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Papagoras C, Zioga N, Papadopoulos V, Gerolymatou N, Kalavri E, Bounos C, Simopoulou T, Fragoulis GE, Panopoulos S, Fragiadaki K, Evangelatos G, Bournia VK, Arida A, Karamanakos A, Pappa M, Kravvariti E, Deftereou K, Kougkas N, Zampeli E, Kataxaki E, Melissaropoulos K, Barouta G, Panagiotopoulos A, Koutsianas C, Liossis SN, Georgiou P, Dimitroulas T, Tektonidou MG, Bogdanos DP, Elezoglou A, Voulgari PV, Sfikakis PP, Vassilopoulos D. Omicron variant dominance and anti-SARS-CoV-2 vaccination are key determinants for a milder course of COVID-19 in patients with systemic autoimmune rheumatic diseases. Clin Rheumatol 2023; 42:3375-3385. [PMID: 37731083 PMCID: PMC10640401 DOI: 10.1007/s10067-023-06769-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 06/02/2023] [Revised: 09/05/2023] [Accepted: 09/08/2023] [Indexed: 09/22/2023]
Abstract
INTRODUCTION This study aimed to determine whether the introduction of anti-SARS-CoV-2 vaccines and the dominance of the omicron variant had a significant impact on the outcome of COVID-19 in patients with systemic autoimmune rheumatic diseases (SAIRDs). METHODS Using data entered to the Greek Rheumatology Society COVID-19 registry, we investigated the incidence of hospitalization and death due to COVID-19, during the successive periods of the pandemic according to the prevalent strain (wild-type, Alpha, Delta, Omicron) in vaccinated and unvaccinated patients. Variables independently associated with hospitalization and death were explored using multivariate regression analyses, while Kaplan-Meier curves were used to depict survival data. RESULTS From August 2020 until June 30, 2022, 456 cases (70.2% females) of COVID-19 with a mean age (± SD) of 51.4 ± 14.0 years were reported. In unvaccinated patients, the proportions of hospitalization and death were 24.5% and 4%, compared to 12.5% and 0.8% in the vaccinated group (p < 0.001 for both comparisons). The rates of hospitalization for the wild-type, Alpha, Delta, and Omicron periods were 24.7%, 31.3%, 25.9%, and 8.1% respectively (p < 0.0001), while the case fatality rates were 2.7%, 4%, 7%, and 0%, respectively (p = 0.001). Using multivariable regression analysis, factors independently associated with hospitalization were infection by a non-Omicron variant, being non-vaccinated, exposure to rituximab, older age, and respiratory and cardiovascular disease. Independent predictors for death were contracting COVID-19 during the Alpha or Delta period, pulmonary disease, and older age, while being vaccinated was protective. CONCLUSIONS In this 2-year analysis, the rates of hospitalization and death among patients with SAIRDs have declined significantly. Vaccination and the dominance of the Omicron variant appear to be the major determinants for this shift. Key points • During the late phase of the pandemic, the proportion of severe COVID-19 cases, defined as requiring hospitalization or resulting in death, in patients with systemic autoimmune rheumatic diseases has declined. • Anti-SARS-CoV-2 vaccination and the dominance of the Omicron strain are the key factors that have independently contributed to this shift.
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Affiliation(s)
- Charalampos Papagoras
- First Department of Internal Medicine, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Nikoleta Zioga
- First Department of Internal Medicine, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | | | - Nafsika Gerolymatou
- Department of Rheumatology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Eleni Kalavri
- Department of Rheumatology, Asklepieion General Hospital, Voula, Athens, Greece
| | - Christos Bounos
- Department of Rheumatology, Asklepieion General Hospital, Voula, Athens, Greece
| | - Theodora Simopoulou
- Clinic of Rheumatology and Clinical Immunology, University Hospital of Larissa, Larissa, Greece
| | - George E Fragoulis
- 1st Department of Propedeutic Internal Medicine, Joint Academic Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Stylianos Panopoulos
- 1st Department of Propedeutic Internal Medicine, Joint Academic Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Kalliopi Fragiadaki
- 1st Department of Propedeutic Internal Medicine, Joint Academic Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Gerasimos Evangelatos
- 1st Department of Propedeutic Internal Medicine, Joint Academic Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasiliki-Kalliopi Bournia
- 1st Department of Propedeutic Internal Medicine, Joint Academic Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Aikaterini Arida
- 1st Department of Propedeutic Internal Medicine, Joint Academic Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasios Karamanakos
- 1st Department of Propedeutic Internal Medicine, Joint Academic Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Pappa
- 1st Department of Propedeutic Internal Medicine, Joint Academic Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Evrydiki Kravvariti
- 1st Department of Propedeutic Internal Medicine, Joint Academic Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Kleopatra Deftereou
- Fourth Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Kougkas
- Fourth Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Evangelia Kataxaki
- Rheumatology Department, General Hospital Elefsinas Thriaseio, Athens, Greece
| | | | | | - Alexandros Panagiotopoulos
- Clinical Immunology-Rheumatology Unit, 2nd Department of Medicine and Laboratory, Joint Academic Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 114 Vass. Sophias Ave, 115 27, Athens, Greece
| | - Christos Koutsianas
- Clinical Immunology-Rheumatology Unit, 2nd Department of Medicine and Laboratory, Joint Academic Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 114 Vass. Sophias Ave, 115 27, Athens, Greece
| | - Stamatis-Nick Liossis
- Division of Rheumatology, Department of Internal Medicine, University of Patras Medical School, Patras, Greece
| | | | - Theodoros Dimitroulas
- Fourth Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria G Tektonidou
- 1st Department of Propedeutic Internal Medicine, Joint Academic Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios P Bogdanos
- Clinic of Rheumatology and Clinical Immunology, University Hospital of Larissa, Larissa, Greece
| | - Antonia Elezoglou
- Department of Rheumatology, Asklepieion General Hospital, Voula, Athens, Greece
| | - Paraskevi V Voulgari
- Department of Rheumatology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Petros P Sfikakis
- 1st Department of Propedeutic Internal Medicine, Joint Academic Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Vassilopoulos
- Clinical Immunology-Rheumatology Unit, 2nd Department of Medicine and Laboratory, Joint Academic Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 114 Vass. Sophias Ave, 115 27, Athens, Greece.
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Magiouf KS, Fragiadaki K, Charpidou A, Syrigos A, Kotteas E, Kourlaba G. Impact of biologic therapies on risk of adverse cardiovascular events in patients with Ankylosing Spondylitis or Psoriatic Arthritis: A systematic literature review. ARP Rheumatol 2023; 2:53-63. [PMID: 36809367] [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] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
BACKGROUND Recent evidence highlights increased mortality and morbidity due to cardiovascular disease (CVD), especially within the two major forms of Spondyloarthropathies (SpAs), Ankylosing Spondylitis (AS) and Psoriatic Arthritis (PsA). Healthcare professionals and patients in these populations should be alerted regarding the high risk of cardiovascular (CV) events and thus, customize the treatment strategy accordingly. OBJECTIVE This systematic literature review aimed to determine the effects of biological therapies on serious CV events in AS and PsA. METHODS Screening for the study was carried out using PubMed and Scopus databases from the database's inception to the 17th of July 2021. The literature search strategy for this review is based on the Population, Intervention, Comparator, Outcomes (PICOs) framework. Randomized controlled trials (RCTs) of biologic therapies for the treatment of AS and/or PsA were included. The primary outcome measure was the number of serious CV events reported during the placebo-controlled phase. RESULTS 4,422 articles were generated from keywords, eligibility criteria, and databases. Following the screening, we retained 13 studies for analysis: 3 in AS and 10 in PsA. Meta-analysis of results was not feasible due to the small number of the identified studies, the heterogeneity of the biologic treatment and the included populations, as well as the infrequently reported requested endpoint. According to our review, biologic treatments are safe options as for CV risk in patients with PsA or AS. CONCLUSION Further and more extensive trials in AS/PsA patients at high risk of CV events are needed before firm conclusions can be drawn.
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Affiliation(s)
| | - Kalliopi Fragiadaki
- National and Kapodistrian University of Athens School of Health Sciences, Athens, Greece
| | - Adrianni Charpidou
- "Sotiria" Hospital for Diseases of the Chest, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandros Syrigos
- "Sotiria" Hospital for Diseases of the Chest, National and Kapodistrian University of Athens, Athens, Greece
| | - Elias Kotteas
- "Sotiria" Hospital for Diseases of the Chest, National and Kapodistrian University of Athens, Athens, Greece
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Karamanakos A, Evangelatos G, Pappa M, Fragiadaki K, Fanouriakis A, Fragoulis GE. Chilblains After SARS-CoV-2 Vaccination: Coincidence or Real Association? J Rheumatol 2022; 49:1295-1296. [PMID: 35914789 DOI: 10.3899/jrheum.220487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We read with great interest the article of Meara et al1 in your journal describing a case of chilblain-like lesions after vaccination against SARS-CoV-2. Since the start of the coronavirus disease 2019 (COVID-19) pandemic, millions of vaccine doses have been administered and their safety has been generally confirmed.
