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Bowdish DME, Chandran V, Hitchon CA, Kaplan GG, Avina-Zubieta JA, Fortin PR, Larché MJ, Boire G, Gingras AC, Dayam RM, Colmegna I, Lukusa L, Lee JLF, Richards DP, Pereira D, Watts TH, Silverberg MS, Bernstein CN, Lacaille D, Benoit J, Kim J, Lalonde N, Gunderson J, Allard-Chamard H, Roux S, Quan J, Hracs L, Turnbull E, Valerio V, Bernatsky S. When Should I Get My Next COVID Vaccine? Data from the SUrveillance of responses to COVID-19 vaCcines in systEmic immunE mediated inflammatory Diseases (SUCCEED)study. J Rheumatol 2024:jrheum.2023-1214. [PMID: 38621797 DOI: 10.3899/jrheum.2023-1214] [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: 04/17/2024]
Abstract
OBJECTIVE To determine how serologic responses to COVID vaccination/infection in immunemediated inflammatory disease (IMID) are affected by time since last vaccination and other factors. METHODS Post-COVID-19 vaccination, data and dried blood spots/sera were collected from adults with rheumatoid arthritis, inflammatory bowel disease, systemic lupus, ankylosing spondylitis/spondylarthritis and psoriasis/psoriatic arthritis. First sample was at enrolment and then 2-4 weeks and 3, 6, and 12 months after latest vaccine dose. Multivariate generalized estimating equation regressions (including medications, demographics, and vaccination history) evaluated serologic response, based on log-transformed anti-RBD IgG titres; we also measured anti-nucleocapsid IgG. RESULTS Positive associations for log-transformed anti-RBD titres were seen with female sex, number of doses, and self-reported COVID infections in 2021-2023. Negative associations were seen with prednisone, anti-TNF agents, and rituximab.Over 2021-2023, most (94%) of anti-nucleocapsid positivity was associated with a self-reported infection in the 3 months prior. From March 2021 to Feb 2022, anti-nucleocapsid positivity was present in 5-15% of samples and was highest in the post-Omicron era, with anti-nucleocapsid positivity trending to 30-35% or higher as of March 2023. Anti-nucleocapsid positivity in IMID remained lower than Canada's general population seroprevalence (>50% in 2022 and >75% in 2023).Time since last vaccination was negatively associated with log-transformed anti-RBD titres, particularly after 210 days. CONCLUSION Ours is the first pan-Canadian IMID assessment of how vaccine history and other factors affect serologic COVID-19 vaccine responses. These findings may help individuals personalize vaccination decisions, including consideration of additional vaccination when >6 months has elapsed since last COVID vaccination/infection.
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Affiliation(s)
- Dawn M E Bowdish
- Dawn ME Bowdish PhD, Department of Medicine, McMaster University, 1280 Main St W, Hamilton, Ontario, Canada
| | - Vinod Chandran
- Vinod Chandran MD PhD, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Carol A Hitchon
- Carol A Hitchon MD MSc, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Gilaad G Kaplan
- Gilaad G. Kaplan MD MPH, Division of Gastroenterology and Hepatology, Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - J Antonio Avina-Zubieta
- J. Antonio Avina-Zubieta MD PhD, Arthritis Research Canada and Division of Rheumatology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Paul R Fortin
- Paul R Fortin MD MPH, Centre de Recherche Arthrite, Division of Rheumatology, Department of Medicine, CHU de Québec - Université Laval, Québec City, Québec, Canada
| | - Maggie J Larché
- Maggie J. Larché MD PhD, Division of Rheumatology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Gilles Boire
- Gilles Boire MD MSc, Division of Rheumatology, Department of Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Anne-Claude Gingras
- Anne-Claude Gingras PhD, Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
| | - Roya M Dayam
- Roya M Dayam PhD, Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
| | - Ines Colmegna
- Ines Colmegna MD, The Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada; Department of Medicine, Division of Rheumatology, McGill University, Montreal, Quebec, Canada
| | - Luck Lukusa
- Luck Lukusa MSc, The Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Jennifer L F Lee
- Jennifer LF Lee BSc, The Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Dawn P Richards
- Dawn P Richards PhD, Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada
| | - Daniel Pereira
- Daniel Pereira BSc, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Tania H Watts
- Tania H Watts PhD, Department of Immunology, University of Toronto, Toronto, Ontario, Canada
| | - Mark S Silverberg
- Mark S Silverberg MD PhD, Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada; Zane Cohen Centre for Digestive Diseases, Division of Gastroenterology, Mount Sinai Hospital, Sinai Health, Ontario, Canada
| | - Charles N Bernstein
- Charles N Bernstein MD, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Diane Lacaille
- Diane Lacaille MD MHSc, Arthritis Research Canada and Division of Rheumatology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jenna Benoit
- Jenna Benoit, Department of Medicine, McMaster University, 1280 Main St W, Hamilton, Ontario, Canada
| | - John Kim
- John Kim PhD, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Nadine Lalonde
- Nadine Lalonde BSc, Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada
| | - Janet Gunderson
- Janet Gunderson BEd, Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada
| | - Hugues Allard-Chamard
- Hugues Allard-Chamard MD PhD, Division of Rheumatology , Department of Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Sophie Roux
- Sophie Roux MD PhD, Division of Rheumatology , Department of Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Joshua Quan
- Joshua Quan MSc, Division of Gastroenterology and Hepatology, Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Lindsay Hracs
- Lindsay Hracs PhD, Division of Gastroenterology and Hepatology, Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Elizabeth Turnbull
- Elizabeth Turnbull RN, The Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Valeria Valerio
- Valeria Valerio MD, The Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Sasha Bernatsky
- Sasha Bernatsky MD PhD, The Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada; Department of Medicine, Division of Rheumatology, McGill University, Montreal, Quebec, Canada
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Migowa A, Njeru CM, Were E, Ngwiri T, Colmegna I, Hitchon C, Scuccimarri R. Kawasaki disease in Kenya and review of the African literature. Pediatr Rheumatol Online J 2024; 22:43. [PMID: 38616268 PMCID: PMC11016229 DOI: 10.1186/s12969-024-00977-1] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 03/24/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Kawasaki disease has been described across the globe, although publications from Africa are limited. To our knowledge, there are no publications on Kawasaki disease from Kenya, which triggered this report. METHODS A retrospective cross-sectional study was undertaken to identify in-patients with a discharge diagnosis of Kawasaki disease, over 2 different 5-year periods, at two pediatric hospitals in Nairobi, Kenya. We reviewed the medical records of all patients and report their clinical findings, diagnostic workup and treatment. In addition, we undertook a detailed review of the literature. RESULTS Twenty-three patients with Kawasaki disease were identified, of those 12 (52.2%) had incomplete disease. The mean age was 2.3 years (SD+/-2.2) (range 0.3-10.3) with a male to female ratio of 1:1. The mean duration of fever at diagnosis was 8.3 days (SD+/-4.7) (range 2-20). Oral changes were the most common clinical feature and conjunctivitis the least common. Thrombocytosis at diagnosis was seen in 52% (12/23). Twenty-one patients (91.3%) were treated with intravenous immunoglobulin and all except 1 received aspirin. Baseline echocardiograms were performed in 95.7% (22/23) and found to be abnormal in 3 (13.6%). Follow-up data was limited. Our literature review identified 79 publications with documented cases of Kawasaki disease in children from 22 countries across the African continent with a total of 1115 patients including those from this report. Only 153 reported cases, or 13.7%, are from sub-Saharan Africa. CONCLUSIONS This is the first publication on Kawasaki disease from Kenya and one of the largest reports from sub-Saharan Africa. It is the first to have a complete review of the number of published cases from the African continent. Challenges in the diagnosis and management of Kawasaki disease in many African countries include disease awareness, infectious confounders, access and cost of intravenous immunoglobulin, access to pediatric echocardiography and follow-up. Increasing awareness and health care resources are important for improving outcomes of Kawasaki disease in Africa.
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Affiliation(s)
- A Migowa
- Department of Pediatrics and Child Health, Aga Khan University Medical College (East Africa), Nairobi, Kenya
| | - C M Njeru
- Department of Pediatrics and Child Health, Aga Khan University Medical College (East Africa), Nairobi, Kenya
| | - E Were
- Department of Pediatrics, Gertrude's Children's Hospital, Nairobi, Kenya
| | - T Ngwiri
- Department of Pediatrics, Gertrude's Children's Hospital, Nairobi, Kenya
| | - I Colmegna
- Division of Rheumatology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - C Hitchon
- Section of Rheumatology, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - R Scuccimarri
- Division of Pediatric Rheumatology, Department of Pediatrics, McGill University Health Centre, 1001 boul. Décarie, A04.6306, H4A 3J1, Montreal, QC, Canada.
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Flatman LK, Malhamé I, Colmegna I, Bérard A, Bernatsky S, Vinet É. Tumour necrosis factor inhibitors and serious infections in reproductive-age women and their offspring: a narrative review. Scand J Rheumatol 2024:1-12. [PMID: 38314746 DOI: 10.1080/03009742.2024.2303832] [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] [Received: 08/28/2023] [Accepted: 01/08/2024] [Indexed: 02/07/2024]
Abstract
Tumour necrosis factor inhibitors (TNFi) are commonly used to treat patients with chronic inflammatory diseases, and function by inhibiting the pro-inflammatory cytokine tumour necrosis factor-α (TNF-α). Although beneficial in reducing disease activity, they are associated with an increased risk of serious infections. Data on the risk of serious infections associated with TNFi use during the reproductive years, particularly in pregnancy, are limited. For pregnant women, there is an additional risk of immunosuppression in the offspring as TNFi can be actively transported across the placenta, which increases in the second and third trimesters. Several studies have explored the risk of serious infections with TNFi exposure in non-pregnant and pregnant patients and offspring exposed in utero, indicating an increased risk in non-pregnant patients and a potentially increased risk in pregnant patients. The studies on TNFi-exposed offspring showed conflicting results between in utero TNFi exposure and serious infections during the offspring's first year. Further research is needed to understand differential risks based on TNFi subtypes. Guidelines conditionally recommend the rotavirus vaccine before 6 months of age for offspring exposed to TNFi in utero, but more data are needed to support these recommendations because of limited evidence. This narrative review provides an overview of the risk in non-pregnant patients and summarizes evidence on how pregnancy can increase vulnerability to certain infections and how TNFi may influence this susceptibility. This review focuses on the evidence regarding the risk of serious infections in pregnant patients exposed to TNFi and the risk of infections in their offspring.
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Affiliation(s)
- L K Flatman
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - I Malhamé
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- Division of General Internal Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - I Colmegna
- Division of Rheumatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - A Bérard
- Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada
- Research Center, CHU Sainte-Justine, Montreal, Quebec, Canada
- Faculty of Medicine, Université Claude Bernard Lyon 1, Lyon, France
| | - S Bernatsky
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- Division of Rheumatology, Division of Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - É Vinet
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- Division of Rheumatology, Division of Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
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Colmegna I, Valerio V, Amiable N, Useche M, Rampakakis E, Flamand L, Rollet-Labelle E, Bessette L, Fitzcharles MA, Hazel E, McCormack D, Michou L, Panopalis P, Langlois MA, Bernatsky S, Fortin PR. COVID-19 Vaccine in Immunosuppressed Adults with Autoimmune rheumatic Diseases (COVIAAD): safety, immunogenicity and antibody persistence at 12 months following Moderna Spikevax primary series. RMD Open 2023; 9:e003400. [PMID: 38030231 PMCID: PMC10689388 DOI: 10.1136/rmdopen-2023-003400] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
OBJECTIVE To assess the safety, immunogenicity and cellular responses following the Moderna Spikevax primary series in rheumatic disease. METHODS We conducted a 12-month, prospective, non-randomised, open-label, comparative trial of adults with either rheumatoid arthritis (RA, n=131) on stable treatment; systemic lupus erythematosus (SLE, n=23) on mycophenolate mofetil (MMF); other rheumatic diseases on prednisone ≥10 mg/day (n=8) or age-matched/sex-matched controls (healthy control, HC, n=58). Adverse events (AEs), humoral immune responses (immunogenicity: IgG positivity for anti-SARS-CoV-2 spike protein and its receptor binding domain, neutralising antibodies (NAbs)), cellular responses (ELISpot) and COVID-19 infection rates were assessed. RESULTS Frequency of solicited self-reported AEs following vaccination was similar across groups (HC 90%, RA 86%, SLE 90%); among them, musculoskeletal AEs were more frequent in RA (HC 48% vs RA 66% (Δ95% CI CI 3 to 32.6)). Disease activity scores did not increase postvaccination. No vaccine-related serious AEs were reported. Postvaccination immunogenicity was reduced in RA and SLE (RA 90.2%, SLE 86.4%; for both, ΔCIs compared with HC excluded the null). Similarly, NAbs were reduced among patients (RA 82.6%, SLE 81.8%). In RA, age >65 (OR 0.3, 95% CI 0.1 to 0.8) and rituximab treatment (OR 0.003, 95% CI 0.001 to 0.02) were negative predictors of immunogenicity. ELISpot was positive in 16/52 tested RA and 17/26 HC (ΔCI 11.2-53.3). During the study, 11 HC, 19 RA and 3 SLE patients self-reported COVID-infection. CONCLUSION In COVID-19 Vaccine in Immunosuppressed Adults with Autoimmune Diseases, the Moderna Spikevax primary series was safe. MMF, RA age >65 and rituximab were associated with reduced vaccine-induced protection.
