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Bandeira M, Dourado E, Lopes F, Tenazinha C, Barros R, Barreira SC. Reactive arthritis as a rare complication of intravesical bacillus Calmette-Guérin treatment: Report of two cases. Int J Rheum Dis 2024; 27:e14862. [PMID: 37578016 DOI: 10.1111/1756-185x.14862] [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: 01/10/2023] [Revised: 07/22/2023] [Accepted: 07/27/2023] [Indexed: 08/15/2023]
Abstract
Intravesical bacillus Calmette-Guérin (BCG) immunotherapy is recommended for non-muscle-invasive bladder cancer after transurethral resection. BCG-associated musculoskeletal adverse events are rare. We report two cases of BCG reactive arthritis that were unusually severe and refractory. These describe two male patients who presented with polyarthritis after BCG exposure. Ultrasonography-guided glucocorticoid injections, high-dose systemic glucocorticoids and the institution of sulfasalazine were required for achievement of remission. Bacillus Calmette-Guérin reactive arthritis can present as polyarthritis of small and medium joints or as mono-oligoarthritis of asymmetrical ankles and knees, frequently associated with tenosynovitis and enthesitis. The mechanism by which BCG promotes arthralgia and arthritis is poorly understood. The most well-accepted theory is that the BCG antigens migrate to different peripheral tissues, including the joints. There is also a lack of knowledge regarding risk factors, with possible genetic factors playing a role. As the two presented cases show, BCG-induced reactive arthritis should be considered in the differential diagnosis of arthritis and refractory tenosynovitis in BCG-exposed patients.
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Affiliation(s)
- Matilde Bandeira
- Serviço de Reumatologia, Centro Hospitalar Universitário Lisboa Norte (CHULN), Centro Académico de Medicina de Lisboa (CAML), Lisboa, Portugal
- Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, CAML, Lisboa, Portugal
| | - Eduardo Dourado
- Serviço de Reumatologia, Centro Hospitalar Universitário Lisboa Norte (CHULN), Centro Académico de Medicina de Lisboa (CAML), Lisboa, Portugal
- Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, CAML, Lisboa, Portugal
| | - Filipe Lopes
- Serviço de Urologia, Centro Hospitalar Universitário Lisboa Norte (CHULN), Centro Académico de Medicina de Lisboa (CAML), Lisboa, Portugal
| | - Catarina Tenazinha
- Serviço de Reumatologia, Centro Hospitalar Universitário Lisboa Norte (CHULN), Centro Académico de Medicina de Lisboa (CAML), Lisboa, Portugal
- Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, CAML, Lisboa, Portugal
| | - Rita Barros
- Serviço de Reumatologia, Centro Hospitalar Universitário Lisboa Norte (CHULN), Centro Académico de Medicina de Lisboa (CAML), Lisboa, Portugal
- Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, CAML, Lisboa, Portugal
| | - Sofia C Barreira
- Serviço de Reumatologia, Centro Hospitalar Universitário Lisboa Norte (CHULN), Centro Académico de Medicina de Lisboa (CAML), Lisboa, Portugal
- Serviço de Urologia, Centro Hospitalar Universitário Lisboa Norte (CHULN), Centro Académico de Medicina de Lisboa (CAML), Lisboa, Portugal
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Duarte AC, Fernandes BM, Bernardes M, Tenazinha C, Martins P, Mazeda C, Mendes B, Guimarães F, Gago L, Correia AM, Valido A, Silva L, Brites L, Meirinhos T, Araújo F, Nero P, Cruz M, Teixeira L, Santos MJ. Lung disease in rheumatoid arthritis: Results from a national cohort. Pulmonology 2024; 30:87-89. [PMID: 37394340 DOI: 10.1016/j.pulmoe.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/19/2023] [Accepted: 05/24/2023] [Indexed: 07/04/2023] Open
Affiliation(s)
- A C Duarte
- Serviço de Reumatologia, Hospital Garcia de Orta, Avenida Torrado da Silva, 2805-267 Almada, Portugal.
