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Joven B, Hernández Sánchez R, Pérez-Pampín E, Aragón Díez Á, Almodóvar R, Martínez-Ferrer Á, Belzunegui J, Rubio E, Díaz-Cerezo S, Moyano S, Gómez-Barrera M, Yébenes M, Núñez M. Persistence and Use of Ixekizumab in Patients with Psoriatic Arthritis in Real-World Practice in Spain. The PRO-STIP Study. Rheumatol Ther 2023; 10:1319-1333. [PMID: 37481752 PMCID: PMC10468471 DOI: 10.1007/s40744-023-00584-8] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/30/2023] [Indexed: 07/25/2023] Open
Abstract
INTRODUCTION Ixekizumab (IXE) is an IgG4-type monoclonal antibody targeting IL-17A indicated alone or in combination with methotrexate, for the treatment of active psoriatic arthritis (PsA) in adult patients with insufficient response or with intolerance to one or more disease-modifying anti-rheumatic drug (DMARD) therapy. The PRO-STIP study aimed to describe persistence, patient characteristics, treatment patterns, and effectiveness in patients with PsA receiving IXE in a real-world clinical setting in Spain. METHODS This was an observational, multicentric, retrospective, longitudinal study in adult PsA patients who started IXE between January 2019 and December 2020, with at least 24 weeks of follow-up. A descriptive analysis of patient characteristics and treatment patterns was performed. The primary objective, treatment persistence, was estimated by Kaplan-Meier survival curve. Effectiveness was evaluated by Disease Activity in Psoriatic Arthritis (DAPSA) scores at baseline and at 12 and 24 weeks. RESULTS Eighty-nine patients met the selection criteria (55.1% women and mean age 51.5 years). The median time from PsA diagnosis to starting IXE was 7.7 years (IQR 3.4-14.6). Prior to IXE, 95.5% patients had been treated with at least one biologic or targeted synthetic DMARD (b/tsDMARD). The observed persistence rates were 95.5%, 84.3% and 68.5% at 24, 48, and 104 weeks, respectively. The median persistence was not reached in the study period (mean persistence, 86.9 [95% CI 80.6-93.2] weeks). Twenty-eight (31.5%) patients discontinued IXE, 19 patients (21.3%) due to loss of effectiveness and two patients (2.2%) due to adverse events. In patients receiving treatment and with available effectiveness assessment (n = 24), DAPSA decreased significantly from baseline 23.7 (95% CI 19.5-27.9) to 14.8 (95% CI 10.5-19.2) at 12 weeks (p = 0.005) and 14.3 (95% CI 11.1-17.4) at 24 weeks (p = 0.004). CONCLUSIONS PsA patients treated with IXE in a real-world setting show high treatment persistence through 104 weeks and improvements in disease activity after treatment initiation. This suggests that IXE could be an effective treatment for patients with PsA. RETROSPECTIVELY REGISTERED Date of registration: 25th May 2021.
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Affiliation(s)
- Beatriz Joven
- Hospital Universitario, 12 de Octubre, Madrid, Spain
| | | | - Eva Pérez-Pampín
- Hospital Clínico Universitario Santiago, Santiago de Compostela, Spain
| | | | | | | | | | - Esteban Rubio
- Hospital Universitario Virgen del Rocío, Seville, Spain
| | | | | | - Manuel Gómez-Barrera
- Pharmacoeconomics and Outcomes Research Iberia (PORIB), Pozuelo de Alarcón, Madrid, Spain
| | - María Yébenes
- Pharmacoeconomics and Outcomes Research Iberia (PORIB), Pozuelo de Alarcón, Madrid, Spain
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Rodríguez-Trillo A, Pena C, García S, Pérez-Pampín E, Rodríguez-López M, Mera-Varela A, González A, Conde C. ROCK inhibition with Y-27632 reduces joint inflammation and damage in serum-induced arthritis model and decreases in vitro osteoclastogenesis in patients with early arthritis. Front Immunol 2022; 13:858069. [PMID: 36032152 PMCID: PMC9410766 DOI: 10.3389/fimmu.2022.858069] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 07/21/2022] [Indexed: 12/04/2022] Open
Abstract
Rheumatoid arthritis (RA) is a common chronic inflammatory disease affecting primarily peripheral joints, which is only partially controlled with current treatments. RA leads to pain, disability, deformities, and life expectancy shortening. Its pathogenesis is complex involving multiple cell types and signaling pathways that we incompletely understand. One of the pathways we have elucidated starts with WNT5A signaling and contributes to the aggressive phenotype of the RA synoviocytes through RYK-RhoA/ROCK signaling. Now, we have explored the contribution of ROCK to arthritis in vivo, using the K/BxN serum-transfer arthritis model; and to osteoclastogenesis, using the arthritis model and cells from patients with inflammatory arthritis. The mice and cells were treated with the ROCK inhibitor Y-27632 that caused a significant improvement of arthritis and reduction of osteoclastogenesis. The improvement in mouse arthritis was observed in the clinical evaluation and, histologically, in synovial inflammation, cartilage damage, bone erosion, and the abundance of multinucleated TRAP+ cells. Expression of inflammatory mediators in the arthritic joints, as assessed by real-time PCR, was also significantly reduced. The effect on bone was confirmed with in vitro assays using bone marrow precursors of arthritic mice and peripheral blood monocytes of patients with inflammatory arthritis. These assays showed dramatically reduced osteoclastogenesis and bone resorption. Overall, our findings suggest that ROCK inhibition could be part of a therapeutic strategy for RA by its dual action on inflammation and bone erosion.