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Affiliation(s)
- Ines Colmegna
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Valeria Valerio
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Nathalie Amiable
- Centre de recherche du Centre hospitalier universitaire de Québec-Université Laval, Quebec, Quebec, Canada
| | - Mariana Useche
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | | | - Louis Flamand
- Centre de recherche du Centre hospitalier universitaire de Québec-Université Laval, Quebec, Quebec, Canada
| | - Emmanuelle Rollet-Labelle
- Centre de recherche du Centre hospitalier universitaire de Québec-Université Laval, Quebec, Quebec, Canada
| | - Louis Bessette
- Centre de recherche du Centre hospitalier universitaire de Québec-Université Laval, Quebec, Quebec, Canada
- Universite Laval Faculte de medecine, Quebec, Quebec, Canada
| | - Mary-Ann Fitzcharles
- Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Elizabeth Hazel
- Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Laëtitia Michou
- Centre de recherche du Centre hospitalier universitaire de Québec-Université Laval, Quebec, Quebec, Canada
| | - Pantelis Panopalis
- Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Marc-André Langlois
- Department of Biochemistry Microbiology and Immunology, University of Ottawa, Ottawa, Ontario, Canada
| | - Sasha Bernatsky
- Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Rheumatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Paul R Fortin
- Centre de recherche du Centre hospitalier universitaire de Québec-Université Laval, Quebec, Quebec, Canada
- Medicine - Rheumatology, Centre Hospitalier de l'Universite Laval, Sainte-Foy, Quebec, Canada
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5
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Hazlewood GS, Colmegna I, Hitchon C, Fortin PR, Bernatsky S, Clarke AE, Mosher D, Wilson T, Thomas M, Barber CEH, Harrison M, Bansback N, Proulx L, Richards DP, Kaplan GG. Preferences for COVID-19 Vaccination in People With Chronic Immune-Mediated Inflammatory Diseases. J Rheumatol 2023:jrheum.220697. [PMID: 36642432 DOI: 10.3899/jrheum.220697] [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: 01/16/2023]
Abstract
OBJECTIVE To understand how people with chronic immune-mediated inflammatory diseases (IMIDs) trade off the benefits and risks of coronavirus disease 2019 (COVID-19) vaccine options. METHODS We conducted an online discrete-choice experiment in people with IMIDs to quantify the relative importance (RI) of attributes relevant to COVID-19 vaccination. Participants were recruited between May and August 2021 through patient groups and clinics in Canada, and completed 10 choices where they selected 1 of 2 hypothetical vaccine options or no vaccine. The RI of each attribute was estimated and heterogeneity was explored through latent class analysis. RESULTS The survey was completed by 551 people (89% female, mean age 46 yrs) with a range of IMIDs (inflammatory bowel disease [48%], rheumatoid arthritis [38%], systemic lupus erythematosus [16%]). Most had received 1 (94%) or 2 (64%) COVID-19 vaccinations. Across the ranges of levels considered, vaccine effectiveness was most important (RI = 66%), followed by disease flare (21%), rare but serious risks (9%), and number/timing of injections (4%). Patients would accept a risk of disease flare requiring a treatment change of ≤ 8.8% for a vaccine with a small absolute increase in effectiveness (10%). Of the 3 latent classes, the group with the greatest aversion to disease flare were more likely to be male and have lower incomes, but this group still valued effectiveness higher than other attributes. CONCLUSION Patients perceived the benefits of COVID-19 vaccination to outweigh rare serious risks and disease flare. This supports COVID-19 vaccine strategies that maximize effectiveness, while recognizing the heterogeneity in preferences that exists.
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Affiliation(s)
- Glen S Hazlewood
- G.S. Hazlewood, MD, PhD, Department of Medicine, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Arthritis Research Canada, Vancouver, British Columbia
| | - Ines Colmegna
- I. Colmegna, MD, The Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec
| | - Carol Hitchon
- C. Hitchon, MD, MSc, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba
| | - Paul R Fortin
- P.R. Fortin, MD, Division de Rhumatologie, Departement de Medecine, CHU de Quebec, and Centre de Recherche ARThrite, Universite Laval, Quebec City, Quebec
| | - Sasha Bernatsky
- S. Bernatsky, MD, PhD, The Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec
| | - Ann E Clarke
- A.E. Clarke, MD, Department of Medicine, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Arthritis Research Canada, Vancouver, British Columbia
| | - Dianne Mosher
- D. Mosher, MD, Department of Medicine, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Arthritis Research Canada, Vancouver, British Columbia
| | - Todd Wilson
- T. Wilson, PhD, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary
| | - Megan Thomas
- M. Thomas, MSc, Arthritis Research Canada, and Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia
| | - Claire E H Barber
- C.E.H. Barber, MD, PhD, Department of Medicine, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Arthritis Research Canada, Vancouver, British Columbia
| | - Mark Harrison
- M. Harrison, PhD, Arthritis Research Canada, and Pharmaceutical Sciences, and School of Population and Public Health, University of British Columbia, and Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia
| | - Nick Bansback
- N. Bansback, PhD, Arthritis Research Canada, and School of Population and Public Health, University of British Columbia, and Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia
| | - Laurie Proulx
- L. Proulx, BCom, Canadian Arthritis Patient Alliance, Ontario
| | - Dawn P Richards
- D.P. Richards, PhD, Canadian Arthritis Patient Alliance, Ontario
| | - Gilaad G Kaplan
- G.G. Kaplan, MD, MPH, Department of Medicine, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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6
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Lopez-Olivo MA, Valerio V, Karpes Matusevich AR, Brizio M, Kwok M, Geng Y, Suarez-Almazor ME, Colmegna I. Safety and Efficacy of Influenza Vaccination in Patients Receiving Immune Checkpoint Inhibitors. Systematic Review with Meta-Analysis. Vaccines (Basel) 2022; 10:vaccines10081195. [PMID: 36016085 PMCID: PMC9412390 DOI: 10.3390/vaccines10081195] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/13/2022] [Accepted: 07/23/2022] [Indexed: 12/24/2022] Open
Abstract
The potential increased risk of immune-related adverse events (irAEs) post-influenza vaccine is a concern in patients receiving immune checkpoint inhibitors (ICI). We conducted a systematic review with meta-analysis of studies reporting the effects of influenza vaccination in patients with cancer during ICI treatment. We searched five electronic databases until 01/2022. Two authors independently selected studies, appraised their quality, and collected data. The primary outcome was the determination of pooled irAE rates. Secondary outcomes included determination of immunogenicity and influenza infection rates and cancer-related outcomes. Nineteen studies (26 publications, n = 4705) were included; 89.5% were observational. Vaccinated patients reported slighter lower rates of irAEs compared to unvaccinated patients (32% versus 41%, respectively). Seroprotection for influenza type A was 78%-79%, and for type B was 75%. Influenza and irAE-related death rates were similar between groups. The pooled proportion of participants reporting a laboratory-confirmed infection was 2% (95% CI 0% to 6%), and influenza-like illness was 14% (95% CI 2% to 32%). No differences were reported on the rates of laboratory-confirmed infection between vaccinated and unvaccinated patients. Longer progression-free and overall survival was also observed in vaccinated compared with unvaccinated patients. Current evidence suggests that influenza vaccination is safe in patients receiving ICIs, does not increase the risk of irAEs, and may improve survival.
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Affiliation(s)
- Maria A. Lopez-Olivo
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1444, Houston, TX 77030, USA;
- Correspondence: ; Tel.: +1-713-563-0020
| | - Valeria Valerio
- The Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, QC H4A 3J1, Canada; (V.V.); (I.C.)
| | | | - Marianela Brizio
- Division of Experimental Medicine, McGill University, Montreal, QC H4A 3J1, Canada;
| | - Michelle Kwok
- Department of Clinical Immunology and Allergy, McGill University Health Centre, Montreal, QC H4A 3J1, Canada;
| | - Yimin Geng
- Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Maria E. Suarez-Almazor
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1444, Houston, TX 77030, USA;
- Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Ines Colmegna
- The Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, QC H4A 3J1, Canada; (V.V.); (I.C.)
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7
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Mendel A, Colmegna I, Bourque G, Rajda E, Lee TC, Gálvez JH, Vinet É, Cheng MP. More than a 'Hundred Days War': Persistent SARS-CoV-2 infection in a patient with ANCA-associated vasculitis. J Assoc Med Microbiol Infect Dis Can 2022; 7:131-134. [PMID: 36337358 PMCID: PMC9608116 DOI: 10.3138/jammi-2021-0033] [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] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 12/14/2021] [Accepted: 12/24/2021] [Indexed: 06/16/2023]
Abstract
BACKGROUND Few reports exist on the characteristics and outcomes of persistent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in immunocompromised hosts. METHODS A 49-year-old patient with granulomatosis with polyangiitis (GPA) and a renal transplant experienced multiple hospitalizations for coronavirus disease 2019 (COVID-19) pneumonia and relapses between October 2020 and February 2021. Careful chart review of medical history, hospitalizations, and microbiological testing including SARS-CoV-2 cycle threshold values, therapies, and imaging was undertaken. SARS-CoV-2 genome sequencing was performed in five viral samples to distinguish persistent infection from re-infection with a different strain. RESULTS Sequencing confirmed that all samples tested were from the same viral lineage, indicating a long-term, persistent infection rather than re-infection with a new strain. The patient ultimately stabilized after two courses of remdesivir plus dexamethasone, replacement intravenous immunoglobulin, and bamlanivimab. Rituximab maintenance therapy for vasculitis remains on hold. CONCLUSIONS SARS-CoV-2 may persist for several months in immunocompromised hosts and may go unrecognized as an ongoing active infection. More studies are needed to determine how to optimize COVID-19 treatment in this vulnerable population.
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Affiliation(s)
- Arielle Mendel
- Division of Rheumatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Ines Colmegna
- Division of Rheumatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Guillaume Bourque
- Canadian Centre for Computational Genomics, McGill University, Montreal, Quebec, Canada
| | - Ewa Rajda
- Divisions of Infectious Diseases & Medical Microbiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Todd C Lee
- Divisions of Infectious Diseases & Medical Microbiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - José Héctor Gálvez
- Canadian Centre for Computational Genomics, McGill University, Montreal, Quebec, Canada
| | - Évelyne Vinet
- Division of Rheumatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Matthew P Cheng
- Canadian Centre for Computational Genomics, McGill University, Montreal, Quebec, Canada
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Jamal S, Gonzalez Arreola L, Tan J, Ye C, Roberts J, Fifi-Mah A, Hudson M, Hoa S, Pope J, Colmegna I, Appleton CT. POS1361 THE CANADIAN RESEARCH GROUP OF RHEUMATOLOGY IN IMMUNO-ONCOLOGY (CanRIO): A NATIONWIDE MULTI-CENTER PROSPECTIVE COHORT. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4114] [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: 11/03/2022]
Abstract
BackgroundImmune Checkpoint Inhibitors (ICI) have altered the landscape of cancer therapy. However, toxicities are common and up to 80% of patients will develop immune-related adverse events (irAE), including rheumatic irAEs (Rh-irAE), which can often limit their cancer treatment. Our knowledge of clinical manifestations and optimal management of patients with Rh-irAE continues to evolve as these agents are being used to treat a wider variety of cancers. Currently available data is limited to retrospective case series and case reports. There is also scarce data on the use of ICI in patients with pre-existing autoimmune disease (PAD) as these patients are often excluded from clinical trials.ObjectivesTo describe the clinical presentation, management and early outcomes of patients exposed to ICI with Rh-irAE or PAD recruited and followed prospectively from multiple sites across Canada.MethodsAdult patients with Rh-irAE from cancer immunotherapy (CTLA-4, PD-1 or PDL-1 inhibitors) or those with PAD exposed to cancer immunotherapy are prospectively recruited across 9 academic sites in Canada. Standardized clinical and biologic data are also collected. We describe clinical characteristics and management of patients recruited between January 2020 and October 2021, stratified based on the presence or absence of PAD.Results103 patients were recruited from 9 sites. From those, 85 had Rh-irAE, 47 had pre-existing musculoskeletal and rheumatic diseases, and 20 had other PAD. The most frequent Rh-irAE were joint manifestations (n = 73). Other Rh-irAE included muscle symptoms (n = 7), connective tissue disease (n = 6), vasculitis (n=2) and sarcoid (n = 3). Prednisone was the most common treatment (n = 53). Intraarticular corticosteroids were used in 7 patients. Eleven patients required conventional synthetic disease-modifying anti-rheumatic drugs (DMARD) and only one required biologic DMARD to control the Rh-irAE. Anti-PD-1 therapies were the most used ICI (56.3%), followed by combination therapy (35.9%). Response to index immunotherapy at 6 months was available for 21 patients. Most patients had partial response (57.1%) and only 4 patients had tumor progression (19.1%). The ICI was permanently discontinued due to an irAE in 21 patients (38.1% with PAD and 61.9% without PAD). There were no deaths related to Rh-irAE.ConclusionThe initial sample of the CanRIO prospective national cohort suggests that demographic characteristics and tumor representation in people with PAD and without PAD is similar. Patients with PAD are less likely to receive combination therapy (n= 12 vs. n=25) and are less likely to have tumor progression on ICI (n=1) compared to those without PAD (n=3). Selection bias is noted in this initial sample since half of recruited patients have PAD. The CanRIO cohort provides valuable insight into real-world spectrum and management of Rh-irAE secondary to immunotherapy for cancer.Disclosure of InterestsShahin Jamal Grant/research support from: CanRIO has received financial support from BMS and Organon, Lourdes Gonzalez Arreola: None declared, Julia Tan: None declared, Carrie Ye: None declared, Janet Roberts: None declared, Aurore Fifi-Mah: None declared, Marie Hudson: None declared, Sabrina Hoa: None declared, Janet Pope: None declared, Ines Colmegna: None declared, C. Thomas Appleton: None declared
