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Lee KA, Kim BY, Kim SS, Cheon YH, Lee SI, Kim SH, Jung JH, Kim GT, Hur JW, Lee MS, Kim YS, Hong SJ, Park S, Kim HS. Effect of abatacept versus conventional synthetic disease modifying anti-rheumatic drugs on rheumatoid arthritis-associated interstitial lung disease. Korean J Intern Med 2024; 39:855-864. [PMID: 39252490 PMCID: PMC11384256 DOI: 10.3904/kjim.2023.207] [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: 05/08/2023] [Accepted: 12/11/2023] [Indexed: 09/11/2024] Open
Abstract
BACKGROUND/AIMS To compare the effects of abatacept and conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs) on the progression and development of rheumatoid arthritis-associated interstitial lung disease (RA-ILD). METHODS This multi-center retrospective study included RA patients receiving abatacept or csDMARDs who underwent at least two pulmonary function tests and/or chest high-resolution computed tomography (HRCT). We compared the following outcomes between the groups: progression of RA-ILD, development of new ILD in RA patients without ILD at baseline, 28-joint Disease Activity Score with the erythrocyte sedimentation rate (DAS28-ESR), and safety. Longitudinal changes were compared between the groups by using a generalized estimating equation. RESULTS The study included 123 patients who were treated with abatacept (n = 59) or csDMARDs (n = 64). Nineteen (32.2%) and 38 (59.4%) patients treated with abatacept and csDMARDs, respectively, presented with RA-ILD at baseline. Newly developed ILD occurred in one patient receiving triple csDMARDs for 32 months. Among patients with RA-ILD at baseline, ILD progressed in 21.1% of cases treated with abatacept and 34.2% of cases treated with csDMARDs during a median 21-month follow-up. Longitudinal changes in forced vital capacity and diffusing capacity for carbon monoxide were comparable between the two groups. However, the abatacept group showed a more significant decrease in DAS28-ESR and glucocorticoid doses than csDMARDs group during the follow-up. The safety of both regimens was comparable. CONCLUSION Abatacept and csDMARDs showed comparable effects on the development and stabilization of RA-ILD. Nevertheless, compared to csDMARDs, abatacept demonstrated a significant improvement in disease activity and led to reduced glucocorticoid use.
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Affiliation(s)
- Kyung-Ann Lee
- Division of Rheumatology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Bo Young Kim
- Division of Rheumatology, Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Sung Soo Kim
- Division of Rheumatology, Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Yun Hong Cheon
- Division of Rheumatology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Sang-Il Lee
- Division of Rheumatology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Sang-Hyon Kim
- Division of Rheumatology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Jae Hyun Jung
- Division of Rheumatology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Geun-Tae Kim
- Division of Rheumatology, Department of Internal Medicine, Kosin University Gospel Hospital, Busan, Korea
| | - Jin-Wuk Hur
- Division of Rheumatology, Department of Internal Medicine, Nowon Eulji Medical Center, Seoul, Korea
| | - Myeung-Su Lee
- Division of Rheumatology, Department of Internal Medicine, Wonkwang University Hospital, Iksan, Korea
| | - Yun Sung Kim
- Division of Rheumatology, Department of Internal Medicine, Chosun University Hospital, Gwangju, Korea
| | - Seung-Jae Hong
- Division of Rheumatology, Department of Internal Medicine, Kyung Hee University Medical Center, Seoul, Korea
| | - Suyeon Park
- Biostatistics, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Hyun-Sook Kim
- Division of Rheumatology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea
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Molteni E, Pirone C, Ceccarelli F, Castellani C, Alessandri C, Di Franco M, Riccieri V, Spinelli FR, Priori R, Scrivo R, Conti F. Retention rate of abatacept in rheumatoid arthritis patients in a real-life setting: results from a monocentric cohort. Reumatismo 2024; 76. [PMID: 38916170 DOI: 10.4081/reumatismo.2024.1608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 02/22/2024] [Indexed: 06/26/2024] Open
Abstract
OBJECTIVE Data from trials demonstrated that abatacept (ABA) has a good safety and efficacy profile in treating rheumatoid arthritis. We have studied the retention rate of ABA in a real-life cohort of patients with rheumatoid arthritis. METHODS This is a monocentric, retrospective study including patients with rheumatoid arthritis classified by the American College of Rheumatology/European League Against Rheumatism 2010 criteria who started treatment with ABA. The Kaplan-Meier method was applied to evaluate the ABA retention rate. RESULTS This analysis was conducted on 161 patients [male/female 21/140, median age 65 years, interquartile range (IQR) 18.7, median disease duration 169 months, IQR 144.0]. 111 patients (68.9%) received ABA subcutaneously. ABA was associated with methotrexate in 61.9% of patients and was the first biological disease-modifying antirheumatic drug in 41%. We observed a median ABA survival of 66 months [95% confidence interval (CI) 57.3-74.7], with a retention rate of 88% at 6 months and 50.9% at 5 years. Drug survival was significantly higher in patients treated with ABA subcutaneously and in male patients (p=0.039 and p=0.018, respectively). Adjusted for main confounders, female gender was the main predictor of withdrawal (hazard ratio 5.1, 95% CI 1.2-21.3). CONCLUSIONS Our study shows that better survival is associated with subcutaneous administration and male gender, confirming ABA effectiveness.
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Affiliation(s)
- E Molteni
- Rheumatology Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome.
| | - C Pirone
- Rheumatology Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome.
| | - F Ceccarelli
- Rheumatology Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome.
| | - C Castellani
- Rheumatology Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome.
| | - C Alessandri
- Rheumatology Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome.
| | - M Di Franco
- Rheumatology Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome.
| | - V Riccieri
- Rheumatology Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome.
| | - F R Spinelli
- Rheumatology Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome.
| | - R Priori
- Department of Internal Medicine and Medical Specialties, Rheumatology Clinic, Sapienza University of Rome; Saint Camillus International University of Health Science, UniCamillus, Rome.
| | - R Scrivo
- Rheumatology Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome.
| | - F Conti
- Rheumatology Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome.
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Kristensen LE, Deodhar A, Leung YY, Vranic I, Mortezavi M, Fallon L, Yndestad A, Kinch CD, Gladman DD. Risk Stratification of Patients with Psoriatic Arthritis and Ankylosing Spondylitis for Treatment with Tofacitinib: A Review of Current Clinical Data. Rheumatol Ther 2024; 11:487-499. [PMID: 38696034 PMCID: PMC11111604 DOI: 10.1007/s40744-024-00662-5] [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: 12/22/2023] [Accepted: 03/08/2024] [Indexed: 05/23/2024] Open
Abstract
In this commentary, we review clinical data which helps inform individualized benefit-risk assessment for tofacitinib in patients with psoriatic arthritis (PsA) and ankylosing spondylitis (AS). ORAL Surveillance, a safety trial of patients ≥ 50 years of age with rheumatoid arthritis (RA) and cardiovascular risk factors, found increased rates of safety outcomes (including major adverse cardiovascular events [MACE], malignancies excluding non-melanoma skin cancer, and venous thromboembolism) with tofacitinib versus tumor necrosis factor inhibitors (TNFi). Post hoc analyses of ORAL Surveillance have identified subpopulations with different relative risk versus TNFi; higher risk with tofacitinib was confined to patients ≥ 65 years of age and/or long-time current/past smokers, and specifically for MACE, patients with a history of atherosclerotic cardiovascular disease (ASCVD). In patients without these risk factors, risk differences between tofacitinib and TNFi could not be detected. Given differences in demographics, pathophysiology, and comorbidities, we sought to examine whether the risk stratification observed in RA is also appropriate for PsA and AS. Data from the PsA tofacitinib development program show low absolute risk of safety outcomes in patients < 65 years of age and never smokers, and low MACE risk in patients with no history of ASCVD, consistent with results from ORAL Surveillance. No MACE, malignancies, or venous thromboembolism were reported in the tofacitinib AS development program. The mechanism of the ORAL Surveillance safety findings is unknown, and there are no similar prospective studies of sufficient size and duration. Accordingly, it is appropriate to use a precautionary approach and extrapolate differentiating risk factors identified from ORAL Surveillance (age ≥ 65 years, long-time current/past smoking, and history of ASCVD) to PsA and AS. We recommend an individualized approach to treatment decisions based on these readily identifiable risk factors, in line with updated labeling for Janus kinase inhibitors and international guidelines for the treatment of PsA and AS.Trial Registration: NCT02092467, NCT01262118, NCT01484561, NCT00147498, NCT00413660, NCT00550446, NCT00603512, NCT00687193, NCT01164579, NCT00976599, NCT01059864, NCT01359150, NCT02147587, NCT00960440, NCT00847613, NCT00814307, NCT00856544, NCT00853385, NCT01039688, NCT02281552, NCT02187055, NCT02831855, NCT00413699, NCT00661661, NCT01877668, NCT01882439, NCT01976364, NCT00678210, NCT01710046, NCT01241591, NCT01186744, NCT01276639, NCT01309737, NCT01163253, NCT01786668, NCT03502616.
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Affiliation(s)
- Lars Erik Kristensen
- The Parker Institute, Bispebjerg and Frederiksberg, Copenhagen, Denmark.
- Copenhagen University, Copenhagen, Denmark.
| | - Atul Deodhar
- Division of Arthritis and Rheumatic Diseases, Oregon Health and Science University, Portland, OR, USA
| | - Ying-Ying Leung
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
| | | | | | | | | | | | - Dafna D Gladman
- Schroeder Arthritis Institute, Krembil Research Institute, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
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Simon TA, Suissa S, Boers M, Hochberg MC, Skovron ML, Askling J, Michaud K, Strangfeld A, Pedro S, Frisell T, Meissner Y, Dominique A, Gomez A. Malignancy outcomes in patients with rheumatoid arthritis treated with abatacept and other disease-modifying antirheumatic drugs: Results from a 10-year international post-marketing study. Semin Arthritis Rheum 2024; 64:152240. [PMID: 37500379 DOI: 10.1016/j.semarthrit.2023.152240] [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: 10/07/2022] [Revised: 05/12/2023] [Accepted: 06/25/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVE To evaluate the risk of malignancy (overall, breast, lung, and lymphoma) in patients with rheumatoid arthritis treated with abatacept, conventional synthetic (cs) disease-modifying antirheumatic drugs (DMARDs), and other biologic/targeted synthetic (b/ts)DMARDs in clinical practice. METHODS Four international observational data sources were included: ARTIS (Sweden), RABBIT (Germany), FORWARD (USA), and BC (Canada). Crude incidence rates (IRs) per 1000 patient-years of exposure with 95% confidence intervals (CIs) for a malignancy event were calculated; rate ratios (RRs) were estimated and adjusted for demographics, comorbidities, and other potential confounders. RRs were then pooled in a random-effects model. RESULTS Across data sources, mean follow-up for patients treated with abatacept (n = 5182), csDMARDs (n = 73,755), and other b/tsDMARDs (n = 37,195) was 3.0-3.7, 2.9-6.2, and 3.1-4.7 years, respectively. IRs per 1000 patient-years for overall malignancy ranged from 7.6-11.4 (abatacept), 8.6-13.2 (csDMARDs), and 5.0-11.8 (other b/tsDMARDs). IRs ranged from: 0-4.4, 0-3.3, and 0-2.5 (breast cancer); 0.1-2.8, 0-3.7, and 0.2-2.9 (lung cancer); and 0-1.1, 0-0.9, and 0-0.6 (lymphoma), respectively, for the three treatment groups. The numbers of individual cancers (breast, lung, and lymphoma) in some registries were low; RRs were not available. There were a few cases of lymphoma in some of the registries; ARTIS observed an RR of 2.8 (95% CI 1.1-6.8) with abatacept versus csDMARDs. The pooled RRs (95% CIs) for overall malignancy with abatacept were 1.1 (0.8-1.5) versus csDMARDs and 1.0 (0.8-1.3) versus b/tsDMARDs. CONCLUSIONS This international, post-marketing observational safety study did not find any statistically significant increase in the risk of overall malignancies in pooled data in patients treated with abatacept compared with csDMARDs or with other b/tsDMARDs. Assessment of larger populations is needed to further evaluate the risks for individual cancers, especially lymphoma.
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Affiliation(s)
| | | | - Maarten Boers
- Department of Epidemiology & Data Science, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, the Netherlands
| | - Marc C Hochberg
- Departments of Medicine and Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Johan Askling
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Kaleb Michaud
- University of Nebraska Medical Center, Omaha, NE, USA; FORWARD, The National Databank for Rheumatic Diseases, Wichita, KS, USA
| | - Anja Strangfeld
- Pharmacoepidemiology and Health Services Research, German Rheumatism Research Center, Berlin, Germany; Charité University Medicine, Berlin, Germany
| | - Sofia Pedro
- FORWARD, The National Databank for Rheumatic Diseases, Wichita, KS, USA
| | - Thomas Frisell
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Yvette Meissner
- Pharmacoepidemiology and Health Services Research, German Rheumatism Research Center, Berlin, Germany
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5
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Kristensen LE, Danese S, Yndestad A, Wang C, Nagy E, Modesto I, Rivas J, Benda B. Identification of two tofacitinib subpopulations with different relative risk versus TNF inhibitors: an analysis of the open label, randomised controlled study ORAL Surveillance. Ann Rheum Dis 2023; 82:901-910. [PMID: 36931693 PMCID: PMC10314011 DOI: 10.1136/ard-2022-223715] [Citation(s) in RCA: 44] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/08/2023] [Indexed: 03/19/2023]
Abstract
OBJECTIVES Based on primary results from ORAL Surveillance, an event-driven clinical trial of risk-enriched patients, identify subpopulations with different relative risk (ie, 'high-risk' and 'low-risk') with tofacitinib versus tumour necrosis factor inhibitors (TNFi). METHODS Patients with rheumatoid arthritis aged ≥50 years with ≥1 additional cardiovascular risk factor received tofacitinib 5 or 10 mg two times a day or TNFi. Prior analyses had identified age and smoking as risk factors of particular interest across safety outcomes. Hazard ratios (HRs) and incidence rates were evaluated by age and smoking individually and in combination. Results were validated across tofacitinib development programmes. RESULTS 'Age ≥65 years or ever smoker' defined a group ('high-risk') with increased risk of malignancies (excluding non-melanoma skin cancer), major adverse cardiovascular events, myocardial infarction, venous thromboembolism and all-cause death with tofacitinib (combined doses) versus TNFi (HRs 1.41-5.19). In patients 'aged <65 years and never smokers' ('low-risk'), there was no detectable risk increase with tofacitinib versus TNFi (HRs ≈1.0) up to 6 years of follow-up, and absolute risk remained low and was corroborated across tofacitinib rheumatoid arthritis, psoriatic arthritis and ulcerative colitis programmes with up to 10 years of observation. CONCLUSIONS This posthoc analysis of ORAL Surveillance identified two tofacitinib subpopulations with different relative risk versus TNFi. High risk was confined to patients defined by distinct risk factors age ≥65 years or smoking, and these differentiating risk factors accounted for the excess risk observed with tofacitinib versus TNFi. These findings can guide individualised benefit/risk assessment and clinical decision-making on treatment with tofacitinib. TRIAL REGISTRATION NUMBERS NCT02092467, NCT01262118, NCT01484561, NCT00147498, NCT00413660, NCT00550446, NCT00603512, NCT00687193, NCT01164579, NCT00976599, NCT01059864, NCT01359150, NCT02147587, NCT00960440, NCT00847613, NCT00814307, NCT00856544, NCT00853385, NCT01039688, NCT02281552, NCT02187055, NCT02831855, NCT00413699, NCT00661661, NCT00787202, NCT01465763, NCT01458951, NCT01458574, NCT01470612, NCT01877668, NCT01882439, NCT01976364.
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Affiliation(s)
- Lars Erik Kristensen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Silvio Danese
- Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital and Vita‑Salute San Raffaele University, Milan, Italy
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Jiang FY, Zhang YZ, Tai YH, Chou CY, Hsieh YC, Chang YC, Huang HC, Li ZQ, Hsieh YC, Chen IJ, Huang BC, Su YC, Lin WW, Lin HC, Chao JI, Yuan SSF, Wang YM, Cheng TL, Tzou SC. A lesion-selective albumin-CTLA4Ig as a safe and effective treatment for collagen-induced arthritis. Inflamm Regen 2023; 43:13. [PMID: 36797799 PMCID: PMC9933273 DOI: 10.1186/s41232-023-00264-8] [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: 11/14/2022] [Accepted: 02/01/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND CTLA4Ig is a dimeric fusion protein of the extracellular domain of cytotoxic T-lymphocyte protein 4 (CTLA4) and an Fc (Ig) fragment of human IgG1 that is approved for treating rheumatoid arthritis. However, CTLA4Ig may induce adverse effects. Developing a lesion-selective variant of CTLA4Ig may improve safety while maintaining the efficacy of the treatment. METHODS We linked albumin to the N-terminus of CTLA4Ig (termed Alb-CTLA4Ig) via a substrate sequence of matrix metalloproteinase (MMP). The binding activities and the biological activities of Alb-CTLA4Ig before and after MMP digestion were analyzed by a cell-based ELISA and an in vitro Jurkat T cell activation assay. The efficacy and safety of Alb-CTLA4Ig in treating joint inflammation were tested in mouse collagen-induced arthritis. RESULTS Alb-CTLA4Ig is stable and inactive under physiological conditions but can be fully activated by MMPs. The binding activity of nondigested Alb-CTLA4Ig was at least 10,000-fold weaker than that of MMP-digested Alb-CTLA4Ig. Nondigested Alb-CTLA4Ig was unable to inhibit Jurkat T cell activation, whereas MMP-digested Alb-CTLA4Ig was as potent as conventional CTLA4Ig in inhibiting the T cells. Alb-CTLA4Ig was converted to CTLA4Ig in the inflamed joints to treat mouse collagen-induced arthritis, showing similar efficacy to that of conventional CTLA4Ig. In contrast to conventional CTLA4Ig, Alb-CTLA4Ig did not inhibit the antimicrobial responses in the spleens of the treated mice. CONCLUSIONS Our study indicates that Alb-CTLA4Ig can be activated by MMPs to suppress tissue inflammation in situ. Thus, Alb-CTLA4Ig is a safe and effective treatment for collagen-induced arthritis in mice.
