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Damiani A, Orlandi M, Bruni C, Bandini G, Lepri G, Scaletti C, Ravaglia C, Frassanito F, Guiducci S, Moggi-Pignone A, Matucci-Cerinic M, Poletti V, Tofani L, Colby TV, Randone SB, Tomassetti S. The role of lung biopsy for diagnosis and prognosis of interstitial lung disease in systemic sclerosis: a systematic literature review. Respir Res 2024; 25:138. [PMID: 38521926 PMCID: PMC10960984 DOI: 10.1186/s12931-024-02725-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 02/12/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND The prognostic and theragnostic role of histopathological subsets in systemic sclerosis interstitial lung disease (SSc-ILD) have been largely neglected due to the paucity of treatment options and the risks associated with surgical lung biopsy. The novel drugs for the treatment of ILDs and the availability of transbronchial cryobiopsy provide a new clinical scenario making lung biopsy more feasible and a pivotal guide for treatment. The aim of our study was to investigate the usefulness of lung biopsy in SSc ILD with a systematic literature review (SLR). METHODS PubMed, Embase and Cochrane databases were searched up to June 30, 2023. Search terms included both database-specific controlled vocabulary terms and free-text terms relating to lung biopsy and SSc-ILD diagnostic and prognosis. The SLR was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). Studies were selected according to the PEO (population, exposure, and outcomes) framework and Quality assessment of diagnostic accuracy studies (QUADAS) were reported. RESULTS We selected 14 articles (comprising 364 SSc-ILD patients). The paucity and heterogeneity of the studies prevented a systematic analysis. Diffuse cutaneous SSc was present in 30-100% of cases. Female predominance was observed in all studies (ranging from 64 to 100%). Mean age ranged from 42 to 64 years. Mean FVC was 73.98 (+/-17.3), mean DLCO was 59.49 (+/-16.1). Anti-Scl70 antibodies positivity was detected in 33% of cases (range: 0-69.6). All patients underwent surgical lung biopsies, and multiple lobes were biopsied in a minority of studies (4/14). Poor HRCT-pathologic correlation was reported with HRCT-NSIP showing histopathologic UIP in up to 1/3 of cases. Limited data suggest that SSc-UIP patients may have a worse prognosis and response to immunosuppressive treatment compared to other histopathologic patterns. CONCLUSIONS The data from this SLR clearly show the paucity and heterogeneity of the studies reporting lung biopsy in SSc ILD. Moreover, they highlight the need for further research to address whether the lung biopsy can be helpful to refine prognostic prediction and guide therapeutic choices.
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Affiliation(s)
- A Damiani
- Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Florence, Careggi University Hospital, Florence, Italy
| | - M Orlandi
- Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Florence, Careggi University Hospital, Florence, Italy
- Department of Medical and Surgical for Children and Adults, Modena, Italy
| | - C Bruni
- Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Florence, Careggi University Hospital, Florence, Italy
| | - G Bandini
- Department of Experimental and Clinical Medicine, Division of Internal Medicine, University of Florence, Careggi University Hospital, Florence, Italy
| | - G Lepri
- Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Florence, Careggi University Hospital, Florence, Italy
| | - C Scaletti
- Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Florence, Careggi University Hospital, Florence, Italy
| | - C Ravaglia
- Pulmonary Unit, Department of Thoracic Diseases, Azienda USL Romagna, GB Morgagni-L-Pierantoni Hospital, Bologna University, Forlì, Italy
| | - F Frassanito
- Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Florence, Careggi University Hospital, Florence, Italy
| | - S Guiducci
- Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Florence, Careggi University Hospital, Florence, Italy
| | - A Moggi-Pignone
- Department of Experimental and Clinical Medicine, Division of Internal Medicine, University of Florence, Careggi University Hospital, Florence, Italy
| | - M Matucci-Cerinic
- Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Florence, Careggi University Hospital, Florence, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare diseases (UnIRAR), IRCCS San Raffaele Hospital, Milan, Italy
| | - V Poletti
- Pulmonary Unit, Department of Thoracic Diseases, Azienda USL Romagna, GB Morgagni-L-Pierantoni Hospital, Bologna University, Forlì, Italy
| | - L Tofani
- Department of Statistics, Informatics and Applications, University of Florence, Florence, Italy
| | - T V Colby
- Department of Pathology and Laboratory Medicine (Emeritus), Mayo Clinic, Scottsdale, AZ, 13400, USA
| | - S Bellando Randone
- Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Florence, Careggi University Hospital, Florence, Italy
| | - Sara Tomassetti
- Department of Clinical and Experimental Medicine, University of Florence and Interventional Pulmonology Unit, Careggi University Hospital, Largo Brambilla 3, Florence, 50134, Italy.
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Bruni C, Tofani L, Garaiman A, Jordan S, Mihai CM, Dobrota R, Elhai M, Becker MO, Hoffmann-Vold AM, Frauenfelder T, Matucci-Cerinic M, Distler O. Histogram-Based Densitometry Index to Assess the Severity of Interstitial Lung Disease in Systemic Sclerosis in Standard and Low-Dose Computed Tomography. J Rheumatol 2024; 51:270-276. [PMID: 38302169 DOI: 10.3899/jrheum.2023-0415] [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: 12/04/2023] [Indexed: 02/03/2024]
Abstract
OBJECTIVE Mean lung attenuation, skewness, and kurtosis are histogram-based densitometry variables that quantify systemic sclerosis-associated interstitial lung disease (SSc-ILD) and were recently merged into a computerized integrated index (CII). Our work tested the CII in low-dose 9-slice (reduced) and standard high-resolution computed tomography (CT) scans to evaluate extensive SSc-ILD and predict mortality. METHODS CT scans from patients with SSc-ILD were assessed using the software Horos to compute standard and reduced CIIs. Extensive ILD was determined following the Goh staging system. The association between CIIs and extensive ILD was analyzed with a generalized estimating equation regression model, the predictive ability of CIIs by the area under the receiver-operation characteristic curve (AUC), and the association between CIIs and death by Kaplan-Meier analysis. RESULTS Among 243 patients with standard and reduced CT scans available, 157 CT scans from 119 patients with SSc-ILD constituted the derivation cohort. The validation cohort included 116 standard and 175 reduced CT scans. Both CIIs from standard (odds ratio [OR] 0.53, 95% CI 0.37-0.75; AUC 0.77, 95% CI 0.68-0.87) and reduced CT scans (OR 0.54, 95% CI 0.35-0.82; AUC 0.78, 95% CI 0.70-0.87) were significantly associated with extensive ILD. A threshold of CII ≤ -0.96 for standard CT scans and CII ≤ -1.85 for reduced CT scans detected extensive ILD with high sensitivity in both derivation and validation cohorts. Extensive ILD according to Goh staging (OR 2.94, 95% CI 1.10-7.82) and standard CII ≤ -0.96 (OR 1.78, 95% CI 1.24-2.56) significantly predicted mortality; a marginal P value was observed for reduced CII ≤ -1.85 (OR 1.27, 95% CI 0.93-1.75). CONCLUSION Thresholds for both standard and reduced CII to identify extensive ILD were developed and validated, with an additional association with mortality. CIIs might help in clinical practice when radiology expertise is missing.