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Hitchon C, Dacosta D, Abdissa Adugna B, Bernatsky S, Colmegna I, Demelash B, Fortin P, Meltzer M, Mendel A, Scuccimarri R, Melkie A. AB1089 PSYCHOSOCIAL IMPACTS OF THE COVID-19 PANDEMIC ON ETHIOPIAN AND CANADIAN RHEUMATOLOGY PATIENTS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.443] [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: 11/04/2022]
Abstract
BackgroundThe Coronavirus-2019 (COVID-19) pandemic increased psychosocial distress in the general population and in patients with rheumatic disease. Limited data exists on the impact of COVID-19 in rheumatology patients living in Africa.ObjectivesTo describe COVID-19 related illness and psychosocial impact in Ethiopian (ET) rheumatology patients attending the only public rheumatology clinic in Ethiopia (Tikur Anbessa Specialized Hospital (TAH) in Addis Ababa). To compare findings in ET with findings in Canadian (CA) rheumatology patients.MethodsBetween May 1 and Oct 31 2021, 130 patients attending the TAH rheumatology clinic answered questions related to COVID-19 infection, symptoms and testing, and psychosocial impacts of the COVID-19 pandemic. We assessed depression (Patient Health Questionnaire- 9), anxiety (General Anxiety Disorder-7; GAD7), COVID-19 stress factors and coping measures, Resilience (Brief Resilience Scale-BRS) and medication compliance (Morisky medication adherence scale – 4 item; MAS4). Rheumatic disease severity was assessed with the Routine Assessment of Patient Index Data-3 (RAPID-3). Questionnaires were translated to Amharic. Descriptive statistics are reported [mean (standard deviation), median (25%, 75%) number and percent.)] and compared to data of 97 CA patients with rheumatoid arthritis (RA) and lupus patients from Quebec1.ResultsET patients were mainly female (71%) with a mean (SD) age of 47 (16), and resided in the capital city (Addis Ababa) (72%). Half had RA or lupus. A quarter of patients had moderate to severe rheumatic disease severity desite good medication adherence [MAS4 score of 3(2,4)]. Most (89%) reported no COVID-19 symptoms since the beginning of the pandemic, were not tested for COVID-19 and reported few risk factors for COVID-19 exposure. Eight (6%) ETs were diagnosed with COVID-19; 2 required hospitalization. Diagnosed patients reported a median of 2 COVID-19 symptoms (range 0-8; mainly cough, fever and malaise). Within the entire cohort, depression (PHQ9= 10 or above) and anxiety (GAD7=10 or above) were more frequent in ETs than CAs (depression 30% vs 3%; anxiety 16% vs 1%) yet nearly half (47%) of ETs had normal or high resilience levels. The most common COVID-19 stressors were risk of contracting COVID illness personally [ETs vs CAs risk ratio(95% confidence limits- CL); 0.67 (0.5, 0.99)] or of loved one [0.56 (0.36, 0.86)]. More ETs reported COVID-19 related stress related to difficulty obtaining food, medicine or other essentials [1.74, (1.00-3.0)], and getting needed supports [1.97 (1.03, 3.77)] (Table 1). CAs and ETs used similar levels of problem solving [median (25%,75%) CA 3.3 (2.8, 3.3), ET 3.5 (3.0, 3.7)] and emotion-focus [CA 2.5 (2.2, 3.1); ET 3.3 (2.8, 3.7)] coping strategies.Table 1.COVID-19 related stressors reported by Ethiopian and Canadian rheumatology patientsCommon stressors from the coronavirus pandemic reported as severe †ET % reportedCA % reportedRR (95% CI) ET vs CAGetting sick28410.67 (0.5, 0.99)Having a loved one who becomes ill23410.56 (0.36, 0.86)Difficulty getting food, medicine and other essentials29161.74 (1.0-3.0)Difficulty getting support or help24121.97 (1.03-3.77)Postponement or cancellation of tests8200.42 (0.18, 0.95)Losing a job or experiencing a drop in income19100.185 (0.90, 3.81)Having more responsibilities at home21201.06 (0.59, 1.87)Having to work in a place likely to expose you to the coronavirus20270.73 (0.42, 1.24)Postponement or cancellation of medical visits19151.2 (0.63, 2.28)Changes in treatments7150.43 (0.17, 1.06)†Severe stress = score 2 (moderately) to 5 (extremely)ConclusionDuring the COVID-19 pandemic, depression was more common in ETs compared to CAs with rheumatic disease. COVID-19-related stressors due to insecurity in obtaining the basic essentials and support were more pronounced in ETs. Differences between ETs and CA in these stressors may reflect local public health and economic supports. There were no differences in coping strategies.References[1]DaCosta et al presented at 21stCentury Lupus Conference, Sept. 2021AcknowledgementsStudy supported by the Global Rheumatology Alliance-International League of Associations for Rheumatology “ COVID-19 illness in Ethiopian rheumatology patients” and the Arthritis Society: “The impact of antimalarial drugs in arthritis patients exposed to SARS-CoV-2-the CoVIRAL project. The Arthritis Society. COVID-20-001.”Disclosure of InterestsNone declared
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Brizio M, Lora M, Freton A, Hudson M, Farge D, Colmegna I. Mesenchymal Stem/Stromal Cells: IN VITRO ANTI-FIBROTIC EFFECTS OF THE HUMAN MESENCHYMAL STROMAL CELLS’ SECRETOME. Cytotherapy 2022. [DOI: 10.1016/s1465-3249(22)00223-7] [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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Ta V, Schieir O, Valois MF, Colmegna I, Hitchon C, Bessette L, Hazlewood G, Thorne C, Pope J, Boire G, Tin D, Keystone EC, Bykerk VP, Bartlett SJ. Predictors of Influenza Vaccination in Early Rheumatoid Arthritis 2017-2021: Results From the Canadian Early Arthritis Cohort. ACR Open Rheumatol 2022; 4:566-573. [PMID: 35349768 PMCID: PMC9274339 DOI: 10.1002/acr2.11427] [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: 08/11/2021] [Revised: 12/27/2021] [Accepted: 01/10/2022] [Indexed: 11/18/2022] Open
Abstract
Objective Adults with rheumatoid arthritis (RA) are at a higher risk for infections, including influenza and related complications. We identified influenza vaccination coverage in adults newly diagnosed with RA and examined sociodemographic RA characteristics and attitudes associated with vaccination. Methods We used data from patients enrolled in the Canadian Early Arthritis Cohort between September 2017 and February 2021. At enrollment, participants reported their vaccination status in the previous year and completed the Beliefs About Medicines Questionnaire (BMQ). Clinical data were obtained from medical records. Logistic regression was used to identify predictors of vaccination in the year after RA diagnosis. Results The baseline analytic sample of 431 patients were mostly White (80%) women (67%) with a mean age of 56 (SD 14) years. Prediagnosis, influenza vaccine coverage was 38%, increasing to 46% post diagnosis in the longitudinal sample (n = 229). Participants with previous influenza vaccination (odds ratio [OR] 15.33; 95% confidence interval [CI] 6.37‐36.90), on biologics or JAKs (OR 5.42; 95% CI 1.72‐17.03), and with a higher change in BMQ Necessity‐Concerns Differential scores (OR 1.08; 95% CI 1.02‐1.15) had greater odds, whereas women (OR 0.32; 95% CI 0.14‐0.71), participants with a non‐White racial background (OR 0.13; 95% CI 0.04‐0.51), and participants currently smoking (OR 0.09; 95% CI 0.02‐0.37) had lower odds of influenza vaccine coverage. Conclusion Influenza vaccination coverage in patients with early RA remains below national targets in adults living with a chronic condition. Discussing vaccine history and medication attitudes at initial clinic visits with new patients with RA may enhance vaccine acceptance and uptake.
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Affiliation(s)
- Viviane Ta
- McGill University, Montreal, Quebec, Canada
| | | | | | - Ines Colmegna
- McGill University and McGill University Health Centre, Montreal, Quebec, Canada
| | | | | | | | - Carter Thorne
- The Arthritis Research Program, Newmarket, Ontario, Canada
| | - Janet Pope
- Western University, London, Ontario, Canada
| | - Gilles Boire
- University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Diane Tin
- The Arthritis Research Program, Newmarket, Ontario, Canada
| | | | - Vivian P Bykerk
- Hospital for Special Surgery, New York, New York, and Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Susan J Bartlett
- McGill University and McGill University Health Centre, Montreal, Quebec, Canada
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Farge D, Loisel S, Resche-Rigon M, Lansiaux P, Colmegna I, Langlais D, Charles C, Pugnet G, Maria ATJ, Chatelus E, Martin T, Hachulla E, Kheav VD, Lambert NC, Wang H, Michonneau D, Martinaud C, Sensebé L, Cras A, Tarte K. Safety and preliminary efficacy of allogeneic bone marrow-derived multipotent mesenchymal stromal cells for systemic sclerosis: a single-centre, open-label, dose-escalation, proof-of-concept, phase 1/2 study. The Lancet Rheumatology 2022. [DOI: 10.1016/s2665-9913(21)00326-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Hitchon CA, Mody GM, Feldman CH, Lau Y, Shi S, Meltzer M, Scuccimarri R, Weinblatt ME, Colmegna I. Perceptions and Challenges Experienced by African Physicians When Prescribing Methotrexate for Rheumatic Disease: An Exploratory Study. ACR Open Rheumatol 2021; 3:522-530. [PMID: 34196510 PMCID: PMC8363848 DOI: 10.1002/acr2.11290] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 05/13/2021] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Guidelines for methotrexate (MTX) use in rheumatic disease may not be feasible for physicians practicing in the least developed countries. We aimed to understand the experiences of MTX prescribers relating to MTX use for rheumatic disease in African countries to inform the development of culturally and geographically appropriate recommendations. METHODS African physicians who self-identified as MTX prescribers from countries classified as having a low versus a medium or high Human Development Index (L-HDI versus MH-HDI) participated in semistructured interviews between August 2016 and September 2017. Interviews were transcribed verbatim, coded thematically, and stratified by HDI. RESULTS Physicians (23 rheumatologists; six internists) from 29 African countries were interviewed (15 L-HDI; 14 MH-HDI). Identified barriers to MTX use included inconsistent MTX supply (reported by 87% L-HDI versus 43% MH-HDI), compounded by financial restrictions (reported by 93% L-HDI versus 64% MH-HDI), patient hesitancy based partly on cultural beliefs and societal roles (reported by 71%), few prescribers (reported by 33%), prevalent infections (especially viral hepatitis, tuberculosis, and human immunodeficiency virus), and both availability and cost of monitoring tests. MTX pretreatment evaluation and starting and maximal doses were similar between L-HDI countries and MH-HDI countries. CONCLUSION The challenges of treating rheumatic disease in African countries include unreliable drug availability and cost, limited subspecialists, and patient beliefs. Adapting recommendations for MTX use in the context of prevalent endemic infections; ensuring safe but feasible MTX monitoring strategies, enhanced access to stable drug supply, and specialized rheumatology care; and improving patient education are key to reducing the burden of rheumatic diseases in L-HDI countries.
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Affiliation(s)
| | | | | | - Yan Lau
- McGill UniversityMontrealQuebecCanada
| | - Steven Shi
- Université de MontréalMontrealQuebecCanada
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Ju S, Hudson M, Colmegna I, Bernatsky S, LI Y. OP0018 PREDICTING RESPONSES TO ANTI-TNF TREATMENTS IN RHEUMATOID ARTHRITIS PATIENTS FROM GENETIC AND CLINICAL DATA USING A MACHINE LEARNING APPROACH. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1107] [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: 11/04/2022]
Abstract
Background:Tumor necrosis factor (TNF) inhibitors are key therapies in rheumatoid arthritis (RA). However, a third of patients fail to respond to these agents, and there are no reliable predictors for response. Predictive models, potentially based on clinical and genomic data, are vital to personalizing therapy. The Dialogue for Reverse Engineering Assessments and Methods (DREAM) RA Responder Challenge invited research teams to create models for patient response to anti-TNF therapy. The winning model relied heavily on limited genetic input and was unable to correctly predict responses in a large number of individuals.Objectives:We compared non-linear and linear analytic methods to predict response and non-response to anti-TNF treatment for RA patients in the DREAM database, using moth clinical variables and a large number of potential genome-wide predictors.Methods:DREAM data on anti-TNF treated RA patients were accessed through Synapse (synapse.sagebase.org). Analogously to the DREAM challenge, we were provided with the clinical and genomic data of 2706 patients with at least moderate disease activity according to their composite disease activity scores for 28 joints (DAS28). In contrast to the previous analysis that focused on single nucleotide polymorphisms (SNPs) based on existing knowledge of RA, we used the full genome-wide dataset of 2.5 million SNPs. We first reduced this to 284 SNPs by considering the marginal p-value of 0.001 for each SNP based on whether or not it predicted response. Then, we removed SNPs with borderline significant p-values if they were in linkage disequilibrium with the most significant SNPs. Instead of predicting a binary outcome of responder or non-responder, we trained both linear (e.g. least absolute shrinkage and selection operator, or LASSO) and non-linear models (e.g. Random Forest) to predict a continuous outcome, the change in DAS28 from baseline to 3-12 months after initiation of anti-TNF therapy. We split the patients into training (N=2031) and testing (N=675) subsets and used the predicted response scores to evaluate the true binary response labels for the test patients.Results:The best performing method was Random Forest (RF), a non-linear model that uses decision trees to progressively separate subjects into groups based on the most predictive features. Support Vector Regression (SVR) also out-performed linear methods. Compared to only clinical covariates such as age and sex, adding SNPs improved the prediction from an area under the receiver operating curve (AUROC) of 0.63 to 0.67, i.e., 0.04 improvement. This AUROC of 0.67 was 0.046 greater than the DREAM challenge winner.Conclusion:Non-linear methods such as RF and SVR gave larger predictive improvements compared to linear methods. This may imply some interaction between SNPs and clinical covariatesas potential predictors of response to anti-TNF therapy in RA. We are further investigating these 284 SNPs and their interactions in this regard.References:[1]Guan, Y., Zhang, H., Quang, D., Wang, Z., Parker, S., Pappas, D. A., Kremer, J. M., & Zhu, F. (2019). Machine Learning to Predict Anti-Tumor Necrosis Factor Drug Responses of Rheumatoid Arthritis Patients by Integrating Clinical and Genetic Markers. Arthritis & rheumatology (Hoboken, N.J.), 71(12), 1987–1996. https://doi.org/10.1002/art.41056[2]Sieberts, S. K., Zhu, F., García-García, J., Stahl, E., Pratap, A., Pandey, G., Pappas, D., Aguilar, D., Anton, B., Bonet, J., Eksi, R., Fornés, O., Guney, E., Li, H., Marín, M. A., Panwar, B., Planas-Iglesias, J., Poglayen, D., Cui, J., Falcao, A. O., … Mangravite, L. M. (2016). Crowdsourced assessment of common genetic contribution to predicting anti-TNF treatment response in rheumatoid arthritis. Nature communications, 7, 12460. https://doi.org/10.1038/ncomms12460Figure.Disclosure of Interests:None declared
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Valerio V, Shen HC, Field E, Mcdonald EG, Turner A, Bernatsky S, Hudson M, Colmegna I. POS1268 COVID-19 VACCINE HESITANCY AMONG RHEUMATOLOGY PATIENTS RECEIVING INFLUENZA VACCINE. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.4150] [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: 11/04/2022]
Abstract
