Moro”, Bari, Italy
| | - Sergio Colella
- Rheumatology Unit, Department of Emergency and Organ Transplantations, University of Bari “Aldo Moro”, Bari, Italy
| | - Maria Morrone
- Rheumatology Unit, Department of Emergency and Organ Transplantations, University of Bari “Aldo Moro”, Bari, Italy
| | - Sabina Tangaro
- Dipartimento di Scienze del Suolo, della Pianta e degli Alimenti, University of Bari “Aldo Moro”, Bari, Italy
- Istituto Nazionale di Fisica Nucleare - Sezione di Bari, Bari, Italy
| | - Florenzo Iannone
- Rheumatology Unit, Department of Emergency and Organ Transplantations, University of Bari “Aldo Moro”, Bari, Italy
- *Correspondence: Florenzo Iannone,
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Ramonda R, Lorenzin M, Sole Chimenti M, D’Angelo S, Marchesoni A, Salvarani C, Lubrano E, Costa L, Dal Bosco Y, Fracassi E, Ortolan A, Ferraioli M, Carriero A, Visalli E, Bixio R, Desiati F, Bergamini A, Pedrollo E, Doria A, Foti R, Carletto A. Effectiveness and safety of secukinumab in axial spondyloarthritis: a 24-month prospective, multicenter real-life study. Ther Adv Musculoskelet Dis 2022; 14:1759720X221090310. [PMID: 35510168 PMCID: PMC9058366 DOI: 10.1177/1759720x221090310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 03/10/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives: To evaluate, in a multicentric Italian cohort of axial spondyloarthritis (axSpA) patients on Secukinumab (SEC) followed for 24 months: (1) the long-term effectiveness and safety of SEC; (2) the drug retention rate and low disease activity (LDA) measured as Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) < 4/Ankylosing Spondylitis Disease Activity Score (ASDAS) < 2.1 and very low disease activity (VLDA) measured as BASDAI < 2/ASDAS < 1.3; (3) any differences in outcomes according to line of biological treatment (naïve/non-naïve), gender (male/female), subtype of axSpA [radiographic axSpA (r-axSpA)/non-radiographic axSpA (nr-axSpA)]. Methods: Consecutive axSpA patients treated with SEC were evaluated prospectively. Disease characteristics, previous/ongoing treatments, comorbidities, and follow-up duration were collected. Disease activity/functional/clinimetric scores and biochemical-values were recorded at baseline (T0), 6 (T6), 12 (T12), and 24 (T24) months. Effectiveness was evaluated over-time with descriptive statistics; multivariate Cox and logistic regression models were used to evaluate predictors of drug discontinuation and LDA at T6. Infections and adverse events were recorded. Results: A total 249 patients (47.8% male; median age 51) were enrolled; 40.9% had HLA-B27; 53.8% had r-axSpA, and 46.2% nr-axSpA. SEC was prescribed in 28.9% naïve and in 71.1% non-naïve patients. SEC effectiveness was shown as an improvement in several outcomes, such as ASDAS [T0 = 3.5 (2.9–4.4) versus T24 = 1.9 (1.2–2.4); p = 0.02] and BASDAI [T0 = 6.5 (5.0–7.5) versus T24 = 2.8 (1.8–4.0); p = 0.03]. At T24, naïve patients showed better physical functioning and lower disease activity than non-naïve. After 24 months of treatment, 90.7% of naïve and 75.3% of non-naïve patients achieved LDA (BASDAI < 4). Treatment was discontinued in 24.5% patients, mainly due to primary/secondary loss of effectiveness, and in 6.8% due to adverse events. Retention rate at T24 was 75% in the whole population, with some difference depending on gender ( p = 0.002). Conclusion: In a real-life clinical setting, SEC proved to be safe and effective in axSpA, mainly in naïve-patients, with a notable drug retention rate. No differences were observed between r-axSpA and nr-axSpA.
