1
|
Jubber A, Tahir H, Moorthy A. Clinical efficacy of JAK inhibitors on enthesitis in spondyloarthropathy: A scoping literature review. Musculoskeletal Care 2023; 21:1195-1203. [PMID: 37501580 DOI: 10.1002/msc.1802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 07/19/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Enthesitis is a key feature of spondyloarthropathy (SpA). In recent years, JAK inhibitors have emerged as efficacious drugs in the landscape of advanced therapies for patients with SpA. METHOD The aim of this scoping literature review was to search the published literature for studies on JAK inhibitors and their effects on enthesitis in patients with SpA and evaluate the data and summarise the findings. The clinical trials reviewed used the Leeds Enthesitis Index, Spondyloarthritis Research Consortium of Canada Enthesitis Index, and Maastrich Ankylosing Spondylitis Enthesitis Score as outcome measures. RESULTS Tofacitinib, upadacitinib, and filgotinib had numerically greater reductions in the enthesitis scores when compared with placebo. CONCLUSION While the JAK inhibitors are therapeutic options for enthesitis in SpA, head-to-head studies are needed to compare the JAK inhibitors against the biological drugs (targeting TNF, IL-17, and IL-12/23) as well as studies showing the effects of JAK inhibitors on enthesitis imaging.
Collapse
Affiliation(s)
- Ameen Jubber
- Rheumatology Department, University Hospitals of Leicester, Leicester, UK
| | - Hasan Tahir
- Division of Medicine, University College London, London, UK
| | - Arumugam Moorthy
- Rheumatology Department, University Hospitals of Leicester, Leicester, UK
- College of Life Sciences, University of Leicester, Leicester, UK
| |
Collapse
|
2
|
Jubber A, Woodward J, Hasan T, Moorthy A. Venous thromboembolism risk with Janus kinase inhibitors. Is it a class wide effect? Expert Opin Drug Saf 2022; 21:1005-1007. [PMID: 35818715 DOI: 10.1080/14740338.2022.2100343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Ameen Jubber
- University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester, UK
| | | | - Tahir Hasan
- Royal Free London NHS Foundation Trust, London, UK.,University College London, Division of Medicine, London, UK
| | - Arumugam Moorthy
- University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester, UK.,University of Leicester, College of Life Sciences, Leicester, UK
| |
Collapse
|
3
|
Jubber A, Hussain WHZ, Moorthy A. P184 Are there any ethnic differences in the response to Janus Kinase Inhibitor therapy for the treatment of rheumatoid arthritis? Rheumatology (Oxford) 2022. [DOI: 10.1093/rheumatology/keac133.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background/Aims
Baricitinib is an oral, synthetic Janus Kinase inhibitor. It has become a commonly used drug in the treatment of rheumatoid arthritis (RA), both as combination therapy and monotherapy. Previous studies have compared drug efficacy in different ethnicities, but no studies have compared the efficacy of baricitinib for the treatment of RA in different ethnicities. Given the large South Asian population in Leicestershire, we reviewed our cohort of RA patients on baricitinib to see whether there is any difference in drug response rates between the Asian and Caucasian cohorts.
Methods
This was a retrospective study. Patients included were those under the care of rheumatology at University Hospitals of Leicester (UHL) with a diagnosis of RA and either receiving baricitinib, or had received it in the past. Data was collected using the UHL IT systems, clinic letters, and pharmacy records. In addition to ethnicity, we reviewed patient age, gender, concurrent DMARDs used, previous biologics used, baseline and post-treatment DAS28, dropout from therapy, baseline biochemical assays (anti-CCP and RF status) and radiographic findings. Independent T-test was used to compare continuous data and the Pearson Chi-Square test was used to compare categorical data. SPSS was used to analyse the results.
Results
120 patients were included in the analysis and data was analysed with PFA. There was no statistically significant difference in the mean DAS28 at baseline (Asian 5.17 vs Caucasian 4.65, p value 0.107) and post-treatment (Asian 2.83 vs Caucasian 3.33, p value 0.404) (see table 1). Comparing both ethnicities, there was no statistically significant difference in previous biologics used, the presence or absence of anti-CCP and RF, and radiographic findings of erosions. Limitations of the study include the low proportion of post treatment DAS28 values recorded and absence of data comparing primary or secondary biologic failure.