Background:Adults with rheumatic diseases are a COVID-19 vulnerable population with potential increased risk for severe infection. COVID-19 vaccines are a key strategy to ending the pandemic. Unfortunately, fears about vaccines, some of which are propagated by misinformation, are common and may prevent or inappropriately delay vaccination. Refusal or uncertainty to get a vaccine despite its availability is known as vaccine hesitancy.Objectives:This study aims at defining causes of COVID-19 vaccine hesitancy among rheumatology patients.Methods:Between November and December 2020, a cross-sectional survey was completed by rheumatology patients presenting to a large Canadian tertiary-care center for influenza immunization. COVID-19 risk factors, previous COVID-19 infection, the likelihood of getting a future COVID-19 vaccine (scale 0-10), and contextual, individual, and vaccine-specific potential determinants of vaccine hesitancy were assessed. Patients were classified into 5 groups based on how likely they were to get a future COVID-19 vaccine (0= not likely at all; 2.5= unlikely; 5= intermediate; 7.5= likely; 10= highly likely). A machine learning approach (XgBoost) was used to fit univariate models for a multi-class correlation.Results:157 rheumatology patients completed the survey. Most were females (n=112, 71%) with a mean age of 54.6 (standard deviation 17.9). The majority (73%) had tertiary-education, and 46% were employed at the time of the survey. The most common rheumatology diagnoses were rheumatoid arthritis (n=90, 58%), systemic lupus erythematosus/vasculitis (n=41, 26%) and spondyloarthropathies (n=39, 25%). Most patients were on immunosuppressors (n=93, 59%). Only half (n=85, 54%) were highly likely to accept a future COVID vaccine, 17% (n=26) likely, 19% (n=30) intermediate, 6% (n=10) unlikely, and 4% (n=6) not likely at all. One hundred thirty-five patients (86%) previously received the flu vaccine, whereas 6% (n=10) previously rejected it. Only three patients were previously diagnosed with COVID-19 (2%) one of whom was hospitalized. Eighty-seven patients (56%) considered that the COVID-19 vaccine should be mandatory, and 101 (65%) that they should receive it. Most respondents were somewhat concerned about receiving a future COVID-19 vaccine (n=116, 76%) despite that 65% believed that vaccines benefits outweighed their risks. Almost all, (n=145, 96%) believed that governmental decisions about vaccines are in the best interest of the population, while less than half (n=70, 45%) were confident that pharmaceutical companies would provide safe and effective vaccines. One hundred participants (65%) denied feeling social pressure to get the vaccine, and 55% (n=81) were willing to pay for the vaccine. Feeling social pressure about getting a COVID-19 vaccine, having severe concerns about receiving a future COVID-19 vaccine, distrust in pharmaceutical companies, lower education, and doubts of whether vaccines benefits outweigh their risks, were negatively associated with COVID vaccine acceptance.Conclusion:Forty six percent of rheumatology patients being immunized against influenza showed at least some hesitancy towards COVID-19 vaccination. Multiple contextual, individual, and vaccine-related factors may contribute. Targeted educational strategies, including producing and communicating data on vaccine safety, may help promote vaccine uptake in this potentially vulnerable population.Disclosure of Interests:None declared
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Hazlewood GS, Pardo JP, Barnabe C, Schieir O, Barber CEH, Bernatsky S, Colmegna I, Hitchon C, Loeb M, Mertz D, Proulx L, Richards DP, Scuccimarri R, Tugwell P, Schünemann HJ, Mirza RD, Zhou AL, Nikolic RPA, Thomas M, Chase H, Ejaredar M, Nieuwlaat R. Canadian Rheumatology Association Recommendation for the Use of COVID-19 Vaccination for Patients With Autoimmune Rheumatic Diseases. J Rheumatol 2021; 48:1330-1339. [PMID: 33993119 DOI: 10.3899/jrheum.210288] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To develop guidance on the use of coronavirus disease 2019 (COVID-19) vaccines in patients with autoimmune rheumatic diseases (ARD). METHODS The Canadian Rheumatology Association (CRA) formed a multidisciplinary panel including rheumatologists, researchers, methodologists, vaccine experts, and patients. The panel used the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. Outcomes were prioritized according to their importance for patients and clinicians. Evidence from the COVID-19 clinical trials was summarized. Indirect evidence for non-COVID-19 vaccines in ARD was also considered. The GRADE evidence-to-decision (EtD) framework was used to develop a recommendation for the use of the 4 COVID-19 vaccines approved in Canada as of March 25, 2021 (BNT162b2, mRNA-1273, ChAdOx1, and Ad26.COV2.S), over 4 virtual panel meetings. RESULTS The CRA guideline panel suggests using COVID-19 vaccination in persons with ARD. The panel unanimously agreed that for the majority of patients, the potential health benefits of vaccination outweigh the potential harms in people with ARDs. The recommendation was graded as conditional because of low or very low certainty of the evidence on the effects in the population of interest, primarily due to indirectness and imprecise effect estimates. The panel felt strongly that persons with autoimmune rheumatic diseases who meet local eligibility should not be required to take additional steps compared to people without ARDs to obtain their vaccination. Guidance on medications, implementation, monitoring of vaccine uptake, and research priorities are also provided. CONCLUSION This recommendation will be updated over time as new evidence emerges, with the latest recommendation, evidence summaries, and EtD available on the CRA website.
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Affiliation(s)
- Glen S Hazlewood
- G.S. Hazlewood, MD, PhD, Associate Professor of Medicine, C. Barnabe, MD, MSc, Associate Professor of Medicine, C.E. Barber, MD, PhD, Assistant Professor of Medicine, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, and Arthritis Research Canada, Richmond, British Columbia;
| | - Jordi Pardo Pardo
- J.P. Pardo, LDO, Managing Editor, Centre for Global Health, University of Ottawa, Ottawa, Ontario
| | - Cheryl Barnabe
- G.S. Hazlewood, MD, PhD, Associate Professor of Medicine, C. Barnabe, MD, MSc, Associate Professor of Medicine, C.E. Barber, MD, PhD, Assistant Professor of Medicine, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, and Arthritis Research Canada, Richmond, British Columbia
| | - Orit Schieir
- O. Schieir, PhD, Canadian Early Arthritis Cohort Study, Toronto, Ontario
| | - Claire E H Barber
- G.S. Hazlewood, MD, PhD, Associate Professor of Medicine, C. Barnabe, MD, MSc, Associate Professor of Medicine, C.E. Barber, MD, PhD, Assistant Professor of Medicine, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, and Arthritis Research Canada, Richmond, British Columbia
| | - Sasha Bernatsky
- S. Bernatsky, MD, PhD, Professor of Medicine, Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, Quebec
| | - Ines Colmegna
- I. Colmegna, MD, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, McGill University, Montreal, Quebec
| | - Carol Hitchon
- C. Hitchon, MD, MSc, Associate Professor of Medicine, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba
| | - Mark Loeb
- M. Loeb, MD, MSc, Professor, D. Mertz, MD, MSc, Associate Professor of Medicine, H.J. Schünemann, MD, MSc, PhD, Professor of Medicine and Clinical Epidemiology, Departments of Medicine and Health Research Methods, Evidence, and Impact, McMaster GRADE Centers, Hamilton
| | - Dominik Mertz
- M. Loeb, MD, MSc, Professor, D. Mertz, MD, MSc, Associate Professor of Medicine, H.J. Schünemann, MD, MSc, PhD, Professor of Medicine and Clinical Epidemiology, Departments of Medicine and Health Research Methods, Evidence, and Impact, McMaster GRADE Centers, Hamilton
| | - Laurie Proulx
- L. Proulx, B.Com, D.P. Richards, PhD, Canadian Arthritis Patient Alliance, Toronto, Ontario
| | - Dawn P Richards
- L. Proulx, B.Com, D.P. Richards, PhD, Canadian Arthritis Patient Alliance, Toronto, Ontario
| | - Rosie Scuccimarri
- R. Scuccimarri, MD, Associate Professor of Pediatrics, Division of Pediatric Rheumatology, Department of Pediatrics, McGill University, Montreal, Quebec
| | - Peter Tugwell
- P. Tugwell, MD, Professor of Medicine, A.L. Zhou, MD, Department of Medicine, University of Ottawa, Ottawa, Ontario
| | - Holger J Schünemann
- M. Loeb, MD, MSc, Professor, D. Mertz, MD, MSc, Associate Professor of Medicine, H.J. Schünemann, MD, MSc, PhD, Professor of Medicine and Clinical Epidemiology, Departments of Medicine and Health Research Methods, Evidence, and Impact, McMaster GRADE Centers, Hamilton
| | - Reza D Mirza
- R.D. Mirza, MD, Department of Medicine, University of Toronto, Toronto, Ontario
| | - Alan L Zhou
- P. Tugwell, MD, Professor of Medicine, A.L. Zhou, MD, Department of Medicine, University of Ottawa, Ottawa, Ontario
| | - Roko P A Nikolic
- R.P. Nikolic, BSc, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Megan Thomas
- M. Thomas, BHSc, M. Ejaredar, PhD, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | | | - Maede Ejaredar
- M. Thomas, BHSc, M. Ejaredar, PhD, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Robby Nieuwlaat
- R. Nieuwlaat, MSc, PhD, Associate Professor, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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17
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Jeon P, Lora M, Hussain S, Farge D, Hudson M, Oldak T, Colmegna I. Angiogenic effects of adipose tissue- and wharton’s jelly-derived human multipotent mesenchymal stromal cells. Cytotherapy 2021. [DOI: 10.1016/s1465324921003637] [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: 11/17/2022]
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18
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Kizilay Mancini O, Huynh DN, Menard L, Shum-Tim D, Ong H, Marleau S, Colmegna I, Servant MJ. Ex vivo Ikkβ ablation rescues the immunopotency of mesenchymal stromal cells from diabetics with advanced atherosclerosis. Cardiovasc Res 2021; 117:756-766. [PMID: 32339220 PMCID: PMC7898947 DOI: 10.1093/cvr/cvaa118] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/16/2020] [Accepted: 04/21/2020] [Indexed: 12/16/2022] Open
Abstract
AIMS Diabetes is a conventional risk factor for atherosclerotic cardiovascular disease and myocardial infarction (MI) is the most common cause of death among these patients. Mesenchymal stromal cells (MSCs) in patients with type 2 diabetes mellitus (T2DM) and atherosclerosis have impaired ability to suppress activated T-cells (i.e. reduced immunopotency). This is mediated by an inflammatory shift in MSC-secreted soluble factors (i.e. pro-inflammatory secretome) and can contribute to the reduced therapeutic effects of autologous T2DM and atherosclerosis-MSC post-MI. The signalling pathways driving the altered secretome of atherosclerosis- and T2DM-MSC are unknown. Specifically, the effect of IκB kinase β (IKKβ) modulation, a key regulator of inflammatory responses, on the immunopotency of MSCs from T2DM patients with advanced atherosclerosis has not been studied. METHODS AND RESULTS MSCs were isolated from adipose tissue obtained from patients with (i) atherosclerosis and T2DM (atherosclerosis+T2DM MSCs, n = 17) and (ii) atherosclerosis without T2DM (atherosclerosis MSCs, n = 17). MSCs from atherosclerosis+T2DM individuals displayed an inflammatory senescent phenotype and constitutively expressed active forms of effectors of the canonical IKKβ nuclear factor-κB transcription factors inflammatory pathway. Importantly, this constitutive pro-inflammatory IKKβ signature resulted in an altered secretome and impaired in vitro immunopotency and in vivo healing capacity in an acute MI model. Notably, treatment with a selective IKKβ inhibitor or IKKβ knockdown (KD) (clustered regularly interspaced short palindromic repeats/Cas9-mediated IKKβ KD) in atherosclerosis+T2DM MSCs reduced the production of pro-inflammatory secretome, increased survival, and rescued their immunopotency both in vitro and in vivo. CONCLUSIONS Constitutively active IKKβ reduces the immunopotency of atherosclerosis+T2DM MSC by changing their secretome composition. Modulation of IKKβ in atherosclerosis+T2DM MSCs enhances their myocardial repair ability.
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Affiliation(s)
- Ozge Kizilay Mancini
- Faculty of Pharmacy, University of Montreal, C.P. 6128, Succursale Centre-Ville, Montréal, QC H3C 3J7, Canada
| | - David N Huynh
- Faculty of Pharmacy, University of Montreal, C.P. 6128, Succursale Centre-Ville, Montréal, QC H3C 3J7, Canada
| | - Liliane Menard
- Faculty of Pharmacy, University of Montreal, C.P. 6128, Succursale Centre-Ville, Montréal, QC H3C 3J7, Canada
| | - Dominique Shum-Tim
- Division of Cardiac Surgery Department of Surgery, McGill University, Montreal, QC H4A 3J1, Canada
- Division of Surgical Research, Department of Surgery, McGill University, Montreal, QC H4A 3J1, Canada
| | - Huy Ong
- Faculty of Pharmacy, University of Montreal, C.P. 6128, Succursale Centre-Ville, Montréal, QC H3C 3J7, Canada
| | - Sylvie Marleau
- Faculty of Pharmacy, University of Montreal, C.P. 6128, Succursale Centre-Ville, Montréal, QC H3C 3J7, Canada
| | - Ines Colmegna
- Division of Rheumatology, Department of Medicine, McGill University, Montreal, QC H4A 3J1, Canada
| | - Marc J Servant
- Faculty of Pharmacy, University of Montreal, C.P. 6128, Succursale Centre-Ville, Montréal, QC H3C 3J7, Canada
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19
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Valerio V, Bazan MC, Wang M, Mazer BD, Pineau CA, Hazel EM, Bernatsky S, Ward BJ, Colmegna I. A multimodal intervention increases influenza vaccine uptake in rheumatoid arthritis. Clin Rheumatol 2020; 40:575-579. [PMID: 33030631 DOI: 10.1007/s10067-020-05435-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 08/23/2020] [Revised: 09/25/2020] [Accepted: 09/28/2020] [Indexed: 11/24/2022]
Abstract
Annual influenza vaccination is recommended for patients with rheumatoid arthritis (RA), but coverage is suboptimal. We assessed the impact of an implementation strategy in enhancing vaccination uptake in RA. We evaluated a multimodal implementation strategy at rheumatology clinics that included 3 approaches: patient recalls, a nurse providing vaccines, and physician reminders. We compared patient-reported vaccination rates after implementation with those reported before the implementation strategy in a nonequivalent control group. In multivariate analyses, we assessed factors potentially associated with influenza vaccine uptake. One hundred and sixteen RA patients were vaccinated during the intervention. The influenza vaccination rate in RA increased from 48.5% (65/136) before implementation to 62.6% (67/107) after implementation (difference of 14.1, 95% CI 1.5, 26.1). In multivariate analyses, older age, biologics use, and physician recommendation for vaccination were associated with influenza vaccine uptake. A multimodal intervention was associated with increased influenza vaccine coverage among RA patients. Older patients and those on biologics were more likely to be immunized against influenza. Physician's recommendations are important to promote vaccine coverage. Key Points • Despite current recommendations, influenza vaccine uptake among rheumatoid arthritis (RA) patients is suboptimal. • A multimodal implementation strategy facilitating access to influenza vaccine and raising awareness through vaccination reminders improved immunization uptake in RA. • Physicians play a key role in promoting annual seasonal influenza vaccination. • The reasons for vaccine hesitancy in RA should be addressed to reach a vaccination target of 80% required to reduce the burden of this preventable infection.