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Affiliation(s)
- Cosimo Bruni
- C. Bruni, MD, PhD, Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland, and Department of Experimental Medicine, Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy;
| | - Lorenzo Tofani
- L. Tofani, MStat, Department of Statistics, Computer Science, Applications, University of Florence, Florence, Italy
| | - Alexandru Garaiman
- A. Garaiman, MD, PhD, S. Jordan, PhD, C.M. Mihai, MD, PhD, R. Dobrota, MD, PhD, M. Elhai, MD, PhD, M.O. Becker, MD, PhD, O. Distler, MD, Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Suzana Jordan
- A. Garaiman, MD, PhD, S. Jordan, PhD, C.M. Mihai, MD, PhD, R. Dobrota, MD, PhD, M. Elhai, MD, PhD, M.O. Becker, MD, PhD, O. Distler, MD, Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Carmen-Marina Mihai
- A. Garaiman, MD, PhD, S. Jordan, PhD, C.M. Mihai, MD, PhD, R. Dobrota, MD, PhD, M. Elhai, MD, PhD, M.O. Becker, MD, PhD, O. Distler, MD, Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Rucsandra Dobrota
- A. Garaiman, MD, PhD, S. Jordan, PhD, C.M. Mihai, MD, PhD, R. Dobrota, MD, PhD, M. Elhai, MD, PhD, M.O. Becker, MD, PhD, O. Distler, MD, Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Muriel Elhai
- A. Garaiman, MD, PhD, S. Jordan, PhD, C.M. Mihai, MD, PhD, R. Dobrota, MD, PhD, M. Elhai, MD, PhD, M.O. Becker, MD, PhD, O. Distler, MD, Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Mike Oliver Becker
- A. Garaiman, MD, PhD, S. Jordan, PhD, C.M. Mihai, MD, PhD, R. Dobrota, MD, PhD, M. Elhai, MD, PhD, M.O. Becker, MD, PhD, O. Distler, MD, Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Anna-Maria Hoffmann-Vold
- A.M. Hoffmann-Vold, MD, PhD, Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland, and Department of Rheumatology, Oslo University Hospital, Oslo, Norway
| | - Thomas Frauenfelder
- T. Frauenfelder, MD, Institute of Diagnostic and Interventional of Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Marco Matucci-Cerinic
- M. Matucci-Cerinic, MD, PhD, Department of Experimental Medicine, Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy, and Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UniRAR), IRCSS San Raffaele Hospital, Milan, Italy
| | - Oliver Distler
- A. Garaiman, MD, PhD, S. Jordan, PhD, C.M. Mihai, MD, PhD, R. Dobrota, MD, PhD, M. Elhai, MD, PhD, M.O. Becker, MD, PhD, O. Distler, MD, Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Lepri G, Bruni C, Tofani L, Moggi-Pignone A, Orlandi M, Tomassetti S, Hughes M, Del Galdo F, Irace R, Distler O, Riccieri V, Allanore Y, Gheorghiu AM, Siegert E, De Vries-Bouwstra J, Hachulla E, Tikly M, Damjanov N, Spertini F, Mouthon L, Hoffmann-Vold AM, Gabrielli A, Guiducci S, Matucci-Cerinic M, Furst D, Bellando-Randone S. The Performance of Pulmonary Function Tests in Predicting Systemic Sclerosis-Interstitial Lung Disease in the European Scleroderma Trial and Research Database. Diagnostics (Basel) 2024; 14:295. [PMID: 38337811 PMCID: PMC10855256 DOI: 10.3390/diagnostics14030295] [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: 12/04/2023] [Revised: 12/27/2023] [Accepted: 01/04/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND AND OBJECTIVES In SSc, ILD is a major cause of morbidity and mortality. We aimed to investigate the performance of DLCO (diffusing capacity of lung carbon monoxide) and FVC (forced vital capacity) delta change (Δ) and baseline values in predicting the development of SSc-ILD. METHODS Longitudinal data of DLCO, FVC, and ILD on the HRCT of SSc patients from the EUSTAR database were evaluated at baseline (t0) and after 12 (±4) (t1) and 24 (±4) (t2) months. RESULTS 474/17805 patients were eligible for the study (403 females); 46 (9.7%) developed ILD at t2. Positivity for anti-topoisomerase antibodies (117 patients) showed an association with ILD development at t2 (p = 0.0031). Neither the mean t0 to t1 change (Δ) of DLCO nor the mean t0 to t1 FVCΔ predicted the appearance of ILD at t2. Investigating the possible role of baseline DLCO and FVC values in predicting ILD appearance after 24 (±4) months, we observed a moderate predictive capability of t0 DLCO < 80%, stronger than that of FVC < 80%. CONCLUSIONS We suggest that an impaired baseline DLCO may be predictive of the appearance of ILD after 2 years of follow-up. This result advances the hypothesis that a reduction in gas exchange may be considered an early sign of lung involvement. However, further rigorous studies are warranted to understand the predictive role of DLCO evaluation in the course of SSc.