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Affiliation(s)
- Roberta Ramonda
- Rheumatology Unit, Department of Medicine (DIMED), University of Padova, Via Giustiniani, 2, 35128 Padova, Italy
| | - Mariagrazia Lorenzin
- Rheumatology Unit, Department of Medicine (DIMED), University of Padova, Padova, Italy
| | - Maria Sole Chimenti
- Rheumatology, Allergology and Clinical Immunology, Department of ‘Medicina dei Sistemi’, University of Rome ‘Tor Vergata’, Rome, Italy
| | - Salvatore D’Angelo
- Rheumatology Institute of Lucania (IReL), Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Potenza Local Health System, Potenza, Italy
| | | | - Carlo Salvarani
- Rheumatology Unit, Department of Internal Medicine, Azienda USL-IRCCS, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy
- University of Modena and Reggio Emilia, Modena, Italy
| | - Ennio Lubrano
- Academic Rheumatology Unit, Dipartimento di Medicina e Scienze per la Salute ‘Vincenzo Tiberio’, University of Molise, Campobasso, Italy
| | - Luisa Costa
- Rheumatology Research Unit, Department of Clinical Medicine and Surgery, School of Medicine and Surgery, University of Naples FEDERICO II, Naples, Italy
| | | | - Elena Fracassi
- Rheumatology Unit, Department of Medicine, AOUI University of Verona, Verona, Italy
| | - Augusta Ortolan
- Rheumatology Unit, Department of Medicine (DIMED), University of Padova, Padova, Italy
| | - Mario Ferraioli
- Rheumatology, Allergology and Clinical Immunology, Department of ‘Medicina dei Sistemi’, University of Rome ‘Tor Vergata’, Rome, Italy
| | - Antonio Carriero
- Rheumatology Institute of Lucania (IReL), Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Potenza Local Health System, Potenza, Italy
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - Elisa Visalli
- Rheumatology Unit, A.O.U. Policlinico S. Marco, Catania, Italy
| | - Riccardo Bixio
- Rheumatology Unit, Department of Medicine, AOUI University of Verona, Verona, Italy
| | | | - Alberto Bergamini
- Rheumatology, Allergology and Clinical Immunology, Department of ‘Medicina dei Sistemi’, University of Rome ‘Tor Vergata’, Rome, Italy
| | - Elisa Pedrollo
- Rheumatology Unit, Department of Medicine, AOUI University of Verona, Verona, Italy
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine (DIMED), University of Padova, Padova, Italy
| | - Rosario Foti
- Rheumatology Unit, A.O.U. Policlinico S. Marco, Catania, Italy
| | - Antonio Carletto
- Rheumatology Unit, Department of Medicine, AOUI University of Verona, Verona, Italy
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Queiro R, Seoane-Mato D, Laiz A, Galindez Agirregoikoa E, Montilla C, Park HS, Pinto Tasende JA, Bethencourt Baute JJ, Joven Ibáñez B, Toniolo E, Ramírez J, Pruenza García-Hinojosa C. Severe Disease in Patients With Recent-Onset Psoriatic Arthritis. Prediction Model Based on Machine Learning. Front Med (Lausanne) 2022; 9:891863. [PMID: 35572968 PMCID: PMC9097678 DOI: 10.3389/fmed.2022.891863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/05/2022] [Indexed: 01/11/2023] Open
Abstract
Objectives To identify patient- and disease-related characteristics that make it possible to predict higher disease severity in recent-onset PsA. Methods We performed a multicenter observational prospective study (2-year follow-up, regular annual visits). The study population comprised patients aged ≥ 18 years who fulfilled the CASPAR criteria and less than 2 years since the onset of symptoms. Severe disease was defined at each visit as fulfillment of at least 1 of the following criteria: need for systemic treatment, Health Assessment Questionnaire (HAQ) > 0.5, polyarthritis. The dataset contained data for the independent variables from the baseline visit and follow-up visit number 1. These were matched with the outcome measures from follow-up visits 1 and 2, respectively. We trained a logistic regression model and random forest-type and XGBoost machine learning algorithms to analyze the association between the outcome measure and the variables selected in the bivariate analysis. Results The sample comprised 158 patients. At the first follow-up visit, 78.2% of the patients who attended the clinic had severe disease. This percentage decreased to 76.4% at the second visit. The variables predicting severe disease were patient global pain, treatment with synthetic DMARDs, clinical form at diagnosis, high CRP, arterial hypertension, and psoriasis affecting the gluteal cleft and/or perianal area. The mean values of the measures of validity of the machine learning algorithms were all ≥ 80%. Conclusion Our prediction model of severe disease advocates rigorous control of pain and inflammation, also addressing cardiometabolic comorbidities, in addition to actively searching for hidden psoriasis.