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Affiliation(s)
- Valeria Valerio
- The Research Institute of the McGill University Health Centre (MUHC), 1001 Decarie Blvd, Office # EM02-3238, Montreal, QC, H4A 3J1, Canada
| | - Maria Celia Bazan
- The Research Institute of the McGill University Health Centre (MUHC), 1001 Decarie Blvd, Office # EM02-3238, Montreal, QC, H4A 3J1, Canada
| | - Mianbo Wang
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
| | - Bruce D Mazer
- The Research Institute of the McGill University Health Centre (MUHC), 1001 Decarie Blvd, Office # EM02-3238, Montreal, QC, H4A 3J1, Canada
| | - Christian A Pineau
- Division of Rheumatology, Department of Medicine, McGill University, Montreal, QC, Canada
| | - Elizabeth M Hazel
- Division of Rheumatology, Department of Medicine, McGill University, Montreal, QC, Canada
| | - Sasha Bernatsky
- Division of Rheumatology, Department of Medicine, McGill University, Montreal, QC, Canada.,Division of Clinical Epidemiology, Department of Medicine, McGill University, Montreal, QC, Canada
| | - Brian J Ward
- The Research Institute of the McGill University Health Centre (MUHC), 1001 Decarie Blvd, Office # EM02-3238, Montreal, QC, H4A 3J1, Canada.,Division of Infectious Diseases, Department of Medicine, McGill University, Montreal, QC, Canada
| | - Ines Colmegna
- The Research Institute of the McGill University Health Centre (MUHC), 1001 Decarie Blvd, Office # EM02-3238, Montreal, QC, H4A 3J1, Canada. .,Division of Rheumatology, Department of Medicine, McGill University, Montreal, QC, Canada.
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20
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Zhao N, Smargiassi A, Colmegna I, Hudson M, Fritzler M, Bernatsky S. Sunlight exposure, sun-protective behaviour, and anti-citrullinated protein antibody positivity: A general population-based study in Quebec, Canada. Arthritis Care Res (Hoboken) 2020; 74:236-242. [PMID: 32961027 DOI: 10.1002/acr.24448] [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] [Received: 04/15/2020] [Revised: 08/04/2020] [Accepted: 09/08/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To examine associations between sunlight exposure and anti-citrullinated protein antibodies (ACPA) using general population data in Quebec, Canada. METHODS A random sample of 7600 individuals (including 786 positive ACPA subjects and 201 self-reported rheumatoid arthritis, RA cases) from the CARTaGENE cohort was studied cross-sectionally. All subjects were nested in four census metropolitan areas, and mixed-effects logistic regression models were used to calculate odds ratios (OR) and 95% confidence intervals (CIs) for ACPA positivity related to sunlight exposure, adjusting for sun-block use, industrial fine particulate matter (PM2.5 ) exposures, smoking, age, sex, French Canadian ancestry, and family income. We also performed sensitivity analyses excluding subjects with RA, defining ACPA positivity by higher titers, and stratifying by age and sex. RESULTS The adjusted ORs and 95% CIs did not suggest conclusive associations between ACPA and sunlight exposure or sun-block use, but robust positive relationships were observed between industrial PM2.5 emissions and ACPA (OR 1.19 per µg/m3 , 95% CI 1.03 - 1.36 in primary analyses). CONCLUSIONS We did not see clear links between ACPA and sunlight exposure or sun-block use, but we did note positive associations with industrial PM2.5 . Future studies of sunlight and RA (or ACPA) should take air pollution exposures into account.
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Affiliation(s)
- Naizhuo Zhao
- Division of Clinical Epidemiology, McGill University Health Centre, Montreal, QC, Canada
| | - Audrey Smargiassi
- Département de Santé Environnementale et de Santé au Travail, Université de Montréal, Montréal, QC, Canada.,Institut National de Santé Publique du Québec, Montréal, QC, Canada.,Centre de Recherche en Santé Publique de l, Université de Montréal, Montréal, QC, Canada
| | - Ines Colmegna
- Department of Medicine, McGill University, Montréal, QC, Canada.,Division of Rheumatology, McGill University Health Center, Montréal, QC, Canada
| | - Marie Hudson
- Department of Medicine, McGill University, Montréal, QC, Canada.,Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada
| | - Marvin Fritzler
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sasha Bernatsky
- Division of Clinical Epidemiology, McGill University Health Centre, Montreal, QC, Canada.,Department of Medicine, McGill University, Montréal, QC, Canada.,Division of Rheumatology, McGill University Health Center, Montréal, QC, Canada
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21
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Maltez N, Puyade M, Wang M, Lansiaux P, Marjanovic Z, Charles C, Steele R, Baron M, Colmegna I, Hudson M, Farge D. Association of Autologous Hematopoietic Stem Cell Transplantation in Systemic Sclerosis With Marked Improvement in Health-Related Quality of Life. Arthritis Rheumatol 2020; 73:305-314. [PMID: 32909693 DOI: 10.1002/art.41519] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 08/18/2020] [Accepted: 09/03/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To quantify the magnitude, domains, and duration of change in health-related quality of life (HRQoL) in patients with systemic sclerosis (SSc) who underwent autologous hematopoietic stem cell transplantation (HSCT) as compared to SSc patients with similar characteristics who did not undergo autologous HSCT. METHODS The study was designed as a retrospective study comparing SSc patients who underwent autologous HSCT and SSc patients who met the criteria for transplantation but were treated with conventional care. Outcomes included scores on the 36-item Short Form (SF-36) health survey and the Health Assessment Questionnaire (HAQ) and its disease-specific symptom scales. Differences in scores between the groups were compared using linear models, adjusting for baseline scores and inverse probability of treatment and censoring weights. RESULTS In total, 41 SSc patients who underwent autologous HSCT and 65 SSc patients treated with conventional care were compared. In marginal linear weighted models, the SF-36 physical component summary score was a mean ± SEM 7.02 ± 1.94 points higher at the first annual visit (P = 0.001) and 14.40 ± 6.16 points higher at the seventh annual visit (P = 0.03) in patients treated with autologous HSCT compared to the conventional care group. HAQ scores were significantly better in the autologous HSCT group compared to the conventional care group during follow-up (mean ± SEM difference from baseline -0.57 ± 0.13 [P < 0.001] at the first annual visit and -0.94 ± 0.49 [P = 0.07] at the seventh annual visit). There were no differences in the SF-36 mental component summary scores between the 2 groups either at baseline or during follow-up. CONCLUSION This study provides robust complementary HRQoL data, including overall and event-free survival data, to expand on the standard repertoire of biomedical variables, thus potentially supporting the physical benefits of autologous HSCT in patients with SSc.
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Affiliation(s)
| | | | - Mianbo Wang
- Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada
| | - Pauline Lansiaux
- Centre de Référence des Maladies Auto-Immunes Systémiques Rares d'Ile-de-France, AP-HP, Hôpital St. Louis, Université de Paris, Institut de Recherche St. Louis, EA 3518, Paris, France
| | | | - Catney Charles
- Centre de Référence des Maladies Auto-Immunes Systémiques Rares d'Ile-de-France, AP-HP, Hôpital St. Louis, Université de Paris, Institut de Recherche St. Louis, EA 3518, Paris, France
| | | | - Murray Baron
- Jewish General Hospital and McGill University Health Center, Montreal, Quebec, Canada
| | - Ines Colmegna
- Jewish General Hospital and McGill University Health Center, Montreal, Quebec, Canada
| | - Marie Hudson
- Lady Davis Institute, Jewish General Hospital, and McGill University, Montreal, Quebec, Canada
| | - Dominique Farge
- Centre de Référence des Maladies Auto-Immunes Systémiques Rares d'Ile-de-France, AP-HP, Hôpital St. Louis, Université de Paris, Institut de Recherche St. Louis, EA 3518, Hôpital St. Antoine, Paris, France, and McGill University, Montreal, Quebec, Canada
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22
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Puyade M, Maltez N, Lansiaux P, Pugnet G, Roblot P, Colmegna I, Hudson M, Farge D. Health-related quality of life in systemic sclerosis before and after autologous haematopoietic stem cell transplant-a systematic review. Rheumatology (Oxford) 2020; 59:779-789. [PMID: 31504944 DOI: 10.1093/rheumatology/kez300] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 03/08/2019] [Revised: 06/10/2019] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES In severe rapidly progressive SSc, autologous haematopoietic stem cell transplantation (AHSCT) allows significant improvements in overall and event-free survival. We undertook this study to identify, appraise and synthesize the evidence on health-related quality of life (HRQoL) before and after AHSCT for SSc. METHODS We performed a systematic review of the literature, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, in PubMed and ScienceDirect from database inception to 1 February 2019. All articles with original HRQoL data were selected. RESULTS The search identified 1080 articles, of which 8 were selected: 3 unblinded randomized controlled trials [American Scleroderma Stem Cell versus Immune Suppression Trial (ASSIST), Autologous Stem Cell Transplantation International Scleroderma, Scleroderma: Cyclophosphamide or Transplantation), 3 uncontrolled phase I or II trials and 2 cohort studies. HRQoL data from 289 SSc patients treated with AHSCT and 125 treated with intravenous CYC as a comparator with median 1.25-4.5 years follow-up were included. HRQoL was evaluated with the HAQ Disability Index (HAQ-DI; 275 patients), the 36-item Short Form Health Survey (SF-36; 249 patients) and the European Quality of Life 5-Dimensions questionnaire (EQ-5D; 138 patients). The quality of the studies was moderate to low. AHSCT was associated with significant improvement in the HAQ-DI (P = 0.02-<0.001), SF-36 Physical Component Summary score (P = 0.02-<0.0001) and EQ-5D index-based utility score (P < 0.001). The SF-36 Mental Component Summary score improved in the ASSIST (n = 19) and one small retrospective cohort (n = 30 patients, P = 0.005) but did not improve significantly in 2 randomized controlled trials (n = 200 patients, P = 0.1-0.91). CONCLUSION AHSCT in severe SSc patients is associated with significant and durable improvement in physical HRQoL.
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Affiliation(s)
- Mathieu Puyade
- Centre Hospitalier Universitaire de Poitiers, Service de Médecine Interne, Maladies infectieuses, France.,Centre Hospitalier Universitaire de Poitiers, CIC1402, Poitiers, France
| | | | - Pauline Lansiaux
- Unité de Médecine Interne: Maladies Auto-immunes et Pathologie Vasculaire (UF 04), Centre de Référence des Maladies auto-immunes systémiques Rares d'Ile-de-France, AP-HP, Hôpital St-Louis, Saint Louis.,Université de Paris, IRSL, Recherche clinique appliquée à l'hématologie, EA 3518, F-75010 Paris
| | - Grégory Pugnet
- CHU de Toulouse, Hôpital Purpan, Service de Médecine Interne, France.,CHU de Toulouse, CIC 1436 module Biothérapie, Toulouse, France
| | - Pascal Roblot
- Centre Hospitalier Universitaire de Poitiers, Service de Médecine Interne, Maladies infectieuses, France.,Université de Poitiers, Poitiers, France
| | - Ines Colmegna
- Research Institute of the McGill University Health Center, Montreal, Canada.,Department of Medicine, McGill University, Montreal, Canada
| | - Marie Hudson
- Department of Medicine, McGill University, Montreal, Canada.,Jewish General Hospital, Lady Davis Institute, Montreal, Canada
| | - Dominique Farge
- Unité de Médecine Interne: Maladies Auto-immunes et Pathologie Vasculaire (UF 04), Centre de Référence des Maladies auto-immunes systémiques Rares d'Ile-de-France, AP-HP, Hôpital St-Louis, Saint Louis.,Université de Paris, IRSL, Recherche clinique appliquée à l'hématologie, EA 3518, F-75010 Paris.,Department of Medicine, McGill University, Montreal, Canada
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23
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Zhao N, Smargiassi A, Hatzopoulou M, Colmegna I, Hudson M, Fritzler MJ, Awadalla P, Bernatsky S. Long-term exposure to a mixture of industrial SO 2, NO 2, and PM 2.5 and anti-citrullinated protein antibody positivity. Environ Health 2020; 19:86. [PMID: 32727483 PMCID: PMC7391811 DOI: 10.1186/s12940-020-00637-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/21/2020] [Indexed: 06/02/2023]
Abstract
BACKGROUND Studies of associations between industrial air emissions and rheumatic diseases, or diseases-related serological biomarkers, are few. Moreover, previous evaluations typically studied individual (not mixed) emissions. We investigated associations between individual and combined exposures to industrial sulfur dioxide (SO2), nitrogen dioxide (NO2), and fine particles matter (PM2.5) on anti-citrullinated protein antibodies (ACPA), a characteristic biomarker for rheumatoid arthritis (RA). METHODS Serum ACPA was determined for 7600 randomly selected CARTaGENE general population subjects in Quebec, Canada. Industrial SO2, NO2, and PM2.5 concentrations, estimated by the California Puff (CALPUFF) atmospheric dispersion model, were assigned based on residential postal codes at the time of sera collection. Single-exposure logistic regressions were performed for ACPA positivity defined by 20 U/ml, 40 U/ml, and 60 U/ml thresholds, adjusting for age, sex, French Canadian origin, smoking, and family income. Associations between regional overall PM2.5 exposure and ACPA positivity were also investigated. The associations between the combined three industrial exposures and the ACPA positivity were assessed by weighted quantile sum (WQS) regressions. RESULTS Significant associations between individual industrial exposures and ACPA positivity defined by the 20 U/ml threshold were seen with single-exposure logistic regression models, for industrial emissions of PM2.5 (odds ratio, OR = 1.19, 95% confidence intervals, CI: 1.04-1.36) and SO2 (OR = 1.03, 95% CI: 1.00-1.06), without clear associations for NO2 (OR = 1.01, 95% CI: 0.86-1.17). Similar findings were seen for the 40 U/ml threshold, although at 60 U/ml, the results were very imprecise. The WQS model demonstrated a positive relationship between combined industrial exposures and ACPA positivity (OR = 1.36, 95% CI: 1.10-1.69 at 20 U/ml) and suggested that industrial PM2.5 may have a closer association with ACPA positivity than the other exposures. Again, similar findings were seen with the 40 U/ml threshold, though 60 U/ml results were imprecise. No clear association between ACPA and regional overall PM2.5 exposure was seen. CONCLUSIONS We noted positive associations between ACPA and industrial emissions of PM2.5 and SO2. Industrial PM2.5 exposure may play a particularly important role in this regard.