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Affiliation(s)
- Gemma Lepri
- Division of Rheumatology, AOU Careggi, University of Florence, 50121 Florence, Italy
| | - Cosimo Bruni
- Division of Rheumatology, AOU Careggi, University of Florence, 50121 Florence, Italy
- Department of Rheumatology, University Hospital Zurich, University of Zurich, 8006 Zurich, Switzerland
| | - Lorenzo Tofani
- Division of Rheumatology, AOU Careggi, University of Florence, 50121 Florence, Italy
| | - Alberto Moggi-Pignone
- Division of Internal Medicine, AOU Careggi, University of Florence, 50121 Florence, Italy
| | - Martina Orlandi
- Division of Rheumatology, AOU Careggi, University of Florence, 50121 Florence, Italy
| | - Sara Tomassetti
- Interventional Pulmonology Unit, AOU Careggi, University of Florence, 50121 Florence, Italy
| | - Michael Hughes
- Department of Rheumatology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield S10 2JF, UK
| | - Francesco Del Galdo
- Raynaud’s and Scleroderma Programme, NIHR Biomedical Research Centre and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS2 9JT, UK
| | - Rosaria Irace
- Rheumatology Unit, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 81100 Naples, Italy
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, 8006 Zurich, Switzerland
| | | | - Yannick Allanore
- Rheumatology Department, Hopital Cochin, University of Paris, 75019 Paris, France
| | - Ana Maria Gheorghiu
- Internal Medicine & Rheumatology Department, Cantacuzino Hospital, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Elise Siegert
- Rheumatology, Charite University Hospital, 10117 Berlin, Germany
| | - Jeska De Vries-Bouwstra
- Department of Rheumatology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Eric Hachulla
- Service de Médecine Interne, Centre Hospitalier Universitaire, 59000 Lille, France
| | - Mohammed Tikly
- Department of Internal Medicine, Division of Rheumatology, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg 1864, South Africa
| | - Nemanja Damjanov
- Institute of Rheumatology, University Belgrade Medical School, 11000 Belgrade, Serbia
| | | | - Luc Mouthon
- National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, University Paris Descartes, 75006 Paris, France
| | | | - Armando Gabrielli
- Department of Clinical and Molecular Science, Università Politecninca delle Marche, 60121 Ancona, Italy
| | - Serena Guiducci
- Division of Rheumatology, AOU Careggi, University of Florence, 50121 Florence, Italy
| | - Marco Matucci-Cerinic
- Division of Rheumatology, AOU Careggi, University of Florence, 50121 Florence, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, 20132 Milan, Italy
| | - Daniel Furst
- Division of Rheumatology, AOU Careggi, University of Florence, 50121 Florence, Italy
- Division of Rheumatology, University California Los Angeles, Los Angeles, CA 90095, USA
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Seravalli V, Abati I, Strambi N, Tofani L, Tucci C, Tartarotti E, Di Tommaso M. Universal cervical length screening for preterm birth is not useful after 24 weeks of gestation. Acta Obstet Gynecol Scand 2023; 102:1541-1548. [PMID: 37737470 PMCID: PMC10577617 DOI: 10.1111/aogs.14683] [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: 02/08/2023] [Revised: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 09/23/2023]
Abstract
INTRODUCTION Cervical length measurement using transvaginal sonography at 18+0 -24+0 weeks of gestation is used to identify women at risk of preterm delivery, who may benefit from treatment with progesterone to prevent premature birth. Few and conflicting data exist regarding the predictive value of cervical length measurement performed at later gestational ages. The primary objective of this study was to evaluate the predictive accuracy for spontaneous preterm birth of a single cervical length measurement performed between 24 and 32 weeks of gestation in asymptomatic singleton pregnancies at low risk for spontaneous preterm birth. The secondary objective was to test the predictive accuracy of different cervical length thresholds in the same population. MATERIAL AND METHODS This was a historical cohort study conducted in a tertiary referral hospital. A total of 2728 asymptomatic women with singleton pregnancy at low risk for spontaneous preterm birth were recruited. Of these women, 1548 had cervical length measured at 24+0 -27+6 weeks of gestation and 2191 women at 28+0 -32+0 weeks. In all, 1010 women were present in both gestational age windows. Maternal demographics, medical and obstetrical history, and pregnancy outcome were reviewed. The predictive value of cervical length for spontaneous preterm birth was evaluated through logistic regression analysis. Results were adjusted for confounding factors. RESULTS Overall, spontaneous preterm birth occurred in 53/2728 women (1.9%). In both the 24+0 -27+6 and 28+0 -32+0 weeks groups, a shorter cervical length was significantly associated with spontaneous preterm birth (p < 0.01), but it had a low predictive value, as shown by the receiver operating characteristics curve analysis (areas under the curve 0.62, 95% CI 0.50-0.74 for the 24+0 -27+6 weeks group, and 0.61, 95% CI 0.52-0.70 in the 28+0 -32+0 weeks group). When the predictive accuracy for preterm delivery of different cervical length cut-offs was evaluated, the sensitivity and positive predictive value were low in both gestational age windows, irrespective of the threshold used. CONCLUSIONS In asymptomatic women with singleton pregnancy at low risk for spontaneous preterm birth, the predictive value of cervical length after 24+0 weeks of gestation is low. Therefore, cervical length screening in these women should be discouraged.
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Affiliation(s)
- Viola Seravalli
- Department of Health SciencesDivision of Obstetrics and GynecologyUniversity of FlorenceCareggi HospitalFlorenceItaly
| | - Isabella Abati
- Department of Health SciencesDivision of Obstetrics and GynecologyUniversity of FlorenceCareggi HospitalFlorenceItaly
| | - Noemi Strambi
- Department of Health SciencesDivision of Obstetrics and GynecologyUniversity of FlorenceCareggi HospitalFlorenceItaly
| | - Lorenzo Tofani
- Department of StatisticsComputer Science, ApplicationsUniversity of FlorenceFlorenceItaly
| | - Claudia Tucci
- Department of Health SciencesDivision of Obstetrics and GynecologyUniversity of FlorenceCareggi HospitalFlorenceItaly
| | - Enrico Tartarotti
- Department of Health SciencesDivision of Obstetrics and GynecologyUniversity of FlorenceCareggi HospitalFlorenceItaly
| | - Mariarosaria Di Tommaso
- Department of Health SciencesDivision of Obstetrics and GynecologyUniversity of FlorenceCareggi HospitalFlorenceItaly
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Lepri G, Airò P, Distler O, Andréasson K, Braun-Moscovici Y, Hachulla E, Balbir-Gurman A, De Langhe E, Rednic S, Ingegnoli F, Rosato E, Groseanu L, Ionescu R, Bellando-Randone S, Garzanova L, Beretta L, Bellocchi C, Moiseev S, Novikov P, Szabo I, Krasowska D, Codullo V, Walker UA, Manolaraki C, Guiducci S, Truchetet ME, Iannone F, Tofani L, Bruni C, Smith V, Cuomo G, Krusche M, Matucci-Cerinic M, Allanore Y. Systemic sclerosis and primary biliary cholangitis: Longitudinal data to determine the outcomes. J Scleroderma Relat Disord 2023; 8:210-220. [PMID: 37744053 PMCID: PMC10515998 DOI: 10.1177/23971983231155948] [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: 11/07/2022] [Accepted: 12/15/2022] [Indexed: 09/26/2023]
Abstract
Background Several studies described the cross-sectional characteristics of systemic sclerosis patients and coexisting primary biliary cholangitis, but longitudinal prognostic data are lacking. Aims To describe the systemic sclerosis-primary biliary cholangitis phenotype, including baseline characteristics and outcomes. Methods We performed a multicentre the European Scleroderma Trials and Research Group study of systemic sclerosis patients with primary biliary cholangitis or with primary biliary cholangitis-specific antibodies, matched with systemic sclerosis controls free from hepatobiliary involvement matched for disease duration and cutaneous subset. Data were recorded at baseline and at the last available visit. Results A total of 261 patients were enrolled (115 primary biliary cholangitis-systemic sclerosis, 161 systemic sclerosis). At baseline, systemic sclerosis-primary biliary cholangitis patients had a higher prevalence of anti-centromere antibodies (p = 0.0023) and a lower prevalence of complete absence of digital ulcers. The milder vascular involvement was confirmed at follow-up when crucial differences emerged in the percentage of patients experiencing digital ulcers; a significantly higher number of patients who never experienced digital ulcers were observed among primary biliary cholangitis-systemic sclerosis patients (p = 0.0015). Moreover, a greater incidence of pulmonary arterial hypertension (p < 0.001) and of conduction blocks (p = 0.0256) was observed in systemic sclerosis patients without primary biliary cholangitis. Patients with primary biliary cholangitis had higher levels of liver enzymes at baseline than systemic sclerosis patients; a significant decrease in liver enzymes was observed at follow-up. Out of 18 patients with cholangitis, one received a liver transplant at follow-up. Conclusion Our data show that systemic sclerosis-primary biliary cholangitis exhibit a mild systemic sclerosis and primary biliary cholangitis phenotype with outcomes being in general favourable.