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Affiliation(s)
- Angela Rodríguez-Trillo
- Laboratorio de Reumatología Experimental y Observacional y Servicio de Reumatología, Instituto de Investigación Sanitaria de Santiago (IDIS), Hospital Clínico Universitario de Santiago de Compostela (CHUS), Servizo Galego de Saúde (SERGAS), Santiago de Compostela, Spain
| | - Carmen Pena
- Laboratorio de Reumatología Experimental y Observacional y Servicio de Reumatología, Instituto de Investigación Sanitaria de Santiago (IDIS), Hospital Clínico Universitario de Santiago de Compostela (CHUS), Servizo Galego de Saúde (SERGAS), Santiago de Compostela, Spain
| | - Samuel García
- Laboratorio de Reumatología y Enfermedades Inmunomediadas (IRIDIS), Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), Hospital Álvaro Cunqueiro, Vigo, Spain
| | - Eva Pérez-Pampín
- Servicio de Reumatología, Instituto de Investigación Sanitaria de Santiago (IDIS), Hospital Clínico Universitario de Santiago de Compostela (CHUS), Servizo Galego de Saúde (SERGAS), Santiago de Compostela, Spain
| | - Marina Rodríguez-López
- Servicio de Reumatología, Instituto de Investigación Sanitaria de Santiago (IDIS), Hospital Clínico Universitario de Santiago de Compostela (CHUS), Servizo Galego de Saúde (SERGAS), Santiago de Compostela, Spain
| | - Antonio Mera-Varela
- Servicio de Reumatología, Instituto de Investigación Sanitaria de Santiago (IDIS), Hospital Clínico Universitario de Santiago de Compostela (CHUS), Servizo Galego de Saúde (SERGAS), Santiago de Compostela, Spain
| | - Antonio González
- Laboratorio de Reumatología Experimental y Observacional y Servicio de Reumatología, Instituto de Investigación Sanitaria de Santiago (IDIS), Hospital Clínico Universitario de Santiago de Compostela (CHUS), Servizo Galego de Saúde (SERGAS), Santiago de Compostela, Spain
| | - Carmen Conde
- Laboratorio de Reumatología Experimental y Observacional y Servicio de Reumatología, Instituto de Investigación Sanitaria de Santiago (IDIS), Hospital Clínico Universitario de Santiago de Compostela (CHUS), Servizo Galego de Saúde (SERGAS), Santiago de Compostela, Spain
- *Correspondence: Carmen Conde,
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3
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Calderón-Goercke M, Castañeda S, Aldasoro V, Villa I, Prieto-Peña D, Atienza-Mateo B, Patiño E, Moriano C, Romero-Yuste S, Narváez J, Gómez-Arango C, Pérez-Pampín E, Melero R, Becerra-Fernández E, Revenga M, Álvarez-Rivas N, Galisteo C, Sivera F, Olivé-Marqués A, Álvarez Del Buergo M, Marena-Rojas L, Fernández-López C, Navarro F, Raya E, Galindez-Agirregoikoa E, Arca B, Solans-Laqué R, Conesa A, Hidalgo C, Vázquez C, Román-Ivorra JA, Loricera J, Lluch P, Manrique-Arija S, Vela P, De Miguel E, Torres-Martín C, Nieto JC, Ordas-Calvo C, Salgado-Pérez E, Luna-Gomez C, Toyos-Sáenz de Miera FJ, Fernández-Llanio N, García A, Larena C, González-Vela C, Corrales A, Varela-García M, Aurrecoechea E, Dos Santos R, García-Manzanares Á, Ortego N, Fernández S, Ortiz-Sanjuán F, Corteguera M, Hernández JL, González-Gay MÁ, Blanco R. Tocilizumab in giant cell arteritis: differences between the GiACTA trial and a multicentre series of patients from the clinical practice. Clin Exp Rheumatol 2020; 38 Suppl 124:112-119. [PMID: 32441643] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 04/06/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES A potential point of concern among clinicians is whether results derived from the clinical trials can be reasonably applied or generalised to a definable group of patients seen in real world. It can be the case of the GiACTA study that is a phase III randomised controlled trial of tocilizumab (TCZ) in giant cell arteritis (GCA). To address this question, we compared the clinical features and the responses to TCZ from the GiACTA trial patients with those from a series of GCA seen in the daily clinical practice. METHODS Comparative study of clinical features between patients from the GiACTA trial (overall n=251) and those from a multicentre series of real-world GCA patients undergoing TCZ therapy (n=134). The diagnosis of GCA in the GiACTA trial was established by the ACR modified criteria whereas in the series of real-world patients it was made by using the ACR criteria, a positive biopsy of temporal artery or the presence of imaging techniques consistent with large-vessel vasculitis in individuals who presented cranial symptoms of GCA. GiACTA trial patients received subcutaneous TCZ (162 mg every 1 or 2 weeks) whereas those from the clinical practice series were treated using standard IV dose (8 mg/kg/month) or subcutaneous (162 mg/week). RESULTS Real-life patients undergoing TCZ were older with longer disease duration and higher values of ESR and had received conventional immunosuppressive therapy (mainly methotrexate) more commonly than those included in the GiACTA trial. Despite clinical differences, TCZ was equally effective in both GiACTA trial and clinical practice patients. However, serious infections were more commonly observed in GCA patients recruited from the clinical practice. CONCLUSIONS Despite clinical differences with patients recruited in clinical trials, data from real-life patients confirm the efficacy of TCZ in GCA.