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Affiliation(s)
- Anastasios Karamanakos
- Joint Academic Rheumatology Program, First Department of Propedeutic and Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. G.E. Fragoulis, Joint Academic Rheumatology Program, First Department of Propedeutic Internal Medicine, Laiko Hospital, School of Medicine, National and Kapodistrian University of Athens, Agiou Thoma 17 Goudi, 11527, Athens, Greece.
| | - Gerasimos Evangelatos
- Joint Academic Rheumatology Program, First Department of Propedeutic and Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. G.E. Fragoulis, Joint Academic Rheumatology Program, First Department of Propedeutic Internal Medicine, Laiko Hospital, School of Medicine, National and Kapodistrian University of Athens, Agiou Thoma 17 Goudi, 11527, Athens, Greece.
| | - Maria Pappa
- Joint Academic Rheumatology Program, First Department of Propedeutic and Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. G.E. Fragoulis, Joint Academic Rheumatology Program, First Department of Propedeutic Internal Medicine, Laiko Hospital, School of Medicine, National and Kapodistrian University of Athens, Agiou Thoma 17 Goudi, 11527, Athens, Greece.
| | - Kalliopi Fragiadaki
- Joint Academic Rheumatology Program, First Department of Propedeutic and Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. G.E. Fragoulis, Joint Academic Rheumatology Program, First Department of Propedeutic Internal Medicine, Laiko Hospital, School of Medicine, National and Kapodistrian University of Athens, Agiou Thoma 17 Goudi, 11527, Athens, Greece.
| | - Antonis Fanouriakis
- Joint Academic Rheumatology Program, First Department of Propedeutic and Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. G.E. Fragoulis, Joint Academic Rheumatology Program, First Department of Propedeutic Internal Medicine, Laiko Hospital, School of Medicine, National and Kapodistrian University of Athens, Agiou Thoma 17 Goudi, 11527, Athens, Greece.
| | - George E Fragoulis
- Joint Academic Rheumatology Program, First Department of Propedeutic and Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. G.E. Fragoulis, Joint Academic Rheumatology Program, First Department of Propedeutic Internal Medicine, Laiko Hospital, School of Medicine, National and Kapodistrian University of Athens, Agiou Thoma 17 Goudi, 11527, Athens, Greece.
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Fragoulis GE, Koutsianas C, Fragiadaki K, Mariolis I, Panopoulos S, Tsalapaki C, Pappa M, Dimitroulas T, Tektonidou MG, Vassilopoulos D, Sfikakis PP. Oral antiviral treatment in patients with systemic rheumatic disease at risk for development of severe COVID-19: a case series. Ann Rheum Dis 2022; 81:annrheumdis-2022-222845. [PMID: 35701154 DOI: 10.1136/annrheumdis-2022-222845] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 05/31/2022] [Indexed: 11/03/2022]
Affiliation(s)
- George E Fragoulis
- Joint Rheumatology Program, First Department of Internal Medicine, Propedeutic Clinic, "Laiko" hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Christos Koutsianas
- Joint Rheumatology Program, Second Department of Internal Medicine, "Hippokration" Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Kalliopi Fragiadaki
- Joint Rheumatology Program, First Department of Internal Medicine, Propedeutic Clinic, "Laiko" hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ilias Mariolis
- Joint Rheumatology Program, Second Department of Internal Medicine, "Hippokration" Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Stylianos Panopoulos
- Joint Rheumatology Program, First Department of Internal Medicine, Propedeutic Clinic, "Laiko" hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Christina Tsalapaki
- Joint Rheumatology Program, Second Department of Internal Medicine, "Hippokration" Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Pappa
- Joint Rheumatology Program, First Department of Internal Medicine, Propedeutic Clinic, "Laiko" hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodoros Dimitroulas
- Fourth Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria G Tektonidou
- Joint Rheumatology Program, First Department of Internal Medicine, Propedeutic Clinic, "Laiko" hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Vassilopoulos
- Joint Rheumatology Program, Second Department of Internal Medicine, "Hippokration" Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Petros P Sfikakis
- Joint Rheumatology Program, First Department of Internal Medicine, Propedeutic Clinic, "Laiko" hospital, National and Kapodistrian University of Athens, Athens, Greece
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Fragoulis GE, Karamanakos A, Arida A, Bournia VK, Evangelatos G, Fanouriakis A, Fragiadaki K, Kravvariti E, Laskari K, Panopoulos S, Papazoglou N, Pappa M, Tektonidou MGG, Sfikakis PP. Clinical outcomes of breakthrough COVID-19 after booster vaccination in patients with systemic rheumatic diseases. RMD Open 2022; 8:rmdopen-2022-002279. [PMID: 35246472 PMCID: PMC8918070 DOI: 10.1136/rmdopen-2022-002279] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- George E Fragoulis
- Joint Academic Rheumatology Program, First Department of Propedeutic and Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasios Karamanakos
- Joint Academic Rheumatology Program, First Department of Propedeutic and Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Aikaterini Arida
- Joint Academic Rheumatology Program, First Department of Propedeutic and Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasiliki-Kalliopi Bournia
- Joint Academic Rheumatology Program, First Department of Propedeutic and Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Gerasimos Evangelatos
- Joint Academic Rheumatology Program, First Department of Propedeutic and Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Antonis Fanouriakis
- Joint Academic Rheumatology Program, First Department of Propedeutic and Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Kalliopi Fragiadaki
- Joint Academic Rheumatology Program, First Department of Propedeutic and Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Evrydiki Kravvariti
- Joint Academic Rheumatology Program, First Department of Propedeutic and Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Katerina Laskari
- Joint Academic Rheumatology Program, First Department of Propedeutic and Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Stylianos Panopoulos
- Joint Academic Rheumatology Program, First Department of Propedeutic and Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Papazoglou
- Joint Academic Rheumatology Program, First Department of Propedeutic and Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Pappa
- Joint Academic Rheumatology Program, First Department of Propedeutic and Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria G G Tektonidou
- Joint Academic Rheumatology Program, First Department of Propedeutic and Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Petros P Sfikakis
- Joint Academic Rheumatology Program, First Department of Propedeutic and Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Keramiotou K, Anagnostou C, Konstantonis G, Fragiadaki K, Kataxaki E, Sfikakis PP, Tektonidou MG. SLICC-Frailty Index is independently associated with impaired physical function, activities of daily living, and quality of life measures. Rheumatology (Oxford) 2022; 61:3808-3813. [PMID: 35015829 DOI: 10.1093/rheumatology/keac001] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 12/23/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The Systemic Lupus International Collaborating Clinics Frailty Index (SLICC-FI) was developed to assess health deficits including disease activity, organ damage, comorbidities and functional status. We examined any relationship between SLICC-FI and objective physical function measures, activities of daily living (ADL) performance, and quality of life in Systemic Lupus Erythematosus (SLE). METHODS SLICC-FI was estimated using data from patient files and patient-reported questionnaires. Jamar Dynamometer, pinch gauge and Purdue pegboard test measured grip strength, pinch strength and dexterity, respectively. ADL performance was assessed by the Disabilities of Arm, Shoulder and Hand (DASH) questionnaire, and Health Assessment Questionnaire (HAQ). Quality of life was evaluated by LupusQol questionnaire. RESULTS This cross-sectional study included 240 SLE patients (90% female, mean (SD) age: 47.63 (13.01), median (IQR) disease duration: 9 (4-16). Mean (SD) SLICC-FI was 0.09 (0.06). Forty-three (17.9%) patients were classified as robust, 105 (43.8%) as relatively less fit, 77 (32.1%) as least fit, and 15 (6.2%) as frail. In univariate analysis, SLICC-FI was significantly associated with DASH and HAQ with an inverse association with grip strength, pinch strength, and all purdue scores (all p < 0.001). A negative correlation was found between SLICC-FI score and all LupusQoL domain scores (all p < 0.001). All associations remained statistically significant in multivariate regression analysis, after adjustment for age, disease duration, SLEDAI-2K, SLICC, immunosuppressives, corticosteroids and Charlson score. CONCLUSION SLICC-FI is independently associated with poor physical function and ADL performance and impaired quality of life and may help to identify patients in need for additional interventions beyond routine care.
