Persistence of bDMARD therapy in Rheumatoid Arthritis after first-line TNF-inhibitor failure: the RECORD study of the Italian Society for Rheumatology

OBJECTIVE

The optimal choice of a second biological disease-modifying anti-rheumatic drug (bDMARD) after failure with first line tumour necrosis factor inhibitor (TNFi) represents a critical therapeutic challenge. This study aims to evaluate the persistence with treatment using second line bDMARDs with different mechanisms of action in rheumatoid arthritis (RA) patients with inadequate response to first line TNFi.

METHOD

A retrospective cohort study on administrative healthcare databases was conducted. We analysed the relationship between different bDMARDs and persistence with treatment in RA patients who started second line bDMARD therapy according to two different strategies: cycling (second TNFi) or switching [change in mechanism of action: abatacept (ABA), tocilizumab (TCZ), and rituximab (RTX)] with or without concomitant conventional synthetic (cs) DMARDs.

RESULTS

The cohort comprised 1434 patients. The mean age was 53.8 years and 1142 (79.6%) were women. Among second line bDMARDs, 969 patients (67.6%) started TNFi, 204 (14.2%) ABA, 145 (10.1%) RTX, and 116 (8.1%) TCZ. A bDMARD was prescribed as monotherapy in 359 patients (25.0%). The switching strategy showed a lower overall discontinuation rate [hazard ratio (HR) 0.72], while switching compared to cycling showed significantly better survival for ABA (HR 0.61) and RTX (HR 0.76), but no significant difference for TCZ (HR 0.82). A lower impact of better drug survival in the switching strategy occurred in patients with concurrent methotrexate.

CONCLUSIONS

Among RA patients failing a first TNFi, switching is associated with marginally better persistence, in particular for ABA and RTX, with only marginal differences in patients on concurrent csDMARDs.

Alpha lipoic acid and superoxide dismutase in the treatment of chronic low back pain

BACKGROUND

Neuropathic mechanisms largely contribute to low back pain (LBP) and oxidative stress is acknowledged as one of the causes of nerve damage typical of neuropathic pain: antioxidant agents may be a useful choice in the multimodal treatment strategy for chronic LBP patients.

AIM

The aim of this study was to detect changes in perceived pain, functional activity and in the assumption of analgesics in patients with chronic LBP treated with a combination of alpha-lipoic acid (ALA) and superoxide dismutase (SOD).

DESIGN

Prospective non-randomized open-label study.

SETTING

Outpatient at TAMMEF (Therapeutic Application of Musically Modulated Electromagnetic Fields) Centre of the University of Siena.

POPULATION

The study enrolled 98 adult patients with chronic (≥12 weeks) LBP with or without radiculopathy and without neoplastic or inflammatory pathologies.

METHODS

Patients were treated for 60 days with 600 mg ALA and 140 UI SOD/die. The Roland Morris Disability Questionnaire and Pain Rating Scale were used and concomitant use of medications (with particular attention to analgesics) and adverse events (toxicity) were recorded during treatment. Differences between all the study time points were calculated for the scores of the two tools and for the need of concomitant treatment with analgesics.

RESULTS

At the end of the study only 8% of patients still used analgesics versus 73.5% registered at baseline (P<0.01). Regarding self-reported tools, a statistically significant improvement both for perceived pain and functional disabilities occurred: pain ameliorated after 40 days of therapy and the improvement was significant both statistically (P<0.05) and clinically. Only 4 patients stopped the treatment due to unacceptable pain (not related to the treatment).

CONCLUSION

Oral treatment with ALA and SOD improves functionality and reduces the use of analgesics in chronic LBP patients.

CLINICAL REHABILITATION IMPACT

Oral combination of ALA and SOD may be a powerful adjuvant in multimodal therapy of chronic LBP patients.

Food habits and nutritional status of adolescents in Emilia-Romagna, Italy

INTRODUCTION

The prevalence of childhood and adolescent obesity is increasing, with negative medical and psychosocial consequences.

AIMS

This study examines the association between weight status and nutrient intake, sport and leisure habits of middle school students in Bologna (Italy).

METHODS

Anthropometric data (height, weight) of 598 subjects (321 males and 277 females) 11-14 years old were collected. Questionnaires on nutrient intake, sport and leisure behaviour were administered.

RESULTS

Protein, carbohydrate and total fat intakes of the adolescents were higher than the recommended ranges in all age groups and in both sexes. The proportion of energy from protein and total fat was higher than recommended, but the percentage from carbohydrate was lower. A significant proportion of the adolescents had a cholesterol intake above the Italian RDA and lower than recommended intakes for micronutrients. The prevalence of overweight and obesity is higher in males than in females at all ages (overweight: 35.2 vs 31.6 at 11 yrs.; 27.5 vs 20.2 at 12 yrs.; 18.6 vs 17.8 at 13 yrs.; 18.7 vs 10.9 at 14 yrs.; obesity: 5.5 vs 3.2 at 12 yrs.; 3.9 vs 1.1 at 13 yrs.; 5.3 vs 3.6 at 14 yrs.), except in subjects 11 years old (obesity: 7.4 vs 10.5). The overweight and obese adolescents consumed less carbohydrates and less fibre than their normal weight and underweight counterparts.

