1
|
Schultz O, Fiehn C, Kneitz C, Picker N, Kromer D, Zignani M, De Leonardis F, Orzechowski HD, Gurrath M, Krüger K. Real-world experience with filgotinib for rheumatoid arthritis in Germany : A retrospective chart review. Z Rheumatol 2024:10.1007/s00393-024-01506-x. [PMID: 38689038 DOI: 10.1007/s00393-024-01506-x] [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] [Accepted: 03/21/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Real-world data for filgotinib, a Janus kinase (JAK)1 inhibitor, are limited in patients with rheumatoid arthritis (RA). OBJECTIVES To explore real-world filgotinib use in patients with RA in Germany. MATERIALS AND METHODS This retrospective chart review included patients aged ≥ 18 years with confirmed moderate to severe RA who initiated filgotinib before December 1, 2021, with ≥ 6 months of medical records available prior to filgotinib initiation or after initial diagnosis. Patient characteristics, prior treatments, reasons for initiating/discontinuing filgotinib, disease activity, dose adjustments and concomitant treatments were recorded. RESULTS In total, 301 patients from 20 German rheumatology outpatient units were included. One-third were aged ≥ 65 years and almost half had ≥ 1 cardiovascular (CV) risk factor. Most patients initiated filgotinib as monotherapy (83.7%; 12.7% of whom with glucocorticoids) and at the 200 mg dose (84.7%); higher proportions of those initiating the 100 versus 200 mg dose were aged ≥ 65 years and had renal impairment or ≥ 1 CV risk factor. Oral administration (78.4%), fast onset of action (66.8%) and administration as monotherapy (65.4%) were the most common reasons for initiating filgotinib. At 12 months, 41 (18.4%) patients had discontinued filgotinib, most commonly due to lack of effectiveness. After 6‑months of follow-up, 36.8% of patients had achieved Clinical Disease Activity Index (CDAI) remission and 45.6% had achieved CDAI low disease activity. CONCLUSIONS In clinical practice in Germany, reasons for initiating filgotinib in patients with RA were related to dosing flexibility and general JAK inhibitor attributes. Filgotinib was used predominantly as monotherapy and was effective and generally well tolerated; however, longer-term data in larger, prospective cohorts are needed.
Collapse
Affiliation(s)
- Olaf Schultz
- ACURA Kliniken Baden-Baden/Rheumazentrum, Rotenbachtalstraße 5, 76530, Baden-Baden, Germany.
| | - Christoph Fiehn
- Praxis for Rheumatology and Clinical Immunology, Medical Center Baden-Baden, Baden-Baden, Germany
| | | | - Nils Picker
- Ingress-Health HWM GmbH-A Cytel Company, Wismar, Germany
| | - Daniel Kromer
- Ingress-Health HWM GmbH-A Cytel Company, Berlin, Germany
| | | | | | | | | | - Klaus Krüger
- Rheumatologisches Praxiszentrum St. Bonifatius, Munich, Germany
| |
Collapse
|
2
|
Fiehn C, Leipe J, Weseloh C, Bergner R, Krüger K. Assessment of interactions and dosage recommendations of synthetic DMARDs-Evidence-based and consensus-based recommendations based on a systematic literature search. Z Rheumatol 2024; 83:8-19. [PMID: 37831190 DOI: 10.1007/s00393-023-01417-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2023] [Indexed: 10/14/2023]
Abstract
Conventional synthetic (cs) and targeted synthetic (ts) disease-modifying antirheumatic drugs (DMARD) have potential interactions with a multitude of drugs. Furthermore, they sometimes have a lower therapeutic index, particularly in cases of limited organ functions. The aim of this work was to establish evidence-based recommendations on the therapeutic use of DMARDs in the context of drug interactions and dosage recommendations. A systematic literature search was carried out on the issue of drug interactions and dosages in cases of patients with limited kidney function and higher age and suffering from rheumatoid arthritis. A total of 2756 scientific publications were screened and 154 selected of which 68 were scrutinized in detail. Furthermore, the respective product information was also analyzed. A multitude of possible interactions of synthetic DMARDs with different drugs were detected, which were then assessed with respect to the clinical significance and consequences. A consensus process led to making recommendations with which the interactions were classified: A: dangerous combination, B: avoid combination (if possible, pausing DMARD treatment), C: possible combination requiring increased monitoring and potential adjustments in dosage and D: pharmacological interaction without relevance in DMARD standard doses. Apart from that dosage recommendations were established for each csDMARD and tsDMARD depending on kidney function and age. There are 3 primary recommendations and 11 core recommendations on interactions and dosages of csDMARDs and tsDMARDs meant as a practical help for therapeutic decision making and to improve safety in the treatment of rheumatoid arthritis.
Collapse
Affiliation(s)
- C Fiehn
- Kommission Pharmakotherapie, Deutsche Gesellschaft für Rheumatologie (DGRh), Berlin, Germany.
- Tätigkeitsschwerpunkt klinische Immunologie, Rheumatologie Baden-Baden, Beethovenstr. 2, 76530, Baden-Baden, Germany.
| | - J Leipe
- Kommission Pharmakotherapie, Deutsche Gesellschaft für Rheumatologie (DGRh), Berlin, Germany
- V. Medizinische Klinik, Universitätsmedizin Mannheim, Mannheim, Germany
| | - C Weseloh
- Kommission Pharmakotherapie, Deutsche Gesellschaft für Rheumatologie (DGRh), Berlin, Germany
- Deutsche Gesellschaft für Rheumatologie (DGRh), Berlin, Germany
| | - R Bergner
- Kommission Pharmakotherapie, Deutsche Gesellschaft für Rheumatologie (DGRh), Berlin, Germany
- Medizinische Klinik A, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - K Krüger
- Kommission Pharmakotherapie, Deutsche Gesellschaft für Rheumatologie (DGRh), Berlin, Germany
- Rheumatologisches Praxiszentrum St. Bonifatius, Munich, Germany
| |
Collapse
|
3
|
Hecksteden A, Hoppstädter J, Bizjak DA, Jerg A, Kirsten J, Krüger K, Niess A, Steinacker J, Kiemer AK. Effects of acute exercise and training status on glucocorticoid-induced leucine zipper (GILZ) expression in human skeletal muscle. J Sci Med Sport 2023; 26:707-710. [PMID: 37951824 DOI: 10.1016/j.jsams.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/02/2023] [Accepted: 10/12/2023] [Indexed: 11/14/2023]
Abstract
Interactions between statin therapy and physical exercise complicate effective cardiovascular prevention. Emerging evidence suggests that muscle strain related changes in the expression of the glucocorticoid-induced leucine zipper (GILZ) may be involved. Therefore, we measured GILZ mRNA expression levels in M. vastus lateralis samples of 32 healthy individuals before and after a standardized bout of strength or endurance exercise. Overall, we found a highly significant downregulation of GILZ after exercise training (p < 0.001). Within-subgroup changes were statistically significant only after strength training, supporting the role of muscle (as opposed to cardiocirculatory) strain. If confirmed, this may help fitting training recommendations and medication.
Collapse
Affiliation(s)
- A Hecksteden
- Universität Innsbruck, Institute of Sport Science, Austria; Medical University Innsbruck, Institute of Physiology, Austria.
| | - J Hoppstädter
- Saarland University, Department of Pharmacy, Chair of Pharmaceutical Biology, Germany
| | - D A Bizjak
- University of Ulm, Department of Internal Medicine, Division of Sports and Rehabilitation Medicine, Germany
| | - A Jerg
- University of Ulm, Department of Internal Medicine, Division of Sports and Rehabilitation Medicine, Germany
| | - J Kirsten
- University of Ulm, Department of Internal Medicine, Division of Sports and Rehabilitation Medicine, Germany
| | - K Krüger
- University of Giessen, Department of Exercise Physiology and Sports Therapy, Germany
| | - A Niess
- University Hospital Tübingen, Department of Sports Medicine, Germany
| | - J Steinacker
- University of Ulm, Department of Internal Medicine, Division of Sports and Rehabilitation Medicine, Germany
| | - A K Kiemer
- Saarland University, Department of Pharmacy, Chair of Pharmaceutical Biology, Germany
| |
Collapse
|
4
|
Witte T, Kiltz U, Haas F, Riechers E, Prothmann U, Adolf D, Holland C, Rössler A, Soppa U, Fritz B, Götz K, Krüger K. The impact of C-reactive protein levels on the effectiveness of upadacitinib in patients with rheumatoid arthritis: a 12-month prospective, non-interventional German study. Clin Exp Rheumatol 2023:20143. [PMID: 37976112 DOI: 10.55563/clinexprheumatol/11255h] [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: 07/06/2023] [Accepted: 09/26/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES We investigated whether the effectiveness of upadacitinib in rheumatoid arthritis (RA) treatment is affected by baseline CRP levels in a real-world setting. METHODS UPwArds was a prospective, non-interventional study. Patients had moderate-to-severe RA and an inadequate response or intolerance to ≥1 disease-modifying anti-rheumatic drug (DMARD). The primary endpoint was clinical remission (Clinical Disease Activity Index [CDAI] ≤2.8) at 6 months. Secondary endpoints at 12 months included clinical remission and low disease activity assessed by CDAI and Simple Disease Activity Index criteria, DAS28-CRP <2.6/≤3.2, and patient-reported outcomes. The impact of baseline CRP levels (normal vs. above the upper limit of normal [ULN]) on primary and secondary endpoints was evaluated. The effect of concomitant MTX and prior inadequate response to biologic or targeted synthetic DMARDs (b/tsDMARD-IR) on the effectiveness of upadacitinib was also assessed. Safety was evaluated through 12 months. RESULTS 518 patients were included in the effectiveness analyses. At 6 months, 24.4% of patients achieved the primary endpoint (CDAI ≤2.8). At 12 months, similar proportions of patients with normal CRP and CRP above the ULN at baseline achieved CDAI ≤2.8 (27.3% and 29.1%) and other key secondary endpoints. The effectiveness of upadacitinib was comparable with and without concomitant MTX and in b/tsDMARD-naive and b/tsDMARD-IR patients. The safety results were consistent with the known safety profile of upadacitinib; no new safety signals were identified. CONCLUSIONS Upadacitinib therapy was effective for RA in a real-world setting. Baseline CRP levels had no significant impact on the effectiveness of upadacitinib.
Collapse
Affiliation(s)
- Torsten Witte
- Department of Rheumatology and Clinical Immunology, Hannover Medical School, Hannover, Germany.
| | - Uta Kiltz
- Rheumazentrum Ruhrgebiet, Herne, and Ruhr-University Bochum, Bochum, Germany
| | - Florian Haas
- Internistisch-Rheumatologische Facharztpraxis, Rheumatology, Tübingen, Germany
| | - Elke Riechers
- Department of Rheumatology and Clinical Immunology, Hannover Medical School, Hannover, Germany
| | | | | | - Carsten Holland
- AbbVie Deutschland GmbH & Co. KG, Medical Immunology, Wiesbaden, Germany
| | - Alexander Rössler
- AbbVie Deutschland GmbH & Co. KG, Medical Immunology, Wiesbaden, Germany
| | - Ulf Soppa
- AbbVie Deutschland GmbH & Co. KG, Medical Immunology, Wiesbaden, Germany
| | - Björn Fritz
- AbbVie Deutschland GmbH & Co. KG, Medical Immunology, Wiesbaden, Germany
| | - Konrad Götz
- AbbVie Deutschland GmbH & Co. KG, Medical Immunology, Wiesbaden, Germany
| | - Klaus Krüger
- Praxiszentrum St. Bonifatius, Rheumatology, Munich, Germany
| |
Collapse
|
5
|
Tinwell H, Karmaus A, Gaskell V, Gomes C, Grant C, Holmes T, Jonas A, Kellum S, Krüger K, Malley L, Melching-Kollmuss S, Mercier O, Pandya H, Placke T, Settivari R, De Waen B. Evaluating H295R steroidogenesis assay data for robust interpretation. Regul Toxicol Pharmacol 2023; 143:105461. [PMID: 37490962 DOI: 10.1016/j.yrtph.2023.105461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 06/22/2023] [Accepted: 07/21/2023] [Indexed: 07/27/2023]
Abstract
The in vitro H295R steroidogenesis assay (OECD TG 456) is used to determine a chemical's potential to interfere with steroid hormone synthesis/metabolism. As positive outcomes in this assay can trigger significant higher tiered testing, we compiled a stakeholder database of reference and test item H295R data to characterize assay outcomes. Information concerning whether a Level 5 reproductive toxicity study was triggered due to a positive outcome in the H295R assay was also included. Quality control acceptance criteria were not always achieved, suggesting this assay is challenging to conduct within the guideline specifications. Analysis of test item data demonstrated that pairwise significance testing to controls allowed for overly sensitive statistically significant positive outcomes, which likely contribute to the assay's high positive hit rate. Complementary interpretation criteria (e.g., 1.5-fold change threshold) markedly reduced the rate of equivocal and positive outcomes thus improving identification of robust positive effects in the assay. Finally, a case study (positive H295R outcome and no endocrine adversity in vivo) is presented, which suggests that stricter data interpretation criteria could refine necessary in vivo follow-up testing. Overall, the described additional criteria could improve H295R data interpretation and help inform on how to best leverage this assay for regulatory purposes.
Collapse
Affiliation(s)
- H Tinwell
- Bayer SAS, 16 Rue Jean-Marie Leclair, 69009, Lyon, France.
| | - A Karmaus
- Inotiv, 601 Keystone Park Drive, Morrisville, NC, 27560, United States
| | - V Gaskell
- Nufarm UK Ltd, Wyke Lane, Bradford, BD12 9EJ, UK
| | - C Gomes
- BASF SE, Experimental Toxicology and Ecology, Carl-Bosch-Strasse 38, 67056, Ludwigshafen, Germany
| | - C Grant
- Regulatory Science Associates, Kip Marina, Inverkip, Renfrewshire, PA16 OAS, UK
| | - T Holmes
- ADAMA Deutschland GmbH, Edmund-Rumpler-Str. 651149, Koeln (Cologne), Germany
| | - A Jonas
- Sumitomo Chemical Agro Europe, Parc D'Affaires de Crécy, 10A Rue de La Voie Lactée, 69370, Saint Didier Au Mont D'Or, France
| | - S Kellum
- Corteva Agriscience, Haskell R&D Center, 1090 Elkton Rd, Bldg 320, Newark, DE, 19711, USA
| | - K Krüger
- HELM AG, Nordkanalstrasse 28, 20097, Hamburg, Germany
| | - L Malley
- FMC, Stine Research Center, 1090 Elkton Road, Newark, DE, 19711, USA
| | | | - O Mercier
- Sumitomo Chemical Agro Europe, Parc D'Affaires de Crécy, 10A Rue de La Voie Lactée, 69370, Saint Didier Au Mont D'Or, France
| | - H Pandya
- UPL Limited, Mumbai, 400051, India
| | - T Placke
- Syngenta, Rosentalstrasse 67, CH-4058 Basel, Switzerland
| | - R Settivari
- Corteva Agriscience, Haskell R&D Center, 1090 Elkton Rd, Bldg 320, Newark, DE, 19711, USA
| | - B De Waen
- ISK, De Kleetlaan 12b, 1831, Machelen, Belgium
| |
Collapse
|
6
|
Abstract
Hyperplasia of the pharyngeal tonsils is to be considered pathologic when nasopharyngeal symptoms of mechanical obstruction and/or chronic inflammation occur. Chronic Eustachian tube dysfunction can result in various middle ear diseases such as conductive hearing loss, cholesteatoma, and recurrent acute otitis media. During examination, attention should be paid to the presence of adenoid facies (long face syndrome), with a permanently open mouth and visible tip of the tongue. In the case of severe symptoms and/or failure of conservative treatment, adenoidectomy is usually performed on an outpatient basis. Conventional curettage remains the established standard treatment in Germany. Histologic evaluation is indicated for clinical evidence of mucopolysaccharidoses. Due to the risk of hemorrhage, the preoperative bleeding questionnaire, which is obligatory before every pediatric surgery, is referred to. Recurrence of adenoids is possible despite correct adenoidectomy. Before discharge home, otorhinolaryngologic inspection of the nasopharynx for secondary bleeding should be performed and anesthesiologic clearance obtained.