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Affiliation(s)
- Mónica Calderón-Goercke
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Santos Castañeda
- Department of Rheumatology, Hospital Universitario de La Princesa, IIS-Princesa, Madrid; Cátedra UAM-Roche, EPID-Future, Universidad Autónoma (UAM), Madrid, Spain
| | - Vicente Aldasoro
- Department of Rheumatology, Complejo Hospitalario de Navarra, Spain
| | - Ignacio Villa
- Department of Rheumatology, Hospital de Sierrallana, Torrelavega, Cantabria, Spain
| | - Diana Prieto-Peña
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Belén Atienza-Mateo
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Esther Patiño
- Department of Rheumatology, Hospital Universitario de La Princesa, IIS-Princesa, Madrid; Cátedra UAM-Roche, EPID-Future, Universidad Autónoma (UAM), Madrid, Spain
| | - Clara Moriano
- Department of Rheumatology, Complejo Asistencial Universitario de León, Spain
| | - Susana Romero-Yuste
- Department of Rheumatology, Complejo Hospitalario Universitario Pontevedra, Spain
| | - Javier Narváez
- Department of Rheumatology, Hospital de Bellvitge, Barcelona, Spain
| | | | - Eva Pérez-Pampín
- Department of Rheumatology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Rafael Melero
- Department of Rheumatology, Complexo Hospitalario Universitario de Vigo, Spain
| | | | | | | | - Carles Galisteo
- Department of Rheumatology, Hospital Parc Taulí, Barcelona, Spain
| | - Francisca Sivera
- Department of Rheumatology, Hospital Universitario de Elda, Alicante, Spain
| | | | | | - Luisa Marena-Rojas
- Department of Rheumatology, Hospital La Mancha Centro, Alcázar de San Juan, Spain
| | | | - Francisco Navarro
- Department of Rheumatology, Hospital General Universitario de Elche, Alicante, Spain
| | - Enrique Raya
- Department of Rheumatology and Internal Medicine, Hospital San Cecilio, Granada, Spain
| | | | - Beatriz Arca
- Department of Rheumatology, Hospital Universitario San Agustín, Avilés, Spain
| | - Roser Solans-Laqué
- Department of Internal Medicine, Hospital Valle de Hebrón, Barcelona, Spain
| | - Arantxa Conesa
- Department of Rheumatology, Hospital General Universitario de Castellón, Spain
| | - Cristina Hidalgo
- Department of Rheumatology, Complejo Asistencial Universitario de Salamanca, Spain
| | - Carlos Vázquez
- Department of Rheumatology, Hospital Miguel Servet, Zaragoza, Spain
| | | | - Javier Loricera
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Pau Lluch
- Department of Rheumatology, Hospital Mateu Orfila, Menorca, Spain
| | | | - Paloma Vela
- Department of Rheumatology, Hospital General Universitario de Alicante, Spain
| | | | | | - Juan Carlos Nieto
- Department of Rheumatology, Hospital Gregorio Marañón, Madrid, Spain
| | | | - Eva Salgado-Pérez
- Department of Rheumatology, Complejo Hospitalario Universitario de Ourense, Spain
| | - Cristina Luna-Gomez
- Department of Rheumatology, Hospital Universitario Nuestra Señora de la Candelaria, Tenerife, Spain
| | | | | | - Antonio García
- Department of Rheumatology, Hospital Virgen de las Nieves, Granada, Spain
| | - Carmen Larena
- Department of Rheumatology, Hospital Ramón y Cajal, Madrid, Spain
| | - Carmen González-Vela
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Alfonso Corrales
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - María Varela-García
- Department of Rheumatology, Hospital Universitario de La Princesa, IIS-Princesa, Madrid; Cátedra UAM-Roche, EPID-Future, Universidad Autónoma (UAM), Madrid, Spain
| | - Elena Aurrecoechea
- Department of Rheumatology, Hospital de Sierrallana, Torrelavega, Cantabria, Spain
| | - Raquel Dos Santos
- Department of Rheumatology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | | | - Norberto Ortego
- Department of Rheumatology and Internal Medicine, Hospital San Cecilio, Granada, Spain
| | - Sabela Fernández
- Department of Rheumatology, Hospital Universitario San Agustín, Avilés, Spain
| | | | | | - José L Hernández
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Miguel Á González-Gay
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain.