| | - B M Fernandes
- Serviço de Reumatologia, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - M Bernardes
- Serviço de Reumatologia, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal; Departamento de Medicina, Faculdade de Medicina, Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - C Tenazinha
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Centro Hospitalar Lisboa Norte, Avenida Professor Egas Moniz, 1649-035 Lisboa, Portugal; Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
| | - P Martins
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Centro Hospitalar Lisboa Norte, Avenida Professor Egas Moniz, 1649-035 Lisboa, Portugal; Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
| | - C Mazeda
- Serviço de Reumatologia, Centro Hospitalar do Baixo Vouga, Avenida Artur Ravara, 3814-501 Aveiro, Portugal
| | - B Mendes
- Serviço de Reumatologia, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3004-561 Coimbra, Portugal
| | - F Guimarães
- Serviço de Reumatologia, Unidade Local de Saúde do Alto Minho, Rua Conde de Bertiandos, 4990-041 Ponte de Lima, Portugal
| | - L Gago
- Serviço de Reumatologia, Centro Hospitalar de Lisboa Ocidental, Hospital Egas Moniz, Rua da Junqueira 126, 1349-019 Lisboa, Portugal
| | - A M Correia
- Serviço de Reumatologia, Hospital de Braga, Sete Fontes - São Victor, 4710-243 Braga, Portugal
| | - A Valido
- Serviço de Reumatologia, Unidade Local de Saúde do Litoral Alentejano, Monte do Gilbardinho, 7540-230 Santiago do Cacém, Portugal
| | - L Silva
- Serviço de Reumatologia, Centro Hospitalar de Trás-os-Montes e Alto Douro, Avenida Noruega/Lordelo, 5000-508 Vila Rela, Portugal
| | - L Brites
- Serviço de Reumatologia, Centro Hospitalar de Leiria, Rua de Santo André, 2410-197 Leiria, Portugal
| | - T Meirinhos
- Serviço de Reumatologia, Centro Hospitalar do Tâmega e Sousa, Av. do Hospital Padre Américo 210, 4564-007 Guilhufe, Portugal
| | - F Araújo
- Serviço de Reumatologia, Hospital Ortopédico de Sant`Ana, Rua de Benguela 2779-501 Parede, Portugal
| | - P Nero
- Serviço de Reumatologia, Hospital CUF Descobertas, Rua Mário Botas, 1998-018 Lisboa, Portugal
| | - M Cruz
- Serviço de Reumatologia, Centro Hospitalar de S. Francisco, Rua Fonte Cabeço d'El Rei 15, Leiria, Portugal
| | - L Teixeira
- Serviço de Reumatologia, Hospital Central do Funchal, Avenida Luís de Camões, nº 57 9004-514 Funchal, Portugal
| | - M J Santos
- Serviço de Reumatologia, Hospital Garcia de Orta, Avenida Torrado da Silva, 2805-267 Almada, Portugal; Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
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3
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Tenazinha C, Barros R, Fonseca JE, Vieira-Sousa E. Histopathology of Psoriatic Arthritis Synovium—A Narrative Review. Front Med (Lausanne) 2022; 9:860813. [PMID: 35847785 PMCID: PMC9283901 DOI: 10.3389/fmed.2022.860813] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 04/05/2022] [Indexed: 11/13/2022] Open
Abstract
Psoriatic arthritis (PsA) is a phenotypically heterogeneous chronic inflammatory disease associated to type I major histocompatibility complex alleles whose complex pathogenesis is still not completely understood. The psoriatic synovium shares general features of chronic inflammation with rheumatoid arthritis (RA) and other arthritis, such as hyperplasia of the intimal lining layer, sublining influx of inflammatory cells and neoangiogenesis, but recognizing disease-specific histopathologic findings may help in diagnosis and definition of therapeutic targets. Available literature reports conflicting data regarding the extension of lining hyperplasia, that does not allow depiction from RA. Sublining inflammatory cells consist of T and B cells and macrophages, plasma cells, mast cells and follicular dendritic cells, with a higher amount of overall T, mast cell and IL-17 producing CD8+ T lymphocytes and lower proportion of plasma cells when compared to the rheumatoid synovium. The amount of synovium IL17+ CD8+ T cells correlates positively to measures of disease activity. Lymphoid follicles with characteristics of germinal centers have been identified, similar to the ones described in RA. Neoangiogenesis is more prominent in PsA but can also be an outstanding feature in some RA samples, and different molecules involved in the process appear to have different influence in each disease. IL-17 and IL-22 expression in the synovium does not allow depiction between diseases. Among other cytokines and molecules likely implicated in disease physiopathology, only IL-35 is demonstrated to be reduced in PsA when compared to RA.