Conclusion
This is the first study of its kind and found no significant difference in baricitinib response between the Asian and Caucasian cohorts. Future studies are needed to evaluate this subject further. Such data is important as it can contribute to a body of evidence that may in future help inform clinical decision making.
Disclosure
A. Jubber: None. W.H.Z. Hussain: None. A. Moorthy: None.
Collapse
Affiliation(s)
- Ameen Jubber
- University Hospitals of Leicester, Rheumatology department, Leicester, UNITED KINGDOM
| | - Wajith H. Z Hussain
- University Hospitals of Leicester, Rheumatology department, Leicester, UNITED KINGDOM
| | - Arumugam Moorthy
- University Hospitals of Leicester, Rheumatology department, Leicester, UNITED KINGDOM
- College of Life Sciences, University of Leicester, Leicester, UNITED KINGDOM
| |
Collapse
|
4
|
Zahir Hussain WH, Jubber A, Moorthy A. Are There Any Ethnic Differences in the Response to Baricitinib for the Treatment of Rheumatoid Arthritis? Cureus 2021; 13:e20024. [PMID: 34873553 PMCID: PMC8636192 DOI: 10.7759/cureus.20024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction Baricitinib is an oral synthetic Janus Kinase inhibitor that inhibits JAK1 and JAK2, and the new kid on the block in the treatment of rheumatoid arthritis (RA). To date, there are no studies comparing the clinical benefit of baricitinib in RA between different ethnicities. Ethnicity plays a role in the effectiveness of therapeutic agents. Given the large multi-ethnic population of Leicestershire in the United Kingdom and the range of new therapeutics in RA, we reviewed our cohort of patients with RA to see whether there is any difference in baricitinib Disease Activity Score 28 (DAS28) response between the Asian and White cohorts. Methods This was a retrospective study. The patients included were those under the care of rheumatology at University Hospitals of Leicester (UHL) with a diagnosis of RA and either receiving baricitinib or had received it in the past. Data was collected using the UHL information technology systems, clinic letters and pharmacy records. In addition to ethnicity, we reviewed patient age, gender, concurrent disease-modifying anti-rheumatic drugs (DMARDs) used, previous biologics used, baseline and post-treatment DAS28, dropout from therapy, baseline biochemical assays (anti-cyclic citrullinated peptide (anti-CCP) and rheumatoid factor (RF) status) and radiographic findings. An independent t-test was used to compare continuous data, and Pearson's chi-squared test was used to compare categorical data. Results A total of 120 patients were included in the analysis, and data were analysed with Portable Format for Analytics (PFA). There was no statistically significant difference in the mean DAS28 at baseline (Asian: 5.17 versus White: 4.65; p-value = 0.107) and post-treatment (Asian: 2.8 versus White: 3.3; p-value = 0.404). Comparing both ethnicities, there was no statistically significant difference in previous biologics used, anti-CCP and RF titres, and radiographic findings of erosions. Conclusion This is the first study of its kind, and it found no significant difference in baricitinib response between the Asian and White cohorts. Our study had certain limitations, and future studies will be needed to evaluate this subject further. Such data is important as it can contribute to a body of evidence that may in the future help inform clinical decision-making.
Collapse
Affiliation(s)
| | - Ameen Jubber
- Department of Rheumatology, University Hospitals of Leicester NHS Trust, Leicester, GBR
| | - Arumugam Moorthy
- College of Life Sciences, University of Leicester, Leicester, GBR
- Department of Rheumatology, University Hospitals of Leicester NHS Trust, Leicester, GBR
| |
Collapse
|
5
|
Abstract
Reactive arthritis (ReA) is a form of inflammatory arthritis triggered by a remote antecedent infection, usually in the genitourinary or gastrointestinal tract. It is part of the spondyloarthropathy (SpA) spectrum, an umbrella term for a group of distinct conditions with shared clinical features. Typically, it presents with an asymmetric oligoarthritis of the lower limb joints, and patients may also have sacroiliitis, enthesitis and dactylitis. Other features often seen include anterior uveitis, urethritis and skin manifestations such as pustular lesions on the plantar areas. Although ReA was characterised initially as a sterile arthritis, the detection of metabolically active Chlamydia species in the joint fluid of some affected patients has generated further questions on the pathophysiology of this condition. There are no formal diagnostic criteria, and the diagnosis is mainly clinical. HLA-B27 can support the diagnosis in the correct clinical context, and serves as a prognostic indicator. The majority of patients have a self-limiting course, but some develop chronic SpA and require immunomodulatory therapy.