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Affiliation(s)
- Naizhuo Zhao
- Division of Clinical Epidemiology, McGill University Health Centre, Montreal, QC Canada
| | - Audrey Smargiassi
- Département de Santé Environnementale et de Santé au Travail, Université de Montréal, Montréal, QC Canada
- Institut National de Santé Publique du Québec, Montréal, QC Canada
- Centre de Recherche en Santé Publique de l’Université de Montréal (CReSP), Montréal, QC Canada
| | | | - Ines Colmegna
- Department of Medicine, McGill University, Montréal, QC Canada
- Division of Rheumatology, McGill University Health Center, Montréal, QC Canada
| | - Marie Hudson
- Department of Medicine, McGill University, Montréal, QC Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC Canada
| | - Marvin J. Fritzler
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB Canada
| | - Philip Awadalla
- Ontario Institute for Cancer Research, Toronto, ON Canada
- Department of Molecular Genetics, University of Toronto, Toronto, ON Canada
| | - Sasha Bernatsky
- Division of Clinical Epidemiology, McGill University Health Centre, Montreal, QC Canada
- Department of Medicine, McGill University, Montréal, QC Canada
- Division of Rheumatology, McGill University Health Center, Montréal, QC Canada
- Centre for Outcomes Research & Evaluation, 5252 boul de Maisonneuve Ouest, (3F.51), Montreal, QC H4A 3S5 Canada
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24
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Moura CS, Schieir O, Valois M, Thorne C, Bartlett SJ, Pope JE, Hitchon CA, Boire G, Haraoui B, Hazlewood GS, Keystone EC, Tin D, Bykerk VP, Bernatsky S, Baron M, Bessette L, Colmegna I, Fallavollita S, Haaland D, Haraoui P, Jamal S, Jamal S, Joshi R, Nair B, Panopoulos P, Penney C, Rubin L, Villeneuve E, Zummer M. Treatment Strategies in Early Rheumatoid Arthritis Methotrexate Management: Results From a Prospective Cohort. Arthritis Care Res (Hoboken) 2020; 72:1104-1111. [DOI: 10.1002/acr.23927] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 05/14/2019] [Indexed: 11/08/2022]
Affiliation(s)
| | | | | | - Carter Thorne
- Southlake Regional Health Center Newmarket California USA
| | | | | | | | - Gilles Boire
- Université de Sherbrooke Sherbrooke Quebec Canada
| | - Boulos Haraoui
- Institut de Rhumatologie de Montréal Montreal Quebec Canada
| | - Glen S. Hazlewood
- University of Toronto, Toronto, Ontario, Canada and University of Calgary Calgary Alberta Canada
| | | | - Diane Tin
- Southlake Regional Health Center Newmarket California USA
| | - Vivian P. Bykerk
- Mount Sinai Hospital, Toronto, Ontario, Canada and Hospital for Special Surgery New York
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25
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Davidson A, Gunay A, Colmegna I, Lacaille D, Loewen H, Meltzer M, Scuccimarri R, Mengistu Y, Bernatsky S, Hitchon C. FRI0064 SAFETY OF LOW DOSE METHOTREXATE (MTX) AND TUBERCULOSIS (TB). Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1544] [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: 11/03/2022]
Abstract
Background:Increased awareness of the importance of MTX in rheumatic disease is leading to more MTX use in patients from TB-endemic areas. Current management guidelines for rheumatic disease address TB in the context of biologics but not MTX use.Objectives:To systematically review the published literature on TB rates with MTX ≤30 mg per week.Methods:We searched CINAHL, Embase, Global, MEDLINE and World of Science databases (Jan 1990 to May 2018) for terms including ‘methotrexate’ and ‘tuberculosis’. We also searched citations from review articles. Titles, abstracts or full manuscripts of the 4707 reports identified were screened independently by 2 reviewers to identify studies reporting TB in patients taking MTX. Study quality was assessed using the McGill Mixed Methods Appraisal Tool (MMAT). Data was extracted on TB incidence (new TB diagnosis vs reactivation of latent TB), and outcomes (pulmonary, dissemination, death) and safety of isoniazid, INH. Descriptive summaries are presented on studies providing outcomes in patients taking MTX ≤30 mg per week.Results:After removing duplicates and studies not meeting criteria or providing sufficient information, 31 studies were included (8 cohort, 7 case-control, 1 clinical trial, 15 case reports/case series). Only 27% of articles reported data from low to moderate human development index countries. Studies were of moderate quality. Seven case control studies were heterogeneous but most demonstrated a modest increased risk of TB with MTX (Table). Five cohort studies reported TB incidence rates in rheumatic disease (treated with MTX +/- biologics) ranging from 102-367.9/100,000 patient-years. These rates were generally higher than comparator general population rates. Two cohort studies of MTX in RA (without biologic) reported cumulative TB incidence in Maldova (12 TB cases in 44 RA patients, 27%) and in China (9/114, 7.9%). Other cohort studies generated rates of overt infection (143/100,000 patient years in Spain, higher if co-prescribed with corticosteroids and other immunosuppressants in South Africa), and latent TB rates detection (16/922 RA screened, 1.7%, in Canada). When reported, rates of extra-pulmonary TB were higher than comparator general population rates. One clinical trial (China), 2 cohorts (Japan, USA) and 2 case-series (Belgium, USA) evaluated safety of INH and MTX. Isoniazid-related hepatotoxicity and neutropenia were generally more common when taken with MTX, but were usually reversible.Conclusion:Despite a paucity of high-quality data, this review confirms that TB screening and clinical surveillance are needed in patients from TB-endemic areas who are prescribed MTX, particularly with co-administration of corticosteroids or other immunosuppressants. Isoniazid, if monitored, appears safe and prevents TB reactivation.References:Table .Case control studiesRegion (Year)DiagnosisTB with MTXTB without MTXOdds RatioMexico(1999)Mixed (4 RA)1/65/752.76Japan(2004)RA3/4717/1540.56Canada(2009)RA29/48321/10463.12Brazil(2010)Lupus2/31/57112Taiwan(2012)Psoriasis33/144464/23411.2Taiwan(2015)JIA4/3574/10262.90South Africa (2017)RA0/1340/18NAJIA=juvenile idiopathic arthritisAcknowledgments:Funded by the International League Against Rheumatism and McGill University Global Health Scholar AwardsDisclosure of Interests:Anna Davidson: None declared, Alize Gunay: None declared, Ines Colmegna: None declared, Diane Lacaille: None declared, Hal Loewen: None declared, Michele Meltzer: None declared, Rosie Scuccimarri: None declared, Yewondwossen Mengistu: None declared, Sasha Bernatsky: None declared, Carol Hitchon Grant/research support from: UCB Canada; Pfizer Canada
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Valerio V, Bazan M, Wang M, Mazer B, Hazel EM, Pineau C, Bernatsky S, Colmegna I. THU0154 PERCEPTIONS ABOUT INTERVENTIONS TO ENHANCE INFLUENZA VACCINE UPTAKE DIFFER BETWEEN VACCINATED AND UNVACCINATED RA/JIA PATIENTS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3429] [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: 03/18/2023]
Abstract
Background:To optimize the control of vaccine preventable diseases, high immunization coverage rates must be achieved. Influenza vaccination rates among patients with rheumatoid arthritis (RA) and juvenile idiopathic arthritis (JIA) are suboptimal. Understanding patient preferences for interventions that may increase vaccine uptake is the first step to inform the development of specific strategies to enhance vaccine coverage in RA/JIA.Objectives:To compare the perceptions of vaccinated and unvaccinated RA/JIA patients on a multi-modal intervention to enhance seasonal influenza vaccine coverage.Methods:During the 2018-2019 influenza season, a multi-modal intervention was implemented at a large Canadian academic center. This consisted of (i) a letter sent from the Division of Rheumatology to patients addressing common misconceptions about flu vaccines and encouraging patients to plan for immunization; (ii) a nurse providing inactivated influenza vaccine at the rheumatology clinics for the first 7 weeks after the vaccine was released, and (iii) clinics posters specifically designed for rheumatic patients and rheumatologists to prompt a discussion on influenza prevention. Patients that were vaccinated on site completed a survey evaluating the relevance of the individual components of the intervention. After the intervention, during a scheduled rheumatology visit, RA/JIA patients were asked to complete a similar survey. We compared the responses from RA/JIA patients that were vaccinated at our institution, to those of patients that reported not having received the influenza vaccine in 2018-2019.Results:During the intervention, 116 immunized RA/JIA patients completed the first survey. Forty RA/JIA patients not vaccinated during the 2018-2019 season completed the post-intervention survey. Both vaccinated and unvaccinated groups were mostly female (74.1% versus 87.2%), but vaccinated patients were older (50.8±19.4 versus: 40.5±14.9; 95% CI 3.7%,17%), and had shorter disease duration (10.1±9.3 versus 15.0±9.8; 95% CI -8.9%,-1.1%) than those not vaccinated. Unvaccinated patients were less likely than vaccinated patients to approve of the clinic’s provision of influenza vaccine (98.2% versus 75%; 95% CI 12.8%, 43.5%). When asked about elements of the intervention, unvaccinated patients were less likely than vaccinated patients to consider posters (65.2% versus 38.9%; 95% CI 7.9%, 42.9%), letters (69.4% versus 35.3%; 95% CI 16.2%, 51.2%), or phone calls (58.0% versus 41.7%; 95% CI 2.1%, 33.5%) as good reminders.Conclusion:Unvaccinated RA/JIA patients’ opinions about interventions to increase vaccine uptake differ from vaccinated patients. Alternative, novel strategies to target vaccine hesitant RA/JIA patients are needed to optimize vaccine coverage.Disclosure of Interests:None declared
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Gunay A, Davidson A, Colmegna I, Lacaille D, Loewen H, Meltzer M, Mengistu Y, Scuccimarri R, Yirsaw Z, Bernatsky S, Hitchon C. SAT0078 SAFETY OF LOW DOSE METHOTREXATE (MTX) IN HUMAN IMMUNODEFICIENCY VIRUS (HIV) INFECTION. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Increased awareness of the efficacy of MTX in rheumatic disease is leading to more MTX use in patients from HIV endemic areas. While HIV related immunosuppression may contribute to improvement of some rheumatic diseases, immune reconstitution from highly active antiretroviral therapy (HAART) may lead to exacerbation or presentation of autoimmune disorders for which MTX therapy may be warranted. Most management guidelines for rheumatic disease do not address MTX use in the context of HIV.Objectives:To systematically review the published literature on the safety of using MTX ≤30 mg per week in HIV.Methods:We searched CINAHL, Embase, Global, MEDLINE and World of Science databases (Jan 1990 to May 2018) for terms including ‘methotrexate’ and ‘human immunodeficiency virus’. We also searched citations from review articles. Titles, abstracts or full manuscripts were screened independently by 2 reviewers to identify studies reporting HIV in patients taking MTX. Study quality was assessed using the McGill Mixed Methods Appraisal Tool (MMAT). Data was extracted on MTX and HIV adverse events (MTX toxicity, HIV viral load, CD4 count). Descriptive summaries are presented for studies providing outcomes in patients taking MTX ≤30 mg per week.Results:After removing duplicates and studies not meeting criteria or not providing sufficient information, 42 of the 2714 identified reports were included (1 clinical trial, 2 cohort, 1 cross-sectional study, 38 case reports/case series). Most reports (81%) originated from USA or Europe. Study quality was generally good with most studies fulfilling 50-100% of MMAT criteria. The randomized controlled trial (USA) assessing MTX on atherosclerotic disease in HIV showed that adverse events were more common in MTX versus placebo (12.8% vs 5.6%, p non-inferiority <0.05) and included infection, transient CD4 and CD8 drop, pulmonary toxicity, and death (1 attributed to MTX/HIV, 1 unrelated). One cohort study (South Africa) reported 43 RA patients on MTX who acquired HIV. In this cohort, RA generally improved despite only 5 individuals continuing MTX. No data on MTX adverse event rates was reported. One cohort study (USA) reported 13 HIV patients with myositis. One received MTX (with other immunosuppression) without MTX adverse effects but died due to AIDS. A cross-sectional study (France) of 43 HIV pts with autoimmune disease reported one patient on MTX (and other immunosuppression) developed an adverse event (cytopenia) compared to 5/33 patients not on MTX (cytopenia). The 38 case reports/series described 54 individuals with HIV receiving MTX. Of these studies, 27 (describing 42 subjects) reported on MTX adverse events and 35 (describing 46 subjects) reported on HIV adverse events. MTX adverse events developed in 29 subjects (hematologic 13, renal/hepatic 1, opportunistic infections 10, other events 2). HIV adverse events were noted in 23 subjects (Kaposi’s sarcoma 4, CD4 decrease 16, HIV viral titer increase 4). Five deaths were reported (2 infection, 1 infection and wasting, 2 HIV related deaths). Most subjects also received corticosteroids or other immunosuppressants including biologics.Conclusion:There remains limited data on the safety of low dose MTX in HIV. Surveillance for HIV is warranted for individuals on MTX who are at risk for acquiring HIV. Caution and careful monitoring for MTX toxicity, opportunistic infections and HIV state is suggested if MTX is used in the setting of HIV particularly if combined with other immunosuppression.References:[1] Clin Infectious Disease 2019:68[2] J Rheumatology 2014:41[3] Arthritis and Rheumatism 2003:49[4] Medicine 2017:96Acknowledgments :Funding from International League Against RheumatismMcGill University Global Health Scholar AwardsDisclosure of Interests:Alize Gunay: None declared, Anna Davidson: None declared, Ines Colmegna: None declared, Diane Lacaille: None declared, Hal Loewen: None declared, Michele Meltzer: None declared, Yewondwossen Mengistu: None declared, Rosie Scuccimarri: None declared, Zenebe Yirsaw: None declared, Sasha Bernatsky: None declared, Carol Hitchon Grant/research support from: UCB Canada; Pfizer Canada