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Affiliation(s)
- Catarina Tenazinha
- Department of Rheumatology and Metabolic Bone Diseases, Hospital de Santa Maria, Centro Hospitalar Universitàrio de Lisboa-Norte, Lisbon, Portugal
- Rheumatology Research Unit, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Lisbon Academic Medical Center, Universidade de Lisboa, Lisbon, Portugal
- *Correspondence: Catarina Tenazinha,
| | - Rita Barros
- Department of Rheumatology and Metabolic Bone Diseases, Hospital de Santa Maria, Centro Hospitalar Universitàrio de Lisboa-Norte, Lisbon, Portugal
| | - João Eurico Fonseca
- Department of Rheumatology and Metabolic Bone Diseases, Hospital de Santa Maria, Centro Hospitalar Universitàrio de Lisboa-Norte, Lisbon, Portugal
- Rheumatology Research Unit, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Lisbon Academic Medical Center, Universidade de Lisboa, Lisbon, Portugal
| | - Elsa Vieira-Sousa
- Department of Rheumatology and Metabolic Bone Diseases, Hospital de Santa Maria, Centro Hospitalar Universitàrio de Lisboa-Norte, Lisbon, Portugal
- Rheumatology Research Unit, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Lisbon Academic Medical Center, Universidade de Lisboa, Lisbon, Portugal
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Tenazinha C, Barros R, Romão VC. Candida albicans tenosynovitis of the hand. ARP Rheumatol 2022; 1:183-184. [PMID: 35810380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
An immunosuppressed 72 year-old woman presented with bilateral hand-fingers tenderness and increased circumference. Serum leukocyte and neutrophil counts were slightly raised and C-reactive protein moderately increased. On ultrasound there was flexor tenosynovitis of the 3rd right and 1st to 4th left hand-fingers and left common flexor tendon sheet. Candida albicans was isolated in synovial fluid cultures and the symptoms resolved with fluconazole. This is the first case reporting bilateral Candida tenosynovitis of the hand, highlighting the possible role of concealed hematogenous spread of opportunistic microorganisms in atypical clinical manifestations in immunocompromised patients.
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Affiliation(s)
- Catarina Tenazinha
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Hospital de Santa Maria - CHULN
| | - Rita Barros
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Hospital de Santa Maria - CHULN
| | - Vasco C Romão
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Hospital de Santa Maria - CHULN
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Nascimento J, Tenazinha C, Campanilho-Marques R, Cordeiro I, Salgado S. Rituximab in the treatment of anti-MDA5 dermatomyositis-associated interstitial lung disease: a case-based literature review. ARP Rheumatol 2022; 1:168-173. [PMID: 35810375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Interstitial lung disease (ILD) occurs with Idiopathic Inflammatory Myopathy (IIM) as a life-threating complication and is considered the most important prognostic determinant in this disease group. The antibody anti-melanoma differentiation-associated gene 5 (anti-MDA5) is associated to rapidly progressive ILD and poor overall survival. Rituximab (RTX) is becoming a drug of choice in management of refractory IIM-ILDs and rapidly progressive ILDs, despite its low level of evidence. We report the case of a 49-year-old man with new-onset clinically amyopathic dermatomyositis (CADM) with severe respiratory symptoms and mixed radiologic pattern of non-specific interstitial and organizing pneumonia, refractory to high dose corticosteroids and intravenous immunoglobulin and oxygen dependent. He was started on RTX 375mg/m2/week of which he completed 4 perfusions, with significant clinical improvement, and has been on maintenance to date with the rheumatology RTX standard protocol with no need for oxygen supplementation. RTX may represent a rescue therapy for patients with severe anti-MDA5-related CADM-ILD refractory to conventional immunotherapies. We identified reports of a total of 12 patients treated with RTX. Infection was the only reported adverse event (25%). Respiratory improvement (defined by symptoms, imaging or PFTs) was observed in 75% of patients, with 2 (17%) having achieved clinical remission. A total of three deaths occurred (25%), all resulting from ILD progression despite treatment. No therapeutic protocol with RTX seems to be more efficient nor associated with more adverse events than the others. Comparative studies are necessary.