Collapse
Affiliation(s)
- Ameen Jubber
- Department of Rheumatology, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, UK,
| | - Arumugam Moorthy
- Department of Rheumatology, University Hospitals of Leicester NHS Trust, Leicester; College of Life Sciences, University of Leicester, Leicester
| |
Collapse
|
6
|
Jubber A, Gnanappiragasam D, Durrani M, Kinder A, Harman KE. Pachydermodactyly presenting as juvenile idiopathic arthritis in an adolescent man. BMJ Case Rep 2021; 14:14/1/e237214. [PMID: 33462008 PMCID: PMC7813309 DOI: 10.1136/bcr-2020-237214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
We present the case of a 17-year-old Asian man diagnosed with pachydermodactyly, a rare digital fibromatosis. Although this is a non-inflammatory periarticular soft tissue disorder, the clinical appearance can mimic inflammatory arthritis. The patient had a 2-year history of fusiform swelling of multiple proximal interphalangeal joints. He was initially diagnosed with juvenile idiopathic arthritis and treated with methotrexate, but a lack of clinical response led to the diagnosis of pachydermodactyly. Recognising this rare condition can prevent unnecessary and potentially harmful treatment.
Collapse
Affiliation(s)
- Ameen Jubber
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - Maumer Durrani
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Alison Kinder
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Karen E Harman
- University Hospitals of Leicester NHS Trust, Leicester, UK
| |
Collapse
|
7
|
Jubber A, Toh TY, Nandi P. 274 A study to evaluate the factors most predictive of a positive temporal artery biopsy in giant cell arteritis. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez107.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ameen Jubber
- Rheumatology, Northampton General Hospital, Northampton, UNITED KINGDOM
| | - Tieng Yee Toh
- Rheumatology, Northampton General Hospital, Northampton, UNITED KINGDOM
| | - Pradip Nandi
- Rheumatology, Northampton General Hospital, Northampton, UNITED KINGDOM
| |
Collapse
|
8
|
Jubber A, Tripathi M, Taylor J. Interstitial lung disease and inflammatory myopathy in antisynthetase syndrome with PL-12 antibody. BMJ Case Rep 2018; 2018:bcr-2018-226119. [DOI: 10.1136/bcr-2018-226119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We report the case of an 80-year-old Caucasian man with PL-12 antibody positive antisynthetase syndrome. He presented with progressive dyspnoea and weight loss, later developing dysphagia, mild proximal muscle weakness and mild sicca symptoms. Investigations revealed interstitial lung disease, inflammatory myopathy and an immunology profile consistent with PL-12 antisynthetase syndrome. Prednisolone and cyclophosphamide resulted in a significant improvement of all his symptoms.
Collapse
|
9
|
Zun Swe M, Jubber A, Jeffery R. 15. Uncommon CNS manifestation in systemic lupus erythematosus. Rheumatol Adv Pract 2018. [PMCID: PMC6652463 DOI: 10.1093/rap/rky033.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- May Zun Swe
- Rheumatology, Northampton General Hospital, Northampton, UNITED KINGDOM
| | - Ameen Jubber
- Rheumatology, Northampton General Hospital, Northampton, UNITED KINGDOM
| | - Rachel Jeffery
- Rheumatology, Northampton General Hospital, Northampton, UNITED KINGDOM
| |
Collapse
|
10
|
Jubber A, Zun Swe M, Jeffery R. 93. Recurrent infections in a patient treated with biologic therapy for seropositive rheumatoid arthritis. Rheumatol Adv Pract 2018. [PMCID: PMC6652593 DOI: 10.1093/rap/rky032.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Ameen Jubber
- Rheumatology, Northampton General Hospital, Northampton, UNITED KINGDOM
| | - May Zun Swe
- Rheumatology, Northampton General Hospital, Northampton, UNITED KINGDOM
| | - Rachel Jeffery
- Rheumatology, Northampton General Hospital, Northampton, UNITED KINGDOM
| |
Collapse
|
11
|
Zun Swe M, Jubber A, Jeffery R, Tripathi M. 76. Idiopathic retroperitoneal fibrosis (possibly Ig G4 related). Rheumatol Adv Pract 2018. [PMCID: PMC6652400 DOI: 10.1093/rap/rky034.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- May Zun Swe
- Rheumatology, Northampton General Hospital, Northampton, UNITED KINGDOM
| | - Ameen Jubber