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Affiliation(s)
- Fu-Yao Jiang
- grid.260539.b0000 0001 2059 7017Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan, Republic of China
| | - Yan-Zhu Zhang
- grid.260539.b0000 0001 2059 7017Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan, Republic of China
| | - Yuan-Hong Tai
- grid.260539.b0000 0001 2059 7017Institute of Molecular Medicine and Bioengineering, National Yang Ming Chiao Tung University, Hsinchu, Taiwan, Republic of China
| | - Chien-Yu Chou
- grid.260539.b0000 0001 2059 7017Institute of Molecular Medicine and Bioengineering, National Yang Ming Chiao Tung University, Hsinchu, Taiwan, Republic of China
| | - Yu-Ching Hsieh
- grid.260539.b0000 0001 2059 7017Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan, Republic of China
| | - Ya-Chi Chang
- grid.260539.b0000 0001 2059 7017Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan, Republic of China
| | - Hsiao-Chen Huang
- grid.260539.b0000 0001 2059 7017Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan, Republic of China
| | - Zhi-Qin Li
- grid.260539.b0000 0001 2059 7017Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan, Republic of China
| | - Yuan-Chin Hsieh
- grid.411447.30000 0004 0637 1806School of Medicine for International Students, I-Shou University, Kaoshiung, Taiwan, Republic of China
| | - I-Ju Chen
- grid.411447.30000 0004 0637 1806School of Medicine, I-Shou University, Kaohsiung, Taiwan, Republic of China
| | - Bo-Cheng Huang
- grid.412036.20000 0004 0531 9758Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan, Republic of China
| | - Yu-Cheng Su
- grid.260539.b0000 0001 2059 7017Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan, Republic of China ,grid.412019.f0000 0000 9476 5696Drug Development and Value Creation Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China
| | - Wen-Wei Lin
- grid.412019.f0000 0000 9476 5696Drug Development and Value Creation Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China ,grid.412019.f0000 0000 9476 5696Department of Laboratory Medicine, Post Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China
| | - Hsin-Chieh Lin
- grid.260539.b0000 0001 2059 7017Department of Materials Science and Engineering, National Yang Ming Chiao Tung University, Hsinchu, Taiwan, Republic of China
| | - Jui-I Chao
- grid.260539.b0000 0001 2059 7017Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan, Republic of China ,grid.260539.b0000 0001 2059 7017Institute of Molecular Medicine and Bioengineering, National Yang Ming Chiao Tung University, Hsinchu, Taiwan, Republic of China
| | - Shyng-Shiou F. Yuan
- grid.412027.20000 0004 0620 9374Translational Research Center, Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, and Faculty and College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China
| | - Yun-Ming Wang
- grid.260539.b0000 0001 2059 7017Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan, Republic of China ,grid.260539.b0000 0001 2059 7017Institute of Molecular Medicine and Bioengineering, National Yang Ming Chiao Tung University, Hsinchu, Taiwan, Republic of China ,grid.260539.b0000 0001 2059 7017Center for Intelligent Drug Systems and Smart Bio-devices (IDS2B), National Yang Ming Chiao Tung University, Hsinchu, Taiwan, Republic of China
| | - Tian-Lu Cheng
- grid.412019.f0000 0000 9476 5696Drug Development and Value Creation Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China ,grid.412019.f0000 0000 9476 5696Department of Biomedical Science and Environmental Biology, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China ,grid.412019.f0000 0000 9476 5696Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China
| | - Shey-Cherng Tzou
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan, Republic of China. .,Institute of Molecular Medicine and Bioengineering, National Yang Ming Chiao Tung University, Hsinchu, Taiwan, Republic of China. .,Drug Development and Value Creation Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China. .,Department of Biomedical Science and Environmental Biology, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China. .,Center for Intelligent Drug Systems and Smart Bio-devices (IDS2B), National Yang Ming Chiao Tung University, Hsinchu, Taiwan, Republic of China.
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Narváez J, Díaz Del Campo Fontecha P, Brito García N, Bonilla G, Aburto M, Castellví I, Cano-Jiménez E, Mena-Vázquez N, Nieto MA, Ortiz AM, Valenzuela C, Abad Hernández MÁ, Castrejón I, Correyero Plaza M, Francisco Hernández FM, Hernández Hernández MV, Rodríquez Portal JA. SER-SEPAR recommendations for the management of rheumatoid arthritis-related interstitial lung disease. Part 2: Treatment. REUMATOLOGIA CLINICA 2022; 18:501-512. [PMID: 36064885 DOI: 10.1016/j.reumae.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/15/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To develop multidisciplinary recommendations to improve the management of rheumatoid arthritis-related interstitial lung disease (RA-ILD). METHODS Clinical research questions relevant to the objective of the document were identified by a panel of rheumatologists and pneumologists selected based on their experience in the field. Systematic reviews of the available evidence were conducted, and evidence was graded according to the Scottish Intercollegiate Guidelines Network (SIGN) criteria. Specific recommendations were made. RESULTS Six PICO questions were selected, three of which analysed the safety and effectiveness of glucocorticoids, classical synthetic disease-modifying anti-rheumatic drugs (DMARDs) and other immunosuppressants, biological agents, targeted synthetic DMARDs, and antifibrotic therapies in the treatment of this complication. A total of 12 recommendations were formulated based on the evidence found and/or expert consensus. CONCLUSIONS We present the first official SER-SEPAR document with specific recommendations for RA-ILD management developed to resolve some common clinical questions, reduce clinical healthcare variability, and facilitate decision-making for patients.
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Affiliation(s)
- Javier Narváez
- Servicio de Reumatología, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain.
| | | | - Noé Brito García
- Unidad de Investigación, Sociedad Española de Reumatología, Madrid, Spain
| | - Gema Bonilla
- Servicio de Reumatología, Hospital Universitario La Paz, Madrid, Spain
| | - Myriam Aburto
- Servicio de Neumología, Hospital Universitario Galdakao-Usansolo, Bilbao, Spain
| | - Iván Castellví
- Servicio de Reumatología, Hospital Universitario de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Natalia Mena-Vázquez
- Servicio de Reumatología, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - M Asunción Nieto
- Servicio de Neumología, Hospital Clínico San Carlos, Madrid, Spain
| | - Ana María Ortiz
- Servicio de Reumatología, Hospital Universitario de La Princesa, Madrid, Spain
| | - Claudia Valenzuela
- Servicio de Neumología, Hospital Universitario de La Princesa, Madrid, Spain
| | | | - Isabel Castrejón
- Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - María Correyero Plaza
- Servicio de Reumatología, Hospital Universitario Quironsalud de Pozuelo, Pozuelo de Alarcón, Madrid, Spain
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Gootjes C, Zwaginga JJ, Roep BO, Nikolic T. Functional Impact of Risk Gene Variants on the Autoimmune Responses in Type 1 Diabetes. Front Immunol 2022; 13:886736. [PMID: 35603161 PMCID: PMC9114814 DOI: 10.3389/fimmu.2022.886736] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/08/2022] [Indexed: 11/17/2022] Open
Abstract
Type 1 diabetes (T1D) is an autoimmune disease that develops in the interplay between genetic and environmental factors. A majority of individuals who develop T1D have a HLA make up, that accounts for 50% of the genetic risk of disease. Besides these HLA haplotypes and the insulin region that importantly contribute to the heritable component, genome-wide association studies have identified many polymorphisms in over 60 non-HLA gene regions that also contribute to T1D susceptibility. Combining the risk genes in a score (T1D-GRS), significantly improved the prediction of disease progression in autoantibody positive individuals. Many of these minor-risk SNPs are associated with immune genes but how they influence the gene and protein expression and whether they cause functional changes on a cellular level remains a subject of investigation. A positive correlation between the genetic risk and the intensity of the peripheral autoimmune response was demonstrated both for HLA and non-HLA genetic risk variants. We also observed epigenetic and genetic modulation of several of these T1D susceptibility genes in dendritic cells (DCs) treated with vitamin D3 and dexamethasone to acquire tolerogenic properties as compared to immune activating DCs (mDC) illustrating the interaction between genes and environment that collectively determines risk for T1D. A notion that targeting such genes for therapeutic modulation could be compatible with correction of the impaired immune response, inspired us to review the current knowledge on the immune-related minor risk genes, their expression and function in immune cells, and how they may contribute to activation of autoreactive T cells, Treg function or β-cell apoptosis, thus contributing to development of the autoimmune disease.
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Affiliation(s)
- Chelsea Gootjes
- Laboratory of Immunomodulation and Regenerative Cell Therapy, Department of Internal Medicine, Leiden University Medical Center, Leiden, Netherlands
| | - Jaap Jan Zwaginga
- Laboratory of Immunomodulation and Regenerative Cell Therapy, Department of Internal Medicine, Leiden University Medical Center, Leiden, Netherlands
| | - Bart O Roep
- Laboratory of Immunomodulation and Regenerative Cell Therapy, Department of Internal Medicine, Leiden University Medical Center, Leiden, Netherlands
| | - Tatjana Nikolic
- Laboratory of Immunomodulation and Regenerative Cell Therapy, Department of Internal Medicine, Leiden University Medical Center, Leiden, Netherlands
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9
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Conway R, Nikiphorou E. Efficacy and safety of conventional synthetic, biologic and targeted synthetic DMARDs in RA-ILD: A narrative review. INDIAN JOURNAL OF RHEUMATOLOGY 2022. [DOI: 10.4103/injr.injr_157_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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10
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Tamura N, Azuma T, Misaki K, Yamaguchi R, Hirano F, Sugiyama E, Kanai D, Murakawa Y, Oribe M, Kimata T, Aoki K, Sugiura T, Takasugi K, Takakubo Y, Tomita Y, Isozaki T, Nanki T, Katsuyama N, Kuroiwa T, Oshikawa H, Kaneko M, Fujinaga H, Saito K, Tanaka E, Inoue E, Yoshizawa Y, Matsumoto S, Yamanaka H, Harigai M. Effectiveness and safety of subcutaneous abatacept in biologic-naïve RA patients at Week 52: A Japanese multicentre investigational study (ORIGAMI study). Mod Rheumatol 2021; 32:846-856. [PMID: 34915575 DOI: 10.1093/mr/roab090] [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] [Received: 05/30/2021] [Revised: 07/29/2021] [Accepted: 10/02/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To evaluate the effectiveness and safety of abatacept over 52 weeks in biologic-naïve rheumatoid arthritis (RA) patients with moderate disease activity in the prospective, 5-year, observational study (ORIGAMI study) in Japan. METHODS Abatacept (125 mg) was administered subcutaneously once a week. Clinical outcomes included Simplified Disease Activity Index (SDAI) remission at Week 52 (primary endpoint), Japanese Health Assessment Questionnaire (J-HAQ), EuroQol 5-Dimension Questionnaire (EQ-5D), treatment retention, and safety. The results were compared with those of conventional synthetic disease-modifying antirheumatic drug (csDMARD) controls from the ongoing Institute of Rheumatology, Rheumatoid Arthritis (IORRA) registry. RESULTS Overall, 325 patients were enrolled, with a mean age of 66.9 ± 12.7 years. The proportion of patients achieving SDAI remission (≤3.3) at Week 52 was 18.9% (95% CI: 14.3-23.6) and low disease activity (≤11) was 53.3% (95% CI: 47.4-59.1). A significant improvement was observed in J-HAQ and EQ-5D over 52 weeks in both the abatacept and csDMARD groups. The probability of abatacept treatment retention at Week 52 was 69.9% (95% CI: 64.7-75.5). Adverse events and serious adverse events were reported in 50.0% and 12.1% of patients, respectively. CONCLUSIONS Abatacept significantly improved disease activity, physical disability, and quality of life for up to 52 weeks in RA patients in a real-world setting.
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Affiliation(s)
- Naoto Tamura
- Department of Internal Medicine and Rheumatology, Juntendo University, Tokyo, Japan
| | - Takanori Azuma
- Azuma Rheumatology Clinic, Saitama, Japan; ORIGAMI Study Group
| | - Kenta Misaki
- Department of Rheumatology, Kita-Harima Medical Center, Hyogo, Japan
| | - Rei Yamaguchi
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Fuminori Hirano
- Department of Rheumatology, NHO Asahikawa Medical Center, Hokkaido, Japan
| | - Eiji Sugiyama
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima, Japan
| | - Daisuke Kanai
- Department of Nephrology, Yokohama Minami Kyousai Hospital, Kanagawa, Japan
| | - Yohko Murakawa
- Department of Rheumatology, Shimane University Hospital, Shimane, Japan
| | - Motohiro Oribe
- Department of Rheumatology, Oribe Rheumachika Naika Clinic, Oita, Japan
| | - Takahito Kimata
- Department of Rheumatology, Bayside Misato Medical Center, Kochi, Japan
| | | | - Tomoko Sugiura
- Department of Rheumatology, Sugiura Clinic, Shimane, Japan
| | - Koji Takasugi
- Department of Internal Medicine, Kurashiki Sweet Hospital, Okayama, Japan
| | - Yuya Takakubo
- Department of Rehabilitation Surgery, Yamagata University Hospital, Yamagata, Japan
| | - Yasuyuki Tomita
- Department of Rheumatology, Tomita Medical Clinic, Chiba, Japan
| | - Takeo Isozaki
- Division of Rheumatology, Department of Medicine, Showa University, Tokyo, Japan
| | - Toshihiro Nanki
- Division of Rheumatology, Department of Internal Medicine, Toho University School of Medicine, Tokyo, Japan
| | | | | | - Hideto Oshikawa
- Department of Rheumatology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | | | - Hiroshi Fujinaga
- Department of Rheumatology and Japanese Oriental Medicine, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Kiwamu Saito
- Department of Orthopedics, Nagoya Kyukeikai Saito Clinic Orthopedics & Rheumatology, Aichi, Japan
| | - Eiichi Tanaka
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Eisuke Inoue
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.,Showa University Research Administration Center, Showa University, Tokyo, Japan
| | - Yuri Yoshizawa
- Department of Immunology Medical, Bristol-Myers Squibb K.K, Tokyo, Japan
| | | | - Hisashi Yamanaka
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.,Department of Rheumatology, Sanno Medical Center, Tokyo, Japan
| | - Masayoshi Harigai
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
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11
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Cohen SB, Tanaka Y, Mariette X, Curtis JR, Lee EB, Nash P, Winthrop KL, Charles-Schoeman C, Wang L, Chen C, Kwok K, Biswas P, Shapiro A, Madsen A, Wollenhaupt J. Long-term safety of tofacitinib up to 9.5 years: a comprehensive integrated analysis of the rheumatoid arthritis clinical development programme. RMD Open 2021; 6:rmdopen-2020-001395. [PMID: 33127856 PMCID: PMC7722371 DOI: 10.1136/rmdopen-2020-001395] [Citation(s) in RCA: 96] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/28/2020] [Accepted: 09/29/2020] [Indexed: 12/26/2022] Open
Abstract
Objective Tofacitinib is an oral Janus kinase (JAK) inhibitor for the treatment of rheumatoid arthritis (RA). We report the largest integrated safety analysis of tofacitinib, as of March 2017, using data from phase I, II, III, IIIb/IV and long-term extension studies in adult patients with RA. Methods Data were pooled for patients with RA who received ≥1 tofacitinib dose. Incidence rates (IRs; patients with events/100 patient-years [PY]; 95% CIs) of first-time occurrences were obtained for adverse events (AEs) of interest. Results 7061 patients received tofacitinib (total exposure: 22 875 PY; median [range] exposure: 3.1 [0 to 9.6] years). IRs (95% CI) for serious AEs, serious infections, herpes zoster (all), opportunistic infections (excluding tuberculosis [TB]) and TB were 9.0 (8.6 to 9.4), 2.5 (2.3 to 2.7), 3.6 (3.4 to 3.9), 0.4 (0.3 to 0.5) and 0.2 (0.1 to 0.2), respectively. IRs (95% CI) for malignancies (excluding non-melanoma skin cancer [NMSC]), NMSC and lymphomas were 0.8 (0.7 to 0.9), 0.6 (0.5 to 0.7) and 0.1 (0.0 to 0.1), respectively. IRs (95% CI) for gastrointestinal perforations, deep vein thrombosis, pulmonary embolism, venous thromboembolism, arterial thromboembolism and major adverse cardiovascular events were 0.1 (0.1 to 0.2), 0.2 (0.1 to 0.2), 0.1 (0.1 to 0.2), 0.3 (0.2 to 0.3), 0.4 (0.3 to 0.5) and 0.4 (0.3 to 0.5), respectively. IR (95% CI) for mortality was 0.3 (0.2 to 0.3). IRs generally remained consistent across 6-month intervals to >78 months. Conclusion This represents the largest clinical dataset for a JAK inhibitor in RA to date. IRs remained consistent with previous reports from the tofacitinib RA clinical development programme, and stable over time. Trial registration numbers NCT01262118; NCT01484561; NCT00147498; NCT00413660; NCT00550446; NCT00603512; NCT00687193; NCT01164579; NCT00976599; NCT01059864; NCT01359150; NCT02147587; NCT00960440; NCT00847613; NCT00814307; NCT00856544; NCT00853385; NCT01039688; NCT02187055; NCT00413699; NCT00661661. For summary of phase I, phase II, phase III, phase IIIb/IV and LTE studies included in the integrated safety analysis, see online supplemental table 1.
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Affiliation(s)
- Stanley B Cohen
- Metroplex Clinical Research Center and University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Yoshiya Tanaka
- University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Xavier Mariette
- Paris-Saclay University, AP-HP, INSERM, Le Kremlin Bicêtre, France
| | | | - Eun Bong Lee
- Seoul National University, Seoul, Korea (the Democratic People's Republic of)
| | - Peter Nash
- Department of Medicine, Griffith University, Brisbane, Australia
| | | | | | - Lisy Wang
- Pfizer Inc, Groton, Connecticut, USA
| | | | | | | | | | | | - Jürgen Wollenhaupt
- Struenseehaus Centre for Rheumatology and Clinical Immunology, Hamburg, Germany
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12
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Ebina K. Drug efficacy and safety of biologics and Janus kinase inhibitors in elderly patients with rheumatoid arthritis. Mod Rheumatol 2021; 32:256-262. [PMID: 34894239 DOI: 10.1093/mr/roab003] [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: 02/24/2021] [Revised: 04/21/2021] [Accepted: 05/24/2021] [Indexed: 11/14/2022]
Abstract
Elderly patients with rheumatoid arthritis (RA) are frequently associated with higher disease activity and impaired physical function, although they show intolerance for conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), such as methotrexate, because of their comorbidities. However, the present treatment recommendation based on randomized controlled trials is not distinguished by age or comorbidities. Therefore, this review aimed to investigate the efficacy and safety of biological DMARDs (bDMARDs) and Janus kinase inhibitors (JAKi) in elderly patients. Present bDMARDs, including tumor necrosis factor inhibitors (TNFi), cytotoxic T lymphocyte-associated antigen-4-immunoglobulin (abatacept), interleukin (IL)-6 receptor antibody (tocilizumab and salirumab), and anti-CD20 antibody (rituximab), may be similarly or slightly less effective or safe in elderly patients compared with younger patients. Oral glucocorticoid use, prolonged disease duration, and very old patients appear to be associated with an increased risk of adverse events, such as serious infection. Some recent cohort studies demonstrated that non-TNFi showed better retention than TNFi in elderly patients. Both TNFi and non-TNFi agents may not strongly influence the risk of adverse events such as cardiovascular events and malignancy in elderly patients. Regarding JAKi, the efficacy appears to be similar, although the safety (particularly for serious infections, including herpes zoster) may be attenuated by aging.