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Freton A, Jeon P, Lora M, Farge D, Hudson M, Colmegna I. Modulation of fibroblast-to-myofibroblast differentiation and fibroblast migration: in vitro assessment of the anti-fibrotic effects of human adipose derived multipotent mesenchymal stromal cells. Cytotherapy 2020. [DOI: 10.1016/j.jcyt.2020.03.123] [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: 11/26/2022]
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Jeon P, Lora M, Hussain S, Farge D, Hudson M, Colmegna I. In vitro pro-angiogenic effects of human adipose derived multipotent mesenchymal stromal cells: effect of donor's age. Cytotherapy 2020. [DOI: 10.1016/j.jcyt.2020.03.122] [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: 10/24/2022]
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Affiliation(s)
- Ines Colmegna
- Division of Rheumatology, Department of Medicine, McGill University, Montreal, QC, Canada
| | - Ursula Stochaj
- Department of Physiology, McGill University, Montreal, QC, Canada
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Richards C, Penner J, Colmegna I, Loewen H, Melaku Z, Melkie A, Meltzer M, Scuccimarri R, Mengistu Y, Hitchon CA. Methotrexate exposure and risk of strongyloidiasis. Trop Med Int Health 2019; 24:1032-1041. [PMID: 31302948 DOI: 10.1111/tmi.13288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/28/2022]
Abstract
OBJECTIVE Rheumatologic disease patients receiving immunomodulating drugs such as methotrexate (MTX) have increased infection rates. Strongyloides, a global endemic intestinal parasite, can cause significant or fatal disease in immunocompromised patients. The risk of serious Strongyloides infection with MTX dosed for rheumatologic disease is unknown. METHODS We performed a systematic literature review searching EMBASE, Medline and Web of Science databases. All studies reporting humans exposed to MTX and tested for Strongyloides were reviewed. Exclusion criteria were bone marrow transplantation, intrathecal route and MTX exposure completed >1 year prior to clinically apparent Strongyloides disease. RESULTS After excluding duplicates, 294 articles were reviewed. Of these, 29 cases were described in 27 papers. Twenty cases (69%) had an underlying rheumatologic or dermatologic disease, the rest had a haematologic disease. Hyperinfection or dissemination was found in 59% of cases (52% low-dose MTX; 75% high-dose MTX). Death occurred in 34% of cases (19% low-dose MTX; 75% high-dose MTX, P < 0.01). All eight patients on high-dose MTX received other immunosuppressants. Corticosteroids were taken in 18/21 patients on low-dose MTX. One of the three patients on MTX monotherapy had hyperinfection syndrome. None had disseminated Strongyloides. CONCLUSIONS Serious Strongyloides infection can occur with low-dose MTX particularly when given with other immunosuppression. Global travel and greater awareness of rheumatologic conditions in low- to middle-income countries will increase the exposure of individuals prescribed MTX (with or without corticosteroids) to Strongyloides. Strongyloides screening and treatment should be considered for individuals receiving low-dose MTX therapy, particularly if combined with additional immunosuppression.
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Affiliation(s)
- Ceri Richards
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Justin Penner
- Department of Paediatrics, University of British Columbia, Trail, BC, Canada.,Department of Paediatric Infectious Diseases, Imperial College London, London, UK
| | - Ines Colmegna
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Hal Loewen
- Neil John Mclean Library, University of Manitoba, Winnipeg, MB, Canada
| | - Zenebe Melaku
- ICAP, Mailman School of Public Health, Columbia University, New York, NY, USA.,Department of Internal Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Addisu Melkie
- Department of Internal Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | | | | | | | - Carol A Hitchon
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
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Cheng A, Lora M, Rauch J, Rak J, Colmegna I. Licensing increases the quantity and immunomodulatory cargo of mesenchymal stromal cell exosomes. Cytotherapy 2018. [DOI: 10.1016/j.jcyt.2018.02.028] [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: 11/15/2022]
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Bernatsky S, Smargiassi A, Joseph L, Awadalla P, Colmegna I, Hudson M, Fritzler MJ. Industrial air emissions, and proximity to major industrial emitters, are associated with anti-citrullinated protein antibodies. Environ Res 2017; 157:60-63. [PMID: 28525857 DOI: 10.1016/j.envres.2017.04.035] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 04/23/2017] [Accepted: 04/24/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To determine the association of anti-citrullinated antibodies (ACPA) with the ambient air pollutants fine particulate matter (PM2.5) and sulfur dioxide (SO2). METHODS The CARTaGENE first-wave cohort includes 20,000 general population subjects from Quebec (Canada). On a sample of unselected 1586 subjects, we determined serum, ACPA and performed multivariable logistic regression, for the outcome of positive ACPA, assessing for independent effects of our air pollution variables, adjusting for age, sex, smoking, and French Canadian origin. Two models assessed distance to main industrial emitters of PM2.5, and of SO2, and two models assessed tons of SO2 and of PM2.5 annual emissions. We also assessed associations with PM2.5 regional ambient concentrations estimated with satellite imagery. RESULTS Adjusted analyses suggested a positive association between annual industrial PM2.5 and SO2 emissions and the presence of ACPA antibodies (OR: 1.02, 95%CI 1.00-1.04 per 10t of PM2.5 and 100t of SO2). The data were also consistent with a negative association between the presence of ACPA, and distance to a major industrial emitter of both PM2.5 and SO2. We found no association with PM2.5 estimates of ambient levels. CONCLUSIONS These analyses suggest that exposure to industrial emissions of air pollutants is related to ACPA positivity.
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Affiliation(s)
- Sasha Bernatsky
- Divisions of Rheumatology and Clinical Epidemiology, McGill University Health Centre, 687 Pine Avenue West, V-Building (V2.09), Montreal, Canada H3A 1A1.
| | - Audrey Smargiassi
- Département de santé environnementale et de santé au travail, Université de Montréal, Pavillon Marguerite d'Youville, École de santé publique, Montréal, QC, Canada; Institut National de Santé Publique du Québec, Montréal, QC, Canada
| | - Lawrence Joseph
- Divisions of Rheumatology and Clinical Epidemiology, McGill University Health Centre, 687 Pine Avenue West, V-Building (V2.09), Montreal, Canada H3A 1A1
| | - Phillip Awadalla
- Ontario Institute of Cancer Research, Unviersity of Toronto, ON, Canada
| | - Ines Colmegna
- Research Institute of McGill University Health Centre, Montreal, QC, Canada
| | - Marie Hudson
- Divisions of Rheumatology and Clinical Epidemiology, McGill University Health Centre, 687 Pine Avenue West, V-Building (V2.09), Montreal, Canada H3A 1A1; Jewish General Hospital and Lady Davis Institute for medical research, Montréal, Canada
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Hudson M, Bernatsky S, Colmegna I, Lora M, Pastinen T, Klein Oros K, Greenwood CMT. Novel insights into systemic autoimmune rheumatic diseases using shared molecular signatures and an integrative analysis. Epigenetics 2017; 12:433-440. [PMID: 28387599 DOI: 10.1080/15592294.2017.1303581] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 01/02/2023] Open
Abstract
We undertook this study to identify DNA methylation signatures of three systemic autoimmune rheumatic diseases (SARDs), namely rheumatoid arthritis, systemic lupus erythematosus, and systemic sclerosis, compared to healthy controls. Using a careful design to minimize confounding, we restricted our study to subjects with incident disease and performed our analyses on purified CD4+ T cells, key effector cells in SARD. We identified differentially methylated (using the Illumina Infinium HumanMethylation450 BeadChip array) and expressed (using the Illumina TruSeq stranded RNA-seq protocol) sites between cases and controls, and investigated the biological significance of this SARD signature using gene annotation databases. We recruited 13 seropositive rheumatoid arthritis, 19 systemic sclerosis, 12 systemic lupus erythematosus subjects, and 8 healthy controls. We identified 33 genes that were both differentially methylated and expressed (26 over- and 7 under-expressed) in SARD cases versus controls. The most highly overexpressed gene was CD1C (log fold change in expression = 1.85, adjusted P value = 0.009). In functional analysis (Ingenuity Pathway Analysis), the top network identified was lipid metabolism, molecular transport, small molecule biochemistry. The top canonical pathways included the mitochondrial L-carnitine shuttle pathway (P = 5E-03) and PTEN signaling (P = 8E-03). The top upstream regulator was HNF4A (P = 3E-05). This novel SARD signature contributes to ongoing work to further our understanding of the molecular mechanisms underlying SARD and provides novel targets of interest.
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Affiliation(s)
- Marie Hudson
- a Lady Davis Research Institute , Montréal , QC , Canada.,b Division of Rheumatology , Jewish General Hospital , Montréal , QC , Canada.,c Department of Medicine , McGill University , Montréal , QC , Canada
| | - Sasha Bernatsky
- c Department of Medicine , McGill University , Montréal , QC , Canada.,d The Research Institute of the McGill University Health Centre , Montréal , QC , Canada
| | - Ines Colmegna
- c Department of Medicine , McGill University , Montréal , QC , Canada.,d The Research Institute of the McGill University Health Centre , Montréal , QC , Canada
| | - Maximilien Lora
- d The Research Institute of the McGill University Health Centre , Montréal , QC , Canada
| | - Tomi Pastinen
- e McGill University and Genome Quebec Innovation Centre , McGill University , Montréal , QC , Canada
| | | | - Celia M T Greenwood
- a Lady Davis Research Institute , Montréal , QC , Canada.,f Department of Human Genetics , McGill University , Montréal , QC , Canada.,g Department of Oncology , McGill University , Montréal , QC , Canada.,h Department of Epidemiology , Biostatistics & Occupational Health, McGill University , Montréal , QC , Canada
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El Helou T, Watters KA, Colmegna I. Reply. Arthritis Rheumatol 2016; 68:1791. [DOI: 10.1002/art.39671] [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: 02/26/2016] [Accepted: 03/01/2016] [Indexed: 11/06/2022]
Affiliation(s)
- T. El Helou
- McGill University Health Center; Montreal Quebec Canada
| | - K. A. Watters
- McGill University Health Center; Montreal Quebec Canada
| | - I. Colmegna
- McGill University Health Center; Montreal Quebec Canada
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McGregor K, Bernatsky S, Colmegna I, Hudson M, Pastinen T, Labbe A, Greenwood CM. An evaluation of methods correcting for cell-type heterogeneity in DNA methylation studies. Genome Biol 2016; 17:84. [PMID: 27142380 PMCID: PMC4855979 DOI: 10.1186/s13059-016-0935-y] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 04/05/2016] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Many different methods exist to adjust for variability in cell-type mixture proportions when analyzing DNA methylation studies. Here we present the result of an extensive simulation study, built on cell-separated DNA methylation profiles from Illumina Infinium 450K methylation data, to compare the performance of eight methods including the most commonly used approaches. RESULTS We designed a rich multi-layered simulation containing a set of probes with true associations with either binary or continuous phenotypes, confounding by cell type, variability in means and standard deviations for population parameters, additional variability at the level of an individual cell-type-specific sample, and variability in the mixture proportions across samples. Performance varied quite substantially across methods and simulations. In particular, the number of false positives was sometimes unrealistically high, indicating limited ability to discriminate the true signals from those appearing significant through confounding. Methods that filtered probes had consequently poor power. QQ plots of p values across all tested probes showed that adjustments did not always improve the distribution. The same methods were used to examine associations between smoking and methylation data from a case-control study of colorectal cancer, and we also explored the effect of cell-type adjustments on associations between rheumatoid arthritis cases and controls. CONCLUSIONS We recommend surrogate variable analysis for cell-type mixture adjustment since performance was stable under all our simulated scenarios.