Collapse
Affiliation(s)
- Z Ahmad
- Department of Otolaryngology-Head and Neck Surgery, Bundeswehr Hospital of Ulm, Oberer Eselsberg 40, 89081, Ulm, Germany.
| | - K Krüger
- Institute of General Medicine, Berlin Charité Hospital, Berlin, Germany
| | - J Lautermann
- Department of Otolaryngology-Head and Neck Surgery, Plastic Surgery, Martha-Maria Halle-Dölau Hospital, Halle-Dölau, Germany
| | - B Lippert
- Department of Otolaryngology-Head and Neck Surgery, Plastic Surgery, SLK-Kliniken Heilbronn GmbH am Gesundbrunnen, Heilbronn, Germany
| | - T Tenenbaum
- Department of Paediatric and Adolescent Medicine, Sana Klinikum Lichtenberg, Berlin, Germany
| | - M Tigges
- Department of Otolaryngology, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - M Tisch
- Department of Otolaryngology-Head and Neck Surgery, Bundeswehr Hospital of Ulm, Oberer Eselsberg 40, 89081, Ulm, Germany
| |
Collapse
|
7
|
Stephan M, Tascilar K, Yalcin-Mutlu M, Hagen M, Haschka J, Reiser M, Hartmann F, Kleyer A, Hueber AJ, Manger B, Figueiredo C, Cobra JF, Tony HP, Finzel S, Kleinert S, Wendler J, Schuch F, Ronneberger M, Feuchtenberger M, Fleck M, Manger K, Ochs W, Schmitt-Haendle M, Lorenz HM, Nüsslein H, Alten R, Henes J, Krüger K, Schett G, Rech J. Physical Function of RA patients Tapering Treatment-A Post Hoc Analysis of the Randomized Controlled RETRO Trial. J Clin Med 2023; 12:jcm12113723. [PMID: 37297917 DOI: 10.3390/jcm12113723] [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: 04/24/2023] [Revised: 05/15/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023] Open
Abstract
Several studies have shown that tapering or stopping disease-modifying anti-rheumatic drugs (DMARDs) in rheumatoid arthritis (RA) patients in sustained remission is feasible. However, tapering/stopping bears the risk of decline in physical function as some patients may relapse and face increased disease activity. Here, we analyzed the impact of tapering or stopping DMARD treatment on the physical function of RA patients. The study was a post hoc analysis of physical functional worsening for 282 patients with RA in sustained remission tapering and stopping DMARD treatment in the prospective randomized RETRO study. HAQ and DAS-28 scores were determined in baseline samples of patients continuing DMARD (arm 1), tapering their dose by 50% (arm 2), or stopping after tapering (arm 3). Patients were followed over 1 year, and HAQ and DAS-28 scores were evaluated every 3 months. The effect of treatment reduction strategy on functional worsening was assessed in a recurrent-event Cox regression model with a study-group (control, taper, and taper/stop) as the predictor. Two-hundred and eighty-two patients were analyzed. In 58 patients, functional worsening was observed. The incidences suggest a higher probability of functional worsening in patients tapering and/or stopping DMARDs, which is likely due to higher relapse rates in these individuals. At the end of the study, however, functional worsening was similar among the groups. Point estimates and survival curves show that the decline in functionality according to HAQ after tapering or discontinuation of DMARDs in RA patients with stable remission is associated with recurrence, but not with an overall functional decline.
Collapse
Affiliation(s)
- Marlene Stephan
- Department of Internal Medicine 3, FAU Erlangen-Nuremberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
- Deutsches Zentrum fuer Immuntherapie (DZI), FAU Erlangen-Nuremberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Koray Tascilar
- Department of Internal Medicine 3, FAU Erlangen-Nuremberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
- Deutsches Zentrum fuer Immuntherapie (DZI), FAU Erlangen-Nuremberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Melek Yalcin-Mutlu
- Department of Internal Medicine 3, FAU Erlangen-Nuremberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
- Deutsches Zentrum fuer Immuntherapie (DZI), FAU Erlangen-Nuremberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Melanie Hagen
- Department of Internal Medicine 3, FAU Erlangen-Nuremberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
- Deutsches Zentrum fuer Immuntherapie (DZI), FAU Erlangen-Nuremberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Judith Haschka
- Karl Landsteiner Institute for Gastroenterology and Rheumatology, 1100 Vienna, Austria
- Ludwig Boltzmann Institute of Osteology, I Medical Department, Hanusch Hospital Vienna, 1140 Vienna, Austria
| | - Michaela Reiser
- Department of Internal Medicine 3, FAU Erlangen-Nuremberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
- Deutsches Zentrum fuer Immuntherapie (DZI), FAU Erlangen-Nuremberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Fabian Hartmann
- Department of Internal Medicine 3, FAU Erlangen-Nuremberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
- Deutsches Zentrum fuer Immuntherapie (DZI), FAU Erlangen-Nuremberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Arnd Kleyer
- Department of Internal Medicine 3, FAU Erlangen-Nuremberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
- Deutsches Zentrum fuer Immuntherapie (DZI), FAU Erlangen-Nuremberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Axel J Hueber
- Department of Internal Medicine 3, FAU Erlangen-Nuremberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
- Deutsches Zentrum fuer Immuntherapie (DZI), FAU Erlangen-Nuremberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Bernhard Manger
- Department of Internal Medicine 3, FAU Erlangen-Nuremberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
- Deutsches Zentrum fuer Immuntherapie (DZI), FAU Erlangen-Nuremberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | | | | | - Hans-Peter Tony
- Rheumatology/Clinical Immunology, Department of Internal Medicine II, University of Würzburg, 97080 Würzburg, Germany
| | - Stephanie Finzel
- Department of Rheumatology and Clinical Immunology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Stefan Kleinert
- Rheumatology Clinical Practice Erlangen, 91054 Erlangen, Germany
| | - Jörg Wendler
- Rheumatology Clinical Practice Erlangen, 91054 Erlangen, Germany
| | - Florian Schuch
- Rheumatology Clinical Practice Erlangen, 91054 Erlangen, Germany
| | | | - Martin Feuchtenberger
- Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, 84489 Burghausen, Germany
| | - Martin Fleck
- Asklepios Medical Center, Department of Rheumatology and Clinical Immunology, 93077 Bad Abbach, Germany
| | - Karin Manger
- Rheumatology Practice Bamberg, 96047 Bamberg, Germany
| | - Wolfgang Ochs
- Rheumatology Practice Bayreuth, 95444 Bayreuth, Germany
| | | | - Hannes Martin Lorenz
- Department of Medicine V, Center for Rheumatic Diseases Baden-Baden, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | | | - Rieke Alten
- Schlosspark Klinik, Internal Medicine/Rheumatology, 14059 Berlin, Germany
| | - Joerg Henes
- Centre for Interdisciplinary Clinical Immunology, University of Tübingen, 72076 Tübingen, Germany
| | - Klaus Krüger
- Praxiszentrum St. Bonifatius, 81541 Munich, Germany
| | - Georg Schett
- Department of Internal Medicine 3, FAU Erlangen-Nuremberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
- Deutsches Zentrum fuer Immuntherapie (DZI), FAU Erlangen-Nuremberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Jürgen Rech
- Department of Internal Medicine 3, FAU Erlangen-Nuremberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
- Deutsches Zentrum fuer Immuntherapie (DZI), FAU Erlangen-Nuremberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| |
Collapse
|
8
|
Ahmad Z, Krüger K, Lautermann J, Lippert B, Tenenbaum T, Tigges M, Tisch M. [Adenoids-diagnosis and treatment: the new German S2k guideline]. HNO 2023; 71:285-293. [PMID: 37071194 PMCID: PMC10125940 DOI: 10.1007/s00106-023-01298-7] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2023] [Indexed: 04/19/2023]
Abstract
Hyperplasia of the pharyngeal tonsils is to be considered pathologic when nasopharyngeal symptoms of mechanical obstruction and/or chronic inflammation occur. Chronic Eustachian tube dysfunction can result in various middle ear diseases such as conductive hearing loss, cholesteatoma, and recurrent acute otitis media. During examination, attention should be paid to the presence of adenoid facies (long face syndrome), with a permanently open mouth and visible tip of the tongue. In the case of severe symptoms and/or failure of conservative treatment, adenoidectomy is usually performed on an outpatient basis. Conventional curettage remains the established standard treatment in Germany. Histologic evaluation is indicated for clinical evidence of mucopolysaccharidoses. Due to the risk of hemorrhage, the preoperative bleeding questionnaire, which is obligatory before every pediatric surgery, is referred to. Recurrence of adenoids is possible despite correct adenoidectomy. Before discharge home, otorhinolaryngologic inspection of the nasopharynx for secondary bleeding should be performed and anesthesiologic clearance obtained.
Collapse
Affiliation(s)
- Z Ahmad
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland.
| | - K Krüger
- Institut für Allgemeinmedizin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - J Lautermann
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Plastische Operationen, Krankenhaus Martha-Maria Halle-Dölau, Halle-Dölau, Deutschland
| | - B Lippert
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Plastische Operationen, SLK-Kliniken Heilbronn GmbH - Standort Gesundbrunnen, Heilbronn, Deutschland
| | - T Tenenbaum
- Klinik für Kinder- und Jugendmedizin, Sana Klinikum Lichtenberg, Berlin, Deutschland
| | - M Tigges
- Hals-Nasen-Ohrenklinik, Städtisches Klinikum Karlsruhe, Karlsruhe, Deutschland
| | - M Tisch
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland
| |
Collapse
|
9
|
Krüger K. [DMARD (disease-modifying antirheumatic drug) treatment in patients with former or current cancer]. Z Rheumatol 2023; 82:206-211. [PMID: 36757415 DOI: 10.1007/s00393-023-01316-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 02/10/2023]
Abstract
In contrast to the original fear that treatment with disease-modifying antirheumatic drugs (DMARDs) and especially with biologic DMARDs (bDMARDs), was associated with an increased risk of the induction of malignancies, this has meanwhile fortunately not been confirmed over the long-term administration. Evaluations from register-based investigations as well as from other long-term cohort studies confirm that neither conventional DMARDs, such as methotrexate, nor tumor necrosis factor (TNF) inhibitors or biologics with a different mode of action show such a risk for induction of cancer or hematological malignancies (for skin tumors see the other article). Regarding the question whether recurrences of former malignancies can be induced by DMARDs, the database is considerably smaller; however, published investigations dealing with this topic so far signal that also in this respect no increased risk can be found. When comparing the individual substances with each other no substantial differences can be found. Although used in the treatment of hematological cancers, rituximab does not offer any advantages in comparison to other biologics. For the group of Janus kinase (JAK) inhibitors, which have been in use only for a few years, data outside the randomized controlled studies (which are limited in time and are conducted with a selected patient population) are limited so that a clear statement regarding the malignancy risk is not yet possible for these substances. In a solitary study comparing tofacitinib with TNF inhibitors in high-risk patients, the malignancy risk of the JAK inhibitor was increased compared to that under TNF inhibitor treatment; however, these results have not yet been confirmed by a second investigation.
Collapse
Affiliation(s)
- Klaus Krüger
- Rheumatologisches Praxiszentrum, St. Bonifatius Str. 5, 81541, München, Deutschland.
| |
Collapse
|
10
|
Kiltz U, Buschhorn-Milberger V, Albrecht K, Lakomek HJ, Lorenz HM, Rudwaleit M, Schneider M, Schulze-Koops H, Aringer M, Hasenbring MI, Herzer P, von Hinüber U, Krüger K, Lauterbach A, Manger B, Oltman R, Schuch F, Schmale-Grede R, Späthling-Mestekemper S, Zinke S, Braun J. [Development of quality standards for patients with rheumatoid arthritis for use in Germany]. Z Rheumatol 2022; 81:744-759. [PMID: 34652486 PMCID: PMC9646547 DOI: 10.1007/s00393-021-01093-1] [Citation(s) in RCA: 2] [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] [Accepted: 08/17/2021] [Indexed: 10/20/2022]
Abstract
Despite a qualitatively and structurally good care of patients with rheumatoid arthritis (RA) in Germany, there are still potentially amendable deficits in the quality of care. For this reason, the German Society for Rheumatology (DGRh) has therefore decided to ask a group of experts including various stakeholders to develop quality standards (QS) for the care of patients with RA in order to improve the quality of care. The QS are used to determine and quantitatively measure the quality of care, subject to relevance and feasibility. The recently published NICE and ASAS standards and a systematic literature search were used as the basis for development. A total of 8 QS, now published for the first time, were approved with the intention to measure and further optimize the quality of care for patients with RA in Germany.
Collapse
Affiliation(s)
- U Kiltz
- Rheumazentrum Ruhrgebiet, Claudiusstr. 45, 44649, Herne, Deutschland.