| | - Ricardo Blanco
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain.
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López-Mejías R, Carmona FD, Genre F, Remuzgo-Martínez S, González-Juanatey C, Corrales A, Vicente EF, Pulito-Cueto V, Miranda-Filloy JA, Ramírez Huaranga MA, Blanco R, Robustillo-Villarino M, Rodríguez-Carrio J, Alperi-López M, Alegre-Sancho JJ, Mijares V, Lera-Gómez L, Pérez-Pampín E, González A, Ortega-Castro R, López-Pedrera C, García Vivar ML, Gómez-Arango C, Raya E, Narvaez J, Balsa A, López-Longo FJ, Carreira P, González-Álvaro I, Rodríguez-Rodríguez L, Fernández-Gutiérrez B, Ferraz-Amaro I, Gualillo O, Castañeda S, Martín J, Llorca J, González-Gay MA. Identification of a 3'-Untranslated Genetic Variant of RARB Associated With Carotid Intima-Media Thickness in Rheumatoid Arthritis: A Genome-Wide Association Study. Arthritis Rheumatol 2019; 71:351-360. [PMID: 30251476 PMCID: PMC6590191 DOI: 10.1002/art.40734] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 06/28/2018] [Accepted: 09/18/2018] [Indexed: 02/06/2023]
Abstract
Objective To investigate the genetic background influencing the development of cardiovascular (CV) disease in patients with rheumatoid arthritis (RA). Methods We performed a genome‐wide association study (GWAS) in which, after quality control and imputation, a total of 6,308,944 polymorphisms across the whole genome were analyzed in 2,989 RA patients of European origin. Data on subclinical atherosclerosis, obtained through assessment of carotid intima‐media thickness (CIMT) and presence/absence of carotid plaques by carotid ultrasonography, were available for 1,355 individuals. Results A genetic variant of the RARB gene (rs116199914) was associated with CIMT values at the genome‐wide level of significance (minor allele [G] β coefficient 0.142, P = 1.86 × 10−8). Interestingly, rs116199914 overlapped with regulatory elements in tissues related to CV pathophysiology and immune cells. In addition, biologic pathway enrichment and predictive protein–protein relationship analyses, including suggestive GWAS signals of potential relevance, revealed a functional enrichment of the collagen biosynthesis network related to the presence/absence of carotid plaques (Gene Ontology no. 0032964; false discovery rate–adjusted P = 4.01 × 10−3). Furthermore, our data suggest potential influences of the previously described candidate CV risk loci NFKB1,MSRA, and ZC3HC1 (P = 8.12 × 10−4, P = 5.94 × 10−4, and P = 2.46 × 10−4, respectively). Conclusion The present findings strongly suggest that genetic variation within RARB contributes to the development of subclinical atherosclerosis in patients with RA.