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Affiliation(s)
- Kosuke Ebina
- Department of Musculoskeletal Regenerative Medicine, Osaka University, Graduate School of Medicine, Osaka 565-0871, Japan
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13
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Garcia-Melendo C, Cubiró X, Puig L. Janus Kinase Inhibitors in Dermatology: Part 1 — General Considerations and Applications in Vitiligo and Alopecia Areata. ACTAS DERMO-SIFILIOGRAFICAS 2021. [DOI: 10.1016/j.adengl.2021.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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14
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Inhibidores de JAK: usos en dermatología. Parte 1: generalidades, aplicaciones en vitíligo y en alopecia areata. ACTAS DERMO-SIFILIOGRAFICAS 2021. [DOI: 10.1016/j.ad.2020.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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15
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Gandhi Y, Passarell JA, Roy A, Murthy B. Model-Based Selection and Recommendation for Subcutaneous Abatacept Dose in Patients With Polyarticular Juvenile Idiopathic Arthritis. J Clin Pharmacol 2021; 61:688-699. [PMID: 33284480 PMCID: PMC8048692 DOI: 10.1002/jcph.1797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 12/01/2020] [Indexed: 12/04/2022]
Abstract
The selective T-cell costimulation modulator abatacept is approved for treatment of adult rheumatoid arthritis (RA) and polyarticular juvenile idiopathic arthritis (pJIA; 6-17 years [intravenous] and 2-17 years [subcutaneous]). An extrapolation approach was taken to determine subcutaneous weight-tiered doses of abatacept to evaluate in patients with pJIA. Population pharmacokinetic (PPK) and exposure-response (E-R) analyses were conducted to determine whether the weight-tiered subcutaneous regimen provides near-maximal efficacy and is therapeutically comparable to the intravenous regimen in patients with pJIA aged 2-17 years. Combined study data from intravenous or subcutaneous abatacept were used to assess clinically relevant exposure outcomes. The PPK model was developed with data from 13 phase 2/3 studies in RA and pJIA; the E-R model for the American College of Rheumatology pediatric scores (JIA-ACR 30/50/70/100 responses) in month 4 was developed with data from 2 phase 3 pJIA studies. Predefined covariates were investigated in both analyses. PPK model-predicted exposures were steady-state peak, trough (Cminss ), and time-averaged concentrations. Abatacept PK was characterized by a linear 2-compartment model (zero-order intravenous infusion, first-order subcutaneous absorption, first-order elimination); body weight was the only clinically relevant covariate. Cminss was the best exposure predictor for the JIA-ACR response: log odds for response increased in proportion to log-transformed Cminss ; JIA-ACR30 approached a plateau when Cminss ≥ 10 μg/mL. The PPK and E-R analyses demonstrated that the weight-tiered subcutaneous and intravenous abatacept dosing regimens provide near-maximal efficacy and are clinically comparable across children with pJIA who are > 2 years old.
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Affiliation(s)
| | | | - Amit Roy
- Bristol Myers SquibbPrincetonNew JerseyUSA
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16
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Vicente-Rabaneda EF, Atienza-Mateo B, Blanco R, Cavagna L, Ancochea J, Castañeda S, González-Gay MÁ. Efficacy and safety of abatacept in interstitial lung disease of rheumatoid arthritis: A systematic literature review. Autoimmun Rev 2021; 20:102830. [PMID: 33887489 DOI: 10.1016/j.autrev.2021.102830] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 02/11/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Interstitial lung disease (ILD) is a serious complication that represents the second leading cause of death in patients with rheumatoid arthritis (RA). Treatment of RA-ILD remains controversial. The absence of randomized clinical trials and specific ACR or EULAR therapeutic guidelines makes it difficult to establish solid therapeutic recommendations on this issue. In this scenario, real-world data is especially valuable. OBJECTIVE To review the literature evidence on the efficacy and safety of abatacept (ABA) for the treatment of rheumatoid arthritis (RA) with associated interstitial lung disease (ILD), given its clinical relevance and the lack of consensus on its therapeutic management. METHODS PUBMED and EMBASE were searched from the date of approval of ABA to the end of 2020 using a combination of RA, ILD and ABA terms following PRISMA guidelines. Identified studies were evaluated by two independent investigators. RESULTS Nine original studies (1 case series and 8 observational studies) were selected for inclusion in the systematic review. No randomized trial or meta-analysis were identified. The mean age of patients ranged from 61.2 to 75 years and the mean RA duration varied from 7.4 to 18 years. Subcutaneous ABA (74.5%-91%) predominated in combination with conventional synthetic DMARDs (csDMARDs) (58%-75%), and it was used as first-line biologic agent in 22.8%-64.9% of the patients. The mean course of ILD ranged from 1 to 6.7 years, being usual and nonspecific interstitial pneumonia the most frequent patterns. Improvement or stabilization of ILD imaging (76.6%-92.7%) and FVC or DLCO (>85%) was described after a mean follow-up of 17.4-47.8 months, regardless of the pattern of lung involvement, being more remarkable in patients with shorter evolution of ILD. ABA led to significantly lower ILD worsening rates than TNF inhibitors (TNFi) and was associated with a 90% reduction in the relative risk of deterioration of ILD at 24 months of follow-up compared to TNFi and csDMARDs. Combination with methotrexate may have a corticoid-sparing effect. No unexpected adverse events were identified. CONCLUSIONS Current evidence suggests that ABA may be a plausible alternative to treat RA patients with ILD. It would be highly desirable to develop prospective randomized controlled studies to confirm these findings.
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Affiliation(s)
- Esther F Vicente-Rabaneda
- Rheumatology Division, Hospital Universitario de la Princesa, IIS-Princesa, C/Diego de León 62, 28006 Madrid, Spain.
| | - Belén Atienza-Mateo
- Rheumatology Division, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla 25, 39008 Santander, Cantabria, Spain.
| | - Ricardo Blanco
- Rheumatology Division, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla 25, 39008 Santander, Cantabria, Spain.
| | - Lorenzo Cavagna
- University and IRCCS Policlinico S. Matteo Foundation, Viale Camillo Golgi 19, 27100 Pavia, Italy.
| | - Julio Ancochea
- Pneumology Division, Hospital Universitario de la Princesa, IIS-Princesa, C/Diego de León 62, 28006 Madrid, Spain; Cátedra UAM-Roche, EPID-Future, Medicine Department, Universidad Autónoma de Madrid, C/Arzobispo Morcillo 4, 28029 Madrid, Spain.
| | - Santos Castañeda
- Rheumatology Division, Hospital Universitario de la Princesa, IIS-Princesa, C/Diego de León 62, 28006 Madrid, Spain; Cátedra UAM-Roche, EPID-Future, Medicine Department, Universidad Autónoma de Madrid, C/Arzobispo Morcillo 4, 28029 Madrid, Spain.
| | - Miguel Á González-Gay
- Rheumatology Division, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla 25, 39008 Santander, Cantabria, Spain; University of Cantabria, Santander, Spain; University of Witwatersrand, Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, South Africa.
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Fernández-Díaz C, Atienza-Mateo B, Castañeda S, Melero-Gonzalez RB, Ortiz-SanJuan F, Loricera J, Casafont-Solé I, Rodríguez-García S, Aguilera-Cros C, Villa-Blanco I, Raya-Alvarez E, Ojeda-García C, Bonilla G, López-Robles A, Arboleya L, Narváez J, Cervantes E, Maiz O, Alvarez-Rivas MN, Cabezas I, Salgado E, Hidalgo-Calleja C, Fernández S, Fernández JC, Ferraz-Amaro I, González-Gay MA, Blanco R. ABATACEPT IN MONOTHERAPY VERSUS COMBINED IN INTERSTITIAL LUNG DISEASE OF RHEUMATOID ARTHRITIS. MULTICENTER STUDY OF 263 CAUCASIAN PATIENTS. Rheumatology (Oxford) 2021; 61:299-308. [PMID: 33779697 DOI: 10.1093/rheumatology/keab317] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To assess the efficacy and safety of abatacept (ABA) in monotherapy (ABAMONO) versus combined-ABA, ABA plus methotrexate (ABAMTX) or ABA plus non-MTX conventional-DMARDs (ABANON-MTX), in Rheumatoid Arthritis (RA) patients with Interstitial Lung Disease (ILD) (RA-ILD). METHODS Restrospective multicenter study of RA-ILD Caucasian patients treated with ABA. We analyzed in the three groups (ABAMONO, ABAMTX, ABANON-MTX) the following outcome variables: a) Dyspnea b) FVC and DLCO c) chest HRCT, d) DAS28-ESR, e) corticosteroid-sparing effect, f) ABA retention and side-effects. Differences between basal and final follow-up were evaluated. Multivariable linear regression was used to assess the differences between the three groups. RESULTS We studied 263 RA-ILD patients (mean age 64.6±10 years) [ABAMONO (n = 111), ABAMTX (n = 46) and ABANON-MTX (n = 106)]. At baseline, ABAMONO patients were older (67±10 years) and took higher prednisone dose (10 [IQR 5-15] mg/day). At that time, there were no statistically significant differences in sex, seropositivity, ILD patterns, FVC and DLCO or disease duration. Following treatment, in all groups, most patients experienced stabilization or improvement in FVC, DLCO, dyspnoea, chest-HRCT as well as improvement in DAS28-ESR. A statistically significant difference between basal and final follow-up was only found in corticosteroid-sparing effect in the group on combined-ABA (ABAMTX or ABANON-MTX). However, in the multivariable analysis, there were no differences in any outcome variables between the three groups. CONCLUSION In Caucasian individuals with RA-ILD, ABA in monotherapy or combined with MTX or with other conventional-DMARDS seems to be equally effective and safe. However, a corticosteroid-sparing effect is only observed with combined-ABA.
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Affiliation(s)
| | | | - Santos Castañeda
- HU La Princesa, IIS-Princesa, Cátedra UAM-Roche (EPID-Future), UAM, Madrid
| | | | | | - Javier Loricera
- HU Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ricardo Blanco
- HU Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander
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Kedra J, Nocturne G, Mariette X, Seror R. Inflammation-targeted therapies and cancer. Joint Bone Spine 2021; 88:105176. [PMID: 33771759 DOI: 10.1016/j.jbspin.2021.105176] [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: 12/15/2020] [Accepted: 02/24/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To review and analyze the current knowledge on the risk of malignancy associated with inflammation-targeted therapies in rheumatic diseases. METHODS We performed a non-systematic literature review on PubMEd MEDLINE by screening randomized controlled trials, meta-analyses, reviews, and observational studies focusing on malignancies and inflammation-targeted therapies including TNF inhibitors, other biologics and JAK inhibitors in rheumatic diseases. RESULTS Data from literature are reassuring regarding the overall risk of incident and recurrent cancer with TNF inhibitors. The risk of lymphoma is more difficult to analyze and data are controversial; however, in most of the studies, this risk does not seem to be significanlty increased. By contrast, there is probably an increased risk of non-melanoma skin cancer associated with TNF inhibitors, as with other immunosuppressants. There is no signal for an increased risk of malignancies with other biological DMARDs, but additional data are needed. A recent post-marketing surveillance study found out an increased risk of malignancies for tofacitinib compared with TNFi; additional data are, therefore, urgently needed to confirm or not these results. CONCLUSION Data are presently reassuring regarding the overall risk of cancer, whatever the inflammation-targeted treatment. However, additional data are needed for non-TNF biologics and JAK-inhibitors.
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Affiliation(s)
- Joanna Kedra
- Inserm U1184, service de rhumatologie, fédération hospitalo-universitaire CARE (Cancer and Autoimmunity Relationship), université Paris-Saclay, hôpital Bicêtre, AP-HP, Le-Kremlin-Bicêtre, France; Inserm UMR S1136, institut Pierre-Louis d'épidémiologie et de santé publique, Sorbonne Université, Paris, France
| | - Gaetane Nocturne
- Inserm U1184, service de rhumatologie, fédération hospitalo-universitaire CARE (Cancer and Autoimmunity Relationship), université Paris-Saclay, hôpital Bicêtre, AP-HP, Le-Kremlin-Bicêtre, France
| | - Xavier Mariette
- Inserm U1184, service de rhumatologie, fédération hospitalo-universitaire CARE (Cancer and Autoimmunity Relationship), université Paris-Saclay, hôpital Bicêtre, AP-HP, Le-Kremlin-Bicêtre, France
| | - Raphaèle Seror
- Inserm U1184, service de rhumatologie, fédération hospitalo-universitaire CARE (Cancer and Autoimmunity Relationship), université Paris-Saclay, hôpital Bicêtre, AP-HP, Le-Kremlin-Bicêtre, France.
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Abstract
Biologic therapies have revolutionized the treatment of immune-mediated inflammatory diseases but are associated with an increased risk of serious and opportunistic infections, including tuberculosis and nontuberculous mycobacterial disease. Despite this increased risk, the overall risk-benefit ratio remains favorable with appropriate screening and risk assessment. Further population-based studies are needed to establish the risk of tuberculosis and nontuberculous mycobacterial disease with the new biologics. This article highlights the incidence and drug-specific risk of tuberculous and nontuberculous mycobacterial infection in the setting of biologics, screening and prevention, and treatment of latent tuberculosis in this setting.
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Affiliation(s)
- Cassandra Calabrese
- Department of Rheumatologic & Immunologic Disease, Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk A50, Cleveland, OH 44195, USA.
| | - Kevin L Winthrop
- Division of Infectious Diseases, Schools of Medicine and Public Health, Oregon Health and Science University, OHSU, 3181 Sam Jackson Road, Mail Code: Gaines Hall, Portland, OR 97239, USA
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20
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Kavanaugh A, Westhovens RR, Winthrop KL, Lee SJ, Tan Y, An D, Ye L, Sundy JS, Besuyen R, Meuleners L, Stanislavchuk M, Spindler AJ, Greenwald M, Alten R, Genovese MC. Safety and Efficacy of Filgotinib: Up to 4-year Results From an Open-label Extension Study of Phase II Rheumatoid Arthritis Programs. J Rheumatol 2021; 48:1230-1238. [PMID: 33526618 DOI: 10.3899/jrheum.201183] [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] [Accepted: 01/14/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The long-term safety and efficacy of filgotinib (from phase II studies), with or without methotrexate (MTX), for the treatment of patients with rheumatoid arthritis was assessed in DARWIN 3, a long-term, open-label extension study (ClinicalTrials.gov: NCT02065700). METHODS Eligible patients completing the 24-week DARWIN 1 (filgotinib + MTX) and DARWIN 2 (filgotinib monotherapy) studies entered DARWIN 3, where they received filgotinib 200 mg/day, except for 15 men who received filgotinib 100 mg/day. Safety analyses were performed using the safety analysis set and the exposure-adjusted incidence rate (EAIR) of treatment-emergent adverse events (TEAEs) was calculated. Efficacy was assessed from baseline in the parent studies. RESULTS Of 790 patients completing the phase II parent studies, 739 enrolled in the study. Through April 2019, 59.5% of patients had received ≥ 4 years of the study drug. Mean (SD) exposure to filgotinib was 3.55 (1.57) years in the filgotinib + MTX group and 3.38 (1.59) years in the filgotinib monotherapy group. EAIR per 100 patient-years of exposure for TEAEs was 24.6 in the filgotinib + MTX group and 25.8 in the filgotinib monotherapy group, and for serious TEAEs, the EAIR was 3.1 and 4.3, respectively. American College of Rheumatology 20/50/70 responses among patients remaining in the study could be maintained through 4 years, with 89.3%/69.6%/49.1% of the filgotinib + MTX group and 91.8%/69.4%/44.4% of the monotherapy group maintaining ACR20/50/70 responses, respectively, based on observed data. CONCLUSION Filgotinib was well tolerated with a 4-year safety profile comparable to that of the parent trials, both in patients receiving combination therapy with MTX or as monotherapy.
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Affiliation(s)
- Arthur Kavanaugh
- A. Kavanaugh, MD, University of California San Diego, La Jolla, California, USA;
| | - Rene R Westhovens
- R.R. Westhovens, MD, PhD, KU Leuven, Skeletal Biology and Engineering Research Center, Leuven, Belgium
| | - Kevin L Winthrop
- K.L. Winthrop, MD, MPH, Oregon Health and Science University, Portland, Oregon, USA
| | - Susan J Lee
- S.J. Lee, MD, Y. Tan, PhD, D. An, PhD, L. Ye, PhD, J.S. Sundy, MD, PhD, Gilead Sciences Inc., Foster City, California, USA
| | - YingMeei Tan
- S.J. Lee, MD, Y. Tan, PhD, D. An, PhD, L. Ye, PhD, J.S. Sundy, MD, PhD, Gilead Sciences Inc., Foster City, California, USA
| | - Di An
- S.J. Lee, MD, Y. Tan, PhD, D. An, PhD, L. Ye, PhD, J.S. Sundy, MD, PhD, Gilead Sciences Inc., Foster City, California, USA
| | - Lei Ye
- S.J. Lee, MD, Y. Tan, PhD, D. An, PhD, L. Ye, PhD, J.S. Sundy, MD, PhD, Gilead Sciences Inc., Foster City, California, USA
| | - John S Sundy
- S.J. Lee, MD, Y. Tan, PhD, D. An, PhD, L. Ye, PhD, J.S. Sundy, MD, PhD, Gilead Sciences Inc., Foster City, California, USA
| | - Robin Besuyen
- R. Besuyen, MD, L. Meuleners, MS, Galapagos NV, Mechelen, Belgium
| | - Luc Meuleners
- R. Besuyen, MD, L. Meuleners, MS, Galapagos NV, Mechelen, Belgium
| | - Mykola Stanislavchuk
- M. Stanislavchuk, MD, National Pirogov Memorial Medical University, Vinnytsya, Ukraine
| | - Alberto J Spindler
- A.J. Spindler, MD, Centro Medico Privado de Reumatologia, San Miguel de Tucuman, Argentina
| | - Maria Greenwald
- M. Greenwald, MD, Desert Medical Advances, Palm Desert, California, USA
| | - Rieke Alten
- R. Alten, MD, Schlosspark Klinik, University Medicine Berlin, Berlin, Germany
| | - Mark C Genovese
- M.C. Genovese, MD, Stanford University School of Medicine, Division of Immunology & Rheumatology, Stanford, and Gilead Sciences Inc., Foster City, California, USA
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21
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Wertheimer T, Dohse M, Afram G, Weber D, Heidenreich M, Holler B, Kattner AS, Neubauer A, Mielke S, Ljungman P, Holler E, Herr W, Edinger M, Martínez AP, Fante M, Wolff D. Abatacept as salvage therapy in chronic graft-versus-host disease-a retrospective analysis. Ann Hematol 2021; 100:779-787. [PMID: 33515310 PMCID: PMC7914235 DOI: 10.1007/s00277-021-04434-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 01/18/2021] [Indexed: 01/08/2023]
Abstract
The immunomodulatory fusion protein abatacept has recently been investigated for the treatment of steroid-refractory chronic graft-versus-host disease (cGvHD) in a phase 1 clinical trial. We analyzed the safety and efficacy of abatacept for cGvHD therapy in a retrospective study with 15 patients who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) and received abatacept for cGvHD with a median age of 49 years. Grading was performed as part of the clinical routine according to the National Institute of Health’s (NIH) consensus criteria at initiation of abatacept and 1, 3, 6, 9 and 12 months thereafter. The median time of follow-up was 191 days (range 55–393 days). Best overall response rate (ORR) was 40%. In particular, patients with bronchiolitis obliterans syndrome showed significant clinical improvement and durable responses following abatacept treatment with a response rate of 89% based on improvement in lung severity score (n = 6) or stabilized lung function (n = 4) or both (n = 3). Infectious complications CTCAE °III or higher were observed in 3/15 patients. None of the patients relapsed from the underlying malignancy. Thus, abatacept appears to be a promising treatment option for cGvHD, in particular for patients with lung involvement. However, further evaluation within a phase 2 clinical trial is required.