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Affiliation(s)
- Kyriaki Keramiotou
- First Department of Propaedeutic Internal Medicine, Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Rheumatology Unit, Thriasio General Hospital of Elefsina, Magoula, Greece
| | | | - George Konstantonis
- First Department of Propaedeutic Internal Medicine, Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Kalliopi Fragiadaki
- First Department of Propaedeutic Internal Medicine, Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelia Kataxaki
- Rheumatology Unit, Thriasio General Hospital of Elefsina, Magoula, Greece
| | - Petros P Sfikakis
- First Department of Propaedeutic Internal Medicine, Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria G Tektonidou
- First Department of Propaedeutic Internal Medicine, Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Katsifis G, Theodoridou A, Bounas A, Georgiou P, Sfikakis P, Fragiadaki K, Dimitroulas T, Mole E, Bauer L, Kumke T, Hoepken B. Effectiveness and Safety of Certolizumab Pegol in Axial Spondyloarthritis in a Real-World Setting in Greece: A Sub-Analysis of the Prospective Non-Interventional CIMAX Cohort Study. Mediterr J Rheumatol 2022; 33:162-172. [PMID: 36127922 PMCID: PMC9450185 DOI: 10.31138/mjr.33.1.162] [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: 10/29/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 11/22/2022] Open
Abstract
Objectives: We report the effectiveness and safety of certolizumab pegol (CZP) treatment in a real-world Greek axial spondyloarthritis (axSpA) population, including patients with radiographic (r-axSpA) and non-radiographic (nr-axSpA) disease. Methods: We performed a sub-analysis of the Greek cohort from CIMAX (NCT02354105), a multicentre, non-interventional cohort study that prospectively investigated CZP treatment in patients with axSpA. The primary outcome was change from baseline (CfB) in Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) to Week 52. Results: Across 12 sites in Greece, 126 patients (r-axSpA: 91; nr-axSpA: 35) received ≥1 dose of CZP and were included in the Safety Set (SS), with 120 patients (r-axSpA: 86; nr-axSpA: 34) included in the Full Analysis Set (FAS). The mean (standard deviation [SD]) CfB in BASDAI at Week 52 was −3.8 (2.0) in the overall axSpA population, with numerically greater improvements observed for nr-axSpA patients compared with r-axSpA (nr-axSpA: −4.2 [2.1]; r-axSpA: −3.7 [2.0]). Improvements in the axSpA population, including r-axSpA and nr-axSpA subpopulations, were observed in key secondary and additional outcomes at Week 52. Overall, 14.3% (18/126) of patients in the axSpA population experienced ≥1 adverse event (AE). There were no serious AEs or deaths reported during the study. Conclusions: Patients with r-axSpA and nr-axSpA treated with CZP in clinical practice in Greece showed improvements in disease activity and key symptoms. CZP treatment may therefore help address the substantial health burden associated with axSpA in Greece.
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Affiliation(s)
| | | | | | | | | | | | - Theodoros Dimitroulas
- 4th Department of Internal Medicine, Hippokrateion General Hospital of Thessaloniki, School of Medicine, Aristotle University, Thessaloniki, Greece,
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Papagoras C, Fragoulis GE, Zioga N, Simopoulou T, Deftereou K, Kalavri E, Zampeli E, Gerolymatou N, Kataxaki E, Melissaropoulos K, Panopoulos S, Fragiadaki K, Evangelatos G, Bournia VK, Arida A, Karamanakos A, Pappa M, Panagiotopoulos A, Koutsianas C, Mparouta G, Dimitroulas T, Liossis SN, Tektonidou MG, Kravvariti E, Kougkas N, Georgiou P, Voulgari P, Elezoglou A, Bogdanos DP, Vassilopoulos D, Sfikakis PP. Better outcomes of COVID-19 in vaccinated compared to unvaccinated patients with systemic rheumatic diseases. Ann Rheum Dis 2021; 81:1013-1016. [PMID: 34758975 DOI: 10.1136/annrheumdis-2021-221539] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 10/26/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Τo report outcomes of breakthrough COVID-19 in comparison with COVID-19 in unvaccinated patients with systemic rheumatic diseases (SRDs). METHODS Patients with SRD with COVID-19 (vaccinated and unvaccinated) were included by their rheumatologists in a registry operated by the Greek Rheumatology Society in a voluntarily basis. Type, date and doses of SARS-CoV-2 vaccines were recorded, and demographics, type of SRD, concurrent treatment, comorbidities and COVID-19 outcomes (hospitalisation, need for oxygen supplementation and death) were compared between vaccinated and unvaccinated patients. RESULTS Between 1 March 2020 and 31 August 2021, 195 patients with SRD with COVID-19 were included; 147 unvaccinated and 48 vaccinated with at least one dose of a SARS-CoV-2 vaccine (Pfizer n=38 or AstraZeneca n=10). Among vaccinated patients, 29 developed breakthrough COVID-19 >14 days after the second vaccine dose (fully vaccinated), while 19 between the first and <14 days after the second vaccine dose (partially vaccinated). Despite no differences in demographics, SRD type, treatment or comorbidities between unvaccinated and vaccinated patients, hospitalisation and mortality rates were higher in unvaccinated (29.3% and 4.1%, respectively) compared with partially vaccinated (21% and 0%) or fully vaccinated (10.3% and 0%) patients. CONCLUSIONS Vaccinated patients with SRD with breakthrough COVID-19 have better outcomes compared with unvaccinated counterparts with similar disease/treatment characteristics.
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Affiliation(s)
- Charalampos Papagoras
- First Department of Internal Medicine, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - George E Fragoulis
- Joint Academic Rheumatology Program, 1st Department of Propedeutic Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikoleta Zioga
- First Department of Internal Medicine, Democritus University of Thrace, Komotini, Greece
| | - Theodora Simopoulou
- Clinic of Rheumatology and Clinical Immunology, University Hospital of Larissa, Larissa, Greece
| | - Kleopatra Deftereou
- Fourth Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni Kalavri
- Department of Rheumatology, Asklepieion General Hospital, Voula, Athens, Greece
| | - Evangelia Zampeli
- Institute for Autoimmune Systemic and Neurological Diseases, Athens, Greece.,Rheumatology Department, Iaso Hospital, Athens, Greece
| | - Nafsika Gerolymatou
- Rheumatology Clinic, University of Ioannina School of Medicine, Ioannina, Greece
| | - Evangelia Kataxaki
- Rheumatology Department, General Hospital Elefsinas Thriaseio, Athens, Greece
| | | | - Stylianos Panopoulos
- Joint Academic Rheumatology Program, 1st Department of Propedeutic Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Kalliopi Fragiadaki
- Joint Academic Rheumatology Program, 1st Department of Propedeutic Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Gerasimos Evangelatos
- Joint Academic Rheumatology Program, 1st Department of Propedeutic Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasiliki-Kalliopi Bournia
- Joint Academic Rheumatology Program, 1st Department of Propedeutic Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Aikaterini Arida
- Joint Academic Rheumatology Program, 1st Department of Propedeutic Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasios Karamanakos
- Joint Academic Rheumatology Program, 1st Department of Propedeutic Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Pappa
- Joint Academic Rheumatology Program, 1st Department of Propedeutic Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandros Panagiotopoulos
- Joint Academic Rheumatology Program, Clinical Immunology-Rheumatology Unit, 2nd Department of Medicine and Laboratory, National and Kapodistrian University of Athens, Athens, Greece
| | - Christos Koutsianas
- Joint Academic Rheumatology Program, Clinical Immunology-Rheumatology Unit, 2nd Department of Medicine and Laboratory, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Theodoros Dimitroulas
- Fourth Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stamatis-Nick Liossis
- Department of Internal Medicine, University of Patras Medical School, Patras, Greece
| | - Maria G Tektonidou
- Joint Academic Rheumatology Program, 1st Department of Propedeutic Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Evrydiki Kravvariti
- Joint Academic Rheumatology Program, 1st Department of Propedeutic Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Kougkas
- Fourth Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Paraskevi Voulgari
- Rheumatology Clinic, University of Ioannina School of Medicine, Ioannina, Greece
| | - Antonia Elezoglou
- Department of Rheumatology, Asklepieion General Hospital, Voula, Athens, Greece
| | - Dimitrios P Bogdanos
- Clinic of Rheumatology and Clinical Immunology, University Hospital of Larissa, Larissa, Greece
| | - Dimitrios Vassilopoulos
- Joint Academic Rheumatology Program, Clinical Immunology-Rheumatology Unit, 2nd Department of Medicine and Laboratory, National and Kapodistrian University of Athens, Athens, Greece
| | - Petros P Sfikakis
- Joint Academic Rheumatology Program, 1st Department of Propedeutic Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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9
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Fragoulis GE, Bournia VK, Mavrea E, Evangelatos G, Fragiadaki K, Karamanakos A, Kravariti E, Laskari K, Panopoulos S, Pappa M, Mitsikostas DD, Tektonidou MG, Vassilopoulos D, Sfikakis PP. COVID-19 vaccine safety and nocebo-prone associated hesitancy in patients with systemic rheumatic diseases: a cross-sectional study. Rheumatol Int 2021; 42:31-39. [PMID: 34739573 PMCID: PMC8569844 DOI: 10.1007/s00296-021-05039-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 10/22/2021] [Indexed: 12/25/2022]
Abstract
Objective To describe the rate and type of adverse effects (AEs) and the frequency of disease flares after COVID-19 vaccination and to assess the reasons for vaccination hesitancy (non-vaccination) in SRD patients. Methods Telephone interviews were conducted of SRD patients consecutively enrolled (15/06/2021–1/7/2021). Participants were asked about the type of AEs and disease flare after vaccination. Reasons for vaccination hesitancy were recorded. Univariate and mutivariable analyses examined associations of demographic, clinical and other features, with occurrence of AEs, disease flare and non-vaccination. For the latter, association with negative vaccination behaviour (not influenza vaccinated for the last 2 years) and nocebo-prone behaviour (denoting AEs attributed to negative expectations [Q-No questionnaire]) was also tested. Results 561 out of 580 contacted patients were included in the study. 441/561 (78.6%) patients were vaccinated [90% (Pfizer, Moderna), 10% (Astra-Zeneca)]. AEs were reported by 148/441 (33.6%), with rates being comparable between the three vaccines. AEs were more common in females and those with chronic obstructive pulmonary disease [OR, 95% CI; females: 2.23 (1.30–3.83); COPD: 3.31 (1.24–8.83)]. Disease flare was reported in 9/441 (2%) patients. For those unvaccinated, fear that the vaccine would be harmful (53.3%), could cause disease flare (24.2%) and/or could cause thrombosis (21.7%) were the main reasons to do so. Multivariable analysis identified as independent variables for non-vaccination: nocebo-prone behaviour (OR; 95% CI, 3.88; 1.76–8.55), negative vaccination behaviour (6.56; 3.21–13.42) and previous COVID-19 infection (2.83; 1.13–7.05). Higher educational status was protective (0.49; 0.26–0.92). Conclusion No new safety signals for COVID-19 vaccination were observed. Vaccination campaign should target SRD patients with nocebo-prone and negative influenza vaccination behaviour.