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Affiliation(s)
- Gemma Lepri
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Paolo Airò
- Rheumatology and Clinical Immunology, Spedali Civili of Brescia, Brescia, Italy
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zürich, Switzerland
| | - Kristofer Andréasson
- Section of Rheumatology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Yolanda Braun-Moscovici
- Rheumatology Department, Rambam Health Care Campus, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Eric Hachulla
- Department of Internal Medicine, Hôpital Claude Huriez, Lille, France
| | - Alexandra Balbir-Gurman
- Rheumatology Department, Rambam Health Care Campus, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Ellen De Langhe
- ERN ReCONNET, Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium
| | - Simona Rednic
- Department of Rheumatology, Emergency County Teaching Hospital, University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania
| | - Francesca Ingegnoli
- Clinical Rheumatology Unit, ASST Pini-CTO, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milano, Italy
| | - Edoardo Rosato
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Laura Groseanu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Ruxandra Ionescu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Silvia Bellando-Randone
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Liudmila Garzanova
- Laboratory of Microcirculation and Inflammation, VA Nasonova Institute of Rheumatology, Moscow, Russian Federation
| | - Lorenzo Beretta
- Scleroderma Unit, Referral Center for Systemic Autoimmune Diseases, La Fondazione IRCCS Ca’ Granda Ospedale Maggiore di Milano Policlinico, Milano, Italy
| | - Chiara Bellocchi
- Scleroderma Unit, Referral Center for Systemic Autoimmune Diseases, La Fondazione IRCCS Ca’ Granda Ospedale Maggiore di Milano Policlinico, Milano, Italy
| | - Sergey Moiseev
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Pavel Novikov
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Iulia Szabo
- Department of Rheumatology, Emergency County Teaching Hospital, University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania
| | - Dorota Krasowska
- Department of Dermatology, Venereology and Pediatric Dermatology, Medical University of Lublin, Lublin, Poland
| | | | - Ulrich A. Walker
- Department of Rheumatology, Universitätsspital Basel, Basel, Switzerland
| | | | - Serena Guiducci
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Florenzo Iannone
- Rheumatology Unit – DETO, School of Medicine, University of Bari, Bari, Italy
| | - Lorenzo Tofani
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Cosimo Bruni
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zürich, Switzerland
| | - Vanessa Smith
- Department of Rheumatology, Ghent University Hospital and Department of Internal Medicine, Ghent University, Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Center (IRC), Ghent, Belgium
| | - Giovanna Cuomo
- Department of Precision of Medicine, University of Campania – L. Vanvitelli, Naples, Italy
| | - Martin Krusche
- Division of Rheumatology and Systemic Inflammatory Diseases, University Hospital Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Marco Matucci-Cerinic
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Scleroderma Unit, Referral Center for Systemic Autoimmune Diseases, La Fondazione IRCCS Ca’ Granda Ospedale Maggiore di Milano Policlinico, Milano, Italy
| | - Yannick Allanore
- Rheumatology, Cochin Hospital, APHP, Paris Cité University, Paris, France
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Nocci M, Villa G, Ragazzoni L, Tofani L, Romagnoli S, Baldini G, Bertini P, Hubloue I, Scolletta S, Mechi MT, Della Corte F. Relationship between intensive care surge capacity and hospital factors: an extensive experience. Intern Emerg Med 2023; 18:1521-1532. [PMID: 36859647 PMCID: PMC9977086 DOI: 10.1007/s11739-023-03233-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/14/2023] [Indexed: 03/03/2023]
Abstract
As a prolonged surge scenario, the COVID-19 pandemic has offered an unparalleled opportunity to improve hospital surge capacity (SC) understanding and the ability to manage it. In this study, the authors report the experience of a large hospital network and evaluate potential relationships between Intensive Care Units SC (ICU-SC) and some hospital-related variables: bed occupancy, emergency department admissions, ward admission from ED, and elective surgery procedures. Pearson's partial correlation coefficient (r) has been used to define the relationship between SC and the daily values of the above variables, collected through a dedicated digital platform that also ensured a regular quality check of the data. The observation has concerned several levels of analysis, namely two different types of SC calculation (SC base-SCb and SC actual-SCa), hospital category level and multi-hospital level, and two consecutive pandemic waves. Among the 16 hospitals observed, the correlation was shown to be moderate-positive with non-ICU bed occupancy (r/ = 0.62, r/ = 0.54), strong/moderate with ICU bed occupancy (r/ = 0.72, r/ = 0.54), and moderate with ward admissions from ED (r/ = 0.50, r/ = 0.51) On the contrary, the correlation proved to be moderate-negative with ED admissions (r/ = - 0.69, r/ = - 0.62) and low with the number of elective surgery procedures (r/ = - 0.10, r/ = - 0.16). This study identified a positive correlation between SC and three variables monitored: ICU bed occupancy, non-ICU bed occupancy, and ward admissions from ED. On the contrary, the correlation was negative for ED admission and the number of elective surgery procedures. The results have been confirmed across all levels of analysis adopted.