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Affiliation(s)
- Tobias Wertheimer
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
| | - Marius Dohse
- Department of Hematology, Oncology and Immunology, University Hospital Giessen and Marburg, Marburg, Germany
| | - Gabriel Afram
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Daniela Weber
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Martin Heidenreich
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Barbara Holler
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Anna-Sophia Kattner
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Andreas Neubauer
- Department of Hematology, Oncology and Immunology, University Hospital Giessen and Marburg, Marburg, Germany
| | - Stephan Mielke
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Per Ljungman
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Ernst Holler
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.,Regensburg Center for Interventional Immunology, Regensburg, Germany
| | - Wolfgang Herr
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.,Regensburg Center for Interventional Immunology, Regensburg, Germany
| | - Matthias Edinger
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.,Regensburg Center for Interventional Immunology, Regensburg, Germany
| | - Antonio Pérez Martínez
- Pediatric Hematology, Oncology and Stem Cell Transplantation, Hospital Universitario La Paz, Universidad Autonóma de Madrid, Madrid, Spain
| | - Matthias Fante
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Daniel Wolff
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.,Regensburg Center for Interventional Immunology, Regensburg, Germany
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22
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Targeted therapies in interstitial lung disease secondary to systemic autoimmune rheumatic disease. Current status and future development. Autoimmun Rev 2020; 20:102742. [PMID: 33333235 DOI: 10.1016/j.autrev.2020.102742] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 07/25/2020] [Indexed: 12/22/2022]
Abstract
Autoimmune rheumatic diseases (ARD) are characterized by systemic manifestations and multiple organ involvement, including the lung. Interstitial Lung Disease (ILD) is a cardinal manifestation of lung involvement in patients with ARD and is associated with significant morbidity and mortality. Corticosteroids and immunosuppressive drugs are used as first -line treatment. Targeted therapies, such as biological disease modifying antirheumatic drugs (DMARDS) and anti- fibrotic agents are new treatment options. In this review we discuss the role of targeted therapies in patients with ILD secondary to ARD.
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23
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Zafari P, Golpour M, Hafezi N, Bashash D, Esmaeili SA, Tavakolinia N, Rafiei A. Tuberculosis comorbidity with rheumatoid arthritis: Gene signatures, associated biomarkers, and screening. IUBMB Life 2020; 73:26-39. [PMID: 33217772 DOI: 10.1002/iub.2413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/01/2020] [Accepted: 11/04/2020] [Indexed: 12/19/2022]
Abstract
Rheumatoid arthritis (RA) is known to be related to an elevated risk of infections because of its pathobiology and the use of immunosuppressive therapies. Reactivation of latent tuberculosis (TB) infection is a serious issue in patients with RA, especially after receiving anti-TNFs therapy. TNF blocking reinforces the TB granuloma formation and maintenance and the growth of Mycobacterium tuberculosis (Mtb). After intercurrent of TB infection, the standard recommendation is that the treatment with TNF inhibitors to be withheld despite its impressive effect on suppression of inflammation until the infection has resolved. Knowing pathways and mechanisms that are common between two diseases might help to find the mechanistic basis of this comorbidity, as well as provide us a new approach to apply them as therapeutic targets or diagnostic biomarkers. Also, screening for latent TB before initiation of an anti-TNF therapy can minimize complications. This review summarizes the shared gene signature between TB and RA and discusses the biomarkers for early detection of this infection, and screening procedures as well.
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Affiliation(s)
- Parisa Zafari
- Department of Immunology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.,Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
| | - Monireh Golpour
- Molecular and Cellular Biology Research Center, Student Research Committee, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Nasim Hafezi
- Department of Immunology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Davood Bashash
- Department of Hematology and Blood Banking, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed-Alireza Esmaeili
- Immunology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Immunology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Naeimeh Tavakolinia
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Rafiei
- Department of Immunology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
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24
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Romano C, Esposito S, Ferrara R, Cuomo G. Tailoring biologic therapy for real-world rheumatoid arthritis patients. Expert Opin Biol Ther 2020; 21:661-674. [PMID: 33147106 DOI: 10.1080/14712598.2021.1847268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Introduction: The cornerstone of rheumatoid arthritis (RA) therapy relies on the treat-to-target strategy, which aims at dampening inflammation as soon as possible in order to achieve persistent low disease activity or, ideally, remission, according to validated disease activity measures. Traditional disease-modifying antirheumatic drugs (DMARDs) may be chosen in monotherapy or in combination as first-line therapy; in case of an unsatisfactory response after a 3-6-month trial, biologic therapy may be commenced.Areas covered: Real-life RA patients may present with concomitant comorbidities/complications or be in peculiar physiological states which raise more than one question as to which biotherapy may be more well suited considering the whole clinical picture. Therefore, a thorough literature search was performed to identify the most appropriate biologic therapy in each setting considered in this review.Expert opinion: Here we provide suggestions for the use of biologic drugs having a predictable better outcome in specific real-world conditions, so as to ideally profile the patient to the best of the current knowledge.
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Affiliation(s)
- Ciro Romano
- Department of Medicine, Clinical Immunology Outpatient Clinic, "Luigi Vanvitelli" University of Campania, Naples, Italy
| | - Sergio Esposito
- Department of Medicine, Clinical Immunology Outpatient Clinic, "Luigi Vanvitelli" University of Campania, Naples, Italy
| | - Roberta Ferrara
- Department of Medicine, Clinical Immunology Outpatient Clinic, "Luigi Vanvitelli" University of Campania, Naples, Italy
| | - Giovanna Cuomo
- Department of Medicine, Clinical Immunology Outpatient Clinic, "Luigi Vanvitelli" University of Campania, Naples, Italy
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25
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Fernández-Díaz C, Castañeda S, Melero-González RB, Ortiz-Sanjuán F, Juan-Mas A, Carrasco-Cubero C, Casafont-Solé I, Olivé A, Rodríguez-Muguruza S, Almodóvar-González R, Castellanos-Moreira R, Rodríguez-García SC, Aguilera-Cros C, Villa I, Ordóñez-Palau S, Raya-Alvarez E, Morales-Garrido P, Ojeda-García C, Moreno-Ramos MJ, Bonilla Hernán MG, Hernández Rodríguez I, López-Corbeto M, Andreu JL, Jiménez de Aberásturi JRD, Ruibal-Escribano A, Expósito-Molinero R, Pérez-Sandoval T, López-Robles AM, Carreira-Delgado P, Mena-Vázquez N, Urruticoechea-Arana A, Peralta-Ginés C, Arboleya-Rodríguez L, Narváez García FJ, Palma-Sánchez D, Cervantes Pérez EC, Maiz-Alonso O, Alvarez-Rivas MN, Fernández-Melón J, Vela Casasempere P, Cabezas-Rodríguez I, Castellvi-Barranco I, González-Montagut C, Blanco-Madrigal J, Del Val-Del Amo N, Fito MC, Rodríguez-Gómez M, Salgado-Pérez E, García-Magallón B, Hidalgo-Calleja C, López-Sánchez R, Fernández-Aguado S, Fernández-López JC, Castro-Oreiro S, Serrano-García I, García-Valle A, Romero-Yuste S, Expósito-Pérez L, Pérez-Albadalejo L, García-Aparicio A, Quillis-Marti N, Bernal-Vidal JA, Loricera-García J, Hernández JL, González-Gay MA, Blanco R. Abatacept in interstitial lung disease associated with rheumatoid arthritis: national multicenter study of 263 patients. Rheumatology (Oxford) 2020; 59:3906-3916. [DOI: 10.1093/rheumatology/keaa621] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/01/2020] [Indexed: 01/11/2023] Open
Abstract
Abstract
Objective
To assess the efficacy of abatacept (ABA) in RA patients with interstitial lung disease (ILD) (RA-ILD).
Methods
This was an observational, multicentre study of RA-ILD patients treated with at least one dose of ABA. ILD was diagnosed by high-resolution CT (HRCT). We analysed the following variables at baseline (ABA initiation), 12 months and at the end of the follow-up: Modified Medical Research Council (MMRC) scale (1-point change), forced vital capacity (FVC) or diffusion lung capacity for carbon monoxide (DLCO) (improvement or worsening ≥10%), HRCT, DAS on 28 joints evaluated using the ESR (DAS28ESR) and CS-sparing effect.
Results
We studied 263 RA-ILD patients [150 women/113 men; mean (s.d.) age 64.6 (10) years]. At baseline, they had a median duration of ILD of 1 (interquartile range 0.25–3.44) years, moderate or severe degree of dyspnoea (MMRC grade 2, 3 or 4) (40.3%), FVC (% of the predicted) mean (s.d.) 85.9 (21.8)%, DLCO (% of the predicted) 65.7 (18.3) and DAS28ESR 4.5 (1.5). The ILD patterns were: usual interstitial pneumonia (UIP) (40.3%), non-specific interstitial pneumonia (NSIP) (31.9%) and others (27.8%). ABA was prescribed at standard dose, i.v. (25.5%) or s.c. (74.5%). After a median follow-up of 12 (6–36) months the following variables did not show worsening: dyspnoea (MMRC) (91.9%); FVC (87.7%); DLCO (90.6%); and chest HRCT (76.6%). A significant improvement of DAS28ESR from 4.5 (1.5) to 3.1 (1.3) at the end of follow-up (P < 0.001) and a CS-sparing effect from a median 7.5 (5–10) to 5 (2.5–7.5) mg/day at the end of follow-up (P < 0.001) was also observed. ABA was withdrawn in 62 (23.6%) patients due to adverse events (n = 30), articular inefficacy (n = 27), ILD worsening (n = 3) and other causes (n = 2).
Conclusion
ABA may be an effective and safe treatment for patients with RA-ILD.
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Affiliation(s)
| | - Santos Castañeda
- Rheumatology Cátedra UAM-Roche (EPID-Future) HU La Princesa, IIS-Princesa, UAM, Madrid
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - José L Hernández
- Rheumatology, HU Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander
| | | | - Ricardo Blanco
- Rheumatology, HU Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander
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26
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Calabrese LH, Caporali R, Blank CU, Kirk AD. Modulating the wayward T cell: New horizons with immune checkpoint inhibitor treatments in autoimmunity, transplant, and cancer. J Autoimmun 2020; 115:102546. [PMID: 32980229 DOI: 10.1016/j.jaut.2020.102546] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 09/02/2020] [Accepted: 09/14/2020] [Indexed: 12/20/2022]
Abstract
The T-cell response is regulated by the balance between costimulatory and coinhibitory signals. Immune checkpoints are essential for efficient T-cell activation, but also for maintaining self-tolerance and protecting tissues from damage caused by the immune system, and for providing protective immunity. Modulating immune checkpoints can serve diametric goals, such that blocking a coinhibitory molecule can unleash anti-cancer immunity whereas stimulating the same molecule can reduce an over-reaction in autoimmune disease. The purpose of this review is to examine the regulation of T-cell costimulation and coinhibition, which is central to the processes underpinning autoimmunity, transplant rejection and immune evasion in cancer. We will focus on the immunomodulation agents that regulate these unwanted over- and under-reactions. The use of such agents has led to control of symptoms and slowing of progression in patients with rheumatoid arthritis, reduced rejection rates in transplant patients, and prolonged survival in patients with cancer. The management of immune checkpoint inhibitor treatment in certain challenging patient populations, including patients with pre-existing autoimmune conditions or transplant patients who develop cancer, as well as the management of immune-related adverse events in patients receiving antitumor therapy, is examined. Finally, the future of immune checkpoint inhibitors, including examples of emerging targets that are currently in development, as well as recent insights gained using new molecular techniques, is discussed. T-cell costimulation and coinhibition play vital roles in these diverse therapeutic areas. Targeting immune checkpoints continues to be a powerful avenue for the development of agents suitable for treating autoimmune diseases and cancers and for improving transplant outcomes. Enhanced collaboration between therapy area specialists to share learnings across disciplines will improve our understanding of the opposing effects of treatments for autoimmune disease/transplant rejection versus cancer on immune checkpoints, which has the potential to lead to improved patient outcomes.
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Affiliation(s)
| | - Roberto Caporali
- University of Milan, Department of Clinical Sciences and Community Health and Rheumatology Division, ASST Pini-CTO Hospital, Milan, Italy
| | | | - Allan D Kirk
- Department of Surgery, Duke University School of Medicine, Durham, NC, United States
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27
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Manfredi A, Luppi F, Cassone G, Vacchi C, Salvarani C, Sebastiani M. Pathogenesis and treatment of idiopathic and rheumatoid arthritis-related interstitial pneumonia. The possible lesson from COVID-19 pneumonia. Expert Rev Clin Immunol 2020; 16:751-770. [PMID: 32722946 PMCID: PMC7594185 DOI: 10.1080/1744666x.2020.1803064] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 07/27/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Main clinical manifestations of SARS-CoV-2 infection are characterized by fever, dyspnea, and interstitial pneumonia, frequently evolving in acute respiratory distress syndrome (ARDS). AREAS COVERED Features of coronavirus disease 2019 (COVID-19) presents some common points with interstitial lung disease (ILD) both idiopathic and related to rheumatoid arthritis (RA), typically characterized by a chronic progression over time and possibly complicated by acute exacerbation (AE). The study of common pathogenetic mechanisms, such as the involvement of toll-like receptor 4, could contribute to the knowledge and treatment of idiopathic and RA-ILD. Moreover, hyperinflammation, mainly characterized by increase of effector T-cells and inflammatory cytokines, and activation of coagulation cascade, observed in COVID-19 related ARDS have been already shown in patients with AE of idiopathic and RA-ILD. A literature search was performed in PubMed, Embase, Scopus, and Web of Science, together with a manual search in COVID-resource centers of the main journals. EXPERT OPINION Despite the uncertainty about pathogenetic aspects about COVID-19- pneumonia, it could be a possible model for other forms of ILD and AE. The great amount of data from studies on COVID-19 could be helpful in proposing safe therapeutic approaches for RA-ILD, in understanding pathogenesis of usual interstitial pneumonia and to develop new therapeutic strategies for AE.
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Affiliation(s)
- A Manfredi
- Rheumatology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico Di Modena, Modena, Italy
| | - F Luppi
- Department of Medicine and Surgery, University of Milan Bicocca, Respiratory Unit, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - G Cassone
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
- Rheumatology Unit, Santa Maria Hospital, IRCCS, Reggio Emilia, Italy
| | - C Vacchi
- Rheumatology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico Di Modena, Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - C Salvarani
- Rheumatology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico Di Modena, Modena, Italy
- Rheumatology Unit, Santa Maria Hospital, IRCCS, Reggio Emilia, Italy
| | - M Sebastiani
- Rheumatology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico Di Modena, Modena, Italy
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28
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Evangelatos G, Koulouri V, Iliopoulos A, Fragoulis GE. Tuberculosis and targeted synthetic or biologic DMARDs, beyond tumor necrosis factor inhibitors. Ther Adv Musculoskelet Dis 2020; 12:1759720X20930116. [PMID: 32612710 PMCID: PMC7309385 DOI: 10.1177/1759720x20930116] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 05/07/2020] [Indexed: 12/12/2022] Open
Abstract
Patients with autoimmune rheumatic diseases (ARD) have an increased risk for tuberculosis (TB). The use of tumor necrosis factor inhibitors (TNFi) and glucocorticoids in these patients has been associated with an increased prevalence of latent TB reactivation. Over the last few years, several biologic disease-modifying anti-rheumatic drugs (bDMARDs), other than TNFi (e.g. rituximab, abatacept, tocilizumab, secukinumab) and targeted synthetic DMARDs (tsDMARDs) [e.g. apremilast, Janus kinase (JAK) inhibitors] have been used for the treatment of patients with ARD. For many of these drugs, especially the newer ones like JAK inhibitors or antibodies against interleukin (IL)-23, most data stem from randomized clinical trials and few are available from real life clinical experience. We sought to review the current evidence for TB risk in patients with ARD treated with tsDMARDs or bDMARDs, other than TNFi. It seems that some of these drugs are associated with a lower TB risk, indirectly compared with TNFi treatment. In fact, it appears that rituximab, apremilast and inhibitors of IL-17 and IL-23 might be safer, while more data are needed for JAK inhibitors. As seen in TNFi, risk for TB is more pronounced in TB-endemic areas. Screening for latent TB must precede initiation of any tsDMARDs or bDMARDs. The growing use of non-TNFi agents has raised the need for more real-life studies that would compare the risk for TB between TNFi and other treatment modalities for ARD. Knowledge about the TB-safety profile of these drugs could help in the decision of drug choice in patients with confirmed latent TB infection or in TB endemic areas.