- Ruhr-Universität Bochum, Bochum, Deutschland.
| | | | - K Albrecht
- Programmbereich Epidemiologie, Deutsches Rheuma-Forschungszentrum (DRFZ), Berlin, Deutschland
| | - H-J Lakomek
- Johannes-Wesling-Klinikum Minden, Universitätsklinik für Geriatrie, Minden, Deutschland
| | - H-M Lorenz
- Sektion Rheumatologie, Medizinische Klinik V, Universitätsklinikum Heidelberg, Universität Heidelberg, Heidelberg, Deutschland
| | - M Rudwaleit
- Universitätsklinik für Innere Medizin und Rheumatologie, Klinikum Bielefeld Rosenhöhe, Universität Bielefeld, Bielefeld, Deutschland
| | - M Schneider
- Poliklinik, Funktionsbereich und Hiller Forschungszentrum für Rheumatologie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - H Schulze-Koops
- Sektion Rheumatologie und Klinische Immunologie, Medizinische Klinik und Poliklinik IV, LMU-Klinikum München, Ludwig-Maximilians-Universität München, München, Deutschland
| | - M Aringer
- Medizinische Klinik und Poliklinik III, Rheumatologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland
| | - M I Hasenbring
- Abteilung für Medizinische Psychologie und Medizinische Soziologie, Ruhr-Universität Bochum, Bochum, Deutschland
| | - P Herzer
- Medicover München MVZ, München, Deutschland
| | - U von Hinüber
- Praxis für Rheumatologie und Osteologie, Hildesheim, Deutschland
| | - K Krüger
- Rheumatologisches Praxiszentrum St. Bonifatius, München, Deutschland
| | - A Lauterbach
- Physiotherapieschule Friedrichsheim, Friedrichsheim, Deutschland
| | - B Manger
- Medizinische Klinik 3 Rheumatologie und Immunologie, Universitätsklinikum, Friedrich-Alexander-Universität Erlangen/Nürnberg, Erlangen, Deutschland
| | - R Oltman
- Hochschule für Gesundheit Bochum, Bochum, Deutschland
| | - F Schuch
- Rheumatologische Schwerpunktpraxis Erlangen, Erlangen, Deutschland
| | | | | | - S Zinke
- Rheumatologische Schwerpunktpraxis Zinke, Berlin, Deutschland
- Bundesverband Deutscher Rheumatologen e. V. (BDRh), Grünwald, Deutschland
| | - J Braun
- Rheumazentrum Ruhrgebiet, Claudiusstr. 45, 44649, Herne, Deutschland
- Ruhr-Universität Bochum, Bochum, Deutschland
| |
Collapse
|
11
|
Reichenberger F, Dechant C, Ley S, Gschwendtner A, Benedikter J, Späthling-Mestekemper S, Kneidinger N, Powitz F, Krüger K, Wahle M, Schwaiblmair M. [Diagnostics of Interstitial Lung Diseases - Practical Instructions with a Focus on Rheumatologic Systemic Diseases]. Dtsch Med Wochenschr 2022; 147:1371-1383. [PMID: 36279863 DOI: 10.1055/a-1877-0275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Interstitial lung diseases (ILD) are etiologically heterogeneous with unknown and known causes like rheumatologic systemic diseases differing in their therapeutic and prognostic consequences. In consensus between pulmonologists, rheumatologists, radiologists, and pathologists, we developed practical instructions for ILD diagnosis in rheumatologic systemic diseases, in particular because ILD can present in early stages of rheumatic systemic diseases. ILD diagnosis is based on clinical assessment results including a detailed medical history, physical examination, focused laboratory tests, radiology with a high-resolution computed tomography, lung function, and histopathology also to differentiate it from cardiac and infection associated lung diseases. The ILD diagnosis is made in a multidisciplinary discussion leading to therapeutic and prognostic consequences. The occurrence of acute exacerbations is especially critical. They are often the causes for ILD progression and are associated with considerable mortality.
Collapse
|
12
|
Krings O, Raabe S, Schumann B, Kamalakkannan S, Glahn F, Krüger K, Foth H. P07-23 C. elegans as a model to study the biological effects of anti-inflammatory drugs and their degradation products after UV-C irradiation under oxygen supply. Toxicol Lett 2022. [DOI: 10.1016/j.toxlet.2022.07.366] [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: 10/14/2022]
|
13
|
Andreev V, Arratia M, Baghdasaryan A, Baty A, Begzsuren K, Belousov A, Bolz A, Boudry V, Brandt G, Britzger D, Buniatyan A, Bystritskaya L, Campbell AJ, Cantun Avila KB, Cerny K, Chekelian V, Chen Z, Contreras JG, Cunqueiro Mendez L, Cvach J, Dainton JB, Daum K, Deshpande A, Diaconu C, Eckerlin G, Egli S, Elsen E, Favart L, Fedotov A, Feltesse J, Fleischer M, Fomenko A, Gal C, Gayler J, Goerlich L, Gogitidze N, Gouzevitch M, Grab C, Greenshaw T, Grindhammer G, Haidt D, Henderson RCW, Hessler J, Hladký J, Hoffmann D, Horisberger R, Hreus T, Huber F, Jacobs PM, Jacquet M, Janssen T, Jung AW, Jung H, Kapichine M, Katzy J, Kiesling C, Klein M, Kleinwort C, Klest HT, Kogler R, Kostka P, Kretzschmar J, Krücker D, Krüger K, Landon MPJ, Lange W, Laycock P, Lee SH, Levonian S, Li W, Lin J, Lipka K, List B, List J, Lobodzinski B, Malinovski E, Martyn HU, Maxfield SJ, Mehta A, Meyer AB, Meyer J, Mikocki S, Mondal MM, Morozov A, Müller K, Nachman B, Naumann T, Newman PR, Niebuhr C, Nowak G, Olsson JE, Ozerov D, Park S, Pascaud C, Patel GD, Perez E, Petrukhin A, Picuric I, Pitzl D, Polifka R, Preins S, Radescu V, Raicevic N, Ravdandorj T, Reimer P, Rizvi E, Robmann P, Roosen R, Rostovtsev A, Rotaru M, Sankey DPC, Sauter M, Sauvan E, Schmitt S, Schmookler BA, Schoeffel L, Schöning A, Sefkow F, Shushkevich S, Soloviev Y, Sopicki P, South D, Spaskov V, Specka A, Steder M, Stella B, Straumann U, Sun C, Sykora T, Thompson PD, Traynor D, Tseepeldorj B, Tu Z, Valkárová A, Vallée C, Van Mechelen P, Wegener D, Wünsch E, Žáček J, Zhang J, Zhang Z, Žlebčík R, Zohrabyan H, Zomer F. Measurement of Lepton-Jet Correlation in Deep-Inelastic Scattering with the H1 Detector Using Machine Learning for Unfolding. Phys Rev Lett 2022; 128:132002. [PMID: 35426724 DOI: 10.1103/physrevlett.128.132002] [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] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 12/20/2021] [Accepted: 02/25/2022] [Indexed: 06/14/2023]
Abstract
The first measurement of lepton-jet momentum imbalance and azimuthal correlation in lepton-proton scattering at high momentum transfer is presented. These data, taken with the H1 detector at HERA, are corrected for detector effects using an unbinned machine learning algorithm (multifold), which considers eight observables simultaneously in this first application. The unfolded cross sections are compared with calculations performed within the context of collinear or transverse-momentum-dependent factorization in quantum chromodynamics as well as Monte Carlo event generators.
Collapse
Affiliation(s)
- V Andreev
- Lebedev Physical Institute, Moscow, Russia
| | - M Arratia
- University of California, Riverside, California 92521, USA
| | | | - A Baty
- Rice University, Houston, Texas 77005-1827, USA
| | - K Begzsuren
- Institute of Physics and Technology of the Mongolian Academy of Sciences, Ulaanbaatar, Mongolia
| | - A Belousov
- Lebedev Physical Institute, Moscow, Russia
| | - A Bolz
- Deutsches Elektronen-Synchrotron DESY, Hamburg, Germany
| | - V Boudry
- LLR, Ecole Polytechnique, CNRS/IN2P3, Palaiseau, France
| | - G Brandt
- II. Physikalisches Institut, Universität Göttingen, Göttingen, Germany
| | - D Britzger
- Max-Planck-Institut für Physik, München, Germany
| | - A Buniatyan
- School of Physics and Astronomy, University of Birmingham, Birmingham, United Kingdom
| | - L Bystritskaya
- Institute for Theoretical and Experimental Physics, Moscow, Russia
| | - A J Campbell
- Deutsches Elektronen-Synchrotron DESY, Hamburg, Germany
| | - K B Cantun Avila
- Departamento de Fisica Aplicada, CINVESTAV, Mérida, Yucatán, México
| | - K Cerny
- Joint Laboratory of Optics, Palacký University, Olomouc, Czech Republic
| | - V Chekelian
- Max-Planck-Institut für Physik, München, Germany
| | - Z Chen
- Shandong University, Shandong, People's Republic of China
| | - J G Contreras
- Departamento de Fisica Aplicada, CINVESTAV, Mérida, Yucatán, México
| | | | - J Cvach
- Institute of Physics, Academy of Sciences of the Czech Republic, Praha, Czech Republic
| | - J B Dainton
- Department of Physics, University of Liverpool, Liverpool, United Kingdom
| | - K Daum
- Fachbereich C, Universität Wuppertal, Wuppertal, Germany
| | - A Deshpande
- Stony Brook University, Stony Brook, New York 11794, USA
| | - C Diaconu
- Aix Marseille Univ, CNRS/IN2P3, CPPM, Marseille, France
| | - G Eckerlin
- Deutsches Elektronen-Synchrotron DESY, Hamburg, Germany
| | - S Egli
- Paul Scherrer Institut, Villigen, Switzerland
| | - E Elsen
- Deutsches Elektronen-Synchrotron DESY, Hamburg, Germany
| | - L Favart
- Inter-University Institute for High Energies ULB-VUB, Brussels and Universiteit Antwerpen, Antwerp, Belgium
| | - A Fedotov
- Institute for Theoretical and Experimental Physics, Moscow, Russia
| | - J Feltesse
- Irfu/SPP, CE Saclay, Gif-sur-Yvette, France
| | - M Fleischer
- Deutsches Elektronen-Synchrotron DESY, Hamburg, Germany
| | - A Fomenko
- Lebedev Physical Institute, Moscow, Russia
| | - C Gal
- Stony Brook University, Stony Brook, New York 11794, USA
| | - J Gayler
- Deutsches Elektronen-Synchrotron DESY, Hamburg, Germany
| | - L Goerlich
- Institute of Nuclear Physics Polish Academy of Sciences, Krakow, Poland
| | | | - M Gouzevitch
- Université Claude Bernard Lyon 1, CNRS/IN2P3, Villeurbanne, France
| | - C Grab
- Institut für Teilchenphysik, ETH, Zürich, Switzerland
| | - T Greenshaw
- Department of Physics, University of Liverpool, Liverpool, United Kingdom
| | | | - D Haidt
- Deutsches Elektronen-Synchrotron DESY, Hamburg, Germany
| | - R C W Henderson
- Department of Physics, University of Lancaster, Lancaster, United Kingdom
| | - J Hessler
- Max-Planck-Institut für Physik, München, Germany
| | - J Hladký
- Institute of Physics, Academy of Sciences of the Czech Republic, Praha, Czech Republic
| | - D Hoffmann
- Aix Marseille Univ, CNRS/IN2P3, CPPM, Marseille, France
| | | | - T Hreus
- Physik-Institut der Universität Zürich, Zürich, Switzerland
| | - F Huber
- Physikalisches Institut, Universität Heidelberg, Heidelberg, Germany
| | - P M Jacobs
- Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - M Jacquet
- IJCLab, Université Paris-Saclay, CNRS/IN2P3, Orsay, France
| | - T Janssen
- Inter-University Institute for High Energies ULB-VUB, Brussels and Universiteit Antwerpen, Antwerp, Belgium
| | - A W Jung
- Department of Physics and Astronomy, Purdue University, West Lafayette, Indiana 47907, USA
| | - H Jung
- Deutsches Elektronen-Synchrotron DESY, Hamburg, Germany
| | - M Kapichine
- Joint Institute for Nuclear Research, Dubna, Russia
| | - J Katzy
- Deutsches Elektronen-Synchrotron DESY, Hamburg, Germany
| | - C Kiesling
- Max-Planck-Institut für Physik, München, Germany
| | - M Klein
- Department of Physics, University of Liverpool, Liverpool, United Kingdom
| | - C Kleinwort
- Deutsches Elektronen-Synchrotron DESY, Hamburg, Germany
| | - H T Klest
- Stony Brook University, Stony Brook, New York 11794, USA
| | - R Kogler
- Deutsches Elektronen-Synchrotron DESY, Hamburg, Germany
| | - P Kostka
- Department of Physics, University of Liverpool, Liverpool, United Kingdom
| | - J Kretzschmar
- Department of Physics, University of Liverpool, Liverpool, United Kingdom
| | - D Krücker
- Deutsches Elektronen-Synchrotron DESY, Hamburg, Germany
| | - K Krüger
- Deutsches Elektronen-Synchrotron DESY, Hamburg, Germany
| | - M P J Landon
- School of Physics and Astronomy, Queen Mary, University of London, London, United Kingdom
| | - W Lange
- Deutsches Elektronen-Synchrotron DESY, Zeuthen, Germany
| | - P Laycock
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - S H Lee
- University of Michigan, Ann Arbor, Michigan 48109, USA
| | - S Levonian
- Deutsches Elektronen-Synchrotron DESY, Hamburg, Germany
| | - W Li
- Rice University, Houston, Texas 77005-1827, USA
| | - J Lin
- Rice University, Houston, Texas 77005-1827, USA
| | - K Lipka
- Deutsches Elektronen-Synchrotron DESY, Hamburg, Germany
| | - B List
- Deutsches Elektronen-Synchrotron DESY, Hamburg, Germany
| | - J List
- Deutsches Elektronen-Synchrotron DESY, Hamburg, Germany
| | | | | | - H-U Martyn
- I. Physikalisches Institut der RWTH, Aachen, Germany
| | - S J Maxfield
- Department of Physics, University of Liverpool, Liverpool, United Kingdom
| | - A Mehta
- Department of Physics, University of Liverpool, Liverpool, United Kingdom
| | - A B Meyer
- Deutsches Elektronen-Synchrotron DESY, Hamburg, Germany
| | - J Meyer
- Deutsches Elektronen-Synchrotron DESY, Hamburg, Germany
| | - S Mikocki
- Institute of Nuclear Physics Polish Academy of Sciences, Krakow, Poland
| | - M M Mondal
- Stony Brook University, Stony Brook, New York 11794, USA
| | - A Morozov
- Joint Institute for Nuclear Research, Dubna, Russia
| | - K Müller
- Physik-Institut der Universität Zürich, Zürich, Switzerland
| | - B Nachman
- Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - Th Naumann
- Deutsches Elektronen-Synchrotron DESY, Zeuthen, Germany
| | - P R Newman
- School of Physics and Astronomy, University of Birmingham, Birmingham, United Kingdom
| | - C Niebuhr
- Deutsches Elektronen-Synchrotron DESY, Hamburg, Germany
| | - G Nowak
- Institute of Nuclear Physics Polish Academy of Sciences, Krakow, Poland
| | - J E Olsson
- Deutsches Elektronen-Synchrotron DESY, Hamburg, Germany
| | - D Ozerov
- Paul Scherrer Institut, Villigen, Switzerland
| | - S Park
- Stony Brook University, Stony Brook, New York 11794, USA
| | - C Pascaud
- IJCLab, Université Paris-Saclay, CNRS/IN2P3, Orsay, France
| | - G D Patel
- Department of Physics, University of Liverpool, Liverpool, United Kingdom
| | | | - A Petrukhin
- Université Claude Bernard Lyon 1, CNRS/IN2P3, Villeurbanne, France
| | - I Picuric
- Faculty of Science, University of Montenegro, Podgorica, Montenegro
| | - D Pitzl
- Deutsches Elektronen-Synchrotron DESY, Hamburg, Germany
| | - R Polifka
- Faculty of Mathematics and Physics, Charles University, Praha, Czech Republic
| | - S Preins
- University of California, Riverside, California 92521, USA
| | - V Radescu
- Department of Physics, Oxford University, Oxford, United Kingdom
| | - N Raicevic
- Faculty of Science, University of Montenegro, Podgorica, Montenegro
| | - T Ravdandorj
- Institute of Physics and Technology of the Mongolian Academy of Sciences, Ulaanbaatar, Mongolia