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Affiliation(s)
| | | | - Fernanda Genre
- Instituto de Investigación Sanitaria Valdecilla, Santander, Spain
| | | | | | - Alfonso Corrales
- Instituto de Investigación Sanitaria Valdecilla, Santander, Spain
| | | | | | | | | | - Ricardo Blanco
- Instituto de Investigación Sanitaria Valdecilla, Santander, Spain
| | | | - Javier Rodríguez-Carrio
- University of Oviedo, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Mercedes Alperi-López
- Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | | | - Verónica Mijares
- Instituto de Investigación Sanitaria Valdecilla, Santander, Spain
| | | | - Eva Pérez-Pampín
- Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - Antonio González
- Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | | | | | | | | | - Enrique Raya
- Hospital Universitario San Cecilio, Granada, Spain
| | | | | | | | | | | | | | | | | | - Oreste Gualillo
- Servizo Galego de Saude and Instituto de Investigación Sanitaria de Santiago, Santiago, University Clinical Hospital, Santiago de Compostela, Spain
| | | | - Javier Martín
- Instituto de Parasitología y Biomedicina López-Neyra, Granada, Spain
| | - Javier Llorca
- University of Cantabria and CIBER Epidemiología y Salud Pública, Instituto de Investigación Sanitaria Valdecilla, Santander, Spain
| | - Miguel A González-Gay
- Instituto de Investigación Sanitaria Valdecilla and University of Cantabria, Santander, Spain, and University of the Witwatersrand, Johannesburg, South Africa
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Calderón-Goercke M, Loricera J, Aldasoro V, Castañeda S, Villa I, Humbría A, Moriano C, Romero-Yuste S, Narváez J, Gómez-Arango C, Pérez-Pampín E, Melero R, Becerra-Fernández E, Revenga M, Álvarez-Rivas N, Galisteo C, Sivera F, Olivé-Marqués A, Álvarez Del Buergo M, Marena-Rojas L, Fernández-López C, Navarro F, Raya E, Galindez-Agirregoikoa E, Arca B, Solans-Laqué R, Conesa A, Hidalgo C, Vázquez C, Román-Ivorra JA, Lluch P, Manrique-Arija S, Vela P, De Miguel E, Torres-Martín C, Nieto JC, Ordas-Calvo C, Salgado-Pérez E, Luna-Gomez C, Toyos-Sáenz de Miera FJ, Fernández-Llanio N, García A, Larena C, Palmou-Fontana N, Calvo-Río V, Prieto-Peña D, González-Vela C, Corrales A, Varela-García M, Aurrecoechea E, Dos Santos R, García-Manzanares Á, Ortego N, Fernández S, Ortiz-Sanjuán F, Corteguera M, Hernández JL, González-Gay MÁ, Blanco R. Tocilizumab in giant cell arteritis. Observational, open-label multicenter study of 134 patients in clinical practice. Semin Arthritis Rheum 2019; 49:126-135. [PMID: 30655091 DOI: 10.1016/j.semarthrit.2019.01.003] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 12/14/2018] [Accepted: 01/02/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Tocilizumab (TCZ) has shown efficacy in clinical trials on giant cell arteritis (GCA). Real-world data are scarce. Our objective was to assess efficacy and safety of TCZ in unselected patients with GCA in clinical practice Methods: Observational, open-label multicenter study from 40 national referral centers of GCA patients treated with TCZ due to inefficacy or adverse events of previous therapy. Outcomes variables were improvement of clinical features, acute phase reactants, glucocorticoid-sparing effect, prolonged remission and relapses. A comparative study was performed: (a) TCZ route (SC vs. IV); (b) GCA duration (≤6 vs. >6 months); (c) serious infections (with or without); (d) ≤15 vs. >15 mg/day at TCZ onset. RESULTS 134 patients; mean age, 73.0 ± 8.8 years. TCZ was started after a median [IQR] time from GCA diagnosis of 13.5 [5.0-33.5] months. Ninety-eight (73.1%) patients had received immunosuppressive agents. After 1 month of TCZ 93.9% experienced clinical improvement. Reduction of CRP from 1.7 [0.4-3.2] to 0.11 [0.05-0.5] mg/dL (p < 0.0001), ESR from 33 [14.5-61] to 6 [2-12] mm/1st hour (p < 0.0001) and decrease in patients with anemia from 16.4% to 3.8% (p < 0.0001) were observed. Regardless of administration route or disease duration, clinical improvement leading to remission at 6, 12, 18, 24 months was observed in 55.5%, 70.4%, 69.2% and 90% of patients. Most relevant adverse side-effect was serious infections (10.6/100 patients-year), associated with higher doses of prednisone during the first three months of therapy. CONCLUSION In clinical practice, TCZ yields a rapid and maintained improvement of refractory GCA. Serious infections appear to be higher than in clinical trials.