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Affiliation(s)
- Gerasimos Evangelatos
- Rheumatology Department, 417 Army Share Fund Hospital (NIMTS), Monis Petraki 10-12, Athens, 11521, Greece
| | - Vasiliki Koulouri
- Department of Physiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexios Iliopoulos
- Rheumatology Department, 417 Army Share Fund Hospital (NIMTS), Athens, Greece
| | - George E Fragoulis
- Rheumatology Unit, First Department of Propaedeutic Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
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Westhovens R, Connolly SE, Margaux J, Vanden Berghe M, Maertens M, Van den Berghe M, Elbez Y, Chartier M, Baeke F, Robert S, Malaise M. Up to 5-year retention of abatacept in Belgian patients with moderate-to-severe rheumatoid arthritis: a sub-analysis of the international, observational ACTION study. Rheumatol Int 2020; 40:1409-1421. [PMID: 32556473 PMCID: PMC7371673 DOI: 10.1007/s00296-020-04619-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 05/31/2020] [Indexed: 11/26/2022]
Abstract
Favorable efficacy and safety profiles have been demonstrated for abatacept in patients with rheumatoid arthritis (RA) in randomized controlled trials, but these data require validation during long-term follow-ups in routine clinical practice. This study explored long-term safety and retention rates in RA patients treated with intravenous abatacept in the Belgian cohort of the international AbataCepT In rOutiNe clinical practice (ACTION) study (NCT02109666). This non-interventional, observational, longitudinal study included Belgian patients aged ≥ 18 years with moderate-to-severe RA who started intravenous abatacept treatment as first- or second/further-line biologic therapy in routine clinical practice. Between October 2010 and December 2012, 141 patients were enrolled in this cohort, of whom 135 evaluable patients (6 biologic-naïve; 129 previously exposed to ≥ 1 prior biologic disease modifying anti-rheumatic drugs) were eligible for the descriptive analysis; 131/135 were included in the effectiveness analysis. Mean disease duration was 10.5 years (standard deviation 9.7) before abatacept initiation. RA patients presented with high disease activity and comorbidity rate, having failed multiple previous treatment options. In this cohort, the 5-year abatacept retention rate was 34% (95% confidence interval, 23-45%) per protocol, and 51% (95% confidence interval, 40-61%) when temporary discontinuations of abatacept > 84 days (n = 24) were not considered as treatment discontinuations. After 5 years of abatacept treatment, clinical outcomes were favorable [good/moderate European League Against Rheumatism (EULAR) responses in 91.7% patients]. No new safety signals were detected for abatacept in routine clinical practice. In this difficult-to-treat Belgian RA population, high retention rates, good clinical outcomes and favorable safety profile were observed with abatacept.
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Affiliation(s)
- R. Westhovens
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Center Leuven, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | | | - J. Margaux
- Rheumatology and Physical Medicine Department, Erasme Hospital, Brussels, Belgium
| | | | | | | | - Y. Elbez
- Excelya, Boulogne-Billancourt, France
| | - M. Chartier
- Bristol-Myers Squibb, Rueil Malmaison, France
| | - F. Baeke
- Bristol-Myers Squibb, Braine-l’Alleud, Belgium
| | - S. Robert
- Bristol-Myers Squibb, Braine-l’Alleud, Belgium
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Burmester GR, Curtis JR, Yun H, FitzGerald O, Winthrop KL, Azevedo VF, Rigby WFC, Kanik KS, Wang C, Biswas P, Jones T, Palmetto N, Hendrikx T, Menon S, Rojo R. An Integrated Analysis of the Safety of Tofacitinib in Psoriatic Arthritis across Phase III and Long-Term Extension Studies with Comparison to Real-World Observational Data. Drug Saf 2020; 43:379-392. [PMID: 32006348 PMCID: PMC7105422 DOI: 10.1007/s40264-020-00904-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Tofacitinib is an oral Janus kinase inhibitor for the treatment of psoriatic arthritis (PsA). OBJECTIVE Our objective was to compare the incidence rates (IRs) of adverse events in tofacitinib clinical trials and real-world observational data for alternative treatments. METHODS The tofacitinib "dose-comparison cohort" included months 0-12 of two phase III studies (tofacitinib 5 [n = 238] and 10 [n = 236] mg twice daily [BID]); the "all-tofacitinib comparison cohort" (n = 783) included two phase III and one ongoing long-term extension study (data cutoff May 2016). An "observational comparison cohort" (n = 5799) comprised patients initiating a conventional synthetic disease-modifying antirheumatic drug (DMARD), biologic DMARD, or apremilast in the US Truven MarketScan database from 2010 to 2015. IRs for serious infections (SIEs; requiring hospitalization), herpes zoster (HZ), malignancies (excluding non-melanoma skin cancer [NMSC]), NMSC, and major adverse cardiovascular events (MACE) across cohorts were qualitatively compared. RESULTS IRs (patients with events/100 patient-years) for SIEs were similar between the tofacitinib dose-comparison cohort (5 mg BID: 1.3; 10 mg BID: 2.0) and the observational comparison cohort (1.1-7.9; treatment dependent). The tofacitinib dose-comparison cohort had a higher rate of HZ (5 mg BID: 2.0; 10 mg BID: 2.7) than did the observational comparison cohort (0.8-2.0). IRs for NMSC were generally lower in the all-tofacitinib comparison cohort (0.5) than in the observational comparison cohort (0.4-6.0). IRs for MACE, malignancies excluding NMSC, and NMSC were similar between cohorts. CONCLUSION In patients with PsA, tofacitinib had a safety profile similar to that of other systemic therapies in real-world settings, except for the risk of HZ, a known risk of tofacitinib. TRIAL REGISTRATION ClinicalTrials.gov: NCT01877668; NCT01882439; NCT01976364.
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Affiliation(s)
- Gerd R Burmester
- Charité - University Medicine Berlin, Charitéplatz 1, 11017, Berlin, Germany
| | | | - Huifeng Yun
- University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Oliver FitzGerald
- Department of Rheumatology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Kevin L Winthrop
- Oregon Health and Science University, 3181 SW Sam Jackson Park Road L457, Portland, OR, 97239-3098, USA
| | - Valderilio F Azevedo
- Universidade Federal do Paraná, Rua XV de Novembro, Rua Alvaro Alvin 224 casa 18, Curitiba, Paraná, 80440080, Brazil
| | - William F C Rigby
- Geisel School of Medicine at Dartmouth, One Medical Center Drive, Lebanon, NH, 03756, USA
| | - Keith S Kanik
- Pfizer Inc, 445 Eastern Point Rd (MS 8260-2578), Groton, CT, 06340, USA
| | - Cunshan Wang
- Pfizer Inc, 445 Eastern Point Rd (MS 8260-2578), Groton, CT, 06340, USA
| | | | | | | | | | - Sujatha Menon
- Pfizer Inc, 445 Eastern Point Rd (MS 8260-2578), Groton, CT, 06340, USA
| | - Ricardo Rojo
- Pfizer Inc, 445 Eastern Point Rd (MS 8260-2578), Groton, CT, 06340, USA.
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Rachid O, Osman A, Abdi R, Haik Y. CTLA4-Ig (abatacept): a promising investigational drug for use in type 1 diabetes. Expert Opin Investig Drugs 2020; 29:221-236. [PMID: 32031422 DOI: 10.1080/13543784.2020.1727885] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Introduction: Type 1 diabetes (T1D) is an autoimmune disease that results from the destruction of insulin-producing beta cells in the pancreas; it leads to the under or nonproduction of insulin. T1D is associated with numerous life-threatening micro- and macro-vascular complications and early deaths, hence the development of preventative strategies is a priority for research.Areas covered: The authors outline the drawbacks of available treatments for T1D and assess the three key strategies for prevention, including immunomodulatory therapies which hold the most potential. This article examines CTLA4-Ig and its efficacy and safety profiles. Finally, the pharmacokinetic parameters and pharmacodynamic markers of abatacept are shown in vivo and in clinical trials, guiding dosage regimen recommendations for future investigational studies.Expert opinion: Immunomodulation is one of the promising strategies for decelerating the progression of beta-cell destruction after the onset of T1D. It holds the advantage of specific immune modulation without systemic general immunosuppression. Preclinical and clinical studies have yielded promising data on the use of CTLA4-Ig in T1D. Variations in response to CTLA4-Ig might be partially explained by the existence of multiple T1D subtypes with varying baseline innate inflammatory/regulatory bias and the rate of C-peptide decline.
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Affiliation(s)
- Ousama Rachid
- Department of Pharmaceutical Sciences, College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | - Aisha Osman
- Department of Pharmaceutical Sciences, College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | - Reza Abdi
- Transplantation Research Center, Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Yousef Haik
- Sustainable Development, College of Science and Engineering, Hamad Bin Khalifa University, Doha, Qatar
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Chiu YM, Chen DY. Infection risk in patients undergoing treatment for inflammatory arthritis: non-biologics versus biologics. Expert Rev Clin Immunol 2020; 16:207-228. [PMID: 31852268 DOI: 10.1080/1744666x.2019.1705785] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction: Despite the therapeutic effectiveness of biologics targeting immune cells or cytokines in patients with inflammatory arthritis, which reflects their pathogenic roles, an increased infection risk is observed in those undergoing biological treatment. However, there are limited data regarding the comparison of infection risks in inflammatory arthritis patients treated with non-biologics (csDMARDs), biologics (bDMARDs), including tumor necrosis factor (TNF) inhibitors and non-TNF inhibitors, or targeted synthetic (ts)DMARDs.Areas covered: Through a review of English-language literature as of 30 June 2019, we focus on the existing evidence on the risk of infections caused by bacteria, Mycobacterium tuberculosis, and hepatitis virus in inflammatory arthritis patients undergoing treatment with csDMARDs, bDMARDs, or tsDMARDs.Expert opinion: While the risks of bacterial and mycobacterial infection are increased in arthritis patients treated with csDMARDs, the risks are further higher in those receiving bDMARDs therapy, particularly TNF inhibitors. Regarding HBV infection, antiviral therapy may effectively prevent HBV reactivation in patients receiving bDMARDs, especially rituximab. However, more data are needed to establish effective preventive strategies for HBsAg-negative/HBcAb-positive patients. It seems safe to use cyclosporine and TNF inhibitors in patients with HCV infection, while those undergoing rituximab therapies should be frequently monitored for HCV activity.Abbreviations: ABT: abatacept; ADA: adalimumab; AS: ankylosing spondylitis; bDMARDs: biologic disease-modifying anti-rheumatic drugs; CKD: chronic kidney disease; COPD: chronic obstructive pulmonary disease; CS: corticosteroids; CsA: cyclosporine A; csDMARDs: conventional synthetic disease-modifying anti-rheumatic drugs; CZP: certolizumab; DAAs: direct-acting antiviral agents; DM: diabetes mellitus; DOT: directly observed therapy; EIN: Emerging Infections Network; ETN: etanercept; GOL: golimumab; GPRD: General Practice Research Database; HBV: hepatitis B virus; HBVr: HBV reactivation; HBsAg+: HBsAg-positive; HBsAg-/anti-HBc+: HBsAg-negative anti-HBc antibodies-positive; HCV: hepatitis C virus; HCQ: hydroxychloroquine: IFX: infliximab; IL-6: interleukin-6; JAK: Janus kinase; LEF: leflunomide; LTBI: latent tuberculosis infection; mAb: monoclonal antibody; MTX: methotrexate; OR: odds ratio; PsA: psoriatic arthritis; PMS: post-marketing surveillance; RA: rheumatoid arthritis; TNF: tumor necrosis factor; TNFi: tumor necrosis factor inhibitor; SCK: secukinumab; SSZ: sulfasalazine; TOZ: tocilizumab; RCT: randomized controlled trial; RR: relative risk; RTX: rituximab; 3HP: 3-month once-weekly isoniazid plus rifapentine; TB: tuberculosis; tsDMARDs: targeted synthetic disease-modifying anti-rheumatic drugs; UTK: ustekinumab; WHO: World Health Organization.
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Affiliation(s)
- Ying-Ming Chiu
- Rheumatology and Immunology Center, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - Der-Yuan Chen
- Rheumatology and Immunology Center, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan.,Translational Medicine Laboratory, Rheumatic Diseases Research Center, China Medical University Hospital, Taichung, Taiwan.,Program in Translational Medicine and Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan.,Institute of Biochemistry, Microbiology and Immunology, Chung Shan Medical University, Taichung, Taiwan
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Esposito AJ, Chu SG, Madan R, Doyle TJ, Dellaripa PF. Thoracic Manifestations of Rheumatoid Arthritis. Clin Chest Med 2019; 40:545-560. [PMID: 31376890 DOI: 10.1016/j.ccm.2019.05.003] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Rheumatoid arthritis (RA) is commonly associated with pulmonary disease that can affect any anatomic compartment of the thorax. The most common intrathoracic manifestations of RA include interstitial lung disease, airway disease, pleural disease, rheumatoid nodules, and drug-induced toxicity. Patients with RA with thoracic involvement often present with nonspecific respiratory symptoms, although many are asymptomatic. Therefore, clinicians should routinely consider pulmonary disease when evaluating any patient with RA, particularly one with known risk factors. The optimal screening, diagnostic, and treatment strategies for RA-associated pulmonary disease remain uncertain and are the focus of ongoing investigation.
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Affiliation(s)
- Anthony J Esposito
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Sarah G Chu
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Rachna Madan
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Tracy J Doyle
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Paul F Dellaripa
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA 02115, USA.
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Ozen G, Pedro S, Schumacher R, Simon TA, Michaud K. Safety of abatacept compared with other biologic and conventional synthetic disease-modifying antirheumatic drugs in patients with rheumatoid arthritis: data from an observational study. Arthritis Res Ther 2019; 21:141. [PMID: 31174592 PMCID: PMC6555014 DOI: 10.1186/s13075-019-1921-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 05/17/2019] [Indexed: 02/06/2023] Open
Abstract
Background To assess the risks of malignancies, infections and autoimmune diseases in patients with rheumatoid arthritis (RA) treated with abatacept compared with other biologic (b) disease-modifying antirheumatic drugs (DMARDs) or conventional synthetic (cs)DMARDs, in a US-wide observational RA cohort Methods Data were reviewed from patients (≥ 18 years) with RA who were registered with FORWARD, the National Databank for Rheumatic Diseases, and who initiated abatacept, other bDMARDs or csDMARDs between 2005 and 2015. Patients who switched treatment during the study could be allocated to more than one group. The incidence rates (IRs) by treatment were calculated for malignancies, hospitalized infections and autoimmune diseases identified by six monthly questionnaires and medical records. The hazard ratios (HRs) (95% confidence intervals [CIs]) for all outcomes with abatacept compared with other bDMARDs or csDMARDs were determined using marginal structural models adjusted for clinical confounders. Results In the study sample, 1496 initiated abatacept, 3490 initiated another bDMARD and 1520 initiated a csDMARD. The risk of malignancies with abatacept was not statistically significant versus other bDMARDs (HR [95% CI)] 1.89 [0.93, 3.84]) or versus csDMARDs (HR [95% CI] 0.93 [0.20, 4.27]). Patients receiving abatacept versus other bDMARDs were at a lower risk of hospitalized infections (HR [95% CI] 0.37 [0.18, 0.75]); the risk versus csDMARDs was lower with wide CIs (HR [95% CI] 0.31 [0.09, 1.05]). The relative risks for psoriasis were similar between treatment groups (HR [95% CI] 1.46 [0.76, 2.81] and HR [95% CI] 2.05 [0.59, 7.16] for abatacept versus other bDMARDs and versus csDMARDS, respectively). The IR (95% CI) of severe infusion/injection reactions was lower with abatacept compared with other bDMARDs (1.57 [1.11, 2.17] vs 2.31 [1.87, 2.82] per 100 patient-years, respectively). Conclusions In this analysis, abatacept was well tolerated and did not result in an overall increased risk of malignancies, infections or autoimmune diseases compared with other bDMARDs or csDMARDs. Electronic supplementary material The online version of this article (10.1186/s13075-019-1921-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gulsen Ozen
- University of Nebraska Medical Center, Omaha, NE, USA
| | - Sofia Pedro
- FORWARD, The National Databank for Rheumatic Diseases, Wichita, KS, USA
| | | | | | - Kaleb Michaud
- University of Nebraska Medical Center, Omaha, NE, USA. .,FORWARD, The National Databank for Rheumatic Diseases, Wichita, KS, USA.
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Simon TA, Soule BP, Hochberg M, Fleming D, Torbeyns A, Banerjee S, Boers M. Safety of Abatacept Versus Placebo in Rheumatoid Arthritis: Integrated Data Analysis of Nine Clinical Trials. ACR Open Rheumatol 2019; 1:251-257. [PMID: 31777801 PMCID: PMC6858048 DOI: 10.1002/acr2.1034] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective To assess the safety of abatacept treatment in rheumatoid arthritis (RA) using integrated data from multiple clinical trials. Methods Data from nine double‐blind, placebo‐controlled studies of abatacept treatment (seven intravenous, two subcutaneous) in patients with RA were pooled, focusing on safety events in the double‐blind treatment period of each study. Incidence rates (IRs) of adverse events (AEs) per 100 patient‐years of exposure were calculated for abatacept‐ and placebo‐treated patients. AEs in abatacept‐treated patients were combined regardless of dose and formulation. Results In total, 2653 patients received abatacept and 1485 received placebo, with 2357 and 1254 patient‐years of exposure, respectively. The mean (SD) durations of exposure in the abatacept and placebo groups were 10.8 (3.3) and 10.3 (3.5) months, respectively. The IRs (95% confidence interval [CI]) for serious AEs were 14.8 (13.3, 16.5) and 14.6 (12.5, 17.0) in the abatacept and placebo groups, respectively. Death occurred in 12 (0.5%) and 12 (0.8%) patients in the abatacept and placebo groups, respectively, and was most commonly caused by cardiac disorders. Malignancies were observed in 31 patients (1.2%) treated with abatacept (IR: 1.32 [95% CI: 0.90, 1.87]) versus 14 (0.9%; IR: 1.12 [0.61, 1.88]) who received placebo. Solid organ tumor was the most frequent malignancy reported in both groups (abatacept: 1.0%; IR: 1.11 [95% CI: 0.72, 1.62]; placebo: 0.8%; 0.96 [0.50, 1.67]). Conclusion In this integrated analysis, the IRs of safety events in the abatacept and placebo groups were similar with no new safety concerns identified.
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Affiliation(s)
| | | | | | | | | | | | - Maarten Boers
- Amsterdam University Medical Centers Vrije Universiteit Amsterdam Netherlands
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Phan K, Sebaratnam DF. JAK inhibitors for alopecia areata: a systematic review and meta-analysis. J Eur Acad Dermatol Venereol 2019; 33:850-856. [PMID: 30762909 DOI: 10.1111/jdv.15489] [Citation(s) in RCA: 123] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 01/18/2019] [Indexed: 12/14/2022]
Abstract
There have been a number of case reports and small clinical trials reporting promising outcomes of Janus Kinase (JAK) inhibitors tofacitinib, ruxolitinib and baricitinib for alopecia areata (AA). The majority of the literature to date is based on small volume data, with a lack of definitive evidence or guidelines. To determine the expected response of AA to JAK inhibitor therapy and factors which influence response and recurrence rates. A systematic review and meta-analysis was performed according to PRISMA guidelines. From 30 studies and 289 cases, there were 72.4% responders, good responders 45.7% and partial responders 21.4%. Mean time to initial hair growth was 2.2 ± 6.7 months, and time to complete hair regrowth was 6.7 ± 2.2 months. All 37 recurrences occurred when treatment was ceased after 2.7 months. Oral route was significantly associated with response to treatment compared to topical therapy. No difference was found between paediatric and adult cases in proportion of responses. There is promising low-quality evidence regarding the effectiveness of JAK inhibitors in AA. Future large-sized randomized studies are required to confirm findings.