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Affiliation(s)
- Matteo Nocci
- Section of Anesthesia and Critical Care, Department of Anesthesia and Critical Care, Azienda Ospedaliero-Universitaria Careggi-Università di Firenze, 50134, Florence, Italy.
- International Joint PhD in Global Health, Humanitarian Aid and Disaster Medicine, Università del Piemonte Orientale, Novara, Italy.
- Vrije Universiteit Brussel-VUB, Brussels, Belgium.
| | - Gianluca Villa
- Section of Anesthesia and Critical Care, Department of Anesthesia and Critical Care, Azienda Ospedaliero-Universitaria Careggi-Università di Firenze, 50134, Florence, Italy
| | - Luca Ragazzoni
- CRIMEDIM-Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy
- Department for Sustainable Development and Ecological Transition, Università del Piemonte Orientale, Vercelli, Italy
| | - Lorenzo Tofani
- Department of Statistics, Informatics, Applications, Università Di Firenze, Florence, Italy
| | - Stefano Romagnoli
- Section of Anesthesia and Critical Care, Department of Anesthesia and Critical Care, Azienda Ospedaliero-Universitaria Careggi-Università di Firenze, 50134, Florence, Italy
| | - Gabriele Baldini
- Section of Anesthesia and Critical Care, Department of Anesthesia and Critical Care, Azienda Ospedaliero-Universitaria Careggi-Università di Firenze, 50134, Florence, Italy
| | - Pietro Bertini
- Cardiothoracic and Vascular Anesthesia and Intensive Care, Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Ives Hubloue
- Department of Emergency Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium
- Research Group on Emergency and Disaster Medicine, Vrije Universiteit Brussels, Brussels, Belgium
| | - Sabino Scolletta
- Unit of Anesthesia and Intensive Care Unit, Department of Emergency, Urgency and Transplantation, University Hospital of Siena, Siena, Italy
| | - Maria Teresa Mechi
- Hospital Health Direction, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Francesco Della Corte
- CRIMEDIM-Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
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7
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Beltrami M, Fedele E, Fumagalli C, Mazzarotto F, Girolami F, Ferrantini C, Coppini R, Tofani L, Bertaccini B, Poggesi C, Olivotto I. Long-Term Prevalence of Systolic Dysfunction in MYBPC3 Versus MYH7-Related Hypertrophic Cardiomyopathy. Circ Genom Precis Med 2023; 16:363-371. [PMID: 37409452 DOI: 10.1161/circgen.122.003832] [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] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 05/30/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND The 2 sarcomere genes most commonly associated with hypertrophic cardiomyopathy (HCM), MYBPC3 (myosin-binding protein C3) and MYH7 (β-myosin heavy chain), are indistinguishable at presentation, and genotype-phenotype correlations have been elusive. Based on molecular and pathophysiological differences, however, it is plausible to hypothesize a different behavior in myocardial performance, impacting lifetime changes in left ventricular (LV) function. METHODS We reviewed the initial and final echocardiograms of 402 consecutive HCM patients with pathogenic or likely pathogenic MYBPC3 (n=251) or MYH7 (n=151) mutations, followed over 9±8 years. RESULTS At presentation, MYBPC3 patients were less frequently obstructive (15% versus 26%; P=0.005) and had lower LV ejection fraction compared with MYH7 (66±8% versus 68±8%, respectively; P=0.03). Both HCM patients harboring MYBPC3 and MYH7 mutations exhibited a small but significant decline in LV systolic function during follow-up; however, new onset of severe LV systolic dysfunction (LV ejection fraction, <50%) was greater among MYBPC3 patients (15% versus 5% among MYH7; P=0.013). Prevalence of grade II/III diastolic dysfunction at final evaluation was comparable between MYBPC3 and MYH7 patients (P=0.509). In a Cox multivariable analysis, MYBPC3-positive status (hazard ratio, 2.53 [95% CI, 1.09-5.82]; P=0.029), age (hazard ratio, 1.03 [95% CI, 1.00-1.06]; P=0.027), and atrial fibrillation (hazard ratio, 2.39 [95% CI, 1.14-5.05]; P=0.020) were independent predictors of severe systolic dysfunction. No statistically significant differences occurred with regard to incidence of atrial fibrillation, heart failure, appropriate implanted cardioverter defibrillator shock, or cardiovascular death. CONCLUSIONS MYBPC3-related HCM showed increased long-term prevalence of systolic dysfunction compared with MYH7, in spite of similar outcome. Such observations suggest different pathophysiology of clinical progression in the 2 subsets and may prove relevant for understanding of genotype-phenotype correlations in HCM.
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Affiliation(s)
- Matteo Beltrami
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy (M.B., C.F.)
| | - Elisa Fedele
- Department of Cardiology, Policlinico Casilino, Rome, Italy (E.F.)
| | - Carlo Fumagalli
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy (M.B., C.F.)
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli," Naples, Italy (C.F.)
| | - Francesco Mazzarotto
- Department of Molecular and Translational Medicine, University of Brescia, Italy (F.M.)
| | | | - Cecilia Ferrantini
- Department of Experimental and Clinical Medicine (C.F., C.P., I.O.), University of Florence, Italy
| | - Raffaele Coppini
- Division of Pharmacology, Department of Neuroscience, Psychology, Drug Sciences and Child Health (NeuroFarBa) (R.C.), University of Florence, Italy
| | - Lorenzo Tofani
- Department of Statistics, Computer Science, Applications (L.T., B.B.), University of Florence, Italy
| | - Bruno Bertaccini
- Department of Statistics, Computer Science, Applications (L.T., B.B.), University of Florence, Italy
| | - Corrado Poggesi
- Department of Experimental and Clinical Medicine (C.F., C.P., I.O.), University of Florence, Italy
| | - Iacopo Olivotto
- Meyer Children's Hospital, IRCSS, Florence, Italy (F.G., I.O.)