| | - P Reimer
- Institute of Physics, Academy of Sciences of the Czech Republic, Praha, Czech Republic
| | - E Rizvi
- School of Physics and Astronomy, Queen Mary, University of London, London, United Kingdom
| | - P Robmann
- Physik-Institut der Universität Zürich, Zürich, Switzerland
| | - R Roosen
- Inter-University Institute for High Energies ULB-VUB, Brussels and Universiteit Antwerpen, Antwerp, Belgium
| | - A Rostovtsev
- Institute for Information Transmission Problems RAS, Moscow, Russia
| | - M Rotaru
- Horia Hulubei National Institute for R&D in Physics and Nuclear Engineering (IFIN-HH), Bucharest, Romania
| | - D P C Sankey
- STFC, Rutherford Appleton Laboratory, Didcot, Oxfordshire, United Kingdom
| | - M Sauter
- Physikalisches Institut, Universität Heidelberg, Heidelberg, Germany
| | - E Sauvan
- LAPP, Université de Savoie, CNRS/IN2P3, Annecy-le-Vieux, France
- Aix Marseille Univ, CNRS/IN2P3, CPPM, Marseille, France
| | - S Schmitt
- Deutsches Elektronen-Synchrotron DESY, Hamburg, Germany
| | - B A Schmookler
- Stony Brook University, Stony Brook, New York 11794, USA
| | | | - A Schöning
- Physikalisches Institut, Universität Heidelberg, Heidelberg, Germany
| | - F Sefkow
- Deutsches Elektronen-Synchrotron DESY, Hamburg, Germany
| | - S Shushkevich
- Lomonosov Moscow State University, Skobeltsyn Institute of Nuclear Physics, Moscow, Russia
| | - Y Soloviev
- Lebedev Physical Institute, Moscow, Russia
| | - P Sopicki
- Institute of Nuclear Physics Polish Academy of Sciences, Krakow, Poland
| | - D South
- Deutsches Elektronen-Synchrotron DESY, Hamburg, Germany
| | - V Spaskov
- Joint Institute for Nuclear Research, Dubna, Russia
| | - A Specka
- LLR, Ecole Polytechnique, CNRS/IN2P3, Palaiseau, France
| | - M Steder
- Deutsches Elektronen-Synchrotron DESY, Hamburg, Germany
| | - B Stella
- Dipartimento di Fisica Università di Roma Tre and INFN Roma 3, Roma, Italy
| | - U Straumann
- Physik-Institut der Universität Zürich, Zürich, Switzerland
| | - C Sun
- Shandong University, Shandong, People's Republic of China
| | - T Sykora
- Faculty of Mathematics and Physics, Charles University, Praha, Czech Republic
| | - P D Thompson
- School of Physics and Astronomy, University of Birmingham, Birmingham, United Kingdom
| | - D Traynor
- School of Physics and Astronomy, Queen Mary, University of London, London, United Kingdom
| | - B Tseepeldorj
- Institute of Physics and Technology of the Mongolian Academy of Sciences, Ulaanbaatar, Mongolia
- Ulaanbaatar University, Ulaanbaatar, Mongolia
| | - Z Tu
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - A Valkárová
- Faculty of Mathematics and Physics, Charles University, Praha, Czech Republic
| | - C Vallée
- Aix Marseille Univ, CNRS/IN2P3, CPPM, Marseille, France
| | - P Van Mechelen
- Inter-University Institute for High Energies ULB-VUB, Brussels and Universiteit Antwerpen, Antwerp, Belgium
| | - D Wegener
- Institut für Physik, TU Dortmund, Dortmund, Germany
| | - E Wünsch
- Deutsches Elektronen-Synchrotron DESY, Hamburg, Germany
| | - J Žáček
- Faculty of Mathematics and Physics, Charles University, Praha, Czech Republic
| | - J Zhang
- Shandong University, Shandong, People's Republic of China
| | - Z Zhang
- IJCLab, Université Paris-Saclay, CNRS/IN2P3, Orsay, France
| | - R Žlebčík
- Faculty of Mathematics and Physics, Charles University, Praha, Czech Republic
| | | | - F Zomer
- IJCLab, Université Paris-Saclay, CNRS/IN2P3, Orsay, France
| |
Collapse
|
14
|
Albrecht K, Krüger K. [New aspects on treatment of RA]. Z Rheumatol 2022; 81:91-93. [PMID: 35239022 DOI: 10.1007/s00393-022-01168-7] [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] [Accepted: 10/31/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Katinka Albrecht
- Programmbereich Epidemiologie und Versorgungsforschung, Deutsches Rheuma-Forschungszentrum Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
| | - Klaus Krüger
- Rheumatologisches Praxiszentrum München, St.-Bonifatius-Str. 5, 81541, München, Deutschland.
| |
Collapse
|
15
|
Tony HP, Feist E, Aries PM, Zinke S, Krüger K, Ahlers J, Albrecht I, Barrionuevo C, Kalus S, Burkhardt H. Sarilumab reduces disease activity in rheumatoid arthritis patients with inadequate response to JAK-inhibitors or tocilizumab in regular care in Germany. Rheumatol Adv Pract 2022; 6:rkac002. [PMID: 35146322 PMCID: PMC8824706 DOI: 10.1093/rap/rkac002] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 08/04/2021] [Accepted: 01/06/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
To evaluate safety and effectiveness of sarilumab in rheumatoid arthritis (RA) patients after inadequate response (IR) to janus kinase inhibitors (JAKi) and tocilizumab.
Methods
The prospective, observational, 24-months single-arm PROSARA study (SARILL08661) is currently running in Germany at 96 sites. RA patients were prospectively selected at physician’s discretion according to label. This interim analysis (IA) included 536 patients over a treatment course of up to 6 months. Patients were stratified in 4 groups according to pretreatment before start of sarilumab therapy: 1. last prior treatment JAKi (JAKi-IR), 2. last prior treatment tocilizumab (tocilizumab-IR), 3. any other biological disease-modifying antirheumatic drug (bDMARD) in treatment history (bDMARD TH) and 4. patients who haven’t received any bDMARDs or targeted synthetic (ts) DMARDs (b/tsDMARD naïve) before.
Results
For this pre-planned IA, 536 patients were included in the baseline population, of which 502 patients had at least one corresponding post-baseline effectiveness assessment documented (main analysis population). In all analysed cohorts, safety was consistent with the anticipated profile of sarilumab, without new safety signals. Six months of sarilumab treatment attenuated disease activity in JAKi-IR, tocilizumab-IR, bDMARD TH and b/tsDMARD naïve patients to a very similar extent. Physical function did not substantially change over the course of treatment. Premature study discontinuation rates were comparable between cohorts.
Conclusion
Sarilumab treatment was effective in patients with IR to JAKi and tocilizumab with an expectable safety profile and drug retention over 6 months. Confirmation of this promising results should encourage further studies on this treatment sequence which is highly practically relevant.
Study registration
Paul-Ehrlich-Institut—Federal Institute for Vaccine and Biomedics, SARILL08661
Collapse
Affiliation(s)
- Hans-Peter Tony
- Department of Internal Medicine 2, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Eugen Feist
- Rheumatology and Clinical Immunology, HELIOS Fachklinik Vogelsang/Gommern, Vogelsang, Germany
| | | | - Silke Zinke
- Rheumatologische Schwerpunktpraxis, Berlin, Germany
| | - Klaus Krüger
- Rheumatology Medical Center St. Bonifatius, München, Germany
| | - Jonas Ahlers
- Sanofi-Aventis Deutschland GmbH, Berlin, Germany
| | | | | | - Stefanie Kalus
- GKM Gesellschaft für Therapieforschung mbH, München, Germany
| | - Harald Burkhardt
- Division of Rheumatology/CIRI, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| |
Collapse
|
16
|
Albrecht K, Poddubnyy D, Leipe J, Sewerin P, Iking-Konert C, Scholz R, Krüger K. [Perioperative management of treatment of patients with inflammatory rheumatic diseases : Updated recommendations of the German Society of Rheumatology]. Z Rheumatol 2021; 81:212-224. [PMID: 34928422 DOI: 10.1007/s00393-021-01140-x] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Prior to surgical interventions physicians and patients with inflammatory rheumatic diseases remain concerned about interrupting or continuing anti-inflammatory medication. For this reason, the German Society for Rheumatology has updated its recommendations from 2014. METHODS After a systematic literature search including publications up to 31 August 2021, the recommendations on the use of of glucocorticoids, conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and biologics (bDMARDs) were revised and recommendations on newer drugs and targeted synthetic (ts)DMARDs were added. RESULTS The glucocorticoid dose should be reduced to as low as possible 2-3 months before elective surgery (in any case <10 mg/day) but should be kept stable 1-2 weeks before and on the day of surgery. In many cases csDMARDs can be continued, exceptions being a reduction of high methotrexate doses to ≤15 mg/week and wash-out of leflunomide if there is a high risk of infection. Azathioprine, mycophenolate and ciclosporin should be paused 1-2 days prior to surgery. Under bDMARDs surgery can be scheduled for the end of each treatment interval. For major interventions Janus kinase (JAK) inhibitors should be paused for 3-4 days. Apremilast can be continued. If interruption is necessary, treatment should be restarted as soon as possible for all substances, depending on wound healing. CONCLUSION Whether bDMARDs increase the perioperative risk of infection and the benefits and risks of discontinuation remain unclear based on the currently available evidence. To minimize the risk of a disease relapse under longer treatment pauses, in the updated recommendations the perioperative interruption of bDMARDs was reduced from at least two half-lives to one treatment interval.
Collapse
Affiliation(s)
| | - Denis Poddubnyy
- Rheumatologie am Campus Benjamin Franklin - Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - Jan Leipe
- Sektion Rheumatologie, Medizinische Klinik V, Universitätsklinikum Mannheim, Mannheim, Deutschland
| | - Philipp Sewerin
- Uniklinik Düsseldorf Poliklinik, Funktionsbereich & Hiller Forschungszentrum für Rheumatologie, UKD, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Christof Iking-Konert
- Sektion Rheumatologie, Medizinische Klinik und Poliklinik III, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Roger Scholz
- Orthopädie und Unfallchirurgie, Collm Klinik Oschatz, Oschatz, Deutschland
| | - Klaus Krüger
- Rheumatologisches Praxiszentrum München, St.-Bonifatius-Str. 5, 81541, München, Deutschland.
| |
Collapse
|
17
|
Specker C, Aries P, Braun J, Burmester G, Fischer-Betz R, Hasseli R, Holle J, Hoyer BF, Iking-Konert C, Krause A, Krüger K, Krusche M, Leipe J, Lorenz HM, Moosig F, Schmale-Grede R, Schneider M, Strangfeld A, Voll R, Voormann A, Wagner U, Schulze-Koops H. Updated recommendations of the German Society for Rheumatology for the care of patients with inflammatory rheumatic diseases in the context of the SARS-CoV-2/COVID-19 pandemic, including recommendations for COVID-19 vaccination. Z Rheumatol 2021; 80:33-48. [PMID: 34491403 PMCID: PMC8422376 DOI: 10.1007/s00393-021-01055-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2021] [Indexed: 01/13/2023]
Affiliation(s)
- Christof Specker
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany.
- Klinik für Rheumatologie & Klinische Immunologie, Kliniken Essen-Mitte, Pattbergstr. 2, 45239, Essen, Germany.
| | - Peer Aries
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Rheumatologie im Struenseehaus, Hamburg, Germany
| | - Jürgen Braun
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Rheumazentrum Ruhrgebiet, Ruhr Universität Bochum, Bochum, Germany
| | - Gerd Burmester
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité - Universitätsmedizin Berlin, Freie Universität und Humboldt Universität zu Berlin, Berlin, Germany
| | - Rebecca Fischer-Betz
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Poliklinik, Funktionsbereich und Hiller Forschungszentrum für Rheumatologie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - Rebecca Hasseli
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Abteilung für Rheumatologie und Klinische Immunologie, Justus-Liebig-Universität Gießen, Campus Kerckhoff, Bad Nauheim, Germany
| | - Julia Holle
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Rheumazentrum Schleswig-Holstein Mitte, Neumünster, Germany
| | - Bimba Franziska Hoyer
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Abteilung für Rheumatologie, 1. Medizinische Klinik, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Christof Iking-Konert
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- III. Medizinische Klinik und Poliklinik Sektion Rheumatologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg-Eppendorf, Germany
| | - Andreas Krause
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Abteilung für Rheumatologie, Osteologie und Klinische Immunologie, Immanuel Krankenhaus Berlin, Berlin, Germany
| | - Klaus Krüger
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Rheumatologisches Praxiszentrum München, Munich, Germany
| | - Martin Krusche
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité - Universitätsmedizin Berlin, Freie Universität und Humboldt Universität zu Berlin, Berlin, Germany
| | - Jan Leipe
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Abteilung für Rheumatologie, Medizinische Klinik V, Universitätskrankenhaus Mannheim, Mannheim, Germany
| | - Hanns-Martin Lorenz
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Sektion Rheumatologie, Medizinische Klinik V, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Frank Moosig
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Rheumazentrum Schleswig-Holstein Mitte, Neumünster, Germany
| | | | - Matthias Schneider
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Poliklinik, Funktionsbereich und Hiller Forschungszentrum für Rheumatologie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - Anja Strangfeld
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Programmbereich Epidemiologie und Versorgungsforschung, Deutsches Rheumaforschungszentrum Berlin, Berlin, Germany
| | - Reinhard Voll
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Klinik für Rheumatologie und Klinische Immunologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Universität Freiburg, Freiburg, Germany
| | - Anna Voormann
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
| | - Ulf Wagner
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Abteilung für Rheumatologie, Klinik und Poliklinik für Endokrinologie, Nephrologie, Rheumatologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Hendrik Schulze-Koops
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany.