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Affiliation(s)
- George E Fragoulis
- Joint Rheumatology Program, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Athens School of Medicine, National and Kapodistrian University, Mikras Asias 75 str, 11527, Athens, Greece.
| | - Vassiliki-Kalliopi Bournia
- Joint Rheumatology Program, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Athens School of Medicine, National and Kapodistrian University, Mikras Asias 75 str, 11527, Athens, Greece
| | - Eugenia Mavrea
- 2nd Department of Medicine and Laboratory, Clinical Immunology-Rheumatology Unit, Hippokration General Hospital, Athens, Greece
| | - Gerasimos Evangelatos
- Joint Rheumatology Program, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Athens School of Medicine, National and Kapodistrian University, Mikras Asias 75 str, 11527, Athens, Greece
| | - Kalliopi Fragiadaki
- Joint Rheumatology Program, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Athens School of Medicine, National and Kapodistrian University, Mikras Asias 75 str, 11527, Athens, Greece
| | - Anastasios Karamanakos
- Joint Rheumatology Program, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Athens School of Medicine, National and Kapodistrian University, Mikras Asias 75 str, 11527, Athens, Greece
| | - Eyrydiki Kravariti
- Joint Rheumatology Program, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Athens School of Medicine, National and Kapodistrian University, Mikras Asias 75 str, 11527, Athens, Greece
| | - Katerina Laskari
- Joint Rheumatology Program, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Athens School of Medicine, National and Kapodistrian University, Mikras Asias 75 str, 11527, Athens, Greece
| | - Stylianos Panopoulos
- Joint Rheumatology Program, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Athens School of Medicine, National and Kapodistrian University, Mikras Asias 75 str, 11527, Athens, Greece
| | - Maria Pappa
- Joint Rheumatology Program, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Athens School of Medicine, National and Kapodistrian University, Mikras Asias 75 str, 11527, Athens, Greece
| | - Dimos D Mitsikostas
- 1st Neurology Department, Medical School, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria G Tektonidou
- Joint Rheumatology Program, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Athens School of Medicine, National and Kapodistrian University, Mikras Asias 75 str, 11527, Athens, Greece
| | - Dimitrios Vassilopoulos
- 2nd Department of Medicine and Laboratory, Clinical Immunology-Rheumatology Unit, Hippokration General Hospital, Athens, Greece
| | - Petros P Sfikakis
- Joint Rheumatology Program, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Athens School of Medicine, National and Kapodistrian University, Mikras Asias 75 str, 11527, Athens, Greece
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10
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Bournia VK, Tektonidou MG, Vassilopoulos D, Laskari K, Panopoulos S, Fragiadaki K, Mathioudakis K, Tsolakidis A, Mitrou P, Sfikakis PP. Introduction and switching of biologic agents are associated with antidepressant and anxiolytic medication use: data on 42 815 real-world patients with inflammatory rheumatic disease. RMD Open 2021; 6:rmdopen-2020-001303. [PMID: 32978302 PMCID: PMC7539856 DOI: 10.1136/rmdopen-2020-001303] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/29/2020] [Accepted: 09/05/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Depression and anxiety are linked bi-directionally with inflammatory rheumatic diseases (IRDs) activity, which in turn, depends on subjective patient reported outcomes that can be distorted by comorbid mood disorders. We tested the hypothesis that introduction and/or switching of biologic agents for IRDs are associated with treatment for depression and/or anxiety, by analysing real-world data. METHODS Using a country-wide electronic prescription database (10 012 604 registered, 99% population coverage), we captured almost all patients with rheumatoid arthritis (n=12 002), psoriatic arthritis (n=5465) and ankylosing spondylitis (n=6423) who received biologic disease modifying anti-rheumatic drugs (bDMARDs) during a 2-year period (8/2016-7/2018). Concomitant antidepressant/anxiolytic medication use was documented in patients who started or switched bDMARDs and compared with those who remained on conventional synthetic (cs)DMARDs or the same bDMARD, respectively, by multivariate regression analysis. RESULTS Two-year data analysis on 42 815 patients revealed that bDMARD introduction was associated with both antidepressant [OR: 1.248, 95% CI 1.153 to 1.350, p<0.0001] and anxiolytic medication use [OR: 1.178, 95% CI 1.099 to 1.263, p<0.0001]. Moreover, bDMARD switching was also associated with antidepressant [OR: 1.502, 95% CI 1.370 to 1.646, p<0.0001] and anxiolytic medication use [OR: 1.161, 95% CI 1.067 to 1.264, p=0.001]. Notably, all these associations were independent of age, gender, underlying disease diagnosis and concomitant glucocorticoid or csDMARD medication use. CONCLUSION In real-world settings, both introduction and switching of bDMARDs in patients with IRDs were associated with the presence of mood disorders. Although a causal relationship is uncertain, the impact of depression and anxiety should always be considered by physicians facing the decision to introduce or switch bDMARDs in patients with active IRDs.
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Affiliation(s)
- Vasiliki-Kalliopi Bournia
- Joint Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria G Tektonidou
- Joint Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Vassilopoulos
- Joint Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Katerina Laskari
- Joint Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Stylianos Panopoulos
- Joint Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Kalliopi Fragiadaki
- Joint Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | | | - Petros P Sfikakis
- Joint Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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11
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Fragoulis GE, Evangelatos G, Arida A, Bournia VK, Fragiadaki K, Karamanakos A, Kravvariti E, Laskari K, Panopoulos S, Pappa M, Mitsikostas DD, Tektonidou MG, Sfikakis PP. Nocebo-Prone Behaviour in Patients with Autoimmune Rheumatic Diseases during the COVID-19 Pandemic. Mediterr J Rheumatol 2020; 31:288-294. [PMID: 33196007 PMCID: PMC7656135 DOI: 10.31138/mjr.31.3.288] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 06/30/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic is associated with emotional distress and significant disruptions in health-care services. These are key players in the development of nocebo phenomena. We aimed to investigate nocebo-prone behaviour in patients with autoimmune rheumatic diseases (ARD) amid the COVID-19 pandemic-associated lockdown. METHODS Consecutive patients were telephone-interviewed during the COVID-19 pandemic in Greece. Clinical and socioeconomic characteristics (eg, level of education) were recorded. For nocebo behaviour, a four-item validated questionnaire (Q-No, cut-off score>15), was used. Results were compared with pre-COVID-19 Q-No scores collected from patients followed-up in our department. RESULTS Nocebo behaviour was detected in 51/500 (10.2%) individuals. In patients with nocebo behaviour, use of anti-hypertensives was less common (17.6% vs 31.8%, p=0.04), but a higher level of education was more common (58.8% vs 35.9%, p=0.002), compared with patients with Q-No score ≤15; the latter retained statistical significance in multivariate regression analysis (p=0.009, OR [95%CI]: 2.29, [1.23-4.25]). Total Q-No scores were higher in the COVID-19-period compared to the pre-COVID-19 era [median (range); 12 (4-20) vs 11 (4-20), p=0.02]. Among 78 patients with available Q-No questionnaires in the pre-COVID-19 era, 11 (14.1%) displayed nocebo behaviour, which increased to 16 (20.5%) amid the COVID-19 pandemic. Interim development of nocebo behaviour was also associated with higher educational level (p=0.049, OR: 3.65, 95%CI: 1.005-13.268). CONCLUSION A considerable proportion of ARD patients manifested nocebo-prone behaviour during the COVID-19 pandemic, which was more common among those with high educational level.