- Department of Experimental and Clinical Medicine (C.F., C.P., I.O.), University of Florence, Italy
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8
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Campione E, Lambiase S, Gaeta Shumak R, Galluzzo M, Lanna C, Costanza G, Borselli C, Artosi F, Cosio T, Tofani L, Dattola A, Di Daniele F, Bianchi L. A Real-Life Study on the Use of Tildrakizumab in Psoriatic Patients. Pharmaceuticals (Basel) 2023; 16:ph16040526. [PMID: 37111283 PMCID: PMC10141711 DOI: 10.3390/ph16040526] [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: 02/06/2023] [Revised: 03/21/2023] [Accepted: 03/23/2023] [Indexed: 04/03/2023] Open
Abstract
Tildrakizumab is a humanized IgG1κ monoclonal antibody that selectively targets the p19 subunit of interleukin IL-23, thereby inhibiting the IL-23/IL-17 axis, which is primarily implicated in the immunopathogenesis of psoriasis. Tildrakizumab is approved for the treatment of moderate-to-severe plaque-type psoriasis in adults based on the evidence of two randomized and controlled phase-III clinical trials (reSURFACE 1 and reSURFACE 2). Here, we report our real-life experience treating 53 psoriatic patients (19 female and 34 male) who were administered tildrakizumab every 12 weeks and received follow-ups over 52 weeks. Descriptive and inferential statistical analyses were performed, in particular the Psoriasis Area and Severity Index (PASI), Dermatology Life Quality Index (DLQI) and, if applicable, the Nail Psoriasis Severity Index (NAPSI) and Palmoplantar Psoriasis Physician Global Assessment (PPPGA). These were assessed at baseline and after different timepoints (weeks) during the follow-up period. We described and evaluated demographical and epidemiological characteristics in our cohort group, focusing on comorbidities. In this group, 35.9% of patients were female and 64.1% were male, with 47.1% being smokers and with a mean age of 51.2 years. A total of 37.7% of these patients was affected by scalp psoriasis; regarding comorbidities, hypertension was the most frequent (32.5%), followed by psoriatic arthritis (PsA) (18.60%) and diabetes (13.9%). At week 52, 93%, 90.2% and 77% of patients achieved a PASI reduction ≥75% (PASI 75), PASI 90 and PASI 100, respectively. In addition, NAPSI, PPPGA and DLQI scores were significantly reduced by week 52. In our cohort of complex psoriasis patients, disease remission began at the end of the fourth week of treatment and remained constant from week 16 to week 52.
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Affiliation(s)
- Elena Campione
- Dermatology Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Sara Lambiase
- Dermatology Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Ruslana Gaeta Shumak
- Dermatology Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Marco Galluzzo
- Dermatology Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Caterina Lanna
- Dermatology Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Gaetana Costanza
- Department of Experimental Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Cristiana Borselli
- Dermatology Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Fabio Artosi
- Dermatology Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Terenzio Cosio
- Dermatology Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
- Department of Experimental Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Lorenzo Tofani
- Dermatology Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Annunziata Dattola
- Dermatology Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Francesca Di Daniele
- Dermatology Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Luca Bianchi
- Dermatology Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
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9
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Allinovi M, Sessa F, Villa G, Cocci A, Innocenti S, Zanazzi M, Tofani L, Paparella L, Curi D, Cirami CL, Campi R, Mari A, Ognibene A, Lorubbio M, Fanelli A, Romagnoli S, Romagnani P, Minervini A. Novel Biomarkers for Early Detection of Acute Kidney Injury and Prediction of Long-Term Kidney Function Decline after Partial Nephrectomy. Biomedicines 2023; 11:biomedicines11041046. [PMID: 37189664 DOI: 10.3390/biomedicines11041046] [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] [Received: 02/25/2023] [Revised: 03/20/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023] Open
Abstract
Background: Identifying acute kidney injury (AKI) within few hours of onset is certainly helpful. However, early prediction of a long-term eGFR decline may be an even more important goal. Our aim was to identify and compare serum [creatinine, kineticGFR, cystatin C, neutrophil gelatinase–associated lipocalin (NGAL)] and urinary (NephroCheck, NGAL, proteinuria, albuminuria, acantocytes at urinary sediment) predictors of AKI that might efficiently predict long-term GFR decline after robotic Nephron-Spearing Surgery (rNSS). Methods: Monocentric prospective observational study. Patients scheduled for rNSS for suspected localized Renal Cell Carcinoma from May 2017 to October 2017 were enrolled. Samples were collected preoperatively and postoperatively (timepoints: 4 h, 10 h, 24 h, 48 h), while kidney function was re-assessed up to 24 months. Results: 38 patients were included; 16 (42%) developed clinical AKI. The eGFR decline at 24 months was more pronounced after postoperative AKI (−20.75 vs. −7.20, p < 0.0001). KineticGFR at 4 h (p = 0.008) and NephroCheck at 10 h (p = 0.001) were, at multivariable linear regression analysis, efficient predictors of post-operative AKI and long-term eGFR decline if compared to creatinine (R2 0.33 vs. 0.04). Conclusions: NephroCheck and kineticGFR have emerged as promising noninvasive, accurate, and early biomarkers of postoperative AKI and long-term GFR decline after rNSS. Combining NephroCheck and kineticGFR in clinical practice would allow to identify high risk of postoperative AKI and long-term GFR decline as early as 10 h after surgery.
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10
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Galluzzo M, Marcelli L, Vellucci L, Paganini C, Maffei V, Tofani L, Belcastro A, Bianchi L, Talamonti M. Guselkumab for treatment of moderate-to-severe plaque psoriasis: real-life effectiveness and drug-survival for up to 148 weeks. Expert Opin Biol Ther 2023; 23:371-381. [PMID: 36971507 DOI: 10.1080/14712598.2023.2194485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
BACKGROUND Real-world data are useful to guide the management of psoriasis. Here, we present data on the effectiveness and survival of guselkumab in moderate-to-severe chronic plaque psoriasis for up to 148 weeks. RESEARCH DESIGN AND METHODS Cross-sectional study of 122 patients receiving guselkumab (100 mg at weeks 0 and 4, and then every 8 weeks thereafter) for>12 weeks, from November 2018 to April 2022. MAIN OUTCOME MEASURES Clinical features and drug survival were analyzed up to 148 weeks. RESULTS Obese patients (32.8%) and those receiving prior biologics (64.8%) were included. Guselkumab treatment was associated with a rapid decrease in PASI, from 16.2 to 3.2 at week 12, and long-term improvements in all subgroups (97.6%, 82.9%, and 63.4% of patients, respectively, achieved PASI 75, 90, and 100 after 148 weeks). More non-obese than obese patients achieved PASI 100 at week 148 (86.4% vs 38.9%), as did bio-naïve vs bio-experienced patients (86.7% vs 50.0%). Previous biologic therapy was a negative prognostic factor for achieving PASI 100 over the long-term by multivariate analysis (p = 0.005). Overall, 96% of patients were on treatment after 2 years. CONCLUSIONS Real-world data confirm the long-term effectiveness of guselkumab in patients with psoriasis.