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Affiliation(s)
- Rubén Queiro
- Faculty of Medicine, Rheumatology Service & the Principality of Asturias Institute for Health Research (ISPA), Universidad de Oviedo, Oviedo, Spain
| | | | - Ana Laiz
- Rheumatology and Autoimmune Disease Department, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Carlos Montilla
- Rheumatology Service, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Hye Sang Park
- Rheumatology and Autoimmune Disease Department, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jose A. Pinto Tasende
- Rheumatology Service-INIBIC, Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | | | | | - Elide Toniolo
- Rheumatology Service, Hospital Universitari Son Llàtzer, Palma, Spain
| | - Julio Ramírez
- Arthritis Unit, Rheumatology Department, Hospital Clínic Barcelona, Barcelona, Spain
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Moreno-Ramos MJ, Sanchez-Piedra C, Martínez-González O, Rodríguez-Lozano C, Pérez-Garcia C, Freire M, Campos C, Cáliz-Caliz R, Calvo J, Blanco-Madrigal JM, Pérez-Gómez A, Moreno-Martínez MJ, Linares L, Sánchez-Alonso F, Sastré C, Castrejón I. Real-World Effectiveness and Treatment Retention of Secukinumab in Patients with Psoriatic Arthritis and Axial Spondyloarthritis: A Descriptive Observational Analysis of the Spanish BIOBADASER Registry. Rheumatol Ther 2022; 9:1031-1047. [PMID: 35467242 PMCID: PMC9314517 DOI: 10.1007/s40744-022-00446-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/04/2022] [Indexed: 01/18/2023] Open
Affiliation(s)
| | | | | | | | | | - Mercedes Freire
- Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | | | | | | | | | - Ana Pérez-Gómez
- Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain
| | | | - Luis Linares
- Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Spain
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22
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García-Dorta A, León-Suarez P, Peña S, Hernández-Díaz M, Rodríguez-Lozano C, González-Dávila E, Hernández-Hernández MV, Díaz-González F. Association of Gender, Diagnosis, and Obesity With Retention Rate of Secukinumab in Spondyloarthropathies: Results Form a Multicenter Real-World Study. Front Med (Lausanne) 2022; 8:815881. [PMID: 35096907 PMCID: PMC8792854 DOI: 10.3389/fmed.2021.815881] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 12/21/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Secukinumab has been shown effective for psoriatic arthritis (PsA) and axial spondylarthritis (AxSpA) in randomized trials. The aim of this study was to analyze baseline patient and disease characteristics associated with a better retention rate of secukinumab under real-world conditions. Patients and Methods: Real-life, prospective multicenter observational study involving 138 patients, 61 PsA and 77 AxSpA, who were analyzed at baseline, 6, 12 months and subsequently every year after starting secukinumab regardless of the line of treatment. Demographics and disease characteristics, measures of activity, secukinumab use, and adverse events were collected. Drug survival was analyzed using Kaplan-Meier curves and factors associated with discontinuation were evaluated using Cox regression. The machine-learning J48 decision tree classifier was also applied. Results: During the 1st year of treatment, 75% of patients persisted with secukinumab, but accrued 71% (n = 32) in total losses (n = 45). The backward stepwise (Wald) method selected diagnosis, obesity, and gender as relevant variables, the latter when analyzing the interactions. At 1 year of follow-up, the Cox model showed the best retention rate in the groups of AxSpa women (95%, 95% CI 93–97%) and PsA men (89%, 95% CI 84–93%), with the worst retention in PsA women (66%, 95% CI 54–79%). The J48 predicted secukinumab retention with an accuracy of 77.2%. No unexpected safety issues were observed. Conclusions: Secukinumab shows the best retention rate at 1 year of treatment in AxSpA women and in PsA men, independently of factors such as the time of disease evolution, the line of treatment or the initial dose of the drug.