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Affiliation(s)
- Mónica Calderón-Goercke
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Javier Loricera
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Vicente Aldasoro
- Department of Rheumatology, Complejo Hospitalario de Navarra, Navarra, Spain
| | - Santos Castañeda
- Department of Rheumatology, Hospital Universitario de La Princesa, IIS-Princesa, Madrid, Spain
| | - Ignacio Villa
- Department of Rheumatology, Hospital de Sierrallana, Torrelavega, Spain
| | - Alicia Humbría
- Department of Rheumatology, Hospital Universitario de La Princesa, IIS-Princesa, Madrid, Spain
| | - Clara Moriano
- Department of Rheumatology, Complejo Asistencial Universitario de León, León, Spain
| | - Susana Romero-Yuste
- Department of Rheumatology, Complejo Hospitalario Universitario Pontevedra, Spain
| | - Javier Narváez
- Department of Rheumatology, Hospital de Bellvitge, Barcelona, Spain
| | | | - Eva Pérez-Pampín
- Department of Rheumatology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Rafael Melero
- Department of Rheumatology, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | | | | | | | - Carles Galisteo
- Department of Rheumatology, Hospital Parc Taulí, Barcelona, Spain
| | - Francisca Sivera
- Department of Rheumatology, Hospital Universitario de Elda, Alicante, Spain
| | | | | | - Luisa Marena-Rojas
- Department of Rheumatology, Hospital La Mancha Centro, Alcázar de San Juan, Spain
| | | | - Francisco Navarro
- Department of Rheumatology, Hospital General Universitario de Elche, Alicante, Spain
| | - Enrique Raya
- Department of Rheumatology and Internal Medicine, Hospital San Cecilio, Granada, Spain
| | | | - Beatriz Arca
- Department of Rheumatology, Hospital Universitario San Agustín, Avilés, Spain
| | - Roser Solans-Laqué
- Department of Internal Medicine, Hospital Valle de Hebrón, Barcelona, Spain
| | - Arantxa Conesa
- Department of Rheumatology, Hospital General Universitario de Castellón, Spain
| | - Cristina Hidalgo
- Department of Rheumatology, Complejo Asistencial Universitario de Salamanca, Spain
| | - Carlos Vázquez
- Department of Rheumatology, Hospital Miguel Servet, Zaragoza, Spain
| | | | - Pau Lluch
- Department of Rheumatology, Hospital Mateu Orfila, Menorca, Spain
| | | | - Paloma Vela
- Department of Rheumatology, Hospital General Universitario de Alicante, Alicante, Spain
| | | | | | - Juan Carlos Nieto
- Department of Rheumatology, Hospital Gregorio Marañón, Madrid, Spain
| | | | - Eva Salgado-Pérez
- Department of Rheumatology, Complejo Hospitalario Universitario de Ourense, Ourense, Spain
| | - Cristina Luna-Gomez
- Department of Rheumatology, Hospital Universitario Nuestra Señora de la Candelaria, Tenerife, Spain
| | | | | | - Antonio García
- Department of Rheumatology, Hospital Virgen de las Nieves, Granada, Spain
| | - Carmen Larena
- Department of Rheumatology, Hospital Ramón y Cajal, Madrid, Spain
| | - Natalia Palmou-Fontana
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Vanesa Calvo-Río
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Diana Prieto-Peña
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Carmen González-Vela
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Alfonso Corrales
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - María Varela-García
- Department of Rheumatology, Complejo Hospitalario de Navarra, Navarra, Spain
| | | | - Raquel Dos Santos
- Department of Rheumatology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | | | - Norberto Ortego
- Department of Rheumatology and Internal Medicine, Hospital San Cecilio, Granada, Spain
| | - Sabela Fernández
- Department of Rheumatology, Hospital Universitario San Agustín, Avilés, Spain
| | | | | | - José L Hernández
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Miguel Á González-Gay
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain.
| | - Ricardo Blanco
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain.
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López-Rodríguez R, Ferreiro-Iglesias A, Lima A, Bernardes M, Pawlik A, Paradowska-Gorycka A, Świerkot J, Slezak R, Gonzalez-Alvaro I, Narvaez J, Pérez-Pampín E, Mera-Varela A, Vidal-Bralo L, Acuña-Ochoa JG, Conde C, Gonzalez A. Evaluation of a clinical pharmacogenetics model to predict methotrexate response in patients with rheumatoid arthritis. Pharmacogenomics J 2018. [PMID: 29520081 DOI: 10.1038/s41397-018-0017-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Variability of response to treatment hinders successful management of rheumatoid arthritis (RA). Consequently, a clinical pharmacogenetics model for predicting response to methotrexate (CP-MTX) has been previously proposed that includes four clinical variables (disease activity, sex, the presence of rheumatoid factor and smoking status) and four SNPs (rs2236225, rs17602729, rs1127354, and rs2372536) in genes of the folate pathway. It showed good performance, but failed to attract attention, likely, in relation with lack of clear clinical benefit. Here, we have revised the value of the CP-MTX model directly addressing its clinical benefit by focusing on the expected benefit-cost of the predictions. In addition, our study included a much larger number of RA patients (n = 720) in MTX monotherapy than previous studies. Benefit of CP-MTX prediction was defined as the patients that would have received combination therapy as first treatment because they were correctly predicted as non-responders to MTX monotherapy. In contrast, cost of CP-MTX prediction was defined as the responder patients that were wrongly predicted as non-responders. Application of CP-MTX predictions to our patients showed a good benefit-cost relationship, with half of the 66.7% non-responders to MTX monotherapy rightly directed to alternative treatments (a benefit of 33.3%) at the cost of 8.5% wrongly predicted non-responders. These benefits-costs were consistent with reanalysis of the previously published studies. Therefore, predictions of CP-MTX showed a good benefit-cost relationship for informing MTX prescription.