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Affiliation(s)
- K Phan
- Department of Dermatology, Liverpool Hospital, Sydney, NSW, Australia.,Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - D F Sebaratnam
- Department of Dermatology, Liverpool Hospital, Sydney, NSW, Australia.,Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.,Departments of Dermatology, Sydney Children's Hospitals' Network, Sydney, NSW, Australia
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Bird P, Bensen W, El-Zorkany B, Kaine J, Manapat-Reyes BH, Pascual-Ramos V, Witcombe D, Soma K, Zhang R, Thirunavukkarasu K. Tofacitinib 5 mg Twice Daily in Patients with Rheumatoid Arthritis and Inadequate Response to Disease-Modifying Antirheumatic Drugs: A Comprehensive Review of Phase 3 Efficacy and Safety. J Clin Rheumatol 2019; 25:115-126. [PMID: 29794874 PMCID: PMC6445596 DOI: 10.1097/rhu.0000000000000786] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Tofacitinib is an oral Janus kinase inhibitor for the treatment of rheumatoid arthritis (RA). We performed a comprehensive review of phase 3 studies of tofacitinib 5 mg twice daily (BID) (approved dose in many countries) in patients with moderate to severe RA and inadequate response to prior disease-modifying antirheumatic drugs. METHODS A search of PubMed and ClinicalTrials.gov identified 5 studies: ORAL Solo (NCT00814307), ORAL Sync (NCT00856544), ORAL Standard (included adalimumab 40 mg once every 2 weeks; NCT00853385), ORAL Scan (NCT00847613), and ORAL Step (NCT00960440). Efficacy and safety data for tofacitinib 5 mg BID, placebo, and adalimumab were analyzed. RESULTS Across the 5 studies, 1216 patients received tofacitinib 5 mg BID, 681 received placebo, and 204 received adalimumab. At month 3, tofacitinib demonstrated significantly higher 20%, 50%, and 70% improvement in American College of Rheumatology response criteria (ACR20, ACR50, and ACR70, respectively) response rates, greater improvement in Health Assessment Questionnaire-Disability Index, and a higher proportion of Disease Activity Score-defined remission than placebo. Frequencies of adverse events (AEs), serious AEs, and discontinuations due to AEs were similar for tofacitinib and placebo at month 3; serious infection events were more frequent for tofacitinib. In ORAL Standard, although not powered for formal comparisons, tofacitinib and adalimumab had numerically similar efficacy and AEs; serious AEs and serious infection events were more frequent with tofacitinib. CONCLUSIONS Tofacitinib 5 mg BID reduced RA signs and symptoms and improved physical function versus placebo in patients with inadequate response to prior disease-modifying antirheumatic drugs. Tofacitinib 5 mg BID had a consistent, manageable safety profile across studies, with no new safety signals identified.
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Affiliation(s)
- Paul Bird
- From the University of New South Wales, Sydney, New South Wales, Australia
| | - William Bensen
- St Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Bernadette Heizel Manapat-Reyes
- Section of Rheumatology, Department of Medicine, University of the Philippines–Philippine General Hospital, Manila, Philippines
| | - Virginia Pascual-Ramos
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - David Witcombe
- Pfizer Australia, Sydney, New South Wales, Australia; and
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Predictors of abatacept retention over 2 years in patients with rheumatoid arthritis: results from the real-world ACTION study. Clin Rheumatol 2019; 38:1413-1424. [DOI: 10.1007/s10067-019-04449-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 01/15/2019] [Accepted: 01/21/2019] [Indexed: 01/24/2023]
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Abstract
INTRODUCTION Rheumatoid arthritis (RA) is a complex disease in which different mechanisms are involved. Studies suggest a key role for aberrant pathways of T-cell activation in the initiation and perpetuation of disease. Abatacept is a fusion protein composed of the Fc region of the immunoglobulin G1 (IgG1) fused to the extracellular domain of cytotoxic T lymphocyte-associated antigen (CTLA4). It has the ability to modulate T-cell activation by interfering with co-stimulation of these cells, a necessary step to become activated. This suggests that abatacept may play a role in the progression and/or even the initiation of RA. Areas covered: a review of the different studies carried out during clinical development of abatacept was performed. Both formulations, intravenous (IV) and subcutaneous (SC), showed a similar and consistent efficacy and safety profile. Abatacept was effective both in RA patients not responding to methotrexate (MTX) and to tumor necrosis factor (TNF) inhibitors. Expert commentary: abatacept, with its unique mechanism of action, proved to be a useful therapeutic alternative in RA, also having an acceptable safety profile. Evidence points out that abatacept may be able to alter the RA disease course. Ongoing studies will clarify this issue.
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Affiliation(s)
- Manuel Pombo-Suarez
- a Rheumatology Service , Hospital Clinico Universitario , Santiago de Compostela , Spain
| | - Juan J Gomez-Reino
- b Fundacion Ramon Dominguez, Hospital Clinico Universitario , Santiago de Compostela , Spain
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41
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Noisette A, Hochberg MC. Abatacept for the treatment of adults with psoriatic arthritis: patient selection and perspectives. PSORIASIS-TARGETS AND THERAPY 2018; 8:31-39. [PMID: 30035098 PMCID: PMC6047621 DOI: 10.2147/ptt.s146076] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Psoriatic arthritis (PsA) is a heterogeneous disease with several clinical subtypes including peripheral arthritis, dactylitis, enthesitis, nail disease, and axial arthritis. Nonsteroidal anti-inflammatory drugs, glucocorticoids, and conventional disease-modifying agents are used as first line in the treatment of active PsA. For moderate-to-severe PsA failing conventional therapy, antitumor necrosis factor inhibitors have historically been the drugs of choice. In recent years, novel interleukin-23/interleukin-17 pathway targets such as ustekinumab and secukinumab, and phosphodiesterase-4 inhibitor apremilast have been approved for use in the United States and Europe. Two sets of recommendations for the management of PsA were published in 2016 with consideration for these newer therapies. Since then, the results from a Phase III randomized controlled trial demonstrated that abatacept has efficacy in the treatment of PsA. Abatacept, a cytotoxic-T-lymphocyte-associated antigen 4 (CTLA-4)–Ig human fusion protein, acts to prevent naïve T-cell activation through the inhibition of the critical CD28 co-stimulatory signal. In the 2017 Active Psoriatic Arthritis Randomized Trial (ASTRAEA), 424 participants were randomized 1:1 to receive subcutaneous abatacept 125 mg weekly versus placebo. At week 24, 39.4% of those who received abatacept achieved a minimum of 20% improvement in the American College of Rheumatology (ACR) response compared to 22.3% in the placebo arm, a statistically significant finding (P<0.001). The 2011 Phase II study published by Mease et al demonstrated statistically significant improvements in the ACR20 response by week 169 in participants treated with intravenous abatacept 10 mg/kg (48%) and 30/10 mg/kg (42%) when compared with placebo (19%). This article reviews the data supporting the efficacy of abatacept in the management of PsA and attempts to place this agent in the context of other biologic disease-modifying antirheumatic drugs and targeted small molecules used in the treatment of patients with PsA.
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Affiliation(s)
- Ashley Noisette
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA,
| | - Marc C Hochberg
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA,
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Mochizuki T, Ikari K, Yano K, Sato M, Okazaki K. Long-term deterioration of interstitial lung disease in patients with rheumatoid arthritis treated with abatacept. Mod Rheumatol 2018; 29:413-417. [DOI: 10.1080/14397595.2018.1481566] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
| | - Katsunori Ikari
- Institute of Rheumatology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Koichiro Yano
- Institute of Rheumatology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Motoaki Sato
- Department of Radiology, Kamagaya General Hospital, Chiba, Japan
| | - Ken Okazaki
- Department of Orthopedic Surgery, Tokyo Women’s Medical University, Tokyo, Japan
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Phase 1 clinical trial evaluating abatacept in patients with steroid-refractory chronic graft-versus-host disease. Blood 2018; 131:2836-2845. [DOI: 10.1182/blood-2017-05-780239] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 03/07/2018] [Indexed: 12/11/2022] Open
Abstract
Key Points
Costimulatory blockade using abatacept represents a novel therapeutic approach for the treatment of cGVHD. Abatacept resulted in a clinical response in 44% of patients with both decreased prednisone use and T-cell PD-1 expression in responders.
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Ursini F, Russo E, De Giorgio R, De Sarro G, D'Angelo S. Current treatment options for psoriatic arthritis: spotlight on abatacept. Ther Clin Risk Manag 2018; 14:1053-1059. [PMID: 29922065 PMCID: PMC5995419 DOI: 10.2147/tcrm.s148586] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Psoriatic arthritis (PsA) is a chronic inflammatory disease of joints, tendon sheaths, and entheses affecting patients with established skin psoriasis, or, less frequently, patients without a personal history of psoriasis with a positive familial history. Many treatment options are now available to deal with the different aspects of the disease, including traditional and biological disease-modifying antirheumatic drugs and the recently released targeted synthetic disease-modifying antirheumatic drugs. However, ~40% of patients still fail to achieve a meaningful clinical response to first-line biologic therapy advocating the development of novel medications. It is now well accepted that T-cells participate in the immunopathogenesis of several autoimmune diseases. For this reason, the potential intervention on T-cells represented an attractive therapeutic target for a long time, becoming a clinical reality with the development of abatacept. Abatacept is a biologic agent selectively targeting the T-cell costimulatory signal delivered through the CD80/86-CD28 pathway and was approved in December 2005 by the US Food and Drug Administration and in May 2007 by European Medicines Agency for the treatment of patients with rheumatoid arthritis in combination with methotrexate. Based on the relevant role of T-cells in PsA pathogenesis and following the positive results obtained in a phase III clinical trial, abatacept recently received approval for treatment of patients with PsA. In this review, we will focus on the current knowledge about the emerging role of abatacept in treatment of PsA.
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Affiliation(s)
- Francesco Ursini
- Department of Health Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy.,Associazione Calabrese per la Ricerca in Reumatologia, Catanzaro, Italy
| | - Emilio Russo
- Department of Health Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | | | | | - Salvatore D'Angelo
- Rheumatology Department of Lucania, Rheumatology Institute of Lucania (IReL), Potenza Italy.,Basilicata Ricerca Biomedica (BRB), Potenza, Italy
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Jain N, Doyon JB, Lazarus JE, Schaefer IM, Johncilla ME, Agoston AT, Dalal AK, Velásquez GE. A Case of Disseminated Histoplasmosis in a Patient with Rheumatoid Arthritis on Abatacept. J Gen Intern Med 2018; 33. [PMID: 29532302 PMCID: PMC5910370 DOI: 10.1007/s11606-018-4383-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Biologic agents are effective treatments for rheumatoid arthritis but are associated with important risks, including severe infections. Tumor Necrosis Factor (TNF) α inhibitors are known to increase the risk of systemic fungal infections such as disseminated histoplasmosis. Abatacept is a biologic agent with a mechanism different from that of TNFα inhibitors: It suppresses cellular immunity by competing for the costimulatory signal on antigen-presenting cells. The risk of disseminated histoplasmosis for patients on abatacept is not known. We report a case of abatacept-associated disseminated histoplasmosis and review the known infectious complications of abatacept. While the safety of resuming biologic agents following treatment for disseminated histoplasmosis is also not known, abatacept is recommended over TNFα inhibitors for rheumatoid arthritis patients with a prior serious infection. We discuss the evidence supporting this recommendation and discuss alternative treatments for rheumatoid arthritis patients with a history of a serious infection.
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Affiliation(s)
- Nina Jain
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Jeffrey B Doyon
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Jacob E Lazarus
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA.,Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Agoston T Agoston
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Anuj K Dalal
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Gustavo E Velásquez
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA. .,Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA. .,Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
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Genovese MC, Pacheco-Tena C, Covarrubias A, Leon G, Mysler E, Keiserman M, Valente RM, Nash P, Simon-Campos JA, Box J, Legerton CW, Nasonov E, Durez P, Elegbe A, Wong R, Li X, Banerjee S, Alten R. Longterm Safety and Efficacy of Subcutaneous Abatacept in Patients with Rheumatoid Arthritis: 5-year Results from a Phase IIIb Trial. J Rheumatol 2018; 45:1085-1092. [PMID: 29657147 DOI: 10.3899/jrheum.170344] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To assess 5-year safety, tolerability, and efficacy of subcutaneous (SC) abatacept (ABA) in methotrexate (MTX)-refractory patients with rheumatoid arthritis (RA). METHODS The Abatacept Comparison of sub[QU]cutaneous versus intravenous in Inadequate Responders to methotrexatE (ACQUIRE) phase IIIb, randomized, double-dummy, multinational trial compared efficacy and safety of SC and intravenous (IV) ABA in patients with RA. In the initial 6-month double-blind (DB) period, patients received IV or SC ABA, plus MTX, and in the subsequent open-label longterm extension (LTE) period, all patients received SC ABA (125 mg/wk). The final 5-year safety, tolerability, and efficacy analyses are reported. RESULTS Of 1385 patients who completed the DB period, 1372 entered LTE and 945 (68.8%) completed ≥ 5 years of treatment. During LTE, 97 (7.1%) patients discontinued treatment because of an adverse event (AE). Incidence rate (IR; event/100 patient-yrs of exposure; based on LTE data, 95% CI) for AE of interest were the following: serious AE 7.73 (6.96-8.58), infection 38.60 (36.24-41.12), serious infection 1.68 (1.35-2.07), malignancies 1.09 (0.84-1.42), and autoimmune disorders 1.33 (1.05-1.69), and were stable over time. No association between immunogenicity and either worsening of ABA safety or loss of efficacy was noted. Efficacy in the LTE was consistent with the DB period and was maintained to the end of the study. CONCLUSION These 5-year data establish that SC ABA (125 mg/wk) has a consistent safety profile and durable efficacy for longterm treatment of patients with RA who had an inadequate response to MTX.
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Affiliation(s)
- Mark C Genovese
- From Stanford University, Palo Alto, California; Arthritis Center of Nebraska, Lincoln, Nebraska; Box Arthritis and Rheumatology of the Carolinas, Charlotte, North Carolina; Low Country Rheumatology, Charleston, South Carolina; Bristol-Myers Squibb, Princeton, New Jersey, USA; Universidad Autónoma de Chihuahua, Chihuahua; Unidad Reumatológica Las Américas S.C.P., Mérida; Köhler & Milstein Research, Mérida, Mexico; Instituto De Ginecología Y Reproducción, Lima, Peru; Organización Médica de Investigación, Buenos Aires, Argentina; Pontifical Catholic University, Porto Alegre, Brazil; University of Queensland, Brisbane, Australia; Russian Academy of Medical Sciences, Moscow, Russia; Cliniques Universitaires Saint-Luc; Université Catholique de Louvain, Brussels, Belgium; Schlosspark-Klinik University Medicine, Berlin, Germany. .,M.C. Genovese, MD, Stanford University; C. Pacheco-Tena, MD, PhD, Universidad Autónoma de Chihuahua; A. Covarrubias, MD, Unidad Reumatológica Las Américas S.C.P.; G. Leon, MD, Instituto De Ginecología Y Reproducción; E. Mysler, MD, Organización Médica de Investigación; M. Keiserman, MD, Pontifical Catholic University; R.M. Valente, MD, Arthritis Center of Nebraska; P. Nash, MBBS (Hons), FRACP, University of Queensland; J.A. Simon-Campos, PhD, Köhler & Milstein Research; J. Box, MD, Box Arthritis and Rheumatology of the Carolinas; C.W. Legerton III, MD, Low Country Rheumatology; E. Nasonov, PhD, Russian Academy of Medical Sciences; P. Durez, MD, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain; A. Elegbe, PhD, Bristol-Myers Squibb; R. Wong, MD, Bristol-Myers Squibb; X. Li, PhD, Bristol-Myers Squibb; S. Banerjee, MD, Bristol-Myers Squibb; R. Alten, MD, PhD, Schlosspark-Klinik University Medicine.