- Rheumatology, Northampton General Hospital, Northampton, UNITED KINGDOM
| | - Rachel Jeffery
- Rheumatology, Northampton General Hospital, Northampton, UNITED KINGDOM
| | - Mudita Tripathi
- Rheumatology, Northampton General Hospital, Northampton, UNITED KINGDOM
| |
Collapse
|
12
|
Hunukumbure AD, Jubber A, Chitkara R, Bernand H, Das S. Insight into undergraduate feedback of clinical practice: Junior Doctors vs Consultants. MedEdPublish 2018. [DOI: 10.15694/mep.2018.0000081.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This article was migrated. The article was not marked as recommended. Background: Constructive feedback is essential to improve clinical practice and is therefore discussed extensively in educational literature. Despite this, students regularly express dissatisfaction with their feedback at medical school. Many challenges to feedback in clinical settings have been documented but few were based on the students perspectives. This qualitative study explores the students experiences of feedback in clinical settings, in their third year at Imperial College London. Method: Seven third year medical students who were based at Hillingdon Hospital during February 2014 were interviewed in a semi-structured format on their experience of feedback in clinical settings. The interviews were transcribed and analysed using a thematic analytical approach. Results: The students claimed that they received little feedback and usually in an ad-hoc manner. Feedback was inconsistent between different clinicians, confusing some participants. There was a marked difference in quality and quantity of feedback between the consultants and junior doctors, with the majority of students preferring feedback from juniors. Junior doctors feedback focussed on medical school assessments, whilst the consultants was geared towards daily clinical practice. Discussion: Feedback provided by both clinician groups was heavily influenced by their own experiences and working environments. For consultants this was their vast clinical experience and considerable time constraints, whereas juniors had more time for students and could focus on exam techniques. Empowering students to take an active role in feedback, either seeking or clarifying the differences may be of help. Conclusion: Though feedback from consultants and junior doctors is not aligned, both are useful in shaping future clinicians.
Collapse
|
13
|
Debbas N, Woodings D, Marks C, Bhans A, Jubber A, Dews I, Stephens J, Vandenburg M. Dose-ranging study of isosorbide-5-mononitrate in chronic congestive heart failure treated with diuretics and angiotensin-converting enzyme inhibitor. Am J Cardiol 1988; 61:28E-30E. [PMID: 2831702 DOI: 10.1016/0002-9149(88)90086-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The hemodynamic response of isosorbide-5-mononitrate (IS-5-MN) to the addition of the widely used therapy of diuretic drugs and the maximally tolerated dose of enalapril for heart failure was assessed in 8 patients with congestive heart failure (CHF) (New York Heart Association class II and III). The diuretic therapy was furosemide, 40 to 80 mg/day, with or without amiloride, 5 to 10 mg/day. The dose of enalapril was 5 to 20 mg/day. Four hours after the administration of the morning dose of enalapril, a Swan-Ganz catheter was positioned in the pulmonary artery. Patients received increasing doses of IS-5-MN to produce a satisfactory decrease in pulmonary capillary wedge pressure. Two of the first 3 patients studied had a large reduction in blood pressure when given 10 mg of IS-5-MN. Subsequent patients were therefore given an initial dose of 5 mg, the total dose being 5 to 20 mg over 2 hours. Results at baseline and 1 hour after the final dose of IS-5-MN are expressed as mean +/- standard deviation. Both pulmonary artery systolic and diastolic pressures decreased significantly (p less than 0.05) by 12.2 +/- 8.9/4.2 +/- 5.2 mm Hg, from 47.2 +/- 16.0/21.6 +/- 6.0 mm Hg to 35.0 +/- 15.2/17.4 +/- 9.3 mm Hg. Pulmonary capillary wedge pressure decreased by 8.6 +/- 4.4 mm Hg, from 22.1 +/- 5.4 to 13.6 +/- 7.5 mm Hg (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- N Debbas
- Department of Cardiology, Oldchurch Hospital, Romford, Essex, England
| | | | | | | | | | | | | | | |
Collapse
|