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Affiliation(s)
- Rosario López-Rodríguez
- Experimental and Observational Rheumatology and Rheumatology Unit. Instituto de Investigación Sanitaria, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - Aida Ferreiro-Iglesias
- Experimental and Observational Rheumatology and Rheumatology Unit. Instituto de Investigación Sanitaria, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - Aurea Lima
- CESPU, Institute of Research & Advanced Training in Health Sciences & Technologies, Drug Discovery, Delivery & Toxicology Group, Gandra PRD, Portugal.,Molecular Oncology & Viral Pathology Group - Research Center, Portuguese Institute of Oncology of Porto, Porto, Portugal
| | - Miguel Bernardes
- Faculty of Medicine, University of Porto, Porto, Portugal.,Rheumatology Department, São João Hospital Center, Porto, Portugal
| | - Andrzej Pawlik
- Department of Physiology, Pomeranian Medical University Szczecin, Szczecin, Poland
| | - Agnieszka Paradowska-Gorycka
- Department of Biochemistry and Molecular Biology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Jerzy Świerkot
- Department of Rheumatology, Wroclaw Medical University, Wrocław, Poland
| | - Ryszard Slezak
- Department of Genetics, Medical University of Wroclaw, Wrocław, Poland
| | - Isidoro Gonzalez-Alvaro
- Rheumatology Department, Instituto de Investigacion del Hospital de La Princesa (IIS-IP), Madrid, Spain
| | - Javier Narvaez
- Department of Rheumatology, Hospital Universitario de Bellvitge-IDIBELL, Barcelona, Spain
| | - Eva Pérez-Pampín
- Experimental and Observational Rheumatology and Rheumatology Unit. Instituto de Investigación Sanitaria, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - Antonio Mera-Varela
- Experimental and Observational Rheumatology and Rheumatology Unit. Instituto de Investigación Sanitaria, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - Laura Vidal-Bralo
- Experimental and Observational Rheumatology and Rheumatology Unit. Instituto de Investigación Sanitaria, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - José Gorgonio Acuña-Ochoa
- Experimental and Observational Rheumatology and Rheumatology Unit. Instituto de Investigación Sanitaria, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - Carmen Conde
- Experimental and Observational Rheumatology and Rheumatology Unit. Instituto de Investigación Sanitaria, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - Antonio Gonzalez
- Experimental and Observational Rheumatology and Rheumatology Unit. Instituto de Investigación Sanitaria, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain.
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7
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Sanchez-Piedra C, Hernández Miguel MV, Manero J, Roselló R, Sánchez-Costa JT, Rodríguez-Lozano C, Campos C, Cuende E, Fernández-Lopez JC, Bustabad S, Martín Domenech R, Pérez-Pampín E, Del Pino-Montes J, Millan-Arciniegas AM, Díaz-González F, Gómez-Reino JJ. Objectives and methodology of BIOBADASER phase iii. ACTA ACUST UNITED AC 2017; 15:229-236. [PMID: 28935290 DOI: 10.1016/j.reuma.2017.08.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 06/29/2017] [Accepted: 08/07/2017] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Describe the objectives, methods and results of the first year of the new version of the Spanish registry of adverse events involving biological therapies and synthetic drugs with an identifiable target in rheumatic diseases (BIOBADASER III). METHODOLOGY Multicenter prospective registry of patients with rheumatic inflammatory diseases being treated with biological drugs or synthetic drugs with an identifiable target in rheumatology departments in Spain. The main objective of BIOBADASER Phase III is the registry and analysis of adverse events; moreover, a secondary objective was added consisting of assessing the effectiveness by means of the registry of activity indexes. Patients in the registry are evaluated at least once every year and whenever they experience an adverse event or a change in treatment. The collection of data for phase iii began on 17 December 2015. RESULTS During the first year, 35 centers participated. The number of patients included in this new phase in December 2016 was 2,664. The mean age was 53.7 years and the median duration of treatment was 8.1 years. In all, 40.4% of the patients were diagnosed with rheumatoid arthritis. The most frequent adverse events were infections and infestations. CONCLUSIONS BIOBADASER Phase III has been launched to adapt to a changing pharmacological environment, with the introduction of biosimilars and small molecules in the treatment of rheumatic diseases. This new stage is adapted to the changes in the reporting of adverse events and now includes information related to activity scores.