- Sektion Rheumatologie und Klinische Immunologie, Medizinische Klinik IV, Ludwig-Maximilians-Universität München, Pettenkoferstraße 8a, Munich, Germany.
| |
Collapse
|
18
|
Schneider U, Siegert E, Gläser S, Krüger K, Krause A. [Importance of mycophenolate mofetil for treatment of interstitial lung disease in systemic sclerosis]. Z Rheumatol 2021; 80:868-878. [PMID: 34545432 PMCID: PMC8575738 DOI: 10.1007/s00393-021-01088-y] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2021] [Indexed: 11/28/2022]
Abstract
Interstitial lung disease in systemic sclerosis (SSc-ILD) is a frequent organ complication with considerable mortality. Therapeutically, immunosuppressants are primarily used, particularly cyclophosphamide (CYC) and mycophenolate mofetil (MMF). Recently acquired data also showed an efficacy of the biologics rituximab and tocilizumab. The therapeutic options have most recently been expanded by the approval of the antifibrotic drug nintedanib. It is particularly beneficial in progressive fibrosing courses of ILD despite immunosuppression. The data from controlled trials on the efficacy and safety of CYC and MMF compiled in this review argue for a preferential use of MMF; however, the approval of MMF for this indication is still lacking. This is urgently needed for improved and simplified care of patients with SSc-ILD.
Collapse
Affiliation(s)
- Udo Schneider
- Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
| | - Elise Siegert
- Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
- Berlin Institute of Health, Berlin, Deutschland
| | - Sven Gläser
- Klinik für Innere Medizin - Pneumologie und Infektiologie, Vivantes Klinikum Neukölln, Berlin, Deutschland
- Klinik für Innere Medizin - Pneumologie, Vivantes Klinikum Spandau, Berlin, Deutschland
| | - Klaus Krüger
- Rheumatologisches Praxiszentrum, München, Deutschland
| | - Andreas Krause
- Klinik für Innere Medizin, Abteilung Rheumatologie, Klinische Immunologie und Osteologie, Immanuel Krankenhaus Berlin, Berlin, Deutschland
| |
Collapse
|
19
|
Leipe J, Holle JU, Weseloh C, Pfeil A, Krüger K. German Society of Rheumatology recommendations for management of glucocorticoid-induced osteoporosis. Z Rheumatol 2021; 80:49-63. [PMID: 34705070 DOI: 10.1007/s00393-021-01025-z] [Citation(s) in RCA: 6] [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] [Accepted: 07/12/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Glucocorticoids are of substantial therapeutic importance in the treatment of inflammatory diseases, but are also associated with bone mineral density loss, osteoporosis, and fractures, especially with long-term use. OBJECTIVE To develop recommendations for the management of glucocorticoid-induced osteoporosis (GIOP) in adult patients on long-term glucocorticoid (GC) treatment. METHODS A systematic literature search (SLR) was conducted to synthesize the evidence for GIOP prevention and treatment options. Recommendations were developed based on SLR/level of evidence and by previously defined questions and in a structured group consensus process. RESULTS Recommendations include supplementation with calcium and vitamin D under long-term GC therapy in adults. If specific osteologic treatment is indicated, we recommend bisphosphonates or denosumab as first-line treatment. If fracture risk is high, we recommend teriparatide as primary specific osteologic treatment. Denosumab should be used in cases of severe renal insufficiency, and specific osteologic treatment should not be given in pregnancy. For patients who have not reached the treatment goal, a switch to another class of specific osteologic drugs should be performed. We recommend re-evaluation after a treatment duration of 3-5 years or after termination of long-term GC treatment. CONCLUSION This work aims to provide evidence-based and consensus-based recommendations for the best possible management of GIOP in Germany and to support treatment decisions.
Collapse
Affiliation(s)
- Jan Leipe
- Division of Rheumatology, Department of Medicine V, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany. .,Division of Rheumatology and Clinical Immunology, Medizinische Klinik and Poliklinik IV, University of Munich, Munich, Germany.
| | - Julia U Holle
- Rheumazentrum Schleswig-Holstein Mitte, Neumünster, Germany
| | - Christiane Weseloh
- German Society of Rheumatology (Deutsche Gesellschaft für Rheumatologie, DGRh), Berlin, Germany
| | - Alexander Pfeil
- Department of Internal Medicine III, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Klaus Krüger
- Rheumatologisches Praxiszentrum München, Munich, Germany
| |
Collapse
|
20
|
Leipe J, Holle JU, Weseloh C, Pfeil A, Krüger K. [German Society of Rheumatology Recommendations for the management of glucocorticoid-induced Osteoporosis. German version]. Z Rheumatol 2021; 80:670-687. [PMID: 34357436 DOI: 10.1007/s00393-021-01028-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Glucocorticoids are of substantial therapeutic importance in the treatment of inflammatory diseases, but are also associated with bone mineral density loss, osteoporosis, and fractures, especially with long-term use. OBJECTIVE To develop recommendations for the management of glucocorticoid-induced osteoporosis (GIOP) in adult patients on long-term glucocorticoid (GC) treatment. METHODS A systematic literature search (SLR) was conducted to synthesize the evidence for GIOP prevention and treatment options. Recommendations were developed based on SLR/level of evidence and by previously defined questions and in a structured group consensus process. RESULTS Recommendations include supplementation with calcium and vitamin D under long-term GC therapy in adults. If specific osteologic treatment is indicated, we recommend bisphosphonates or denosumab as first-line treatment. If fracture risk is high, we recommend teriparatide as primary specific osteologic treatment. Denosumab should be used in cases of severe renal insufficiency, and specific osteologic treatment should not be given in pregnancy. For patients who have not reached the treatment goal, a switch to another class of specific osteologic drugs should be performed. We recommend re-evaluation after a treatment duration of 3-5 years or after termination of long-term GC treatment. CONCLUSION This work aims to provide evidence-based and consensus-based recommendations for the best possible management of GIOP in Germany and to support treatment decisions.
Collapse
Affiliation(s)
- Jan Leipe
- Sektion Rheumatologie, Medizinische Klinik V, Universitätskrankenhaus Mannheim, Universitätsklinikum Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland. .,Sektion Rheumatologie und Klinische Immunologie, Medizinische Klinik IV, Ludwig-Maximilians-Universität München, München, Deutschland.
| | - Julia U Holle
- Rheumazentrum Schleswig-Holstein Mitte, Neumünster, Deutschland
| | | | - Alexander Pfeil
- Klinik für Innere Medizin III, Funktionsbereich Rheumatologie, Universitätsklinikum Jena, Jena, Deutschland
| | - Klaus Krüger
- Rheumatologisches Praxiszentrum München, München, Deutschland
| | | |
Collapse
|
21
|
Specker C, Aries P, Braun J, Burmester G, Fischer-Betz R, Hasseli R, Holle J, Hoyer BF, Iking-Konert C, Krause A, Krüger K, Krusche M, Leipe J, Lorenz HM, Moosig F, Schmale-Grede R, Schneider M, Strangfeld A, Voll R, Voormann A, Wagner U, Schulze-Koops H. [Updated recommendations of the German Society for Rheumatology for the care of patients with inflammatory rheumatic diseases in the context of the SARS-CoV‑2/COVID‑19 pandemic, including recommendations for COVID‑19 vaccination]. Z Rheumatol 2021; 80:570-587. [PMID: 34309739 PMCID: PMC8311067 DOI: 10.1007/s00393-021-01056-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Christof Specker
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland.
- Klinik für Rheumatologie und Klinische Immunologie, Kliniken Essen-Mitte, Pattbergstr. 2, 45239, Essen, Deutschland.
| | - Peer Aries
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Rheumatologie im Struenseehaus, Hamburg, Deutschland
| | - Jürgen Braun
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Rheumazentrum Ruhrgebiet, Ruhr Universität Bochum, Bochum, Deutschland
| | - Gerd Burmester
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité - Universitätsmedizin Berlin, Freie Universität und Humboldt Universität zu Berlin, Berlin, Deutschland
| | - Rebecca Fischer-Betz
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Poliklinik, Funktionsbereich und Hiller Forschungszentrum für Rheumatologie, Universitätsklinikum Düsseldorf, , Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Rebecca Hasseli
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Abteilung für Rheumatologie und Klinische Immunologie, Justus-Liebig-Universität Gießen, Campus Kerckhoff, Bad Nauheim, Deutschland
| | - Julia Holle
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Rheumazentrum Schleswig-Holstein Mitte, Neumünster, Deutschland
| | - Bimba Franziska Hoyer
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Abteilung für Rheumatologie, 1. Medizinische Klinik, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - Christof Iking-Konert
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- III. Medizinische Klinik und Poliklinik Sektion Rheumatologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg-Eppendorf, Deutschland
| | - Andreas Krause
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Abteilung für Rheumatologie, Osteologie und Klinische Immunologie, Immanuel Krankenhaus Berlin, Berlin, Deutschland
| | - Klaus Krüger
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Rheumatologisches Praxiszentrum München, München, Deutschland
| | - Martin Krusche
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité - Universitätsmedizin Berlin, Freie Universität und Humboldt Universität zu Berlin, Berlin, Deutschland
| | - Jan Leipe
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Abteilung für Rheumatologie, Medizinische Klinik V, Universitätskrankenhaus Mannheim, Mannheim, Deutschland
| | - Hanns-Martin Lorenz
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Sektion Rheumatologie, Medizinische Klinik V, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Frank Moosig
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Rheumazentrum Schleswig-Holstein Mitte, Neumünster, Deutschland
| | | | - Matthias Schneider
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Poliklinik, Funktionsbereich und Hiller Forschungszentrum für Rheumatologie, Universitätsklinikum Düsseldorf, , Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Anja Strangfeld
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Programmbereich Epidemiologie und Versorgungsforschung, Deutsches Rheumaforschungszentrum Berlin, Berlin, Deutschland
| | - Reinhard Voll
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Klinik für Rheumatologie und Klinische Immunologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Universität Freiburg, Freiburg, Deutschland
| | - Anna Voormann
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
| | - Ulf Wagner
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Abteilung für Rheumatologie, Klinik und Poliklinik für Endokrinologie, Nephrologie, Rheumatologie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Hendrik Schulze-Koops
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland.
- Sektion Rheumatologie und Klinische Immunologie, Medizinische Klinik IV, Ludwig-Maximilians-Universität München, Pettenkoferstr. 8a, 80336, München, Deutschland.
| |
Collapse
|
22
|
Abstract
Die Frage, ob eine laufende MTX(Methotrexat)-Therapie tatsächlich die protektive Immunantwort nach SARS-CoV-2-Impfung in relevanter Form abschwächt, lässt sich anhand der vorliegenden Daten definitiv nicht beantworten. In Kenntnis der Tatsache, dass ein kurzes z. B. 1‑ oder 2‑maliges Pausieren der wöchentlichen MTX-Gabe bei Patienten in stabiler Krankheitssituation mit einem vergleichsweise geringen Risiko der Auslösung eines Schubes der Grundkrankheit verbunden ist, kann eine solche kurze Unterbrechung der Therapie nach individueller Entscheidung zwischen Patient*in und behandelnder/m Rheumatolog*in durchaus erwogen werden. Zwingend notwendig erscheint sie aber nicht – zumal diese Pause bei den meisten Impfstoffen 2‑mal innerhalb relativ kurzer Zeit erfolgen müsste. Keinesfalls aber sollte eine längere Therapiepause gemacht werden – die Auslösung eines Schubes der Grundkrankheit wäre eine mögliche kritische Folge. Für eine ausführlichere Einschätzung der Datenlage und der Konsequenzen daraus (auch in Bezug auf weitere DMARD [„disease-modifying anti-rheumatic drugs“]) wird auf die demnächst erscheinenden aktualisierten Handlungsempfehlungen der DGRh (Deutsche Gesellschaft für Rheumatologie e. V.) für die Betreuung von Patienten mit entzündlich rheumatischen Erkrankungen im Rahmen der SARS-CoV-2/COVID-19-Pandemie verwiesen.
Collapse
Affiliation(s)
- Klaus Krüger
- Rheumatologisches Praxiszentrum, St.-Bonifatius-Str. 5, 81541, München, Deutschland.
| | | |
Collapse
|
23
|
Schulze-Koops H, Krüger K, Hoyer BF, Leipe J, Iking-Konert C, Specker C. Updated recommendations of the German Society for Rheumatology for the care of patients with inflammatory rheumatic diseases in times of SARS-CoV-2-methodology, key messages and justifying information. Rheumatology (Oxford) 2021; 60:2128-2133. [PMID: 33502500 PMCID: PMC7928544 DOI: 10.1093/rheumatology/keab072] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 09/17/2020] [Revised: 12/13/2020] [Accepted: 12/29/2020] [Indexed: 12/14/2022] Open
Abstract
A few days after the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was declared a pandemic, the German Society for Rheumatology (DGRh) compiled the first group of recommendations for the care of patients with inflammatory rheumatic diseases in light of SARS-CoV-2/coronavirus disease 2019 (COVID-19). These first recommendations were based on an expert consensus and were largely non-evidence-based. Now that the first scientific data from registries, cross-sectional studies, case reports and case series are available, the DGRh has developed a timely update. This update is based on a literature search of publications available through 15 June 2020 and addresses preventive measures (such as hygiene measures or vaccinations) and the use of immunomodulatory/immunosuppressive drugs. Driven by the commitment to let patients benefit from these new evidence-based recommendations as quickly as possible, the DGRh published the update in German on its homepage and in the Zeitschrift für Rheumatologie immediately after completion. Here we report the key recommendations to make them available to the international community, provide the scientific methodology used to develop the recommendations, give additional thoughts and advice for the management of patients with rheumatic diseases during the COVID-19 pandemic and discuss our recommendations in the context of other international recommendations.