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Affiliation(s)
- George E. Fragoulis
- First Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, National and Kapodistrian University of Athens Medical School, “Laiko” General Hospital, Athens, Greece
| | - Gerasimos Evangelatos
- First Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, National and Kapodistrian University of Athens Medical School, “Laiko” General Hospital, Athens, Greece
| | - Aikaterini Arida
- First Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, National and Kapodistrian University of Athens Medical School, “Laiko” General Hospital, Athens, Greece
| | - Vasiliki-Kalliopi Bournia
- First Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, National and Kapodistrian University of Athens Medical School, “Laiko” General Hospital, Athens, Greece
| | - Kalliopi Fragiadaki
- First Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, National and Kapodistrian University of Athens Medical School, “Laiko” General Hospital, Athens, Greece
| | - Anastasios Karamanakos
- First Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, National and Kapodistrian University of Athens Medical School, “Laiko” General Hospital, Athens, Greece
| | - Evrydiki Kravvariti
- First Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, National and Kapodistrian University of Athens Medical School, “Laiko” General Hospital, Athens, Greece
| | - Katerina Laskari
- First Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, National and Kapodistrian University of Athens Medical School, “Laiko” General Hospital, Athens, Greece
| | - Stylianos Panopoulos
- First Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, National and Kapodistrian University of Athens Medical School, “Laiko” General Hospital, Athens, Greece
| | - Maria Pappa
- First Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, National and Kapodistrian University of Athens Medical School, “Laiko” General Hospital, Athens, Greece
| | - Dimos D. Mitsikostas
- First Neurology Department, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria G. Tektonidou
- First Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, National and Kapodistrian University of Athens Medical School, “Laiko” General Hospital, Athens, Greece
| | - Petros P. Sfikakis
- First Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, National and Kapodistrian University of Athens Medical School, “Laiko” General Hospital, Athens, Greece
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12
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Fragoulis GE, Evangelatos G, Arida A, Bournia VK, Fragiadaki K, Karamanakos A, Kravvariti E, Laskari K, Panopoulos S, Pappa M, Tektonidou MG, Sfikakis PP. Treatment adherence of patients with systemic rheumatic diseases in COVID-19 pandemic. Ann Rheum Dis 2020; 80:e60. [PMID: 32475830 DOI: 10.1136/annrheumdis-2020-217935] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 05/12/2020] [Indexed: 11/03/2022]
Affiliation(s)
- George E Fragoulis
- First Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, National and Kapodistrian University of Athens School of Health Sciences, Athens, Greece
| | - Gerasimos Evangelatos
- First Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, National and Kapodistrian University of Athens School of Health Sciences, Athens, Greece
| | - Aikaterini Arida
- First Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, National and Kapodistrian University of Athens School of Health Sciences, Athens, Greece
| | - Vasiliki-Kalliopi Bournia
- First Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, National and Kapodistrian University of Athens School of Health Sciences, Athens, Greece
| | - Kalliopi Fragiadaki
- First Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, National and Kapodistrian University of Athens School of Health Sciences, Athens, Greece
| | - Anastasios Karamanakos
- First Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, National and Kapodistrian University of Athens School of Health Sciences, Athens, Greece
| | - Evrydiki Kravvariti
- First Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, National and Kapodistrian University of Athens School of Health Sciences, Athens, Greece
| | - Katerina Laskari
- First Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, National and Kapodistrian University of Athens School of Health Sciences, Athens, Greece
| | - Stylianos Panopoulos
- First Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, National and Kapodistrian University of Athens School of Health Sciences, Athens, Greece
| | - Maria Pappa
- First Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, National and Kapodistrian University of Athens School of Health Sciences, Athens, Greece
| | - Maria G Tektonidou
- First Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, National and Kapodistrian University of Athens School of Health Sciences, Athens, Greece
| | - Petros P Sfikakis
- First Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, National and Kapodistrian University of Athens School of Health Sciences, Athens, Greece
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13
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Panopoulos S, Bournia VK, Konstantonis G, Fragiadaki K, Sfikakis PP, Tektonidou MG. Predictors of morbidity and mortality in early systemic sclerosis: Long-term follow-up data from a single-centre inception cohort. Autoimmun Rev 2018; 17:816-820. [DOI: 10.1016/j.autrev.2018.02.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 02/22/2018] [Indexed: 11/26/2022]
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14
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Thomas K, Flouri I, Repa A, Fragiadaki K, Sfikakis PP, Koutsianas C, Kaltsonoudis E, Voulgari PV, Drosos AA, Petrikkou E, Sidiropoulos P, Vassilopoulos D. High 3-year golimumab survival in patients with rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis: real world data from 328 patients. Clin Exp Rheumatol 2018; 36:254-262. [PMID: 29148406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 07/24/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Our primary objective was to study the long-term survival on drug (SOD) of patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS) treated with golimumab (GLM) in real life settings. METHODS This was a retrospective, observational study of all patients treated with GLM in 4 Academic Centres in Greece during a 4-year period (09/2010-06/2014). SOD was analysed using Kaplan-Meier survival analysis, while Cox regression analysis estimating hazard ratios (HRs) for different baseline variables associated with drug discontinuation was performed for each disease. RESULTS 328 patients (RA: 166, PsA: 82, AS: 80) were included. The estimated SOD at 2 and 3 years was 68% and 62% overall and was better for AS (79% and 76%) compared to RA (69% and 60%, p=0.067) and PsA (58% and 53%, p=0.001) patients; no difference was noted between RA and PsA patients (p=0.204). There was no difference in SOD between biologic-naïve and experienced nor between non-biologic co-treated or GLM monotherapy treated patients. Seropositivity (rheumatoid factor and/or anti-cyclic citrullinated peptide antibodies) was associated with a lower risk for GLM discontinuation by multivariate analysis (HR=0.5, 95% CI=0.0.25-1.1, p=0.05) in RA patients. During 606 patient-years of follow-up, 11 (3.3%) patients discontinued GLM due to adverse events (AE), accounting for 11% of treatment discontinuations. The rates of serious AEs and serious infections were 2.3 and 1.0/100-patient-years, respectively. CONCLUSIONS In this real-life study, GLM showed a high 3-year SOD in patients with inflammatory arthritides with a low rate of discontinuation due to AEs.
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Affiliation(s)
- Konstantinos Thomas
- Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit, 2nd Department of Medicine and Laboratory, Hippokration General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Irini Flouri
- Department of Rheumatology, Clinical Immunology and Allergy, Medical School, University of Crete, Heraklion, Greece
| | - Argiro Repa
- Department of Rheumatology, Clinical Immunology and Allergy, Medical School, University of Crete, Heraklion, Greece
| | - Kalliopi Fragiadaki
- Joint Rheumatology Program, First Department of Propaedeutic and Internal Medicine, Laikon Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Petros P Sfikakis
- Joint Rheumatology Program, First Department of Propaedeutic and Internal Medicine, Laikon Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Christos Koutsianas
- Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit, 2nd Department of Medicine and Laboratory, Hippokration General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | | | | | - Alexandros A Drosos
- Rheumatology Clinic, Medical School, University of Ioannina, Ioannina, Greece
| | | | - Prodromos Sidiropoulos
- Department of Rheumatology, Clinical Immunology and Allergy, Medical School, University of Crete, Heraklion, Greece
| | - Dimitrios Vassilopoulos
- Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit, 2nd Department of Medicine and Laboratory, Hippokration General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
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15
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Sfikakis PP, Arida A, Panopoulos S, Fragiadaki K, Pentazos G, Laskari K, Tektonidou M, Markomichelakis N. Brief Report: Drug-Free Long-Term Remission in Severe Behçet's Disease Following Withdrawal of Successful Anti-Tumor Necrosis Factor Treatment. Arthritis Rheumatol 2017; 69:2380-2385. [DOI: 10.1002/art.40235] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 08/16/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Petros P. Sfikakis
- National and Kapodistrian University of Athens Medical School; Athens Greece
| | - Aikaterini Arida
- National and Kapodistrian University of Athens Medical School; Athens Greece
| | | | - Kalliopi Fragiadaki
- National and Kapodistrian University of Athens Medical School; Athens Greece
| | - George Pentazos
- National and Kapodistrian University of Athens Medical School; Athens Greece
| | - Katerina Laskari
- National and Kapodistrian University of Athens Medical School; Athens Greece
| | - Maria Tektonidou
- National and Kapodistrian University of Athens Medical School; Athens Greece
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Arida A, Protogerou AD, Konstantonis G, Fragiadaki K, Kitas GD, Sfikakis PP. Atherosclerosis is not accelerated in rheumatoid arthritis of low activity or remission, regardless of antirheumatic treatment modalities. Rheumatology (Oxford) 2017; 56:934-939. [PMID: 28160488 DOI: 10.1093/rheumatology/kew506] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [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: 07/25/2016] [Indexed: 11/14/2022] Open
Abstract
Objectives RA associates with increased cardiovascular disease (CVD) morbidity and mortality due to accelerated atherosclerosis, attributed to both classical risk factors and chronic inflammation. The aim of this study was to test the hypothesis that effective disease control over 3 years modifies acceleration of atherosclerosis in RA. Methods Consecutive, non-diabetic RA patients previously examined by ultrasonography for subclinical atherosclerosis were re-evaluated after 3.2 (0.2) years, provided that they were in remission/low disease activity (DAS28 <3.2) for at least 75% of this period. Patients (n = 139) were demographically matched with 139 non-diabetic, non-RA control individuals studied in parallel. Results Patients and controls (mean age of 56 years at baseline) had a comparable burden of classical CVD risk factors. Patients' pulse wave velocity (reflecting arterial stiffness) changed by 0.07 m/s/year and left carotid intima-media thickness (reflecting wall hypertrophy) increased by 0.009 mm/year; formation of new atheromatic plaques in carotid and/or femoral arterial beds occurred in 22%. Multivariate analysis after correcting for all classical CVD risk factors and anti-hypertensive/lipid-lowering therapies demonstrated no significant differences between patients and controls in any of the subclinical atherosclerosis indices. Changes in all atherosclerosis indices from baseline to end of follow-up were comparable between those 56 patients treated with biologic DMARDs and their demographically matched patients treated with synthetic DMARDs. Conclusion Effective disease control may abrogate any RA-specific effect on the progression of atherosclerosis regardless of treatment. Whether early and sustained RA control translates to the CVD outcomes expected in the general population should be examined in prospective studies.