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Affiliation(s)
| | | | - Javier Manero
- Hospital Universitario Miguel Servet, Zaragoza, España
| | | | | | | | - Cristina Campos
- Hospital General Universitario de Valencia, Valencia, España
| | - Eduardo Cuende
- Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | | | | | | | - Eva Pérez-Pampín
- Hospital Clínico Universitario de Santiago, Santiago, A Coruña, España
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Hernández M, Sánchez-Piedra C, Cañete J, Sánchez-Alonso F, Manero-Ruiz J, Ortiz-García A, Rosello Pardo R, Pérez-Pampín E, Rodriguez-Lozano C, Sanmarti R, Gomez-Reino J. AB0361 Evaluation of Baseline Characteristics of Rheumatoid Arthritis Patients Treated with Abatacept or Tumor Necrosis Factor Inhibitors in Clinical Practice in Spain:. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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9
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Vidal-Bralo L, Montes A, Varela R, Bόveda M, Pérez-Pampín E, Gόmez-Reino J, Gonzalez A. SAT0071 Number of Autoantibodies Associated with All-Cause Mortality in Patients with Rheumatoid Arthritis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.5605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Hernández M, Sánchez-Piedra C, Inciarte-Mundo J, Sánchez-Alonso F, Manero-Ruiz F, Cuende E, Rosellό Pardo R, Pérez-Pampín E, Rodríguez-Lozano C, Vela-Casasempere P, Diaz-Torne C, Sanmartí R, Gόmez-Reino J. AB0278 Are There Differences in Basal Comorbidities between Rheumatoid Arthritis Patients Treated with Abatacept and Those Treated with Tumor Necrosis Factor Inhibitors?: Table 1. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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11
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Palmou-Fontana N, Loricera J, Blanco R, Hernández J, Castañeda S, Ortego N, Peirό E, Collado P, Melchor S, Mera A, Pérez-Pampín E, Rubio E, Calvo-Alén J, Aurrecoechea E, Rúa-Figueroa Í, Mínguez M, Herrero-Beaumont G, Bravo B, Rosas J, Narváez J, Calvo-Catalá J, Ariza R, Freire M, Lluch P, Mata C, Galíndez-Aguirregoikoa E, Blanco-Madrigal J, Sánchez-Andrade A, Salvatierra J, Calvo-Río V, González-Vela C, Pina T, González-Gay M. FRI0270 Tocilizumab Compared to Anti-TNFα Agents in Refractory Aortitis. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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12
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Ferreiro-Iglesias A, Montes A, Pérez-Pampín E, Carreira P, Joven B, Caliz R, Ferrer M, Moreno-Ramos M, Raya E, Magro C, Vasilopoulos Y, Sarafidou T, Balsa A, Pascual-Salcedo D, Fernández-Nebro A, Ordόñez M, Alegre-Sancho J, Márquez A, Navarro F, Moreira V, Blanco F, Narvaez J, Cañete J, Martin J, Gόmez-Reino J, Gonzalez A. OP0125 Replication of GWAS of Response to TNF Inhibitors in Patients with Rheumatoid Arthritis. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.4625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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13
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Loricera J, Blanco R, Hernández JL, Castañeda S, Mera A, Pérez-Pampín E, Peiró E, Humbría A, Calvo-Alén J, Aurrecoechea E, Narváez J, Sánchez-Andrade A, Vela P, Díez E, Mata C, Lluch P, Moll C, Hernández Í, Calvo-Río V, Ortiz-Sanjuán F, González-Vela C, Pina T, González-Gay MÁ. Tocilizumab in giant cell arteritis: Multicenter open-label study of 22 patients. Semin Arthritis Rheum 2015; 44:717-23. [DOI: 10.1016/j.semarthrit.2014.12.005] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 12/16/2014] [Accepted: 12/19/2014] [Indexed: 12/01/2022]
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Salgado E, Campos J, Moreira-Navarrete V, Mulero J, Navarro F, Pérez-Pampín E, Carmona L, Gómez-Reino J. Rheumatoid factor does not predict response to TNF antagonists in rheumatoid arthritis: Three centers experience. Joint Bone Spine 2013; 80:438-40. [DOI: 10.1016/j.jbspin.2013.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 01/08/2013] [Indexed: 10/27/2022]
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15
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Pérez-Pampín E, Campos-Franco J, Losada-Ares L, Barreiro-de-Acosta M. Avascular necrosis of the knees and ulcerative colitis. Rev Esp Enferm Dig 2011; 103:557-558. [PMID: 22054279 DOI: 10.4321/s1130-01082011001000016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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