CONCLUSION

The results of the present study indicate an unbalanced diet of the Bologna adolescents, which could damage their health and quality of life.

Gemcitabine as single agent in pretreated T-cell lymphoma patients: evaluation of the long-term outcome

BACKGROUND

Peripheral T-cell lymphoma unspecified (PTCLU) and mycosis fungoides (MF) often show resistance to conventional chemotherapy. Gemcitabine should be considered a suitable option. We report the long-term update of 39 pretreated T-cell lymphoma patients treated with gemcitabine.

PATIENTS AND METHODS

From May 1997 to September 2007, 39 pretreated MF and PTCLU patients received gemcitabine. Inclusion criteria were as follows: histologic diagnosis of MF or PTCLU; relapsed/refractory disease; age > or =18 years; and World Health Organization performance status of two or less. Nineteen patients had MF and 20 PTCLU. All patients with MF had a T3-T4, N0, and M0 disease and patients with PTCLU had stage III-IV disease. Gemcitabine was given on days 1, 8, and 15 on a 28-day schedule (1200 mg/m(2)/day) for a total of three to six cycles.

RESULTS

Overall response rate was 51% (20 of 39 patients); complete response (CR) and partial response (PR) rates were 23% (9 of 39 patients) and 28% (11 of 39 patients), respectively. Patients with MF had a CR rate of 16% and a PR rate of 32% compared with a CR rate of 30% and a PR rate of 25% of PTCLU patients. Among the CR patients, 7 of 9 are in continuous complete response with a variable disease-free interval (15-120 months).

CONCLUSION

In our experience, gemcitabine proved to be effective in pretreated MF and PTCLU patients, even in the long term.

Growth of Chinese Italian infants in the first 2 years of life

BACKGROUND

Numerous studies have been carried out on the growth of human migrant populations. However, studies on the auxological pattern of Chinese migrant population are limited in Italy.

AIMS

In this paper we examine the growth pattern from birth to 24 months and the body composition of Chinese infants born and living in Bologna (north Italy).

SUBJECTS AND METHODS

A longitudinal study was conducted recruiting 224 healthy Chinese children. The anthropometric measurements were collected when the children were immunized. Body mass index (BMI), Arm Muscle Area and Arm Fat Area were calculated.

RESULTS

The growth of Chinese Italian children is adequate, being within the normal limits according to the NCHS reference standard. In comparison with Chinese children living in China and abroad, their body length is greater. Comparisons with growth curves for Italian children (Emilia-Romagna) show that weight and length values are higher in Chinese children than in Italians until 12 months, and comparable thereafter. The weight and length growth velocities are similar to those reported for Italian children.

CONCLUSION

As a whole, the results of the present study support the hypothesis that Chinese children born and living in Italy grow in an appropriate environment to achieve their growth potential.

[Role of MR cholangiopancreatography in the evaluation of biliary disease]

PURPOSE

To evaluate the diagnostic accuracy of MR cholangiopancreatography (MRCP) in biliary tree patology in comparison with percutaneous transhepatic cholangiography (PTC), endoscopic retrograde cholangiopancreatography (ERCP) and surgical findings.

MATERIALS AND METHODS

Forty-six patients , with clinical and laboratory findings suggestive of biliary tree pathology, and after an abdominal US, underwent MRCP with a 1.5 T superconductive magnet equipped with a phased-array body coil. MR exam was performed with baseline sequences for the examination of the upper abdomen, followed by specific MRCP sequences and, in cases of suspected neoplastic disease, completed with abdominal sequences after a bolus injection of paramagnetic contrast.

RESULTS

MRCP showed normal findings in 16/46 patients, biliary duct dilatation in 25/46 patients (7 choledocolithiasis, 10 benign obstructions and 8 neoplastic stenoses) and stenoses without dilatation of biliary tree in 5/46 patients. In 25 patients with biliary duct dilatation, CPRM correctly identified the level of in 100% of patients (25/25) and the nature in 88% of patients (22/25). In 5 patients with stenosis without dilatation of biliary tree, CPRM identified 2 true positives (sclerosing cholangitis), 2 false positives and 1 patient is still in follow-up.

CONCLUSIONS

In our experience MRCP proved to be highly accurate as fundamental diagnostic step in patients with clinical and laboratory findings suggestive of biliary disease. The workload of ERCP, invasive method with risk of complications, in the diagnosis stage could therefore be reduced and its use be reserved for therapeutic indications.