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Affiliation(s)
| | - Catarina Tenazinha
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Hospital de Santa Maria - CHULN
| | | | - Inês Cordeiro
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Hospital de Santa Maria - CHULN
| | - Sara Salgado
- Serviço de Pneumologia, Hospital de Santa Maria - CHULN
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Pinto AS, Cunha MM, Pinheiro F, Bernardes M, Assunção H, Martins-Martinho J, Tenazinha C, Monteiro AM, Silva S, Martins FR, Silva L, Couto M, Faria M, Araújo F, Fontes T, Santos-Faria D, Tavares-Costa J. Effectiveness and safety of original and biosimilar etanercept (Enbrel® vs Benepali®) in bDMARD-naïve patients in a real-world cohort of Portugal. ARP Rheumatol 2022; 1:109-116. [PMID: 35810368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To compare the effectiveness and safety of original (Enbrel®) and biosimilar (Benepali®) etanercept in Biologic Disease-modifying Antirheumatic Drug (bDMARD)-naïve patients, measured by persistence rates over 36 months of follow-up. METHODS A retrospective multicentre observational study using data collected prospectively from The Rheumatic Diseases Portuguese Registry (Reuma.pt) was performed, including patients with: age ≥ 18 years old; diagnosis of Rheumatoid Arthritis (RA), Psoriatic Arthritis (PsA) or Spondyloarthritis (SpA) (axial or peripheral) with active disease and biologic-naïve who initiated treatment with etanercept as the first line biological treatment after 2010. Kaplan-Meyer and Cox regression were used to calculate the persistence rate in treatment. Disease activity at baseline and follow-up data at 6, 12, 18 and 24 months of treatment were compared. Causes for discontinuing therapy were summarized using descriptive statistics. Statistical significance was assumed for 2-sided p-values <0.05. RESULTS We included 1693 patients (413 on Benepali® and 1280 on Enbrel®): 864 diagnosed with RA, 335 with PsA and 494 with SpA. The 3-year persistence rates were not significantly different between both treatment groups in RA, PsA and SpA patients. In the adjusted Cox model, hazard ratios of discontinuation were not statistically different (p>0.05). The proportion of subjects in remission or low disease activity in each disease was similar in both groups. Overall, 535 (31.6%) patients discontinued etanercept (428 patients on Enbrel® and 107 patients on Benepali®). The major cause of discontinuation was inefficacy (57.8%). No differences for the occurrence of inefficacy or adverse effects were found between treatment groups. CONCLUSIONS Benepali® and Enbrel® demonstrated similar effectiveness and safety in RA, PsA and SpA in our cohort of patients. These data corroborate that the original and biosimilar drugs have similar quality characteristics and biological activity.