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Affiliation(s)
- Alicia García-Dorta
- Servicio de Reumatología, Hospital Universitario de Canarias, San Cristóbal de La Laguna, Spain
| | - Paola León-Suarez
- Servicio de Reumatología, University Hospital of Gran Canaria Dr. Negrin, Las Palmas de Gran Canaria, Spain
| | - Sonia Peña
- Unidad de Reumatología, Fuerteventura General Hospital Virgen de la Peña, Las Palmas de Gran Canaria, Spain
| | - Marta Hernández-Díaz
- Servicio de Reumatología, Hospital Universitario de Canarias, San Cristóbal de La Laguna, Spain
| | - Carlos Rodríguez-Lozano
- Servicio de Reumatología, University Hospital of Gran Canaria Dr. Negrin, Las Palmas de Gran Canaria, Spain
| | - Enrique González-Dávila
- Departamento de Estadística e Investigación Operativa, Universidad de La Laguna, La Laguna, Spain
| | | | - Federico Díaz-González
- Servicio de Reumatología, Hospital Universitario de Canarias, San Cristóbal de La Laguna, Spain.,Departamento de Medicina Interna, Dermatología y Psiquiatría, Universidad de La Laguna, La Laguna, Spain
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Queiro R, Coto P, González-Lara L, Coto E. Genetic Variants of the NF-κB Pathway: Unraveling the Genetic Architecture of Psoriatic Disease. Int J Mol Sci 2021; 22:ijms222313004. [PMID: 34884808 PMCID: PMC8657577 DOI: 10.3390/ijms222313004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 11/27/2021] [Accepted: 11/29/2021] [Indexed: 01/02/2023] Open
Abstract
Psoriasis is a multifactorial genetic disease for which the genetic factors explain about 70% of disease susceptibility. Up to 30–40% of psoriasis patients develop psoriatic arthritis (PsA). However, PsA can be considered as a “disease within a disease”, since in most cases psoriasis is already present when joint complaints begin. This has made studies that attempt to unravel the genetic basis for both components of psoriatic disease enormously difficult. Psoriatic disease is also accompanied by a high burden of comorbid conditions, mainly of the cardiometabolic type. It is currently unclear whether these comorbidities and psoriatic disease have a shared genetic basis or not. The nuclear factor of kappa light chain enhancer of activated B cells (NF-κB) is a transcription factor that regulates a plethora of genes in response to infection, inflammation, and a wide variety of stimuli on several cell types. This mini-review is focused on recent findings that highlight the importance of this pathway both in the susceptibility and in the determinism of some features of psoriatic disease. We also briefly review the importance of genetic variants of this pathway as biomarkers of pharmacological response. All the above may help to better understand the etiopathogenesis of this complex entity.
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Affiliation(s)
- Rubén Queiro
- Rheumatology & ISPA Translational Immunology Division, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
- Department of Medicine, Oviedo University School of Medicine, 33011 Oviedo, Spain;
- Correspondence:
| | - Pablo Coto
- Dermatology Division, Hospital Vital Alvarez Buylla, 33611 Mieres, Spain;
| | - Leire González-Lara
- Dermatology Division, Hôpital Ambroise-Paré, 92100 Boulogne-Billancourt, France;
| | - Eliecer Coto
- Department of Medicine, Oviedo University School of Medicine, 33011 Oviedo, Spain;
- Molecular Genetics Unit, Hospital Universitario Central Asturias, 33011 Oviedo, Spain
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Queiro R. Cardiometabolic comorbidity in the selection of treatment in spondyloarthritis: one step closer to truly personalized medicine? Expert Opin Biol Ther 2021; 21:1539-1541. [PMID: 34694176 DOI: 10.1080/14712598.2022.1998448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Rubén Queiro
- Rheumatology & ISPA Translational Immunology Division, Hospital Universitario Central de Asturias, Oviedo, Spain.,School of Medicine, Oviedo University, Oviedo-Asturia, Spain
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