Collapse
Affiliation(s)
- Hendrik Schulze-Koops
- Division of Rheumatology and Clinical Immunology, Department of Medicine IV, Ludwig-Maximilians-Universität München
| | - Klaus Krüger
- Rheumatologisches Praxiszentrum München, München
| | - Bimba Franziska Hoyer
- Division of Rheumatology, Department of Medicine 1, University Hospital Schleswig-Holstein Campus Kiel, Kiel
| | - Jan Leipe
- Division of Rheumatology, Department of Medicine V, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Heidelberg
| | - Christof Iking-Konert
- Department of Medicine III and Section Rheumatology, University Hospital Hamburg-Eppendorf, Hamburg
| | - Christof Specker
- Clinic for Rheumatology and Clinical Immunology, Kliniken Essen-Mitte, Essen, Germany
| | | |
Collapse
|
24
|
Selmi C, Krüger K, Cantagrel A, Abad Hernández MA, Freudensprung U, Farouk Rezk M, Addison J. BENEFIT: real-world effectiveness of SB4 after transition from reference etanercept in rheumatoid arthritis and axial spondyloarthritis. Clin Exp Rheumatol 2021. [DOI: 10.55563/clinexprheumatol/usrd9z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Carlo Selmi
- Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center - IRCCS, Rozzano, and Department of Biomedical Sciences, Humanitas University, Milan, Italy.
| | | | - Alain Cantagrel
- Centre of Rheumatology, CHU Pierre Paul Riquet, Toulouse, France
| | | | | | | | | |
Collapse
|
25
|
Wernicke K, Grischke J, Stiesch M, Zeissler S, Krüger K, Bauer P, Hillebrecht A, Eberhard J. Influence of physical activity on periodontal health in patients with type 2 diabetes mellitus. A blinded, randomized, controlled trial. Clin Oral Investig 2021; 25:6101-6107. [PMID: 33796948 PMCID: PMC8531088 DOI: 10.1007/s00784-021-03908-6] [Citation(s) in RCA: 4] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 03/23/2021] [Indexed: 11/30/2022]
Abstract
Objectives The aim was to investigate the effect of physical activity on periodontal health and HbA1c levels in patients with type 2 diabetes mellitus (T2DM) over a period of 6 months. Materials and methods Thirty-seven patients with non-insulin-dependent T2DM were included in the study. The intervention group (n=20) performed physical activity over a period of 6 months. The control group (n=17) did not receive any intervention. Baseline and final examinations included dental parameters and concentrations of glycosylated hemoglobin (HbA1c) and high-sensitivity C-reactive protein (hsCRP). Results Physical activity showed a positive effect on periodontal health. Both the BOP (p= 0.005) and the severity of periodontitis (p= 0.001) were significantly reduced in the intervention group compared to the control group. Furthermore, HbA1c levels were reduced (p= 0.010) significantly in the intervention group while hsCRP levels significantly increased in the control group (p= 0.04). Conclusions Within the limitations of this randomized, controlled trial, physical activity over a period of 6 months is a health-promoting measure for patients with T2DM and improves both periodontal health and HbA1c concentrations.
Collapse
Affiliation(s)
- K Wernicke
- Hannover Medical School, Hanover, Germany
| | - J Grischke
- Hannover Medical School, Hanover, Germany. .,Department of Prosthetic Dentistry and Biomedical Materials Science, Hannover Medical School, Carl-Neuberg-Str.1, 30625, Hannover, Germany.
| | - M Stiesch
- Hannover Medical School, Hanover, Germany
| | | | - K Krüger
- Justus-Liebig-Universität Gießen, Gießen, Germany
| | - P Bauer
- Justus-Liebig-Universität Gießen, Gießen, Germany
| | | | - J Eberhard
- The University of Sydney School of Dentistry and the Charles Perkins Centre, Faculty of Health and Medicine, The University of Sydney, Sydney, Australia
| |
Collapse
|
26
|
Abstract
Infektionen spielen für die Morbidität und Mortalität von Patienten mit rheumatologischen Erkrankungen eine wichtige Rolle. Das Infektionsrisiko wird zum einen durch allgemeine Faktoren wie das Alter des Patienten und vorhandene Komorbiditäten, zum anderen krankheitsbezogen durch die Aktivität der Grunderkrankung selbst und durch die laufende – insbesondere immunsuppressive – Therapie bestimmt. Dementsprechend zählen zu wichtigsten risikoverringernden Maßnahmen eine optimale Kontrolle über die Krankheitsaktivität und die Erfassung und optimale Behandlung eventuell vorhandener Komorbiditäten. Notwendig ist außerdem die Erkennung und besondere Überwachung von Patienten mit erhöhtem Infektionsrisiko, wie z. B. schweren Infektionen in der Anamnese. Weiterhin kann die Wahl der antirheumatischen Therapie das Risiko beeinflussen: risikosteigernd wirken besonders Glucocorticoide (GC), eher risikosenkend bei guter Krankheitskontrolle und optimiertem Einsatz DMARDs („disease-modifying anti-rheumatic drugs“). Schließlich sorgen prophylaktische Maßnahmen wie Schutztherapien und optimierter Impfstatus für eine Verringerung des Infektionsrisikos.
Collapse
Affiliation(s)
- Christian Kneitz
- Rheumatologische Schwerpunktpraxis Schwerin, Beethovenstr. 3, 19053, Schwerin, Deutschland.
| | - Klaus Krüger
- Rheumatologisches Praxiszentrum, München, Deutschland
| |
Collapse
|
27
|
Exarchos V, Meyborg H, Krüger K, Giampietro C, Moimas S, Chala N, Cesarovic N, Emmert MY, Falk V, Ferrari A, Shafti MTN. The Rejuvenative Impact of Anisotropic Topographies on Senescent Endothelial Cells. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
28
|
Abstract
BACKGROUND Welders demonstrate a high prevalence of musculoskeletal disorders (MSDs), as indicated by high rates of illness-related absenteeism. Leisure time physical activity (LTPA) could be a preventive strategy. However, little is known about LTPA prevalence and its association with MSDs among welders. AIMS The aim of this study was to analyse the prevalence of MSD and LTPA levels among welders and to identify risk factors for the main disorder of low back pain (LBP). METHODS The following data were collected from 145 welders from 34 companies in the German steel industry: individual factors (demographics, health behaviour), job-related factors (welding process, welding hours per day, employment years, shift work, ergonomic tools) and MSD (Nordic questionnaire). LTPA (International Physical Activity Questionnaire) was calculated to determine the metabolic equivalent of task (MET) per week as an objective measure of energy expenditure. Prevalence and multivariate regression analysis were calculated to determine odds ratios (ORs). RESULTS The 12-month prevalence of LBP was 71%, for neck pain 61% and for shoulder pain 55%. Forty-two per cent of the participants accumulated <600 MET/week. The multivariate regression model revealed LTPA <600 MET/week (OR 3.4, 95% CI 1.05-10.85) and neck pain in the previous 12 months (OR 5.2, 95% CI 2.02-13.56) to be significantly associated with LBP. CONCLUSIONS The results show a high prevalence of MSDs and thus a strong requirement for intervention. Therefore, LTPA should be prioritized and employers should encourage access to regular activity.
Collapse
Affiliation(s)
- C Weyh
- Department of Exercise Physiology and Sports Therapy, Justus-Liebig-University, Kugelberg, Giessen, Germany
| | - C Pilat
- Department of Exercise Physiology and Sports Therapy, Justus-Liebig-University, Kugelberg, Giessen, Germany
| | - K Krüger
- Department of Exercise Physiology and Sports Therapy, Justus-Liebig-University, Kugelberg, Giessen, Germany
| |
Collapse
|
29
|
Tayebi S, Krüger K, Safakar M, Bahrami P, Tahmasb G, Nenasheva A. EFFECTS OF ZIZIPHUS JUJUBE SUPPLEMENTATION ON PRO- AND ANTI-APOPTOTIC PROTEIN EXPRESSION IN NEUTROPHILS AFTER RESISTANCE EXERCISE. hsm 2020. [DOI: 10.14529/hsm200301] [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: 11/10/2022]
Abstract
Introduction. It is suggested that jujube might have beneficial effects on exercise-induced immune perturbations, specifically on neutrophils apoptosis regulation, but its cellular mechanism is unclear. Aim. The aim of this study was to investigate the acute effect of Ziziphus jujuba administration on pro- and anti-apoptotic protein levels in human neutrophils in response to a session of circuit resistance exercise (Ex). Material and Methods. Participants completed an Ex (75 % 1RM, 9 exercises, 3 sets). While one group received a placebo, the other group (Zj) was supplemented daily with jujube (0.5 gr/kg body weight suspended in 2.5cc distilled water) one hour before Ex. Results. Ex increased the neutrophil level of [Ca2+]i, calpain-1 and caspase-3 (p < 0.05) while a reduction of calpastatin and XIAP were observed (p < 0.05). Zj either suppressed the [Ca2+]i or reversed the calpastatin, calpain-1, XIAP, and caspase-3 responses (p < 0.01). Conclusions. The data indicate that a single session of intensive Ex induced apoptotic signaling in human neutrophils with the involvement of [Ca2+]i-calpastatin-calpain axis upstream caspase-3. Acute administration of jujube solution before exercise attenuated these effects probably by providing energy sources for neutrophils or by functioning as antioxidants.
Collapse
|
30
|
Krüger K. Interstitielle Lungenerkrankung (ILD) – wann und wie behandeln? Z Rheumatol 2020; 79:780-781. [DOI: 10.1007/s00393-020-00829-9] [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]
|
31
|
Krüger K. Komorbiditäten-Assessment durch die Fachassistentin – die ERIKO-Studie. Z Rheumatol 2020; 79:55-56. [DOI: 10.1007/s00393-020-00865-5] [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: 12/01/2022]
|
32
|
Affiliation(s)
- A Krause
- Abteilung Rheumatologie, Klinische Immunologie und Osteologie, Immanuel Krankenhaus Berlin, Königstraße 63, 14109, Berlin, Deutschland.
| | - K Krüger
- Rheumatologisches Praxiszentrum, München, Deutschland
| | - J Braun
- Rheumazentrum Ruhrgebiet und Ruhr-Universität Bochum, Herne, Deutschland
| | - G Gauler
- Rheumapraxis an der Hase, Osnabrück, Deutschland
| | - K Hoeper
- Klinik für Immunologie und Rheumatologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - F Schuch
- Internistische Praxisgemeinschaft Rheumatologie - Nephrologie, Erlangen, Deutschland
| | - A J Voormann
- Deutsche Gesellschaft für Rheumatologie, Berlin, Deutschland
| |
Collapse
|
33
|
Abstract
Modern rheumatology enables better and earlier diagnosis and therapy of inflammatory rheumatic system diseases. At the same time, the requirements for the care of rheumatologic patients have risen considerably for non-medical assistant professions and specialists for nursing professions. Since 2006 there has been established an education curriculum "Rheumatological Specialist Assistant DGRh-BDRh" (RFA) with the training to become a "Rheumatological Specialist Assistant (DGRh-BDRh)". In Europe and in parallel in Germany, assistant professions are increasingly involved in the early detection and care of patients with rheumatic diseases and entrusted with tasks.In this work, the overarching principles for delegation of medical tasks to RFA and recommendations for the delegation are published by the Commission for Delegation of the German Society for Rheumatology (DGRh). These recommendations are based on the requirements of the German Medical Association and have been legally evaluated. With the extension of the training of the RFA board certification is aimed for "MFA for Rheumatology". These recommendations enable more transparency and security for delegating doctors and the delegated RFA's.
Collapse
Affiliation(s)
- A Krause
- Klinik für Innere Medizin, Abteilung Rheumatologie, Klinische Immunologie und Osteologie, Immanuel Krankenhaus Berlin, Königstr. 63, 14109, Berlin, Deutschland.
| | - F Schuch
- Rheumatologische Schwerpunktpraxis Erlangen, Erlangen, Deutschland
| | - J Braun
- Rheumazentrum Ruhrgebiet, Lehrstuhl für Rheumatologie, Ruhr Universität Bochum, Bochum, Deutschland
| | - G Gauler
- Rheumapraxis, Else Brandström Str., Osnabrück, Deutschland
| | - K Hoeper
- Klinik für Immunologie und Rheumatologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - K Krüger
- Praxiszentrum St. Bonifatius, München, Deutschland
| | - M Wallhäuser
- PPP Rechtsanwälte, Bergisch Gladbach, Deutschland
| | - A J Voormann
- Dt. Gesellschaft für Rheumatologie, Berlin, Deutschland
| |
Collapse
|
34
|
Fiehn C, Ness T, Weseloh C, Specker C, Hadjiski D, Detert J, Krüger K. [Safety management of the treatment with antimalarial drugs in rheumatology. Interdisciplinary recommendations based on a systematic literature search]. Z Rheumatol 2020; 79:186-194. [PMID: 32095892 DOI: 10.1007/s00393-020-00751-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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] [Indexed: 11/27/2022]
Abstract
BACKGROUND Antimalarial medication (AM) plays an important role in the treatment of rheumatic diseases. OBJECTIVE Updated evidence-based recommendations on the safety management of rheumatological treatment with AM are presented. METHODS A systematic literature search in the databases Medline (PubMed) and Cochrane identified 1160 studies on the safety of treatment with AM in rheumatology. In addition, a manual search was carried out and 67 publications considered to be particularly relevant by the authors were analyzed in more detail. These publications served as a basis for consensus-based recommendations. RESULTS Treatment with AM in rheumatology should be carried out with hydroxychloroquine (HCQ) with a dosage not exceeding 5 mg/kg body weight/day. Patients should undergo a basic ophthalmological examination within the first 6 months of AM treatment. Pre-existing maculopathy, renal insufficiency (glomerular filtration rate, GFR <60 ml/min), tamoxifen comedication, a daily dose of >5 mg/kg HCQ or treatment with chloroquine (CQ) show an increased risk for AM-induced retinopathy. These patients should undergo an annual ophthalmological check from the beginning of the treatment, whereas patients with no risk factors are recommended to start this only after 5 years of taking the medication. The ophthalmological examination should comprise at least both an appropriate subjective and an objective method and these are usually an automated visual field test and optical coherence tomography (OCT). A visual field test revealing a parafoveal sensitivity loss and an OCT showing a parafoveal circumscribed loss of the photoreceptor layer or focal interruptions of the structural line of the outer segment are signs of a possible AM retinopathy. Determination of creatine kinase (CK) and lactate dehydrogenase (LDH) in blood is appropriate to screen for cardiomyopathy and myopathy and should be checked before starting the treatment and then ca. every 3 months. The use of cardiac biomarkers, such as brain natriuretic peptide (BNP) or troponin in serum, electrocardiograph (ECG) or cardiac imaging should be considered depending on the situation. An intake of HCQ is safe during pregnancy and breastfeeding according to the current state of knowledge and is protective for mother and child in patients with systemic lupus erythematosus. CONCLUSION The updated recommendations on AM treatment in rheumatology in particular include a more rigorous measuring of doses, risk stratification in monitoring and defined ophthalmological examination methods to detect a possible retinopathy.