| | - César Pacheco-Tena
- From Stanford University, Palo Alto, California; Arthritis Center of Nebraska, Lincoln, Nebraska; Box Arthritis and Rheumatology of the Carolinas, Charlotte, North Carolina; Low Country Rheumatology, Charleston, South Carolina; Bristol-Myers Squibb, Princeton, New Jersey, USA; Universidad Autónoma de Chihuahua, Chihuahua; Unidad Reumatológica Las Américas S.C.P., Mérida; Köhler & Milstein Research, Mérida, Mexico; Instituto De Ginecología Y Reproducción, Lima, Peru; Organización Médica de Investigación, Buenos Aires, Argentina; Pontifical Catholic University, Porto Alegre, Brazil; University of Queensland, Brisbane, Australia; Russian Academy of Medical Sciences, Moscow, Russia; Cliniques Universitaires Saint-Luc; Université Catholique de Louvain, Brussels, Belgium; Schlosspark-Klinik University Medicine, Berlin, Germany.,M.C. Genovese, MD, Stanford University; C. Pacheco-Tena, MD, PhD, Universidad Autónoma de Chihuahua; A. Covarrubias, MD, Unidad Reumatológica Las Américas S.C.P.; G. Leon, MD, Instituto De Ginecología Y Reproducción; E. Mysler, MD, Organización Médica de Investigación; M. Keiserman, MD, Pontifical Catholic University; R.M. Valente, MD, Arthritis Center of Nebraska; P. Nash, MBBS (Hons), FRACP, University of Queensland; J.A. Simon-Campos, PhD, Köhler & Milstein Research; J. Box, MD, Box Arthritis and Rheumatology of the Carolinas; C.W. Legerton III, MD, Low Country Rheumatology; E. Nasonov, PhD, Russian Academy of Medical Sciences; P. Durez, MD, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain; A. Elegbe, PhD, Bristol-Myers Squibb; R. Wong, MD, Bristol-Myers Squibb; X. Li, PhD, Bristol-Myers Squibb; S. Banerjee, MD, Bristol-Myers Squibb; R. Alten, MD, PhD, Schlosspark-Klinik University Medicine
| | - Arturo Covarrubias
- From Stanford University, Palo Alto, California; Arthritis Center of Nebraska, Lincoln, Nebraska; Box Arthritis and Rheumatology of the Carolinas, Charlotte, North Carolina; Low Country Rheumatology, Charleston, South Carolina; Bristol-Myers Squibb, Princeton, New Jersey, USA; Universidad Autónoma de Chihuahua, Chihuahua; Unidad Reumatológica Las Américas S.C.P., Mérida; Köhler & Milstein Research, Mérida, Mexico; Instituto De Ginecología Y Reproducción, Lima, Peru; Organización Médica de Investigación, Buenos Aires, Argentina; Pontifical Catholic University, Porto Alegre, Brazil; University of Queensland, Brisbane, Australia; Russian Academy of Medical Sciences, Moscow, Russia; Cliniques Universitaires Saint-Luc; Université Catholique de Louvain, Brussels, Belgium; Schlosspark-Klinik University Medicine, Berlin, Germany.,M.C. Genovese, MD, Stanford University; C. Pacheco-Tena, MD, PhD, Universidad Autónoma de Chihuahua; A. Covarrubias, MD, Unidad Reumatológica Las Américas S.C.P.; G. Leon, MD, Instituto De Ginecología Y Reproducción; E. Mysler, MD, Organización Médica de Investigación; M. Keiserman, MD, Pontifical Catholic University; R.M. Valente, MD, Arthritis Center of Nebraska; P. Nash, MBBS (Hons), FRACP, University of Queensland; J.A. Simon-Campos, PhD, Köhler & Milstein Research; J. Box, MD, Box Arthritis and Rheumatology of the Carolinas; C.W. Legerton III, MD, Low Country Rheumatology; E. Nasonov, PhD, Russian Academy of Medical Sciences; P. Durez, MD, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain; A. Elegbe, PhD, Bristol-Myers Squibb; R. Wong, MD, Bristol-Myers Squibb; X. Li, PhD, Bristol-Myers Squibb; S. Banerjee, MD, Bristol-Myers Squibb; R. Alten, MD, PhD, Schlosspark-Klinik University Medicine
| | - Gustavo Leon
- From Stanford University, Palo Alto, California; Arthritis Center of Nebraska, Lincoln, Nebraska; Box Arthritis and Rheumatology of the Carolinas, Charlotte, North Carolina; Low Country Rheumatology, Charleston, South Carolina; Bristol-Myers Squibb, Princeton, New Jersey, USA; Universidad Autónoma de Chihuahua, Chihuahua; Unidad Reumatológica Las Américas S.C.P., Mérida; Köhler & Milstein Research, Mérida, Mexico; Instituto De Ginecología Y Reproducción, Lima, Peru; Organización Médica de Investigación, Buenos Aires, Argentina; Pontifical Catholic University, Porto Alegre, Brazil; University of Queensland, Brisbane, Australia; Russian Academy of Medical Sciences, Moscow, Russia; Cliniques Universitaires Saint-Luc; Université Catholique de Louvain, Brussels, Belgium; Schlosspark-Klinik University Medicine, Berlin, Germany.,M.C. Genovese, MD, Stanford University; C. Pacheco-Tena, MD, PhD, Universidad Autónoma de Chihuahua; A. Covarrubias, MD, Unidad Reumatológica Las Américas S.C.P.; G. Leon, MD, Instituto De Ginecología Y Reproducción; E. Mysler, MD, Organización Médica de Investigación; M. Keiserman, MD, Pontifical Catholic University; R.M. Valente, MD, Arthritis Center of Nebraska; P. Nash, MBBS (Hons), FRACP, University of Queensland; J.A. Simon-Campos, PhD, Köhler & Milstein Research; J. Box, MD, Box Arthritis and Rheumatology of the Carolinas; C.W. Legerton III, MD, Low Country Rheumatology; E. Nasonov, PhD, Russian Academy of Medical Sciences; P. Durez, MD, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain; A. Elegbe, PhD, Bristol-Myers Squibb; R. Wong, MD, Bristol-Myers Squibb; X. Li, PhD, Bristol-Myers Squibb; S. Banerjee, MD, Bristol-Myers Squibb; R. Alten, MD, PhD, Schlosspark-Klinik University Medicine
| | - Eduardo Mysler
- From Stanford University, Palo Alto, California; Arthritis Center of Nebraska, Lincoln, Nebraska; Box Arthritis and Rheumatology of the Carolinas, Charlotte, North Carolina; Low Country Rheumatology, Charleston, South Carolina; Bristol-Myers Squibb, Princeton, New Jersey, USA; Universidad Autónoma de Chihuahua, Chihuahua; Unidad Reumatológica Las Américas S.C.P., Mérida; Köhler & Milstein Research, Mérida, Mexico; Instituto De Ginecología Y Reproducción, Lima, Peru; Organización Médica de Investigación, Buenos Aires, Argentina; Pontifical Catholic University, Porto Alegre, Brazil; University of Queensland, Brisbane, Australia; Russian Academy of Medical Sciences, Moscow, Russia; Cliniques Universitaires Saint-Luc; Université Catholique de Louvain, Brussels, Belgium; Schlosspark-Klinik University Medicine, Berlin, Germany.,M.C. Genovese, MD, Stanford University; C. Pacheco-Tena, MD, PhD, Universidad Autónoma de Chihuahua; A. Covarrubias, MD, Unidad Reumatológica Las Américas S.C.P.; G. Leon, MD, Instituto De Ginecología Y Reproducción; E. Mysler, MD, Organización Médica de Investigación; M. Keiserman, MD, Pontifical Catholic University; R.M. Valente, MD, Arthritis Center of Nebraska; P. Nash, MBBS (Hons), FRACP, University of Queensland; J.A. Simon-Campos, PhD, Köhler & Milstein Research; J. Box, MD, Box Arthritis and Rheumatology of the Carolinas; C.W. Legerton III, MD, Low Country Rheumatology; E. Nasonov, PhD, Russian Academy of Medical Sciences; P. Durez, MD, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain; A. Elegbe, PhD, Bristol-Myers Squibb; R. Wong, MD, Bristol-Myers Squibb; X. Li, PhD, Bristol-Myers Squibb; S. Banerjee, MD, Bristol-Myers Squibb; R. Alten, MD, PhD, Schlosspark-Klinik University Medicine
| | - Mauro Keiserman
- From Stanford University, Palo Alto, California; Arthritis Center of Nebraska, Lincoln, Nebraska; Box Arthritis and Rheumatology of the Carolinas, Charlotte, North Carolina; Low Country Rheumatology, Charleston, South Carolina; Bristol-Myers Squibb, Princeton, New Jersey, USA; Universidad Autónoma de Chihuahua, Chihuahua; Unidad Reumatológica Las Américas S.C.P., Mérida; Köhler & Milstein Research, Mérida, Mexico; Instituto De Ginecología Y Reproducción, Lima, Peru; Organización Médica de Investigación, Buenos Aires, Argentina; Pontifical Catholic University, Porto Alegre, Brazil; University of Queensland, Brisbane, Australia; Russian Academy of Medical Sciences, Moscow, Russia; Cliniques Universitaires Saint-Luc; Université Catholique de Louvain, Brussels, Belgium; Schlosspark-Klinik University Medicine, Berlin, Germany.,M.C. Genovese, MD, Stanford University; C. Pacheco-Tena, MD, PhD, Universidad Autónoma de Chihuahua; A. Covarrubias, MD, Unidad Reumatológica Las Américas S.C.P.; G. Leon, MD, Instituto De Ginecología Y Reproducción; E. Mysler, MD, Organización Médica de Investigación; M. Keiserman, MD, Pontifical Catholic University; R.M. Valente, MD, Arthritis Center of Nebraska; P. Nash, MBBS (Hons), FRACP, University of Queensland; J.A. Simon-Campos, PhD, Köhler & Milstein Research; J. Box, MD, Box Arthritis and Rheumatology of the Carolinas; C.W. Legerton III, MD, Low Country Rheumatology; E. Nasonov, PhD, Russian Academy of Medical Sciences; P. Durez, MD, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain; A. Elegbe, PhD, Bristol-Myers Squibb; R. Wong, MD, Bristol-Myers Squibb; X. Li, PhD, Bristol-Myers Squibb; S. Banerjee, MD, Bristol-Myers Squibb; R. Alten, MD, PhD, Schlosspark-Klinik University Medicine
| | - Robert M Valente
- From Stanford University, Palo Alto, California; Arthritis Center of Nebraska, Lincoln, Nebraska; Box Arthritis and Rheumatology of the Carolinas, Charlotte, North Carolina; Low Country Rheumatology, Charleston, South Carolina; Bristol-Myers Squibb, Princeton, New Jersey, USA; Universidad Autónoma de Chihuahua, Chihuahua; Unidad Reumatológica Las Américas S.C.P., Mérida; Köhler & Milstein Research, Mérida, Mexico; Instituto De Ginecología Y Reproducción, Lima, Peru; Organización Médica de Investigación, Buenos Aires, Argentina; Pontifical Catholic University, Porto Alegre, Brazil; University of Queensland, Brisbane, Australia; Russian Academy of Medical Sciences, Moscow, Russia; Cliniques Universitaires Saint-Luc; Université Catholique de Louvain, Brussels, Belgium; Schlosspark-Klinik University Medicine, Berlin, Germany.,M.C. Genovese, MD, Stanford University; C. Pacheco-Tena, MD, PhD, Universidad Autónoma de Chihuahua; A. Covarrubias, MD, Unidad Reumatológica Las Américas S.C.P.; G. Leon, MD, Instituto De Ginecología Y Reproducción; E. Mysler, MD, Organización Médica de Investigación; M. Keiserman, MD, Pontifical Catholic University; R.M. Valente, MD, Arthritis Center of Nebraska; P. Nash, MBBS (Hons), FRACP, University of Queensland; J.A. Simon-Campos, PhD, Köhler & Milstein Research; J. Box, MD, Box Arthritis and Rheumatology of the Carolinas; C.W. Legerton III, MD, Low Country Rheumatology; E. Nasonov, PhD, Russian Academy of Medical Sciences; P. Durez, MD, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain; A. Elegbe, PhD, Bristol-Myers Squibb; R. Wong, MD, Bristol-Myers Squibb; X. Li, PhD, Bristol-Myers Squibb; S. Banerjee, MD, Bristol-Myers Squibb; R. Alten, MD, PhD, Schlosspark-Klinik University Medicine
| | - Peter Nash
- From Stanford University, Palo Alto, California; Arthritis Center of Nebraska, Lincoln, Nebraska; Box Arthritis and Rheumatology of the Carolinas, Charlotte, North Carolina; Low Country Rheumatology, Charleston, South Carolina; Bristol-Myers Squibb, Princeton, New Jersey, USA; Universidad Autónoma de Chihuahua, Chihuahua; Unidad Reumatológica Las Américas S.C.P., Mérida; Köhler & Milstein Research, Mérida, Mexico; Instituto De Ginecología Y Reproducción, Lima, Peru; Organización Médica de Investigación, Buenos Aires, Argentina; Pontifical Catholic University, Porto Alegre, Brazil; University of Queensland, Brisbane, Australia; Russian Academy of Medical Sciences, Moscow, Russia; Cliniques Universitaires Saint-Luc; Université Catholique de Louvain, Brussels, Belgium; Schlosspark-Klinik University Medicine, Berlin, Germany.,M.C. Genovese, MD, Stanford University; C. Pacheco-Tena, MD, PhD, Universidad Autónoma de Chihuahua; A. Covarrubias, MD, Unidad Reumatológica Las Américas S.C.P.; G. Leon, MD, Instituto De Ginecología Y Reproducción; E. Mysler, MD, Organización Médica de Investigación; M. Keiserman, MD, Pontifical Catholic University; R.M. Valente, MD, Arthritis Center of Nebraska; P. Nash, MBBS (Hons), FRACP, University of Queensland; J.A. Simon-Campos, PhD, Köhler & Milstein Research; J. Box, MD, Box Arthritis and Rheumatology of the Carolinas; C.W. Legerton III, MD, Low Country Rheumatology; E. Nasonov, PhD, Russian Academy of Medical Sciences; P. Durez, MD, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain; A. Elegbe, PhD, Bristol-Myers Squibb; R. Wong, MD, Bristol-Myers Squibb; X. Li, PhD, Bristol-Myers Squibb; S. Banerjee, MD, Bristol-Myers Squibb; R. Alten, MD, PhD, Schlosspark-Klinik University Medicine
| | - J Abraham Simon-Campos
- From Stanford University, Palo Alto, California; Arthritis Center of Nebraska, Lincoln, Nebraska; Box Arthritis and Rheumatology of the Carolinas, Charlotte, North Carolina; Low Country Rheumatology, Charleston, South Carolina; Bristol-Myers Squibb, Princeton, New Jersey, USA; Universidad Autónoma de Chihuahua, Chihuahua; Unidad Reumatológica Las Américas S.C.P., Mérida; Köhler & Milstein Research, Mérida, Mexico; Instituto De Ginecología Y Reproducción, Lima, Peru; Organización Médica de Investigación, Buenos Aires, Argentina; Pontifical Catholic University, Porto Alegre, Brazil; University of Queensland, Brisbane, Australia; Russian Academy of Medical Sciences, Moscow, Russia; Cliniques Universitaires Saint-Luc; Université Catholique de Louvain, Brussels, Belgium; Schlosspark-Klinik University Medicine, Berlin, Germany.,M.C. Genovese, MD, Stanford University; C. Pacheco-Tena, MD, PhD, Universidad Autónoma de Chihuahua; A. Covarrubias, MD, Unidad Reumatológica Las Américas S.C.P.; G. Leon, MD, Instituto De Ginecología Y Reproducción; E. Mysler, MD, Organización Médica de Investigación; M. Keiserman, MD, Pontifical Catholic University; R.M. Valente, MD, Arthritis Center of Nebraska; P. Nash, MBBS (Hons), FRACP, University of Queensland; J.A. Simon-Campos, PhD, Köhler & Milstein Research; J. Box, MD, Box Arthritis and Rheumatology of the Carolinas; C.W. Legerton III, MD, Low Country Rheumatology; E. Nasonov, PhD, Russian Academy of Medical Sciences; P. Durez, MD, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain; A. Elegbe, PhD, Bristol-Myers Squibb; R. Wong, MD, Bristol-Myers Squibb; X. Li, PhD, Bristol-Myers Squibb; S. Banerjee, MD, Bristol-Myers Squibb; R. Alten, MD, PhD, Schlosspark-Klinik University Medicine
| | - Jane Box
- From Stanford University, Palo Alto, California; Arthritis Center of Nebraska, Lincoln, Nebraska; Box Arthritis and Rheumatology of the Carolinas, Charlotte, North Carolina; Low Country Rheumatology, Charleston, South Carolina; Bristol-Myers Squibb, Princeton, New Jersey, USA; Universidad Autónoma de Chihuahua, Chihuahua; Unidad Reumatológica Las Américas S.C.P., Mérida; Köhler & Milstein Research, Mérida, Mexico; Instituto De Ginecología Y Reproducción, Lima, Peru; Organización Médica de Investigación, Buenos Aires, Argentina; Pontifical Catholic University, Porto Alegre, Brazil; University of Queensland, Brisbane, Australia; Russian Academy of Medical Sciences, Moscow, Russia; Cliniques Universitaires Saint-Luc; Université Catholique de Louvain, Brussels, Belgium; Schlosspark-Klinik University Medicine, Berlin, Germany.,M.C. Genovese, MD, Stanford University; C. Pacheco-Tena, MD, PhD, Universidad Autónoma de Chihuahua; A. Covarrubias, MD, Unidad Reumatológica Las Américas S.C.P.; G. Leon, MD, Instituto De Ginecología Y Reproducción; E. Mysler, MD, Organización Médica de Investigación; M. Keiserman, MD, Pontifical Catholic University; R.M. Valente, MD, Arthritis Center of Nebraska; P. Nash, MBBS (Hons), FRACP, University of Queensland; J.A. Simon-Campos, PhD, Köhler & Milstein Research; J. Box, MD, Box Arthritis and Rheumatology of the Carolinas; C.W. Legerton III, MD, Low Country Rheumatology; E. Nasonov, PhD, Russian Academy of Medical Sciences; P. Durez, MD, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain; A. Elegbe, PhD, Bristol-Myers Squibb; R. Wong, MD, Bristol-Myers Squibb; X. Li, PhD, Bristol-Myers Squibb; S. Banerjee, MD, Bristol-Myers Squibb; R. Alten, MD, PhD, Schlosspark-Klinik University Medicine
| | - Clarence W Legerton
- From Stanford University, Palo Alto, California; Arthritis Center of Nebraska, Lincoln, Nebraska; Box Arthritis and Rheumatology of the Carolinas, Charlotte, North Carolina; Low Country Rheumatology, Charleston, South Carolina; Bristol-Myers Squibb, Princeton, New Jersey, USA; Universidad Autónoma de Chihuahua, Chihuahua; Unidad Reumatológica Las Américas S.C.P., Mérida; Köhler & Milstein Research, Mérida, Mexico; Instituto De Ginecología Y Reproducción, Lima, Peru; Organización Médica de Investigación, Buenos Aires, Argentina; Pontifical Catholic University, Porto Alegre, Brazil; University of Queensland, Brisbane, Australia; Russian Academy of Medical Sciences, Moscow, Russia; Cliniques Universitaires Saint-Luc; Université Catholique de Louvain, Brussels, Belgium; Schlosspark-Klinik University Medicine, Berlin, Germany.,M.C. Genovese, MD, Stanford University; C. Pacheco-Tena, MD, PhD, Universidad Autónoma de Chihuahua; A. Covarrubias, MD, Unidad Reumatológica Las Américas S.C.P.; G. Leon, MD, Instituto De Ginecología Y Reproducción; E. Mysler, MD, Organización Médica de Investigación; M. Keiserman, MD, Pontifical Catholic University; R.M. Valente, MD, Arthritis Center of Nebraska; P. Nash, MBBS (Hons), FRACP, University of Queensland; J.A. Simon-Campos, PhD, Köhler & Milstein Research; J. Box, MD, Box Arthritis and Rheumatology of the Carolinas; C.W. Legerton III, MD, Low Country Rheumatology; E. Nasonov, PhD, Russian Academy of Medical Sciences; P. Durez, MD, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain; A. Elegbe, PhD, Bristol-Myers Squibb; R. Wong, MD, Bristol-Myers Squibb; X. Li, PhD, Bristol-Myers Squibb; S. Banerjee, MD, Bristol-Myers Squibb; R. Alten, MD, PhD, Schlosspark-Klinik University Medicine
| | - Evgeny Nasonov