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Affiliation(s)
- Ana Sofia Pinto
- Rheumatology, Unidade Local de Saúde da Guarda; Unidade Local de Saúde do Alto Minho
| | | | | | | | | | | | | | | | | | | | - Lígia Silva
- Rheumatology, Centro Hospitalar Trás-Os-Montes e Alto Douro
| | - Maura Couto
- Rheumatology, Centro Hospitalar Tondela-Viseu
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Leal I, Jose P, Barão R, Mano S, Melo AT, Dourado E, Tenazinha C, Vaz C, Ferreira JF, Dinis S, Santos FC, Fernandes H, Khmelinskii N, Marques‐Neves C, de Sousa EV, Fonseca JE. Vision‐related quality of life in spondyloarthritis patients with history of acute anterior uveitis under treatment with golimumab: preliminary results of the GO‐VISION observational study. Acta Ophthalmol 2022. [DOI: 10.1111/j.1755-3768.2022.119] [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: 11/25/2022]
Affiliation(s)
- Ines Leal
- Ophthalmology Faculdade de Medicina de Lisboa Lisbon Portugal
| | - Patricia Jose
- Ophthalmology Faculdade de Medicina de Lisboa Lisbon Portugal
| | - Rafael Barão
- Ophthalmology Faculdade de Medicina de Lisboa Lisbon Portugal
| | - Sofia Mano
- Ophthalmology Faculdade de Medicina de Lisboa Lisbon Portugal
| | - Ana Teresa Melo
- Rheumatology Faculdade de Medicina de Lisboa Lisboa Portugal
| | - Eduardo Dourado
- Rheumatology Faculdade de Medicina de Lisboa Lisboa Portugal
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Tenazinha C, Barros R, Polido-Pereira J, Saraiva F. Plant thorn synovitis - case-report of a synovial biopsy both diagnostic and therapeutic. Rheumatology (Oxford) 2021; 61:e137-e138. [PMID: 34270678 DOI: 10.1093/rheumatology/keab568] [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] [Received: 06/03/2021] [Revised: 06/22/2021] [Accepted: 06/25/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Catarina Tenazinha
- Department of Rheumatology and Metabolic Bone Diseases, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisboa, Portugal.,Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal.,Research in Rheumatology Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Rita Barros
- Department of Rheumatology and Metabolic Bone Diseases, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
| | - Joaquim Polido-Pereira
- Department of Rheumatology and Metabolic Bone Diseases, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisboa, Portugal.,Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal.,Research in Rheumatology Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Fernando Saraiva
- Department of Rheumatology and Metabolic Bone Diseases, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisboa, Portugal.,Research in Rheumatology Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
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Cunha RN, Monteiro M, Tenazinha C, Khmelinskii N, Ponte C. Prospective clinical and ultrasonographic assessment of the temporal artery in a patient with giant cell arteritis. Rheumatology (Oxford) 2021; 61:1300-1301. [PMID: 34037743 DOI: 10.1093/rheumatology/keab463] [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] [Received: 05/13/2021] [Accepted: 05/19/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Rita N Cunha
- Rheumatology Department, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
| | - Margarida Monteiro
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal.,Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Catarina Tenazinha
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal.,Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Nikita Khmelinskii
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal.,Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Cristina Ponte
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal.,Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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Araújo FC, Sepriano A, Teixeira F, Jesus D, Rocha TM, Martins P, Tenazinha C, Cordeiro A, Mourão AF, Silva C, Vaz C, Duarte C, Ponte C, Dos Santos FP, Canhão H, Santos H, Pimentão JB, da Silva JC, Pereira J, da Silva JAP, Miranda LC, Oliveira M, Saavedra MJ, Gonçalves P, Falcão S, Capela S, Fonseca JE. The Portuguese Society of Rheumatology position paper on the use of biosimilars - 2017 update. Acta Reumatol Port 2017; 42:219-228. [PMID: 28894080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Biosimilars are new and more affordable similar versions of previously approved reference biological drugs. Following the approval of the first monoclonal antibody biosimilar in 2013, the Portuguese Society of Rheumatology issued a position paper on the use of biosimilars in rheumatic conditions covering efficacy, safety, extrapolation, interchangeability, substitution and pharmacovigilance. However, as this is a rapidly evolving field, it was felt that the knowledge and evidence gathered since then justified an update of these statements. Literature searches on these issues were performed and the search results were presented and discussed in a national meeting. Portuguese rheumatologists considered that affordability should be taken into consideration when initiating a biological drug, but other factors were equally important. In patients already on reference biological treatment, switch to a more affordable biosimilar is desirable, provided a set of conditions is rigorously met. Automatic substitution is not acceptable and current evidence is insufficient to support interchangeability. Extrapolation of clinical indications is endorsed by Portuguese rheumatologists, and the statements on safety, pharmacovigilance and traceability are in accordance with the previous position paper.
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