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11
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Anichini G, Raggi C, Pastore M, Carrassa L, Maresca L, Crivaro E, Lottini T, Duwe L, Andersen JB, Tofani L, Di Tommaso L, Banales JM, Arcangeli A, Marra F, Stecca B. Combined Inhibition of Smoothened and the DNA Damage Checkpoint WEE1 Exerts Antitumor Activity in Cholangiocarcinoma. Mol Cancer Ther 2023; 22:343-356. [PMID: 36807728 PMCID: PMC9978885 DOI: 10.1158/1535-7163.mct-22-0379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 10/24/2022] [Accepted: 12/01/2022] [Indexed: 02/23/2023]
Abstract
Cholangiocarcinoma (CCA) is characterized by resistance to chemotherapy and a poor prognosis. Therefore, treatments that can effectively suppress tumor growth are urgently needed. Aberrant activation of hedgehog (HH) signaling has been implicated in several cancers, including those of the hepatobiliary tract. However, the role of HH signaling in intrahepatic CCA (iCCA) has not been completely elucidated. In this study, we addressed the function of the main transducer Smoothened (SMO) and the transcription factors (TFs) GLI1 and GLI2 in iCCA. In addition, we evaluated the potential benefits of the combined inhibition of SMO and the DNA damage kinase WEE1. Transcriptomic analysis of 152 human iCCA samples showed increased expression of GLI1, GLI2, and Patched 1 (PTCH1) in tumor tissues compared with nontumor tissues. Genetic silencing of SMO, GLI1, and GLI2 inhibited the growth, survival, invasiveness, and self-renewal of iCCA cells. Pharmacologic inhibition of SMO reduced iCCA growth and viability in vitro, by inducing double-strand break DNA damage, leading to mitotic arrest and apoptotic cell death. Importantly, SMO inhibition resulted in the activation of the G2-M checkpoint and DNA damage kinase WEE1, increasing the vulnerability to WEE1 inhibition. Hence, the combination of MRT-92 with the WEE1 inhibitor AZD-1775 showed increased antitumor activity in vitro and in iCCA xenografts compared with single treatments. These data indicate that combined inhibition of SMO and WEE1 reduces tumor burden and may represent a strategy for the clinical development of novel therapeutic approaches in iCCA.
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Affiliation(s)
- Giulia Anichini
- Core Research Laboratory - Institute for Cancer Research and Prevention (ISPRO), Florence, Italy
| | - Chiara Raggi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Mirella Pastore
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Laura Carrassa
- Core Research Laboratory - Institute for Cancer Research and Prevention (ISPRO), Florence, Italy
| | - Luisa Maresca
- Core Research Laboratory - Institute for Cancer Research and Prevention (ISPRO), Florence, Italy
| | - Enrica Crivaro
- Core Research Laboratory - Institute for Cancer Research and Prevention (ISPRO), Florence, Italy
| | - Tiziano Lottini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Lea Duwe
- Biotech Research and Innovation Centre (BRIC), Dept. of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jesper B Andersen
- Biotech Research and Innovation Centre (BRIC), Dept. of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lorenzo Tofani
- Department of Statistics, University of Florence, Florence, Italy
| | - Luca Di Tommaso
- Pathology Department, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Jesus M Banales
- Department of Liver and Gastrointestinal Diseases, Biodonostia Health Research Institute - Donostia University Hospital, University of the Basque Country (UPV/EHU), San Sebastian, Spain.,National Institute for the Study of Liver and Gastrointestinal Diseases (CIBERehd, "Instituto de Salud Carlos III"), Madrid, Spain.,Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Lisbon, Portugal.,Department of Biochemistry and Genetics, School of Sciences, University of Navarra, Pamplona, Spain
| | - Annarosa Arcangeli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Fabio Marra
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Barbara Stecca
- Core Research Laboratory - Institute for Cancer Research and Prevention (ISPRO), Florence, Italy
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12
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Landini N, Orlandi M, Occhipinti M, Nardi C, Tofani L, Bellando-Randone S, Ciet P, Wielopolski P, Benkert T, Bruni C, Bertolo S, Moggi-Pignone A, Matucci-Cerinic M, Morana G, Colagrande S. Ultrashort Echo-Time Magnetic Resonance Imaging Sequence in the Assessment of Systemic Sclerosis-Interstitial Lung Disease. J Thorac Imaging 2023; 38:97-103. [PMID: 35482025 DOI: 10.1097/rti.0000000000000637] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To test respiratory-triggered ultrashort echo-time (UTE) Spiral VIBE-MRI sequence in systemic sclerosis-interstitial lung disease assessment compared with computed tomography (CT). MATERIAL AND METHODS Fifty four SSc patients underwent chest CT and UTE (1.5 T). Two radiologists, independently and in consensus, verified ILD presence/absence and performed a semiquantitative analysis (sQA) of ILD, ground-glass opacities (GGO), reticulations and honeycombing (HC) extents on both scans. A CT software quantitative texture analysis (QA) was also performed. For ILD detection, intra-/inter-reader agreements were computed with Cohen K coefficient. UTE sensitivity and specificity were assessed. For extent assessments, intra-/inter-reader agreements and UTE performance against CT were computed by Lin's concordance coefficient (CCC). RESULTS Three UTE were discarded for low quality, 51 subjects were included in the study. Of them, 42 QA segmentations were accepted. ILD was diagnosed in 39/51 CT. UTE intra-/inter-reader K in ILD diagnosis were 0.56 and 0.26. UTE showed 92.8% sensitivity and 75.0% specificity. ILD, GGO, and reticulation extents were 14.8%, 7.7%, and 7.1% on CT sQA and 13.0%, 11.2%, and 1.6% on CT QA. HC was <1% and not further considered. UTE intra-/inter-reader CCC were 0.92 and 0.89 for ILD extent and 0.84 and 0.79 for GGO extent. UTE RET extent intra-/inter-reader CCC were 0.22 and 0.18. UTE ILD and GGO extents CCC against CT sQA and QA were ≥0.93 and ≥0.88, respectively. RET extent CCC were 0.35 and 0.22 against sQA and QA, respectively. CONCLUSION UTE Spiral VIBE-MRI sequence is reliable in assessing ILD and GGO extents in systemic sclerosis-interstitial lung disease patients.