- From Stanford University, Palo Alto, California; Arthritis Center of Nebraska, Lincoln, Nebraska; Box Arthritis and Rheumatology of the Carolinas, Charlotte, North Carolina; Low Country Rheumatology, Charleston, South Carolina; Bristol-Myers Squibb, Princeton, New Jersey, USA; Universidad Autónoma de Chihuahua, Chihuahua; Unidad Reumatológica Las Américas S.C.P., Mérida; Köhler & Milstein Research, Mérida, Mexico; Instituto De Ginecología Y Reproducción, Lima, Peru; Organización Médica de Investigación, Buenos Aires, Argentina; Pontifical Catholic University, Porto Alegre, Brazil; University of Queensland, Brisbane, Australia; Russian Academy of Medical Sciences, Moscow, Russia; Cliniques Universitaires Saint-Luc; Université Catholique de Louvain, Brussels, Belgium; Schlosspark-Klinik University Medicine, Berlin, Germany.,M.C. Genovese, MD, Stanford University; C. Pacheco-Tena, MD, PhD, Universidad Autónoma de Chihuahua; A. Covarrubias, MD, Unidad Reumatológica Las Américas S.C.P.; G. Leon, MD, Instituto De Ginecología Y Reproducción; E. Mysler, MD, Organización Médica de Investigación; M. Keiserman, MD, Pontifical Catholic University; R.M. Valente, MD, Arthritis Center of Nebraska; P. Nash, MBBS (Hons), FRACP, University of Queensland; J.A. Simon-Campos, PhD, Köhler & Milstein Research; J. Box, MD, Box Arthritis and Rheumatology of the Carolinas; C.W. Legerton III, MD, Low Country Rheumatology; E. Nasonov, PhD, Russian Academy of Medical Sciences; P. Durez, MD, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain; A. Elegbe, PhD, Bristol-Myers Squibb; R. Wong, MD, Bristol-Myers Squibb; X. Li, PhD, Bristol-Myers Squibb; S. Banerjee, MD, Bristol-Myers Squibb; R. Alten, MD, PhD, Schlosspark-Klinik University Medicine
| | - Patrick Durez
- From Stanford University, Palo Alto, California; Arthritis Center of Nebraska, Lincoln, Nebraska; Box Arthritis and Rheumatology of the Carolinas, Charlotte, North Carolina; Low Country Rheumatology, Charleston, South Carolina; Bristol-Myers Squibb, Princeton, New Jersey, USA; Universidad Autónoma de Chihuahua, Chihuahua; Unidad Reumatológica Las Américas S.C.P., Mérida; Köhler & Milstein Research, Mérida, Mexico; Instituto De Ginecología Y Reproducción, Lima, Peru; Organización Médica de Investigación, Buenos Aires, Argentina; Pontifical Catholic University, Porto Alegre, Brazil; University of Queensland, Brisbane, Australia; Russian Academy of Medical Sciences, Moscow, Russia; Cliniques Universitaires Saint-Luc; Université Catholique de Louvain, Brussels, Belgium; Schlosspark-Klinik University Medicine, Berlin, Germany.,M.C. Genovese, MD, Stanford University; C. Pacheco-Tena, MD, PhD, Universidad Autónoma de Chihuahua; A. Covarrubias, MD, Unidad Reumatológica Las Américas S.C.P.; G. Leon, MD, Instituto De Ginecología Y Reproducción; E. Mysler, MD, Organización Médica de Investigación; M. Keiserman, MD, Pontifical Catholic University; R.M. Valente, MD, Arthritis Center of Nebraska; P. Nash, MBBS (Hons), FRACP, University of Queensland; J.A. Simon-Campos, PhD, Köhler & Milstein Research; J. Box, MD, Box Arthritis and Rheumatology of the Carolinas; C.W. Legerton III, MD, Low Country Rheumatology; E. Nasonov, PhD, Russian Academy of Medical Sciences; P. Durez, MD, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain; A. Elegbe, PhD, Bristol-Myers Squibb; R. Wong, MD, Bristol-Myers Squibb; X. Li, PhD, Bristol-Myers Squibb; S. Banerjee, MD, Bristol-Myers Squibb; R. Alten, MD, PhD, Schlosspark-Klinik University Medicine
| | - Ayanbola Elegbe
- From Stanford University, Palo Alto, California; Arthritis Center of Nebraska, Lincoln, Nebraska; Box Arthritis and Rheumatology of the Carolinas, Charlotte, North Carolina; Low Country Rheumatology, Charleston, South Carolina; Bristol-Myers Squibb, Princeton, New Jersey, USA; Universidad Autónoma de Chihuahua, Chihuahua; Unidad Reumatológica Las Américas S.C.P., Mérida; Köhler & Milstein Research, Mérida, Mexico; Instituto De Ginecología Y Reproducción, Lima, Peru; Organización Médica de Investigación, Buenos Aires, Argentina; Pontifical Catholic University, Porto Alegre, Brazil; University of Queensland, Brisbane, Australia; Russian Academy of Medical Sciences, Moscow, Russia; Cliniques Universitaires Saint-Luc; Université Catholique de Louvain, Brussels, Belgium; Schlosspark-Klinik University Medicine, Berlin, Germany.,M.C. Genovese, MD, Stanford University; C. Pacheco-Tena, MD, PhD, Universidad Autónoma de Chihuahua; A. Covarrubias, MD, Unidad Reumatológica Las Américas S.C.P.; G. Leon, MD, Instituto De Ginecología Y Reproducción; E. Mysler, MD, Organización Médica de Investigación; M. Keiserman, MD, Pontifical Catholic University; R.M. Valente, MD, Arthritis Center of Nebraska; P. Nash, MBBS (Hons), FRACP, University of Queensland; J.A. Simon-Campos, PhD, Köhler & Milstein Research; J. Box, MD, Box Arthritis and Rheumatology of the Carolinas; C.W. Legerton III, MD, Low Country Rheumatology; E. Nasonov, PhD, Russian Academy of Medical Sciences; P. Durez, MD, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain; A. Elegbe, PhD, Bristol-Myers Squibb; R. Wong, MD, Bristol-Myers Squibb; X. Li, PhD, Bristol-Myers Squibb; S. Banerjee, MD, Bristol-Myers Squibb; R. Alten, MD, PhD, Schlosspark-Klinik University Medicine
| | - Robert Wong
- From Stanford University, Palo Alto, California; Arthritis Center of Nebraska, Lincoln, Nebraska; Box Arthritis and Rheumatology of the Carolinas, Charlotte, North Carolina; Low Country Rheumatology, Charleston, South Carolina; Bristol-Myers Squibb, Princeton, New Jersey, USA; Universidad Autónoma de Chihuahua, Chihuahua; Unidad Reumatológica Las Américas S.C.P., Mérida; Köhler & Milstein Research, Mérida, Mexico; Instituto De Ginecología Y Reproducción, Lima, Peru; Organización Médica de Investigación, Buenos Aires, Argentina; Pontifical Catholic University, Porto Alegre, Brazil; University of Queensland, Brisbane, Australia; Russian Academy of Medical Sciences, Moscow, Russia; Cliniques Universitaires Saint-Luc; Université Catholique de Louvain, Brussels, Belgium; Schlosspark-Klinik University Medicine, Berlin, Germany.,M.C. Genovese, MD, Stanford University; C. Pacheco-Tena, MD, PhD, Universidad Autónoma de Chihuahua; A. Covarrubias, MD, Unidad Reumatológica Las Américas S.C.P.; G. Leon, MD, Instituto De Ginecología Y Reproducción; E. Mysler, MD, Organización Médica de Investigación; M. Keiserman, MD, Pontifical Catholic University; R.M. Valente, MD, Arthritis Center of Nebraska; P. Nash, MBBS (Hons), FRACP, University of Queensland; J.A. Simon-Campos, PhD, Köhler & Milstein Research; J. Box, MD, Box Arthritis and Rheumatology of the Carolinas; C.W. Legerton III, MD, Low Country Rheumatology; E. Nasonov, PhD, Russian Academy of Medical Sciences; P. Durez, MD, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain; A. Elegbe, PhD, Bristol-Myers Squibb; R. Wong, MD, Bristol-Myers Squibb; X. Li, PhD, Bristol-Myers Squibb; S. Banerjee, MD, Bristol-Myers Squibb; R. Alten, MD, PhD, Schlosspark-Klinik University Medicine
| | - Xiaohui Li
- From Stanford University, Palo Alto, California; Arthritis Center of Nebraska, Lincoln, Nebraska; Box Arthritis and Rheumatology of the Carolinas, Charlotte, North Carolina; Low Country Rheumatology, Charleston, South Carolina; Bristol-Myers Squibb, Princeton, New Jersey, USA; Universidad Autónoma de Chihuahua, Chihuahua; Unidad Reumatológica Las Américas S.C.P., Mérida; Köhler & Milstein Research, Mérida, Mexico; Instituto De Ginecología Y Reproducción, Lima, Peru; Organización Médica de Investigación, Buenos Aires, Argentina; Pontifical Catholic University, Porto Alegre, Brazil; University of Queensland, Brisbane, Australia; Russian Academy of Medical Sciences, Moscow, Russia; Cliniques Universitaires Saint-Luc; Université Catholique de Louvain, Brussels, Belgium; Schlosspark-Klinik University Medicine, Berlin, Germany.,M.C. Genovese, MD, Stanford University; C. Pacheco-Tena, MD, PhD, Universidad Autónoma de Chihuahua; A. Covarrubias, MD, Unidad Reumatológica Las Américas S.C.P.; G. Leon, MD, Instituto De Ginecología Y Reproducción; E. Mysler, MD, Organización Médica de Investigación; M. Keiserman, MD, Pontifical Catholic University; R.M. Valente, MD, Arthritis Center of Nebraska; P. Nash, MBBS (Hons), FRACP, University of Queensland; J.A. Simon-Campos, PhD, Köhler & Milstein Research; J. Box, MD, Box Arthritis and Rheumatology of the Carolinas; C.W. Legerton III, MD, Low Country Rheumatology; E. Nasonov, PhD, Russian Academy of Medical Sciences; P. Durez, MD, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain; A. Elegbe, PhD, Bristol-Myers Squibb; R. Wong, MD, Bristol-Myers Squibb; X. Li, PhD, Bristol-Myers Squibb; S. Banerjee, MD, Bristol-Myers Squibb; R. Alten, MD, PhD, Schlosspark-Klinik University Medicine
| | - Subhashis Banerjee
- From Stanford University, Palo Alto, California; Arthritis Center of Nebraska, Lincoln, Nebraska; Box Arthritis and Rheumatology of the Carolinas, Charlotte, North Carolina; Low Country Rheumatology, Charleston, South Carolina; Bristol-Myers Squibb, Princeton, New Jersey, USA; Universidad Autónoma de Chihuahua, Chihuahua; Unidad Reumatológica Las Américas S.C.P., Mérida; Köhler & Milstein Research, Mérida, Mexico; Instituto De Ginecología Y Reproducción, Lima, Peru; Organización Médica de Investigación, Buenos Aires, Argentina; Pontifical Catholic University, Porto Alegre, Brazil; University of Queensland, Brisbane, Australia; Russian Academy of Medical Sciences, Moscow, Russia; Cliniques Universitaires Saint-Luc; Université Catholique de Louvain, Brussels, Belgium; Schlosspark-Klinik University Medicine, Berlin, Germany.,M.C. Genovese, MD, Stanford University; C. Pacheco-Tena, MD, PhD, Universidad Autónoma de Chihuahua; A. Covarrubias, MD, Unidad Reumatológica Las Américas S.C.P.; G. Leon, MD, Instituto De Ginecología Y Reproducción; E. Mysler, MD, Organización Médica de Investigación; M. Keiserman, MD, Pontifical Catholic University; R.M. Valente, MD, Arthritis Center of Nebraska; P. Nash, MBBS (Hons), FRACP, University of Queensland; J.A. Simon-Campos, PhD, Köhler & Milstein Research; J. Box, MD, Box Arthritis and Rheumatology of the Carolinas; C.W. Legerton III, MD, Low Country Rheumatology; E. Nasonov, PhD, Russian Academy of Medical Sciences; P. Durez, MD, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain; A. Elegbe, PhD, Bristol-Myers Squibb; R. Wong, MD, Bristol-Myers Squibb; X. Li, PhD, Bristol-Myers Squibb; S. Banerjee, MD, Bristol-Myers Squibb; R. Alten, MD, PhD, Schlosspark-Klinik University Medicine
| | - Rieke Alten
- From Stanford University, Palo Alto, California; Arthritis Center of Nebraska, Lincoln, Nebraska; Box Arthritis and Rheumatology of the Carolinas, Charlotte, North Carolina; Low Country Rheumatology, Charleston, South Carolina; Bristol-Myers Squibb, Princeton, New Jersey, USA; Universidad Autónoma de Chihuahua, Chihuahua; Unidad Reumatológica Las Américas S.C.P., Mérida; Köhler & Milstein Research, Mérida, Mexico; Instituto De Ginecología Y Reproducción, Lima, Peru; Organización Médica de Investigación, Buenos Aires, Argentina; Pontifical Catholic University, Porto Alegre, Brazil; University of Queensland, Brisbane, Australia; Russian Academy of Medical Sciences, Moscow, Russia; Cliniques Universitaires Saint-Luc; Université Catholique de Louvain, Brussels, Belgium; Schlosspark-Klinik University Medicine, Berlin, Germany.,M.C. Genovese, MD, Stanford University; C. Pacheco-Tena, MD, PhD, Universidad Autónoma de Chihuahua; A. Covarrubias, MD, Unidad Reumatológica Las Américas S.C.P.; G. Leon, MD, Instituto De Ginecología Y Reproducción; E. Mysler, MD, Organización Médica de Investigación; M. Keiserman, MD, Pontifical Catholic University; R.M. Valente, MD, Arthritis Center of Nebraska; P. Nash, MBBS (Hons), FRACP, University of Queensland; J.A. Simon-Campos, PhD, Köhler & Milstein Research; J. Box, MD, Box Arthritis and Rheumatology of the Carolinas; C.W. Legerton III, MD, Low Country Rheumatology; E. Nasonov, PhD, Russian Academy of Medical Sciences; P. Durez, MD, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain; A. Elegbe, PhD, Bristol-Myers Squibb; R. Wong, MD, Bristol-Myers Squibb; X. Li, PhD, Bristol-Myers Squibb; S. Banerjee, MD, Bristol-Myers Squibb; R. Alten, MD, PhD, Schlosspark-Klinik University Medicine
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Mariette X, Chen C, Biswas P, Kwok K, Boy MG. Lymphoma in the Tofacitinib Rheumatoid Arthritis Clinical Development Program. Arthritis Care Res (Hoboken) 2018; 70:685-694. [PMID: 28941219 PMCID: PMC5947561 DOI: 10.1002/acr.23421] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 09/12/2017] [Indexed: 12/19/2022]
Abstract
Objective Tofacitinib is an oral JAK inhibitor indicated for the treatment of rheumatoid arthritis (RA). We characterized lymphoma events in the tofacitinib RA clinical development program. Methods Lymphoma events (up to March 2015) were identified from 19 tofacitinib studies (2 phase I, 9 phase II, 6 phase III, and 2 long‐term extension) of patients with moderate to severe RA. Patients in these studies received tofacitinib dosed at 1–30 mg twice daily or 20 mg once daily, as monotherapy or with conventional synthetic disease‐modifying antirheumatic drugs. Lymphoma incidence rates (IRs; number of patients with events/100 patient‐years) and standardized incidence ratios (SIRs) were calculated. A descriptive case–matched control analysis (1:4) was performed to identify potential risk factors for lymphoma. Results A total of 6,194 patients received tofacitinib (19,406 patient‐years of exposure, 3.4 years median treatment duration). Nineteen lymphomas occurred (IR 0.10 [95% confidence interval (95% CI) 0.06–0.15]), with no increase observed with time of exposure. The age‐ and sex‐adjusted SIR of lymphoma was 2.62 (95% CI 1.58–4.09) (Surveillance, Epidemiology, and End Results [SEER] program database). The clinical characteristics of the 19 lymphomas were typical for the RA population. Three lymphomas were positive for Epstein‐Barr virus, 8 were negative, 2 were equivocal, and 6 were untested. Numerically, more lymphoma cases had a history of Sjögren's syndrome and were positive for anti–cyclic citrullinated protein and rheumatoid factor at baseline versus matched controls. The mean corticosteroid dose was higher for lymphoma cases versus controls. Conclusion In the tofacitinib RA clinical development program, lymphoma rates were stable over time and there were minimal differences in the baseline characteristics of patients with and without lymphoma.
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Affiliation(s)
- Xavier Mariette
- Université Paris-Sud, Assistance publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, INSERM U1184, Le Kremlin Bicêtre, France
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Mohr A, Malhotra R, Mayer G, Gorochov G, Miyara M. Human FOXP3 + T regulatory cell heterogeneity. Clin Transl Immunology 2018; 7:e1005. [PMID: 29484183 PMCID: PMC5822410 DOI: 10.1002/cti2.1005] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 12/11/2017] [Accepted: 12/15/2017] [Indexed: 12/20/2022] Open
Abstract
FOXP3-expressing CD4+ T regulatory (Treg) cells are instrumental for the maintenance of self-tolerance. They are also involved in the prevention of allergy, allograft rejection, foetal rejection during pregnancy and of exaggerated immune response towards commensal pathogens in mucosal tissues. They can also prevent immune responses against tumors and promote tumor progression. FOXP3-expressing Treg cells are not a homogenous population. The different subsets of Treg cells can have different functions or roles in the maintenance of immune homeostasis and can therefore be differentially targeted in the management of autoimmune diseases or in cancer. We discuss here how Treg cell subsets can be differentiated phenotypically, functionally and developmentally in humans.
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Affiliation(s)
- Audrey Mohr
- Sorbonne UniversitéInsermCentre d'immunologie et des maladies infectieuses‐Paris (Cimi‐Paris)AP‐HP Hôpital Pitié‐SalpêtrièreParisFrance
| | - Rajneesh Malhotra
- Immunity departmentRIA IMED Biotech UnitAstraZeneca GothenburgMölndalSweden
| | - Gaell Mayer
- Biometrics & Information SciencesRespiratory, Inflammation, Autoimmunity & NeurosciencesGlobal Medicine Development, AstraZenecaMölndalSweden
| | - Guy Gorochov
- Sorbonne UniversitéInsermCentre d'immunologie et des maladies infectieuses‐Paris (Cimi‐Paris)AP‐HP Hôpital Pitié‐SalpêtrièreParisFrance
- Département d'ImmunologieAP‐HP, Groupement Hospitalier Pitié‐SalpêtrièreParisFrance
| | - Makoto Miyara
- Sorbonne UniversitéInsermCentre d'immunologie et des maladies infectieuses‐Paris (Cimi‐Paris)AP‐HP Hôpital Pitié‐SalpêtrièreParisFrance
- Département d'ImmunologieAP‐HP, Groupement Hospitalier Pitié‐SalpêtrièreParisFrance
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Abstract
Various systemic inflammatory diseases, such as rheumatoid arthritis (RA), Sjögren's syndrome and systemic lupus erythematosus (SLE) are associated with an increased risk for the development of lymphomas. Studies on patients with RA and Sjögren's syndrome have shown that there is a clear association of the incidence of lymphoma with the severity and activity of the disease and lymphomas in particular are diseases which preferentially occur in immunosuppressed patients; therefore, knowledge of the different lymphoma subtypes, their prognosis and treatment options are important for rheumatologists. Currently, there is no evidence for an increased risk of lymphoma with the available conventional basis therapies or biologic disease-modifying antirheumatic drugs (DMARDs). The decision on how to treat a patient with previous lymphoma who requires antirheumatic treatment is more difficult as patients with previous malignancies are not included in clinical studies and in registries a bias with respect to patient selection must be taken into consideration. Decisions on the treatment approach, therefore need to be individualized and interdisciplinary management together with the treating hematologist is warranted.
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