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Affiliation(s)
- Aikaterini Arida
- Rheumatology Unit, 1st Department of Propaedeutic Internal Medicine, Laikon Hospital, National and Kapodistrian Univeristy of Athens.,Joint Academic Rheumatology Program, National and Kapodistrian University of Athens, Medical School, Greece
| | - Athanasios D Protogerou
- Rheumatology Unit, 1st Department of Propaedeutic Internal Medicine, Laikon Hospital, National and Kapodistrian Univeristy of Athens.,Joint Academic Rheumatology Program, National and Kapodistrian University of Athens, Medical School, Greece
| | - George Konstantonis
- Rheumatology Unit, 1st Department of Propaedeutic Internal Medicine, Laikon Hospital, National and Kapodistrian Univeristy of Athens.,Joint Academic Rheumatology Program, National and Kapodistrian University of Athens, Medical School, Greece
| | - Kalliopi Fragiadaki
- Rheumatology Unit, 1st Department of Propaedeutic Internal Medicine, Laikon Hospital, National and Kapodistrian Univeristy of Athens.,Joint Academic Rheumatology Program, National and Kapodistrian University of Athens, Medical School, Greece
| | - George D Kitas
- Rheumatology Unit, 1st Department of Propaedeutic Internal Medicine, Laikon Hospital, National and Kapodistrian Univeristy of Athens.,Joint Academic Rheumatology Program, National and Kapodistrian University of Athens, Medical School, Greece
| | - Petros P Sfikakis
- Rheumatology Unit, 1st Department of Propaedeutic Internal Medicine, Laikon Hospital, National and Kapodistrian Univeristy of Athens.,Joint Academic Rheumatology Program, National and Kapodistrian University of Athens, Medical School, Greece
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Basoulis D, Fragiadaki K, Tentolouris N, Sfikakis PP, Kokkinos A. Anti-TNFα treatment for recalcitrant ulcerative necrobiosis lipoidica diabeticorum: A case report and review of the literature. Metabolism 2016; 65:569-73. [PMID: 26975548 DOI: 10.1016/j.metabol.2015.12.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 12/29/2015] [Accepted: 12/30/2015] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Necrobiosis lipoidica diabeticorum (NLD) is a rare degenerative connective tissue disorder associated with diabetes mellitus, which usually presents with red papules or plaques with raised edges and occasional ulceration. Ulcerating NLD is notoriously difficult to treat. We present a young patient with ulcerative NLD who was successfully treated with the anti-TNFα agent infliximab. Case presentation is followed by a review of therapeutic TNFα blockade in NLD. CASE PRESENTATION A 17-year old woman with type 1 diabetes since the age of 8, presented with a long-standing and extensively ulcerated and infected NLD lesion on her left shin. After achieving better glycemic control and treating her for infection of the wound, several NLD treatments failed to help, including corticosteroids and hyperbaric oxygen. She was treated successfully with 4 monthly sessions of 5mg/kg body weight intravenous infliximab, achieving complete resolution of ulceration. DISCUSSION A multitude of available treatments have been suggested for NLD over the past decades, based on two axes, one through wound healing and the other through immunosuppression. Anti-TNFα agents are relatively new drugs that brought a revolution in chronic inflammatory diseases and have been on the rise as novel potential treatments for NLD. Three out of the five available anti-TNFα agents have been safely tested so far, both topically and systematically, with mostly favorable results. CONCLUSION Intravenous infliximab was successful in the treatment of recalcitrant ulcerating NLD in our patient. Taken together with an increasing number of similar reports revealing a pathogenetic role of TNFα in NLD, we suggest that anti-TNFα agents are promising drugs in the management of this condition.
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Affiliation(s)
- Dimitrios Basoulis
- First Department of Propaedeutic Medicine, Medical School, National and Kapodistrian University of Athens, 17 Agiou Thoma St, Goudi, Athens, Greece.
| | - Kalliopi Fragiadaki
- First Department of Propaedeutic Medicine, Medical School, National and Kapodistrian University of Athens, 17 Agiou Thoma St, Goudi, Athens, Greece.
| | - Nicholas Tentolouris
- First Department of Propaedeutic Medicine, Medical School, National and Kapodistrian University of Athens, 17 Agiou Thoma St, Goudi, Athens, Greece.
| | - Petros P Sfikakis
- First Department of Propaedeutic Medicine, Medical School, National and Kapodistrian University of Athens, 17 Agiou Thoma St, Goudi, Athens, Greece.
| | - Alexander Kokkinos
- First Department of Propaedeutic Medicine, Medical School, National and Kapodistrian University of Athens, 17 Agiou Thoma St, Goudi, Athens, Greece.
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Makrilakis K, Fragiadaki K, Sfikakis PP, Kitas GD. Chemerin and cardiovascular risk in rheumatoid arthritis after interleukin 6 receptor blockade. J Rheumatol 2015; 42:349. [PMID: 25641970 DOI: 10.3899/jrheum.141115] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Konstantinos Makrilakis
- First Department of Propaedeutic/Internal Medicine, University of Athens Medical School, Laiko General Hospital, Athens, Greece;
| | - Kalliopi Fragiadaki
- First Department of Propaedeutic/Internal Medicine, University of Athens Medical School, Laiko General Hospital, Athens, Greece
| | - Petros P Sfikakis
- First Department of Propaedeutic/Internal Medicine, University of Athens Medical School, Laiko General Hospital, Athens, Greece
| | - George D Kitas
- Dudley Group National Health Institutes Foundation Trust, Dudley, and Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester, UK
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Sfikakis PP, Christopoulos PF, Vaiopoulos AG, Fragiadaki K, Katsiari C, Kapsimali V, Lallas G, Panayiotidis P, Korkolopoulou P, Koutsilieris M. Cadherin-11 mRNA transcripts are frequently found in rheumatoid arthritis peripheral blood and correlate with established polyarthritis. Clin Immunol 2014; 155:33-41. [PMID: 25173800 DOI: 10.1016/j.clim.2014.08.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 08/04/2014] [Accepted: 08/19/2014] [Indexed: 01/08/2023]
Abstract
Rheumatoid arthritis (RA) synovial fibroblasts hyperexpress the mesenchymal cadherin-11, which is involved also in tumor invasion/metastasis, whereas anti-cadherin-11 therapeutics prevent and reduce experimental arthritis. To test the hypothesis that cadherin-11 is aberrantly expressed in RA peripheral blood, 100 patients (15 studied serially) and 70 healthy controls were analyzed by real-time reverse transcription-PCR. Cadherin-11 mRNA transcripts were detected in 69.2% of moderately/severely active RA, versus 31.8% of remaining patients (p=0.001), versus 17.1% of controls (p<0.0001). Notably, cadherin-11 positivity correlated significantly and independently only with established (>1year) polyarthritis (>4 swollen tender joints), by multivariate logistic regression analysis including various possible clinical/laboratory factors. Rare cells of undefined nature, detected by flow cytometry following CD45(-) enrichment, strongly expressed surface cadherin-11 (estimated 10-50cells/ml of blood) in 5/6 patients with polyarticular established disease versus 1/6 patients with early RA. Studies on the potential pathogenic role of circulating cells expressing cadherin-11 in RA are warranted.