Collapse
Affiliation(s)
- C Fiehn
- Rheumatologie Baden-Baden GbR, Tätigkeitsschwerpunkt Klinische Immunologie und Belegarzteinheit der ViDia-Kliniken Karlsruhe, Medical Center Baden-Baden, Beethovenstr. 2, 76530, Baden-Baden, Deutschland.
| | - T Ness
- Klinik für Augenheilkunde, Universitätsklinik Freiburg, Freiburg, Deutschland
| | - C Weseloh
- Deutsche Gesellschaft für Rheumatologie, Berlin, Deutschland
| | - C Specker
- Klinik für Rheumatologie und Klinische Immunologie, Kliniken Essen-Mitte, Essen, Deutschland
| | - D Hadjiski
- Rheumatologie Baden-Baden GbR, Tätigkeitsschwerpunkt Klinische Immunologie und Belegarzteinheit der ViDia-Kliniken Karlsruhe, Medical Center Baden-Baden, Beethovenstr. 2, 76530, Baden-Baden, Deutschland
| | - J Detert
- Rheumatologisch-immunologische Arztpraxis, Templin, Deutschland
| | - K Krüger
- Praxiszentrum St. Bonifatius, München, Deutschland
| |
Collapse
|
35
|
Schulze-Koops H, Iking-Konert C, Leipe J, Hoyer BF, Holle J, Moosig F, Aries P, Burmester G, Fiehn C, Krause A, Lorenz HM, Schneider M, Sewerin P, Voormann A, Wagner U, Krüger K, Specker C. [Recommendations of the German Society for Rheumatology for management of patients with inflammatory rheumatic diseases in the context of the SARS-CoV-2/COVID-19 pandemic - Update July 2020]. Z Rheumatol 2020; 79:679-685. [PMID: 32757030 PMCID: PMC7403789 DOI: 10.1007/s00393-020-00851-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
A few days after the SARS-CoV-2 infection was declared a pandemic, the German Society for Rheumatology (DGRh) compiled first recommendations for the care of patients with inflammatory rheumatic diseases (IRD). These first recommendations were based on an expert consensus and were largely non-evidence-based. Now that the first scientific data from registers, cross-sectional studies, case reports and case series are available, the present update is intended to update the previous recommendations and to add new findings. The current recommendations are based on a literature search of publications available up to 15 June 2020 and address preventive measures (such as hygiene measures or vaccinations) and the use of immunomodulatory/immunosuppressive drugs. An important goal of the current recommendations is also to prevent harm to patients with IRD through unjustified restriction of care. The DGRh will continue to update its recommendations in the case of new aspects and will publish them as well as further information on the COVID-19 pandemic on its homepage ( www.dgrh.de ) in an ongoing process.
Collapse
Affiliation(s)
- Hendrik Schulze-Koops
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland.
- Sektion Rheumatologie und Klinische Immunologie, Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität München, Pettenkoferstr. 8a, 80336, München, Deutschland.
| | - Christof Iking-Konert
- III. Medizinische Klinik und Poliklinik, Sektion Rheumatologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Jan Leipe
- Abteilung für Rheumatologie, Medizinische Klinik V, Universitätskrankenhaus Mannheim, Mannheim, Deutschland
| | - Bimba Franziska Hoyer
- Abteilung für Rheumatologie, 1. Medizinische Klinik, Universitätskrankenhaus Schleswig-Holstein Campus Kiel, Kiel, Deutschland
| | - Julia Holle
- Rheumazentrum Schleswig-Holstein Mitte, Neumünster, Deutschland
| | - Frank Moosig
- Rheumazentrum Schleswig-Holstein Mitte, Neumünster, Deutschland
| | - Peer Aries
- Rheumatologie im Struenseehaus, Hamburg, Deutschland
| | - Gerd Burmester
- Klinik für Rheumatologie und Klinische Immunologie, Charité - Universitätsmedizin Berlin, Freie Universität und Humboldt Universität Berlin, Berlin, Deutschland
| | - Christoph Fiehn
- Praxis für Rheumatologie und Klinische Immunologie, Medical Center Baden-Baden und ViDia-Kliniken Karlsruhe, Baden-Baden, Deutschland
| | - Andreas Krause
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Abteilung für Rheumatologie, Osteologie und Klinische Immunologie, Immanuel Krankenhaus Berlin, Berlin, Deutschland
| | - Hanns-Martin Lorenz
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Abteilung für Rheumatologie, Medizinische Klinik V, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Matthias Schneider
- Poliklinik, Funktionsbereich und Hiller Forschungszentrum für Rheumatologie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Philipp Sewerin
- Poliklinik, Funktionsbereich und Hiller Forschungszentrum für Rheumatologie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Anna Voormann
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
| | - Ulf Wagner
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Abteilung für Rheumatologie, Klinik und Poliklinik für Endokrinologie, Nephrologie, Rheumatologie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Klaus Krüger
- Rheumatologisches Praxiszentrum München, St. Bonifatius-Str. 5, 81541, München, Deutschland.
- Kommission Pharmakotherapie, DGRh e. V., Berlin, Deutschland.
| | - Christof Specker
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Klinik für Rheumatologie und Klinische Immunologie, Kliniken Essen-Mitte, Essen, Deutschland
| |
Collapse
|
36
|
Krüger K, Burmester GR, Wassenberg S, Thomas MH. Golimumab improves socio economic and health economic parameters in patients with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. Curr Med Res Opin 2020; 36:1559-1567. [PMID: 32609555 DOI: 10.1080/03007995.2020.1790347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Golimumab (GLM) has shown its efficacy and safety in various clinical trials. We aimed to assess the effect of GLM on socio economic and health economic parameters in daily clinical practice. SETTING Rheumatology offices in Germany. METHOD Analysis of socio economic and health economic parameters of the non-interventional, multicentre, prospective study GO-NICE. Analyses were performed in an exploratory manner using descriptive statistical methods. Further, p-values on socio economic variables were calculated based on one-sample t-test on the differences between baseline and follow-up visits. RESULTS A total of 1458 patients were evaluable, of whom a total of 664 patients completed the 24-month observation period. The proportions of hospitalizations decreased statistically significantly (p ≤ .05) from 10.4/7.6/14.0% at baseline (BL) to 1.7/2.2/0.8%, and the in-patient rehabilitations decreased from 3.3/3.7/7.5% at BL to 0.6/1.8/2.1% at month 24 in patients with RA, PsA, and AS. When considering a 30-day period, the mean number of sick leave days decreased statistically significantly (p ≤ .005) from 4.0 at BL to 0.9 at month 24 (greatest improvement in RA), and the mean number of days with impaired capability decreased statistically significantly (p ≤ .001) from 14.9 at BL to 4.5 at month 24 (greatest improvement in patients with AS). There was also a reduction in the number of consultations and remedies. CONCLUSION This evaluation shows improvements in socio economic and health economic parameters on GLM treatment.
Collapse
Affiliation(s)
- Klaus Krüger
- Praxiszentrum St. Bonifatius München, Munich, Germany
| | | | | | | |
Collapse
|
37
|
Leipe J, Hoyer BF, Iking-Konert C, Schulze-Koops H, Specker C, Krüger K. [SARS-CoV-2 & rheumatic disease : Consequences of the SARS-CoV-2 pandemic for patients with inflammatory rheumatic diseases. A comparison of the recommendations for action of rheumatological societies and risk assessment of different antirheumatic treatments]. Z Rheumatol 2020; 79:686-691. [PMID: 32845393 PMCID: PMC7448266 DOI: 10.1007/s00393-020-00878-0] [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] [Accepted: 08/20/2020] [Indexed: 02/06/2023]
Abstract
The recommendations of the German Society of Rheumatology (DGRh) update, which update and expand the guidance on the management of patients with inflammatory rheumatic diseases in view of SARS-CoV‑2 created at the beginning of the COVID-19 pandemic, correspond in many points with the recommendations for action of the American (ACR) and European (EULAR) societies, but also differ in some points. Therefore, this article discusses the core recommendations of the DGRh update on the prevention of SARS-CoV-2/COVID-19, the risk assessment for inflammatory rheumatic diseases and the use of antirheumatic treatments in the context and in comparison to the ACR and EULAR recommendations, and provides an overview of the risk assessment of individual antirheumatic drugs.
Collapse
Affiliation(s)
- J Leipe
- Sektion Rheumatologie, Medizinische Klinik V, Universitätsklinikum Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland. .,Sektion Rheumatologie und Klinische Immunologie, Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität München, München, Deutschland.
| | - B F Hoyer
- Abteilung für Rheumatologie, 1. Medizinische Klinik, Universitätskrankenhaus Schleswig-Holstein Campus Kiel, Kiel, Deutschland
| | - C Iking-Konert
- III. Medizinische Klinik und Poliklinik Sektion Rheumatologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - H Schulze-Koops
- Sektion Rheumatologie und Klinische Immunologie, Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität München, München, Deutschland
| | - C Specker
- Klinik für Rheumatologie und Klinische Immunologie, Kliniken Essen-Mitte, Essen, Deutschland
| | - K Krüger
- Rheumatologisches Praxiszentrum München, München, Deutschland
| |
Collapse
|
38
|
Mooren FC, Maleki BH, Pilat C, Ringseis R, Eder K, Teschler M, Krüger K. Effects of Escherichia coli strain Nissle 1917 on exercise-induced disruption of gastrointestinal integrity. Eur J Appl Physiol 2020; 120:1591-1599. [PMID: 32399590 PMCID: PMC7295722 DOI: 10.1007/s00421-020-04382-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 04/23/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE The aim of the current study was to investigate the effects of the probiotic Escherichia coli strain Nissle 1917 (EcN) on the exercise-induced disruption of gastrointestinal (GI) integrity and the associated release of damage and inflammatory markers. METHODS After a pre-performance test, 19 untrained subjects (aged 18-35 years) passed two identical exhaustive treadmill exercise tests in an intensity corresponding to 60-80% VO2max in a test-retest design. The exercise tests were separated by a time period of 4 weeks. During this period, all subjects ingested 5 ml of an EcN suspension daily. Serum samples were taken before, immediately following and 3 h after both exercise tests. They were analyzed for indicators of GI integrity (zonulin; claudin-3; LPS), various damage and redox markers (I-FABP, GOT; GPT; TBARS) and inflammatory parameters (hsCRP; leucocytes). GI complaints were evaluated by a questionnaire. RESULTS The intake of EcN resulted in a significantly lower increase in I-FABP and TBARS after exercise (p < 0.05). In contrast, no effect of EcN supplementation was found for hsCRP and leucocyte numbers. Similarly, no differences were found for levels of zonulin and claudin-3. Exercise-associated GI complaints were not affected by the probiotic supplement. CONCLUSION The probiotic EcN reduced the exercise-associated increase in oxidative stress. This antioxidative mechanism probably leads to a reduction of GI epithelial damage after exhaustive exercise. The lack of EcN effects on other markers of GI permeability and systemic inflammation is most likely due to an inadequate exercise load, with rather small and insignificant exercise effects on these parameters.
Collapse
Affiliation(s)
- F C Mooren
- Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany.
| | - B H Maleki
- Department of Exercise Physiology and Sports Therapy, Institute of Sports Sciences, Justus-Liebig-University, Giessen, Germany
| | - C Pilat
- Department of Exercise Physiology and Sports Therapy, Institute of Sports Sciences, Justus-Liebig-University, Giessen, Germany
| | - R Ringseis
- Institute of Animal Nutrition and Nutrition Physiology, Justus-Liebig-University, Giessen, Germany
| | - K Eder
- Institute of Animal Nutrition and Nutrition Physiology, Justus-Liebig-University, Giessen, Germany
| | - M Teschler
- Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - K Krüger
- Department of Exercise Physiology and Sports Therapy, Institute of Sports Sciences, Justus-Liebig-University, Giessen, Germany
| |
Collapse
|
39
|
Schulze-Koops H, Holle J, Moosig F, Specker C, Aries P, Burmester G, Fiehn C, Hoyer B, Krause A, Leipe J, Lorenz HM, Schneider M, Sewerin P, Voormann A, Wager U, Krüger K, Iking-Konert C. [Current guidance of the German Society of Rheumatology for the care of patients with rheumatic diseases during the SARS-CoV-2/Covid 19 pandemic]. Z Rheumatol 2020; 79:385-388. [PMID: 32342184 PMCID: PMC7184809 DOI: 10.1007/s00393-020-00799-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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] [Indexed: 11/24/2022]
Abstract
In der aktuellen SARS-CoV-2 Pandemie bestehen viele Fragen mit Blick auf die sichere Behandlung von Patienten mit entzündlich-rheumatischen Erkrankungen. Auf viele dieser Fragen gibt es zur Zeit noch keine evidenzbasierte Antwort und das macht die Betreuung der Patienten nicht leicht. Die Deutsche Gesellschaft für Rheumatologie e. V. (DGRh) will mit diesen ersten Empfehlungen Hilfestellung für spezielle Belange in der Betreuung von Rheumapatienten angesichts der aktuellen Bedrohung durch SARS-CoV-2 geben. Um den dynamischen weltweiten Erkenntnisgewinn für unsere Patienten zu nutzen, werden die Empfehlungen regelmäßig aktualisiert. Die aktualisierten Versionen der Empfehlungen werden auf der Homepage der DGRh hinterlegt.
Collapse
Affiliation(s)
- H Schulze-Koops
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland. .,Sektion Rheumatologie und Klinische Immunologie, Medizinische Klinik IV, Ludwig-Maximilians-Universität München, Pettenkoferstraße 8a, München, Deutschland.
| | - J Holle
- Rheumazentrum Schleswig-Holstein Mitte, Neumünster, Deutschland
| | - F Moosig
- Rheumazentrum Schleswig-Holstein Mitte, Neumünster, Deutschland
| | - C Specker
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland.,Klinik für Rheumatologie und Klinische Immunologie, Kliniken Essen-Mitte, Essen, Deutschland
| | - P Aries
- Rheumatologie im Struenseehaus, Hamburg, Deutschland
| | - G Burmester
- Klinik für Rheumatologie und Klinische Immunologie, Charité - Universitäts Medizin Berlin, Freie Universität und Humboldt Universität Berlin, Berlin, Deutschland
| | - C Fiehn
- Medical Center Baden-Baden und ViDia-Kliniken Karlsruhe, Praxis für Rheumatologie und Klinische Immunologie, Baden-Baden, Deutschland
| | - B Hoyer
- Abteilung für Rheumatologie, 1. Medizinische Klinik, Universitätskrankenhaus Schleswig-Holstein Campus Kiel, Kiel, Deutschland
| | - A Krause
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland.,Abteilung für Rheumatologie, Osteologie und Klinische Immunologie, Immanuel Krankenhaus Berlin, Berlin, Deutschland
| | - J Leipe
- Abteilung für Rheumatologie, Medizinische Klinik V, Universitätskrankenhaus Mannheim, Mannheim, Deutschland
| | - H-M Lorenz
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland.,Abteilung für Rheumatologie, Medizinische Klinik V, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - M Schneider
- Poliklinik, Funktionsbereich und Hiller Forschungszentrum für Rheumatologie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - P Sewerin
- Poliklinik, Funktionsbereich und Hiller Forschungszentrum für Rheumatologie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - A Voormann
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
| | - U Wager
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland.,Abteilung für Rheumatologie, Klinik und Poliklinik für Endokrinologie, Nephrologie, Rheumatologie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - K Krüger
- Rheumatologisches Praxiszentrum, Kommission Pharmakotherapie der DGRh e. V., St. Bonifatius-Straße 5, 81541, München, Deutschland.