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Affiliation(s)
- Kevin McGregor
- />McGill University, Department of Epidemiology, Biostatistics, and Occupational Health, 1020 Pine Ave. West, Montréal, H3A 1A2 QC Canada
- />Lady Davis Research Institute, Jewish General Hospital, 3755 Chemin de la Côte Sainte Catherine, Montréal, H3T 1E2 QC Canada
| | - Sasha Bernatsky
- />Lady Davis Research Institute, Jewish General Hospital, 3755 Chemin de la Côte Sainte Catherine, Montréal, H3T 1E2 QC Canada
| | - Ines Colmegna
- />The Research Institute of the McGill University Health Centre, Montréal, QC Canada
| | - Marie Hudson
- />Lady Davis Research Institute, Jewish General Hospital, 3755 Chemin de la Côte Sainte Catherine, Montréal, H3T 1E2 QC Canada
- />Division of Rheumatology, Jewish General Hospital, Montréal, QC Canada
- />Department of Medicine, McGill University, Montréal, QC Canada
| | - Tomi Pastinen
- />McGill University and Genome Quebec Innovation Centre, McGill University, Montréal, QC Canada
- />Department of Human Genetics, McGill University, Montréal, QC Canada
| | - Aurélie Labbe
- />McGill University, Department of Epidemiology, Biostatistics, and Occupational Health, 1020 Pine Ave. West, Montréal, H3A 1A2 QC Canada
- />Department of Psychiatry, McGill University, Montréal, QC Canada
- />The Douglas Mental Health University Institute, Verdun, QC Canada
| | - Celia M.T. Greenwood
- />Lady Davis Research Institute, Jewish General Hospital, 3755 Chemin de la Côte Sainte Catherine, Montréal, H3T 1E2 QC Canada
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Gomez YH, Das S, Gorgui J, Colmegna I, Daskalopoulou SS. PO-33 STATIN THERAPY IN RHEUMATOID ARTHRITIS MAY IMPROVE ARTERIAL STIFFNESS IN WOMEN BUT NOT IN MEN: A PRELIMINARY ANALYSIS. Artery Res 2016. [DOI: 10.1016/j.artres.2016.08.036] [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: 11/29/2022] Open
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Oros Klein K, Grinek S, Bernatsky S, Bouchard L, Ciampi A, Colmegna I, Fortin JP, Gao L, Hivert MF, Hudson M, Kobor MS, Labbe A, MacIsaac JL, Meaney MJ, Morin AM, O'Donnell KJ, Pastinen T, Van Ijzendoorn MH, Voisin G, Greenwood CMT. funtooNorm: an R package for normalization of DNA methylation data when there are multiple cell or tissue types. Bioinformatics 2015; 32:593-5. [PMID: 26500152 PMCID: PMC4743629 DOI: 10.1093/bioinformatics/btv615] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [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: 07/22/2015] [Accepted: 10/16/2015] [Indexed: 11/14/2022] Open
Abstract
MOTIVATION DNA methylation patterns are well known to vary substantially across cell types or tissues. Hence, existing normalization methods may not be optimal if they do not take this into account. We therefore present a new R package for normalization of data from the Illumina Infinium Human Methylation450 BeadChip (Illumina 450 K) built on the concepts in the recently published funNorm method, and introducing cell-type or tissue-type flexibility. RESULTS funtooNorm is relevant for data sets containing samples from two or more cell or tissue types. A visual display of cross-validated errors informs the choice of the optimal number of components in the normalization. Benefits of cell (tissue)-specific normalization are demonstrated in three data sets. Improvement can be substantial; it is strikingly better on chromosome X, where methylation patterns have unique inter-tissue variability. AVAILABILITY AND IMPLEMENTATION An R package is available at https://github.com/GreenwoodLab/funtooNorm, and has been submitted to Bioconductor at http://bioconductor.org.
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Affiliation(s)
- Kathleen Oros Klein
- Lady Davis Institute, Jewish General Hospital, Montreal, QC H3T 1E2, Canada, Ludmer Center for Neuroinformatics and Mental Health
| | - Stepan Grinek
- Lady Davis Institute, Jewish General Hospital, Montreal, QC H3T 1E2, Canada, Ludmer Center for Neuroinformatics and Mental Health
| | - Sasha Bernatsky
- Divisions of Rheumatology and Clinical Epidemiology, McGill University Health Centre, McGill University, Montreal, QC H4A 3J1, Canada
| | - Luigi Bouchard
- ECOGENE-21, Centre intégré universitaire de santé et de service sociaux du Saguenay-Lac-Saint-Jean, QC G8H 3P7, Canada, Department of Biochemistry, Université de Sherbrooke, QC J1K 2R1, Canada
| | - Antonio Ciampi
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC H3A 1A2, Canada
| | - Ines Colmegna
- Division of Experimental Medicine, McGill University Health Centre, McGill University, Montreal, QC H3A 1A3, Canada
| | | | - Long Gao
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC H3A 1A2, Canada
| | - Marie-France Hivert
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, MA 02215, USA, Department of Medicine, Division of Endocrinology, Université de Sherbrooke, Sherbrooke, QC J1K 2R1, Canada
| | - Marie Hudson
- Lady Davis Institute, Jewish General Hospital, Montreal, QC H3T 1E2, Canada, Department of Medicine, McGill University Health Center, Montreal, QC H4A 3J1, Canada
| | - Michael S Kobor
- Canadian Institute for Advanced Research, Child, and Brain Development Program, Toronto, ON M5G 1Z8, Canada, Centre for Molecular Medicine and Therapeutics, Child and Family Research Institute, Vancouver, BC V5Z 4H4, Canada, Department of Medical Genetics, University of British Columbia, Vancouver, BC V6H 3N1, Canada
| | - Aurelie Labbe
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC H3A 1A2, Canada
| | - Julia L MacIsaac
- Centre for Molecular Medicine and Therapeutics, Child and Family Research Institute, Vancouver, BC V5Z 4H4, Canada, Department of Medical Genetics, University of British Columbia, Vancouver, BC V6H 3N1, Canada
| | - Michael J Meaney
- Ludmer Center for Neuroinformatics and Mental Health, Canadian Institute for Advanced Research, Child, and Brain Development Program, Toronto, ON M5G 1Z8, Canada, Centre for Molecular Medicine and Therapeutics, Child and Family Research Institute, Vancouver, BC V5Z 4H4, Canada, Douglas Mental Health University Institute, McGill University, Montreal, QC H4H 1R3, Canada, Departments of Psychiatry, McGill University, Montreal, QC, Canada H3A 1A1, Department of Neurology and Neurosurgery, McGill University, Montreal, QC H3A 2B4, Canada
| | - Alexander M Morin
- Centre for Molecular Medicine and Therapeutics, Child and Family Research Institute, Vancouver, BC V5Z 4H4, Canada, Department of Medical Genetics, University of British Columbia, Vancouver, BC V6H 3N1, Canada
| | - Kieran J O'Donnell
- Douglas Mental Health University Institute, McGill University, Montreal, QC H4H 1R3, Canada
| | - Tomi Pastinen
- Department of Human Genetics, McGill University, Montreal, QC H3A 1B1, Canada and
| | | | - Gregory Voisin
- Lady Davis Institute, Jewish General Hospital, Montreal, QC H3T 1E2, Canada, Ludmer Center for Neuroinformatics and Mental Health
| | - Celia M T Greenwood
- Lady Davis Institute, Jewish General Hospital, Montreal, QC H3T 1E2, Canada, Department of Biochemistry, Université de Sherbrooke, QC J1K 2R1, Canada, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC H3A 1A2, Canada, Department of Human Genetics, McGill University, Montreal, QC H3A 1B1, Canada and
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Hudson M, Baron M, Colmegna I, Bernatsky S, Klein Oros K, Pastinen T, Greenwood C. Novel approaches to discovery of biomarkers in rheumatoid arthritis: comment on the article by Oswald et al. Arthritis Rheumatol 2015; 67:2276-7. [PMID: 25988805 DOI: 10.1002/art.39189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 04/23/2015] [Indexed: 11/05/2022]
Affiliation(s)
| | | | | | | | | | - Tomi Pastinen
- McGill University and Genome Quebec Innovation Center
| | - Celia Greenwood
- Jewish General Hospital and McGill University Montreal, Quebec, Canada
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Gregory J, Colmegna I. Diffuse idiopathic skeletal hyperostosis manifesting as recurrent elbow bursitis. Mayo Clin Proc 2011; 86:702. [PMID: 21719624 PMCID: PMC3127565 DOI: 10.4065/mcp.2011.0244] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Abstract
B19 infection-associated joint symptoms occur most frequently in adults, usually presenting as a self-limited, acute symmetric polyarthritis affecting the small joints of the hands, wrists, and knees. A small percentage of patients persist with chronic polyarthritis that mimics rheumatoid arthritis raising the question of whether B19 virus may have a role as a concomitant or precipitating factor in the pathogenesis of autoimmune conditions. Comprehensive and updated reviews address different aspects of human parvovirus infection. This article focuses on the evidence supporting the arthritogenic potential of the B19 virus and the proposed mechanisms that underlie it.
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Affiliation(s)
- Ines Colmegna
- Lowance Center for Human Immunology and Rheumatology, Emory University School of Medicine, 101 Woodruff Circle, Room 1014, Atlanta, GA 30322, USA.
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Shao L, Fujii H, Colmegna I, Goronzy J, Weyand C. OR.16. Resetting Defective T Cell Homeostasis in Rheumatoid Arthritis (RA) by Targeting DNA Repair Mechanisms. Clin Immunol 2009. [DOI: 10.1016/j.clim.2009.03.023] [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: 10/20/2022]
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Justiniano M, Colmegna I, Cuchacovich R, Espinoza LR. Spondyloarthritis as a presentation of gouty arthritis. J Rheumatol 2007; 34:1157-8. [PMID: 17477478] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Affiliation(s)
- Maria Justiniano
- Section of Rheumatology, Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA 70112-2282, USA
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Abstract
We report the case of a patient who presented with right sciatic pain as a manifestation of piriformis muscle syndrome 1 month after a clandestine- induced abortion. MRI revealed the presence of a piriformis abscess. Staphylococcus aureus was isolated from blood cultures and from the purulent material obtained by CT-guided aspiration. Piriformis pyomyositis should be recognized as a potential complication of "unsafe" abortions that if left untreated could progress to sepsis and death.
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Affiliation(s)
- Ines Colmegna
- Section of Rheumatology, Louisiana State University Health Sciences Center, New Orleans, Louisiana 70112, USA
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Abstract
Molecular epidemiologic proof that HERVs and other retroelements are involved in autoimmunity or other disorders is complicated by their large numbers in the human genome. As discussed, most HERVs are no longer functional or active because of the accumulation of mutations, frameshifts, and deletions. Detection or quantification of HERV transcripts that may be pathologically involved in a particular autoimmune disease thus is often compromised by the presence in great excess of related, but nonfunctional, RNA. This phenomenon should not deter active work in the field, although it will require development of improved methods to discriminate accurately between closely related RNA transcripts. Development of improved immunologic methods to precisely identify epitopes on autoantigens or rare self-reactive T-cell clones may further implicate HERVs and the other repetitive elements in regulation of the immune system in health and disease.
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Affiliation(s)
- Ines Colmegna
- Section of Rheumatology, Department of Medicine, Louisiana State University Health Sciences Center, 2020 Gravier Street, New Orleans, LA 70112, USA
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Niessner A, Sato K, Chaikof EL, Colmegna I, Goronzy JJ, Weyand CM. Pathogen-sensing plasmacytoid dendritic cells stimulate cytotoxic T-cell function in the atherosclerotic plaque through interferon-alpha. Circulation 2006; 114:2482-9. [PMID: 17116765 DOI: 10.1161/circulationaha.106.642801] [Citation(s) in RCA: 188] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Unstable atherosclerotic plaque is characterized by an infiltrate of inflammatory cells. Both macrophages and T cells have been implicated in mediating the tissue injury leading to plaque rupture; however, signals regulating their activation remain unidentified. Infectious episodes have been suspected to render plaques vulnerable to rupture. We therefore explored whether plasmacytoid dendritic cells (pDCs) that specialize in sensing bacterial and viral products can regulate effector functions of plaque-residing T cells and thus connect host infection and plaque instability. METHODS AND RESULTS pDCs were identified in 53% of carotid atheromas (n=30) in which they localized to the shoulder region and produced the potent immunoregulatory cytokine interferon (INF)-alpha. IFN-alpha transcript concentrations in atheroma tissues correlated strongly with plaque instability (P<0.0001). Plaque-residing pDCs responded to pathogen-derived motifs, CpG-containing oligodeoxynucleotides binding to toll-like receptor 9, with enhanced IFN-alpha transcription (P=0.03) and secretion (P=0.007). IFN-alpha emerged as a potent regulator of T-cell function, even in the absence of antigen recognition. Specifically, IFN-alpha induced a 10-fold increase of tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) on the surface of CD4 T cells (P<0.0001) and enabled them to effectively kill vascular smooth muscle cells (P=0.0003). CONCLUSIONS pDCs in atherosclerotic plaque sense microbial motifs and amplify cytolytic T-cell functions, thus providing a link between host-infectious episodes and acute immune-mediated complications of atherosclerosis.
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Affiliation(s)
- Alexander Niessner
- Kathleen B. and Mason I. Lowance Center for Human Immunology, Emory University School of Medicine, 101 Woodruff Circle, Atlanta, GA 30322, USA
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Colmegna I, deBoisblanc BP, Gimenez CR, Espinoza LR. Slow development of massive splenomegaly, portal and pulmonary hypertension in systematic lupus erythematosus: can nodular regenerative hyperplasia of the liver explain all these findings? Lupus 2006; 14:976-8. [PMID: 16425581 DOI: 10.1191/0961203305lu2237xx] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Abstract
PURPOSE OF REVIEW The HIV pandemic continues to increase at an alarming rate, and is the leading cause of death worldwide from a single pathogen. The number of HIV-1-infected individuals currently exceeds 40 million, the majority of whom live in the developing countries of Asia, sub-Saharan Africa and south America. In the past 5 years, there has concurrently been an increase in the reported cases of tuberculosis and primary and secondary syphilis. This review addresses the musculoskeletal and autoimmune manifestations associated with HIV, syphilis and tuberculosis infections or their treatments. RECENT FINDINGS During HIV infection the immune system becomes dysfunctional because of the coexistence of immunodeficiency and immune hyperactivity, and a disregulated production or activity of cytokines. Some of these mechanisms explain the development of rheumatic manifestations associated with HIV infection. Highly active antiretroviral therapy changes the course of HIV infection and the spectrum of the HIV-associated rheumatic manifestations. New syndromes such as the immune reconstitution inflammatory syndrome have emerged. HIV, tuberculosis and syphilis infections offer special epidemiological, clinical, and therapeutic challenges. SUMMARY These observations highlight the complexity and multiplicity of the interactions between the pathogen and host that could result in the development of rheumatic manifestations.
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Affiliation(s)
- Ines Colmegna
- Section of Rheumatology, Department of Medicine, Louisiana State University Health Sciences Center, Tulane University Health Sciences Center, New Orleans, Louisiana 70112, USA
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Colmegna I, Sainz B, Garry RF, Espinoza LR. The proteasome and its implications in rheumatology. J Rheumatol 2005; 32:1192-8. [PMID: 15996052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
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