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Affiliation(s)
- P P Sfikakis
- Rheumatology Unit, First Department of Propaedeutic and Internal Medicine, Athens University Medical School, Greece.
| | - P F Christopoulos
- Rheumatology Unit, First Department of Propaedeutic and Internal Medicine, Athens University Medical School, Greece; Department of Physiology, Athens University Medical School, Greece
| | - A G Vaiopoulos
- Rheumatology Unit, First Department of Propaedeutic and Internal Medicine, Athens University Medical School, Greece; Department of Physiology, Athens University Medical School, Greece
| | - K Fragiadaki
- Rheumatology Unit, First Department of Propaedeutic and Internal Medicine, Athens University Medical School, Greece
| | - C Katsiari
- Rheumatology Unit, First Department of Propaedeutic and Internal Medicine, Athens University Medical School, Greece
| | - V Kapsimali
- Department of Microbiology, Athens University Medical School, Greece
| | - G Lallas
- Rheumatology Unit, First Department of Propaedeutic and Internal Medicine, Athens University Medical School, Greece
| | - P Panayiotidis
- Department of Microbiology, Athens University Medical School, Greece
| | - P Korkolopoulou
- Department of Pathology, Athens University Medical School, Greece
| | - M Koutsilieris
- Department of Physiology, Athens University Medical School, Greece
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Fragiadaki K, Makrilakis K, Smith J, Sfikakis PP, Kitas GD. AB0316 Changes of adipokine serum levels after il-6 receptor blockade with tocilizumab in patients with rheumatoid arthritis. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2013-eular.2638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Panopoulos S, Bournia V, Giavri I, Fragiadaki K, Vlachoyiannopoulos P, Sfikakis P. AB0835 More severe expression of systemic sclerosis in men than women from an ethnic cohort followed at a single center. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Giavri I, Panopoulos S, Bournia V, Fragiadaki K, Trakada G, Kostopoulos C, Sfikakis P. FRI0258 Long-term treatment with mycophenolate versus cyclophosphamide for systemic sclerosis-associated pulmonary fibrosis: A case control retrospective study. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sfikakis PP, Christopoulos PF, Vaiopoulos AG, Lallas G, Fragiadaki K, Koutsilieris M. THU0095 Cadherin-11 Gene is Aberrantly Expressed in the Peripheral Blood of Patients with Rheumatoid Arthritis and Strongly Correlates with Multiple Joint Inflammation. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Zampeli E, Protogerou A, Stamatelopoulos K, Fragiadaki K, Katsiari CG, Kyrkou K, Papamichael CM, Mavrikakis M, Nightingale P, Kitas GD, Sfikakis PP. Predictors of new atherosclerotic carotid plaque development in patients with rheumatoid arthritis: a longitudinal study. Arthritis Res Ther 2012; 14:R44. [PMID: 22390577 PMCID: PMC3446411 DOI: 10.1186/ar3757] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [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: 09/29/2011] [Revised: 01/01/2012] [Accepted: 03/05/2012] [Indexed: 01/15/2023] Open
Abstract
Introduction Rheumatoid arthritis (RA) is associated with increased cardiovascular morbidity and mortality attributed to both classical risk factors and chronic inflammation. We assessed longitudinally the factors associated with new carotid plaques in nondiabetic RA patients and apparently healthy individuals. Methods In our present prospective observational study, carotid plaques were identified by ultrasonography at baseline and follow-up end, separated by an average of 3.6 ± 0.2 years, in 64 patients (mean age 59.2 ± 12.0 and disease duration at baseline 7.8 ± 6.2 years, 83% women, clinical and laboratory evaluation every 3 to 6 months). In a substudy, 35 of the patients were matched 1:1 for traditional cardiovascular risk factors with 'healthy' controls and were studied in parallel. Results New atherosclerotic plaques formed in 30% of patients (first plaque in 9%) who were significantly older than the remaining patients. Tobacco use, blood pressure, body mass index, average cumulative low-density lipoprotein, high-sensitivity C-reactive protein, erythrocyte sedimentation rate level, RA stage, functional class, disease duration and treatment modalities during follow-up did not differ significantly between subgroups after application of the Bonferroni correction. RA was in clinical remission, on average, for approximately 70% of the follow-up time and was not different between subgroups. Multivariate analysis including all the above parameters revealed that age (P = 0.006), smoking (P = 0.009) and duration of low-dose corticosteroid use (P = 0.016) associated independently with new plaque formation. RA patients displayed similar numbers of newly formed carotid plaques to the tightly matched for traditional cardiovascular risk factors 'healthy' controls, although more patients than controls had carotid plaques at baseline. Conclusions Formation of new atherosclerotic plaques in this small cohort of patients with well-controlled RA depended mainly on traditional cardiovascular risk factors and corticosteroid use, whereas an adverse effect of residual systemic inflammation was not readily detectable.
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Affiliation(s)
- Evangelia Zampeli
- First Department of Propaedeutic and Internal Medicine, Laikon Hospital, Athens University Medical School, Ag Thoma, 17, GR-11527 Athens, Greece
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Gecene M, Tuncay F, Borman P, Yucel D, Senes M, KaniyeYilmaz B, Franks L, Radusky R, Feig J, Fernandez P, Cronstein B, Chan E, Kim G, Han S, Jung Y, Usmani SE, Ulici V, Beier F, Bell MJ, Veinot P, Embuldeniya G, Nyhof-Young J, Sale J, Sargeant J, Tugwell P, Brooks S, Ross S, Tonon R, Richards D, Boyle J, Knickle K, Sandhu S, Britten N, Bell E, Webster F, Cox-Dublanski M, Ntatsaki E, Watts RA, Scott DGI, Borman P, Tasbas O, Gurhan Karabulut H, Tukun A, Yorgancioglu R, Ferraz-Amaro I, Arce-Franco M, Hernandez-Hernandez V, Delgado-Frias E, Gantes M, Ramon Muniz J, Jesus Dominguez-Luis M, Herrera-Garcia A, Antonio Garcia-Dopico J, Medina L, Rodriguez-Vargas A, Diaz-Gonzalez F, Zampeli E, Protogerou A, Stamatelopoulos K, Fragiadaki K, Katsiari CG, Kyrkou K, Papamichael CM, Mavrikakis M, Nightingale P, Sfikakis PP, Zampeli E, Karanasos A, Felekos I, Aggeli C, Stefanadis C, Toutouzas K, Protogerou A, Sfikakis PP, Faezi ST, Akbarian M, Jamshidi A, Hoseynialmodarresi M, Davatchi F, San Koo B, Wook So M, Kim YG, Lee CK, Yoo B, Warrington KJ, Kermani TA, Crowson CS, Ytterberg SR, Hunder GG, Gabriel SE, Matteson EL. Best Oral Presentations (OP01-OP12). Rheumatology (Oxford) 2012. [DOI: 10.1093/rheumatology/ker437] [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: 11/12/2022] Open
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Fragiadaki K, Tektonidou MG, Konsta M, Chrousos GP, Sfikakis PP. Sleep disturbances and interleukin 6 receptor inhibition in rheumatoid arthritis. J Rheumatol 2011; 39:60-2. [PMID: 22133618 DOI: 10.3899/jrheum.110617] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Interleukin 6 (IL-6)-mediated interactions have been associated with sleep disturbances in healthy subjects. In this pilot study we examined whether administration of the IL-6 receptor antagonist tocilizumab in patients with rheumatoid arthritis (RA) affects sleep disturbances. METHODS Fifteen patients (13 women) with sleep disturbances at baseline received 6 monthly infusions of tocilizumab 8 mg/kg for moderately or severely active RA. Sleep quality was assessed by Pittsburgh Sleep Quality Index (PSQI), daytime sleepiness by Epworth Sleepiness Scale, disease activity by the 28-joint Disease Activity Score-erythrocyte sedimentation rate, functional disability by Health Assessment Questionnaire Disability Index (HAQ-DI), and fatigue by the Functional Assessment of Chronic Illness Therapy (FACIT-Fatigue Scale; FFS) at baseline and first, second, third, and sixth month of treatment. Medications used before enrollment remained unchanged during followup. RESULTS Sleep quality improved and daytime sleepiness decreased significantly at first-month assessment (p < 0.00001 and p < 0.004, respectively, by repeated measurement analysis) compared to baseline, and these changes became more evident through 6 months. Disease activity decreased, fatigue decreased, and functional status improved significantly. Changes in PSQI score over time were not associated with the corresponding changes in DAS28-ESR (r = 0.37, p = 0.17), but correlated significantly with HAQ-DI changes (r = 0.60, p = 0.02) and marginally with changes in FFS scores (r = -0.46, p = 0.08). CONCLUSION Improvement of sleep quality after tocilizumab treatment in patients with RA does not appear to directly result from decreased disease activity, further suggesting that aberrant IL-6 regulation is associated with sleep disturbances.