| | - C Iking-Konert
- III. Medizinische Klinik und Poliklinik Sektion Rheumatologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | | |
Collapse
|
40
|
Wackerhage H, Everett R, Krüger K, Murgia M, Simon P, Gehlert S, Neuberger E, Baumert P, Schönfelder M. Sport, exercise and COVID-19, the disease caused by the SARS-CoV-2 coronavirus. Dtsch Z Sportmed 2020. [DOI: 10.5960/dzsm.2020.441] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
41
|
Leißner T, Diener A, Löwer E, Ditscherlein R, Krüger K, Kwade A, Peuker U. 3D ex-situ and in-situ X-ray CT process studies in particle technology – A perspective. ADV POWDER TECHNOL 2020. [DOI: 10.1016/j.apt.2019.09.038] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
42
|
Dörner T, Schulze-Koops H, Burmester GR, Iking-Konert C, Schmalzing M, Engel A, Kästner P, Kellner H, Kurthen R, Krüger K, Rubbert-Roth A, Schwenke H, Peters MA, Tony HP. Early and late responses in patients with rheumatoid arthritis who were conventional synthetic disease-modifying anti-rheumatic drug inadequate responders and were treated with tocilizumab or switched to rituximab: an open-label phase 3 trial (MIRAI). Clin Exp Rheumatol 2019; 37:937-945. [PMID: 31025930] [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: 08/27/2018] [Accepted: 01/21/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To evaluate early and late responses in biological-naïve patients with rheumatoid arthritis (RA) initiating tocilizumab and early tocilizumab non-responders who switched to rituximab. METHODS In this open-label, non-randomised phase 3 study, RA patients with inadequate response to conventional synthetic DMARDs received tocilizumab 8 mg/kg intravenously at study begin and weeks 4, 8 and 12. After evaluation at week 16, early responders (Disease Activity Score based on 28 joints-erythrocyte sedimentation rate [DAS28-ESR] <2.6) completed the study; partial responders (DAS28-ESR decrease >1.2 or DAS28-ESR ≥2.6-≤3.2) were to continue tocilizumab through week 28; non-responders (DAS28-ESR decrease ≤1.2) switched to rituximab (1000 mg, weeks 16 and 18) with safety follow-up through week 66. RESULTS Of 519 patients, 222 (42.8%) achieved early DAS28-ESR remission at week 16; 240 patients continued treatment, 213 (41.0%) received tocilizumab, and 27 (5.2%) switched to rituximab. At week 32 DAS28-ESR remission was achieved by 117/213 patients (54.9%) who continued tocilizumab and 4/27 patients (14.8%) who switched to rituximab; good EULAR response was achieved by 66.7% and 25.9% and CDAI remission by 19.2% and 14.8% of patients, respectively. Serious adverse events occurred through week 32 in 45/490 patients (9.2%) who received tocilizumab (serious infections, 2.7%) and through week 66 in 8/27 patients (29.6%) who switched to rituximab. CONCLUSIONS Early response to tocilizumab was observed in 42.8% of patients. Half of early partial responders benefitted from continuing tocilizumab. Switching non-responders to rituximab seems feasible. No new safety signals were observed in patients treated with tocilizumab or switched to rituximab.
Collapse
Affiliation(s)
- Thomas Dörner
- Department of Medicine, Rheumatology and Clinical Immunology, Charité Campus Mitte, Medizinische Klinik und Poliklinik m.S. Rheumatologie und Klinische Immunologie, Charité Universitätsmedizin Berlin, Germany.
| | - Hendrik Schulze-Koops
- Division of Rheumatology and Clinical Immunology, Department of Internal Medicine IV, Klinikum der Universität München, Campus Innenstadt, Munich, Germany
| | - Gerd-Rüdiger Burmester
- Department of Medicine, Rheumatology and Clinical Immunology, Charité Campus Mitte, Medizinische Klinik und Poliklinik m.S. Rheumatologie und Klinische Immunologie, Charité Universitätsmedizin Berlin, Germany
| | - Christof Iking-Konert
- Klinik für Nephrologie und Rheumatologie, Med. Klinik III, University Hamburg-Eppendorf, Klinik für Nephrologie und Rheumatologie, Hamburg, Germany
| | - Marc Schmalzing
- Rheumatologie/klinische Immunologie, Medizinische Klinik und Poliklinik II, Klinikum der Universität Würzburg, Germany
| | - Andreas Engel
- Department of Neurophysiology and Pathophysiology, Rheumatologische Schwerpunktpraxis am Feuersee, Stuttgart, Germany
| | - Peter Kästner
- Private Practice, Ambulantes Rheumazentrum Erfurt, Germany
| | - Herbert Kellner
- Private Practice and Division of Rheumatology, Schwerpunktpraxis für Rheumatologie und Gastroenterologie und Ärztlicher Leiter Abteilung Rheumatologie KH Neuwittelsbach, Munich, Germany
| | | | | | - Andrea Rubbert-Roth
- Department of Internal Medicine, Klinikum der Universität zu Köln, Klinik für Innere Medizin I, Cologne, Germany
| | | | | | - Hans-Peter Tony
- Rheumatologie/klinische Immunologie, Medizinische Klinik und Poliklinik II, Klinikum der Universität Würzburg, Germany
| |
Collapse
|
43
|
Kula A, Liersch S, Krüger K, Walter U, Hagen A. Obesity prevention - is school an effective place? A systematic review. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz187.049] [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: 11/14/2022] Open
Abstract
Abstract
Background
Juvenile and childhood obesity or overweight are associated with various secondary diseases and physical limitations, as well as with the effects of discrimination and social exclusion. The early prevention of obesity remains a key area of action worldwide. Schools are considered as a classical setting. The analysis focuses on the effectiveness of interventions, the identification of effective components and conditions as well as barriers. The aim is to provide a differentiated presentation of the current study situation.
Methods
The systematic literature search in eleven databases included studies in English and German published in 1990 to 2015. A control group and posttest data were obligatory. Evaluated outcome measures must map effects on the prevalence of obesity (e.g., BMI, body fat percentage, waist-to-hip ratio). Included full texts were evaluated with the instrument ROBINS-I. Due to the heterogeneity of studies (especially in terms of design, intervention and outcomes) results were analysed qualitatively.
Results
48 primary studies were included of which most studies report data on changes in mean BMI over time, and show predominantly (small) effects in favour of the intervention. Almost all identified interventions include behavioral measures, most of them combine the fields of nutrition and physical activity, with behavioral prevention being overrepresented in particular in activities addressing nutrition.
Conclusions
The results allow the conclusion, that school-based measures to prevent obesity are effective in terms of anthropometric outcome measures, but to a limited extent. There is clear evidence that the effects achieved tend to be maintained beyond the intervention. There are also clear indications for the cost-effectiveness of school-based obesity prevention. The studies from this field of research have clearly gained in quality over the years and are now flanked by health economic analyses.
Funded by DIMDI
Key messages
School-based measures to prevent obesity are effective in terms of anthropometric outcome measures, but to a limited extent. In order to fully realize its potential, school-based measures to prevent obesity should be accompanied by interventions at other levels, like the health-promoting design of living environments.
Collapse
Affiliation(s)
- A Kula
- MHH, Institute for Epidemiology, Social Medicine and Health System Research, Hannover, Germany
| | - S Liersch
- MHH, Institute for Epidemiology, Social Medicine and Health System Research, Hannover, Germany
| | - K Krüger
- MHH, Institute for Epidemiology, Social Medicine and Health System Research, Hannover, Germany
| | - U Walter
- MHH, Institute for Epidemiology, Social Medicine and Health System Research, Hannover, Germany
| | - A Hagen
- MHH, Institute for Epidemiology, Social Medicine and Health System Research, Hannover, Germany
| |
Collapse
|
44
|
Tony HP, Krüger K, Cohen SB, Schulze-Koops H, Kivitz AJ, Jeka S, Vereckei E, Cen L, Kring L, Kollins D. Brief Report: Safety and Immunogenicity of Rituximab Biosimilar GP 2013 After Switch From Reference Rituximab in Patients With Active Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2019; 71:88-94. [PMID: 30295429 DOI: 10.1002/acr.23771] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 09/25/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Comparable clinical efficacy of the rituximab (RTX) biosimilar GP2013 and reference RTX has been established in blinded randomized trials. However, when switching from a reference biologic to a biosimilar, potential safety implications are often an important consideration. Therefore, the aim of this study was to evaluate the safety of switching from reference RTX to RTX biosimilar GP2013 compared with treatment continuation with reference RTX in patients with rheumatoid arthritis (RA). METHODS In this multinational, randomized, double-blind, parallel-group safety study, 107 patients with RA who had previously received treatment (of any duration) with reference RTX as part of routine practice and who required continuation of treatment were randomized to receive either GP2013 or to continue treatment with reference RTX. All patients received a stable dosage of methotrexate and folic acid during the study. Study assessments included the incidence of hypersensitivity, infusion-related and anaphylactic reactions, immunogenicity (antidrug antibodies), and general safety. RESULTS Regardless of whether patients switched to GP2013 or continued treatment with reference RTX, the incidences of hypersensitivity (9.4% and 11.1%, respectively) and infusion-related reactions (11.3% and 18.5%, respectively) were similarly low. Only 1 patient (in the reference RTX group) developed antidrug antibodies to RTX after starting study treatment. No neutralizing antidrug antibodies were observed. Antidrug antibodies were not associated with adverse events (AEs). No clinically meaningful differences in the rate of AEs were observed between treatment groups. CONCLUSION No safety risks were detected when patients switched from reference RTX to GP2013. The safety profiles of patients in both treatment groups were similar, although the study was not powered for statistical testing of equivalence in safety.
Collapse
Affiliation(s)
| | - Klaus Krüger
- Rheumatologisches Praxiszentrum, Munich, Germany
| | | | | | - Alan J Kivitz
- Altoona Center for Clinical Research, Duncansville, Pennsylvania
| | | | - Edit Vereckei
- The National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | - Liyi Cen
- Sandoz (a Novartis Division), Holzkirchen, Germany
| | - Laura Kring
- Sandoz (a Novartis Division), Holzkirchen, Germany
| | | |
Collapse
|
45
|
|
46
|
Palmowski J, Boßlau TK, Ryl L, Krüger K, Reichel T. Managing immune health in sports – a practical guide for athletes and coaches. Dtsch Z Sportmed 2019. [DOI: 10.5960/dzsm.2019.389] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
47
|
Pérez-Rodríguez J, Krüger K, Pérez-Hedo M, Ruíz-Rivero O, Urbaneja A, Tena A. Classical biological control of the African citrus psyllid Trioza erytreae, a major threat to the European citrus industry. Sci Rep 2019; 9:9440. [PMID: 31263114 PMCID: PMC6603031 DOI: 10.1038/s41598-019-45294-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 06/04/2019] [Indexed: 11/14/2022] Open
Abstract
Citrus greening or huanglongbing (HLB) is the main threat to the European citrus industry since one of its vectors, the African citrus psyllid, Trioza erytreae, has recently become established in mainland Europe. In this context, classical biological control programmes should be implemented to reduce the spread of the psyllid. The aims of this study were to: i) disentangle the parasitoid complex of T. erytreae combining morphological and molecular characterization; and ii) to study the biology of its main parasitoids in its area of origin in South Africa for their future importation into Europe. The main citrus producing areas of South Africa were surveyed during 2017. In contrast to previous studies, the parasitoid complex of T. erytreae included three species of primary parasitoids: Tamarixia dryi, Psyllaephagus pulvinatus and another parasitoid of the genus Tamarixia. Molecular analysis showed that it is a new species closely related to T. dryi. Tamarixia dryi was the most abundant parasitoid but its relative abundance varied among sampling sites. The sex ratio (males/females) of T. dryi and Tamarixia sp. decreased with T. erytreae size and became female biased when psyllid nymphs were larger than 0.6 and 1.2 mm2, respectively. These parasitoids were attacked by three species of hyperparasitoids, Aphidencyrtus cassatus, Marietta javensis and a species of the genus Aphanogmus. Aphidencyrtus cassatus, the most abundant hyperparasitoid, tended to emerge from large nymphs, and adult females lived as long as those of T. dryi. The implications of these results are discussed within the framework of the introduction of T. dryi into Europe.
Collapse
Affiliation(s)
- J Pérez-Rodríguez
- Centro de Protección Vegetal y Biotecnología, Instituto Valenciano de Investigaciones Agrarias (IVIA), Carretera Moncada-Náquera km 4.5, 46113, Moncada, Valencia, Spain.,Laboratori d'Investigació d'Entomologia, Departament de Zoologia, Facultat de Ciències Biològiques, Carrer Doctor Moliner s/n, 46100, Burjassot, València, Spain
| | - K Krüger
- Department of Zoology and Entomology, University of Pretoria, Private Bag X20, Pretoria, 0028, South Africa
| | - M Pérez-Hedo
- Centro de Protección Vegetal y Biotecnología, Instituto Valenciano de Investigaciones Agrarias (IVIA), Carretera Moncada-Náquera km 4.5, 46113, Moncada, Valencia, Spain
| | - O Ruíz-Rivero
- Centro de Protección Vegetal y Biotecnología, Instituto Valenciano de Investigaciones Agrarias (IVIA), Carretera Moncada-Náquera km 4.5, 46113, Moncada, Valencia, Spain
| | - A Urbaneja
- Centro de Protección Vegetal y Biotecnología, Instituto Valenciano de Investigaciones Agrarias (IVIA), Carretera Moncada-Náquera km 4.5, 46113, Moncada, Valencia, Spain
| | - A Tena
- Centro de Protección Vegetal y Biotecnología, Instituto Valenciano de Investigaciones Agrarias (IVIA), Carretera Moncada-Náquera km 4.5, 46113, Moncada, Valencia, Spain.
| |
Collapse
|
48
|
Abstract
Due to therapeutic advances, rheumatoid arthritis (RA) today has developed into a satisfactorily treatable disease in most cases, with remission being the target of treatment. Early diagnosis with immediate treatment initiation following treat-to-target strategy is the key to a favorable long-term outcome. A guideline-directed treatment algorithm determines the use of conventional synthetic disease-modifying anti-rheumatic drugs (DMARD; e.g., methotrexate), biological DMARD, and targeted oral DMARD (Janus kinase inhibitors). Comorbidities-in particular cardiovascular and interstitial lung disease-affect 80% of RA patients and represent the leading causes for mortality. The choice of drug treatment is influenced by the presence of comorbidities.
Collapse
Affiliation(s)
- K Krüger
- Rheumatologisches Praxiszentrum München, St.-Bonifatius-Str. 5, 81541, München, Deutschland.
| |
Collapse
|
49
|
|
50
|
Krüger K, Krause A. Komorbiditäten. Z Rheumatol 2019; 78:218-220. [DOI: 10.1007/s00393-019-0609-8] [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: 10/27/2022]
|