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Terpos E, Fragiadaki K, Konsta M, Bratengeier C, Papatheodorou A, Sfikakis PP. Early effects of IL-6 receptor inhibition on bone homeostasis: a pilot study in women with rheumatoid arthritis. Clin Exp Rheumatol 2011; 29:921-925. [PMID: 22032557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Accepted: 06/21/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVES A critical role of interleukin-6 (IL-6) in bone homeostasis has been suggested in experimental studies. We examined whether inhibition of IL-6 receptor in patients with rheumatoid arthritis (RA) results in early alterations of circulating markers of bone remodelling. METHODS Circulating levels of osteoprotegerin, receptor activator of nuclear factor-kappaB ligand (RANKL), Wnt signalling pathway inhibitors Dickkopf-1 (Dkk-1) and sclerostin, markers of bone resorption (C-terminal cross-linking telopeptide of collagen type-I (CTX), tartrate-resistant acid phosphatase isoform-5b) and bone formation (bone-specific alkaline-phosphatase, osteocalcin) were examined in 22 women with active RA before and after two monthly infusions of tocilizumab (8mg/kg each); 'healthy', non-osteopenic, 1:1 age-matched women served as controls. RESULTS At baseline, osteoprotegerin/RANKL ratio in patients was lower than controls by 5-fold; circulating osteoprotegerin correlated negatively with corresponding 28-joint-count disease activity scores and circulating RANKL correlated positively with C-reactive protein. Also, Dkk-1, sclerostin, CTX and osteocalcin levels were higher in RA than controls. After two months, osteoprotegerin/RANKL ratio increased, Dkk-1 decreased and sclerostin increased comparing to baseline; other markers did not change significantly. Increases of osteoprotegerin/RANKL ratio were more prominent in 10 patients who achieved remission or low disease activity after tocilizumab than in 12 patients who did not. In contrast, the significant alterations of both Wnt inhibitors were comparable between these patient subgroups. CONCLUSIONS Anti-IL-6 therapy induced suppression of the inflammatory response affects rapidly the disrupted bone homeostasis in active RA. An additional, possibly specific, effect of IL-6 receptor inhibition on bone remodelling in humans should be further examined.
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Affiliation(s)
- Evangelos Terpos
- First Department of Propedeutic and Internal Medicine, Athens University Medical School, Athens, Greece.
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Protogerou AD, Zampeli E, Fragiadaki K, Stamatelopoulos K, Papamichael C, Sfikakis PP. A pilot study of endothelial dysfunction and aortic stiffness after interleukin-6 receptor inhibition in rheumatoid arthritis. Atherosclerosis 2011; 219:734-6. [PMID: 21968316 DOI: 10.1016/j.atherosclerosis.2011.09.015] [Citation(s) in RCA: 108] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Revised: 09/01/2011] [Accepted: 09/06/2011] [Indexed: 11/30/2022]
Abstract
Interleukin (IL)-6 is a pleiotropic proinflammatory cytokine involved in the pathogenesis of both atherosclerosis and rheumatoid arthritis. The role of the IL-6/IL-6 receptor pathway in the documented acceleration of atherosclerosis in rheumatoid arthritis has not been examined. In a non-randomized prospective pilot study we asked whether endothelial dysfunction, defined as impaired flow mediated dilatation (FMD), and aortic stiffness, assessed by pulse wave velocity (PWV) improve after 3 and 6 monthly therapeutic infusions of the anti-IL-6 receptor antibody tocilizumab for active rheumatoid arthritis. We found that FMD increased from 3.3 ± 0.8 to 4.4 ± 1.2 to 5.2 ± 1.9% (p = 0.003), whereas PWV decreased from 8.2 ± 1.2 to 7.7 ± 1.3 to 7.0 ± 1.0m/s (p < 0.001). Whether these beneficial arterial changes are direct effects of the IL-6/IL-6 receptor pathway inhibition, maintained over time and translate into better clinical outcome warrants further studies.
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Affiliation(s)
- A D Protogerou
- First Department of Propaedeutic and Internal Medicine, Athens University Medical School, Laikon Hospital, Ag Thoma 17, 11527 Athens, Greece.
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Protogerou A, Zampeli E, Stamatelopoulos K, Fragiadaki K, Katsiari C, Kyrkou K, Papamichael C, Mavrikakis M, Kitas G, Sfikakis P. P1.14 FORMATION OF NEW ATHEROSCLEROTIC PLAQUES IN WELL CONTROLLED RHEUMATOID ARTHRITIS DEPENDS ON CLASSICAL CARDIOVASCULAR RISK FACTORS: A PROSPECTIVE LONGITUDINAL STUDY. Artery Res 2011. [DOI: 10.1016/j.artres.2011.10.020] [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: 10/15/2022] Open
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Markomichelakis N, Delicha E, Masselos S, Fragiadaki K, Kaklamanis P, Sfikakis PP. A single infliximab infusion vs corticosteroids for acute panuveitis attacks in Behçet's disease: a comparative 4-week study. Rheumatology (Oxford) 2010; 50:593-7. [PMID: 21097877 DOI: 10.1093/rheumatology/keq366] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To compare a single infusion of the anti-TNF antibody infliximab vs CSs for acute panuveitis attacks in Behçet's disease (BD). METHODS A prospective, observational study of patients with panuveitis, who received either an infliximab infusion (5 mg/kg, 19 eyes) or high-dose methylprednisolone intravenously (1 g/day for 3 days, 8 eyes), or intra-vitreal triamcinolone acetonide (4 mg, 8 eyes) at attack's onset. Baseline maintenance therapy remained unchanged during the following 30 days. Visual acuity, anterior chamber cells, vitreous cells and inflammation of the posterior eye segment were assessed at baseline and at Days 1, 7, 14 and 29 (±1) post-treatment. RESULTS While no significant differences were noted between i.v. and intra-vitreal CSs, infliximab was faster than CSs in decreasing total ocular inflammation scores and fundus inflammation scores (P = 0.01 and P < 0.0001 for treatment × time(2) interaction, respectively, using generalized estimating equation analysis). Independently of time, infliximab was superior to CSs in clearing retinal vasculitis (P < 0.003), as well as in resolution of retinitis (P = 0.008) and cystoid macular oedema (P < 0.007). Moreover, a faster regression of cystoid macular oedema was observed with infliximab compared with CSs (P < 0.03). The beneficial effects of the three treatment modalities on visual acuity were comparable from baseline to the end of follow-up. No side effects were noted with infliximab or methylprednisolone, whereas intra-vitreal triamcinolone acetonide caused ocular hypertension in four of the eight eyes, requiring surgical intervention in two. CONCLUSION A single infusion of infliximab should always be considered, even as an adjunct therapy, for the control of acute panuveitis attacks in BD.
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Affiliation(s)
- Nikos Markomichelakis
- Ophthalmology Department, Ocular Inflammation/Immunology Service, General Hospital, Athens, Greece
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Stamatelopoulos KS, Kitas GD, Papamichael CM, Kyrkou K, Zampeli E, Fragiadaki K, Panoulas VF, Mavrikakis M, Sfikakis PP. Subclinical peripheral arterial disease in rheumatoid arthritis. Atherosclerosis 2010; 212:305-9. [PMID: 20553683 DOI: 10.1016/j.atherosclerosis.2010.05.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2010] [Revised: 04/18/2010] [Accepted: 05/03/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Rheumatoid arthritis (RA) is associated with accelerated atherosclerosis in the carotid arteries, but little is known about the magnitude of this process in peripheral arteries. Assessing preclinical atherosclerosis in both arterial beds in RA might provide additional prognostic value during risk stratification for primary prevention. Therefore in the present structural study we examined femoral versus carotid subclinical atherosclerosis in RA and controls. METHODS Intima-media thickness (IMT) and atheromatous plaque presence and vulnerability in femoral versus carotid arteries were examined in 80 RA patients without overt cardiovascular disease or diabetes and 80 controls matched 1:1 for age, gender and traditional cardiovascular disease risk factors. RESULTS Femoral IMT and plaque prevalence were increased in RA than controls (p=0.001 and 0.008, respectively). These increases remained significant after adjustment for potentially confounding factors that differed between groups, such as C-reactive protein and HDL-cholesterol serum levels, and statin use. Femoral plaque vulnerability did not differ between RA and controls. The presence of RA was found to be an independent predictor of increased femoral IMT (p=0.004), after adjustment for traditional cardiovascular risk factors, C-reactive protein and treatment with angiotensin converting enzyme inhibitors and statins. Femoral plaques were less frequent than carotid plaques in RA patients (22.5% vs 45.0% respectively, p=0.003) and in contrast to carotid plaques were independent of age and glucose levels. CONCLUSIONS Subclinical peripheral atherosclerosis in RA is more advanced than in controls. Prospective studies are required to confirm that RA is an independent risk factor for peripheral arterial disease.
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Affiliation(s)
- Kimon S Stamatelopoulos
- Vascular Laboratory, Department of Clinical Therapeutics, Alexandra Hospital, 80, Vassilissis Sofias Ave, PO Box 11528, Athens, Greece.
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Poulopoulou C, Papadopoulou-Daifoti Z, Hatzimanolis A, Fragiadaki K, Polissidis A, Anderzanova E, Davaki P, Katsiari CG, Sfikakis PP. Glutamate levels and activity of the T cell voltage-gated potassium Kv1.3 channel in patients with systemic lupus erythematosus. ACTA ACUST UNITED AC 2008; 58:1445-50. [DOI: 10.1002/art.23446] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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