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Affiliation(s)
- Nicholas Landini
- Department of Radiology, Ca' Foncello General Hospital, Treviso
- Department of Experimental and Clinical Biomedical Sciences, University of Florence & Radiodiagnostic Unit n. 2 AOUC
| | - Martina Orlandi
- Department of Experimental and Clinical Medicine, University of Florence and Division of Rheumatology AOUC & Scleroderma Unit
| | - Mariaelena Occhipinti
- Department of Experimental and Clinical Biomedical Sciences, University of Florence & Radiodiagnostic Unit n. 2 AOUC
| | - Cosimo Nardi
- Department of Experimental and Clinical Biomedical Sciences, University of Florence & Radiodiagnostic Unit n. 2 AOUC
| | - Lorenzo Tofani
- Department of Experimental and Clinical Medicine, University of Florence and Division of Rheumatology AOUC & Scleroderma Unit
| | - Silvia Bellando-Randone
- Department of Experimental and Clinical Medicine, University of Florence and Division of Rheumatology AOUC & Scleroderma Unit
| | - Pierluigi Ciet
- Department of Pediatric Pulmonology, Erasmus University Medical Centre, Sophia Children's Hospital
- Department of Radiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Piotr Wielopolski
- Department of Radiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Thomas Benkert
- MR Applications Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany
| | - Cosimo Bruni
- Department of Experimental and Clinical Medicine, University of Florence and Division of Rheumatology AOUC & Scleroderma Unit
| | - Silvia Bertolo
- Department of Radiology, Ca' Foncello General Hospital, Treviso
| | - Alberto Moggi-Pignone
- Department of Experimental and Clinical Medicine, University of Florence & Division of Internal Medicine Unit IV AOUC, Florence, Italy
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, University of Florence and Division of Rheumatology AOUC & Scleroderma Unit
| | - Giovanni Morana
- Department of Radiology, Ca' Foncello General Hospital, Treviso
| | - Stefano Colagrande
- Department of Experimental and Clinical Biomedical Sciences, University of Florence & Radiodiagnostic Unit n. 2 AOUC
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Silvano A, Seravalli V, Strambi N, Vallario A, Tofani L, Parenti A, Di Tommaso M. Tryptophan degradation enzymes expression in the placenta and the Kynurenine/Tryptophan ratio in maternal plasma after elective cesarean section. J Reprod Immunol 2023; 156:103823. [PMID: 36739732 DOI: 10.1016/j.jri.2023.103823] [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: 11/30/2022] [Revised: 01/19/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
Indoleamine 2,3-dioxygenase 1 (IDO1) and tryptophan 2,3-dioxygenase (TDO) metabolize tryptophan in the kynurenine pathway. We evaluated these enzymes' mRNA expression in maternal and fetal sides of the placenta of uncomplicated, unlabored full-term pregnancies after elective cesarean section and compared it with that of placentas obtained from vaginal delivery. Tryptophan and kynurenine plasmatic levels after cesarean section were measured, to investigate their possible correlation with IDO1 and TDO mRNA (TDO2) expression. The results suggested that IDO1 and TDO2 expression was higher in the maternal side of the placenta and that labor significantly affects TDO2 expression and the plasma Kynurenine/Tryptophan ratio.
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Affiliation(s)
- Angela Silvano
- Department of Health Sciences, Division of Obstetrics and Gynecology, Careggi Hospital, University of Florence, Florence, Italy
| | - Viola Seravalli
- Department of Health Sciences, Division of Obstetrics and Gynecology, Careggi Hospital, University of Florence, Florence, Italy
| | - Noemi Strambi
- Department of Health Sciences, Division of Obstetrics and Gynecology, Careggi Hospital, University of Florence, Florence, Italy
| | - Arianna Vallario
- Department of Health Sciences, Division of Obstetrics and Gynecology, Careggi Hospital, University of Florence, Florence, Italy
| | - Lorenzo Tofani
- Department of Statistics, Computer Science, Applications, University of Florence, Florence, Italy
| | - Astrid Parenti
- Department of Health Sciences, Clinical Pharmacology and Oncology Section, University of Florence, Florence, Italy.
| | - Mariarosaria Di Tommaso
- Department of Health Sciences, Division of Obstetrics and Gynecology, Careggi Hospital, University of Florence, Florence, Italy.
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Bruni C, Occhipinti M, Pienn M, Camiciottoli G, Bartolucci M, Bosello SL, Payer C, Bálint Z, Larici AR, Tottoli A, Tofani L, De Lorenzis E, Lepri G, Bellando-Randone S, Spinella A, Giuggioli D, Masini F, Cuomo G, Lavorini F, Colagrande S, Olschewski H, Matucci-Cerinic M. Lung vascular changes as biomarkers of severity in systemic sclerosis-associated interstitial lung disease. Rheumatology (Oxford) 2023; 62:696-706. [PMID: 35708639 DOI: 10.1093/rheumatology/keac311] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 11/26/2021] [Revised: 04/21/2022] [Accepted: 05/16/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES It has recently become possible to assess lung vascular and parenchymal changes quantitatively in thoracic CT images using automated software tools. We investigated the vessel parameters of patients with SSc, quantified by CT imaging, and correlated them with interstitial lung disease (ILD) features. METHODS SSc patients undergoing standard of care pulmonary function testing and CT evaluation were retrospectively evaluated. CT images were analysed for ILD patterns and total pulmonary vascular volume (PVV) extents with Imbio lung texture analysis. Vascular analysis (volumes, numbers and densities of vessels, separating arteries and veins) was performed with an in-house developed software. A threshold of 5% ILD extent was chosen to define the presence of ILD, and commonly used cut-offs of lung function were adopted. RESULTS A total of 79 patients [52 women, 40 ILD, mean age 56.2 (s.d. 14.2) years, total ILD extent 9.5 (10.7)%, PVV/lung volume % 2.8%] were enrolled. Vascular parameters for total and separated PVV significantly correlated with functional parameters and ILD pattern extents. SSc-associated ILD (SSc-ILD) patients presented with an increased number and volume of arterial vessels, in particular those between 2 and 4 mm of diameter, and with a higher density of arteries and veins of <6 mm in diameter. Considering radiological and functional criteria concomitantly, as well as the descriptive trends from the longitudinal evaluations, the normalized PVVs, vessel numbers and densities increased progressively with the increase/worsening of ILD extent and functional impairment. CONCLUSION In SSc patients CT vessel parameters increase in parallel with ILD extent and functional impairment, and may represent a biomarker of SSc-ILD severity.
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Affiliation(s)
- Cosimo Bruni
- Division of Rheumatology, Deptartment of Experimental and Clinical Medicine, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy.,Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Michael Pienn
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Gianna Camiciottoli
- Department of Biomedical, Experimental and Clinical Sciences, University of Florence.,Department of CardioThoracoVascular, Careggi University Hospital, Florence
| | | | - Silvia Laura Bosello
- Department of Rheumatology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Roma, Italy
| | - Christian Payer
- Institute of Computer Graphics and Vision, Graz University of Technology, Graz, Austria
| | - Zoltán Bálint
- Faculty of Physics, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Anna Rita Larici
- Department of Radiological and Hematological Sciences, Section of Radiology, Università Cattolica del Sacro Cuore.,Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome
| | - Alessandra Tottoli
- Division of Rheumatology, Deptartment of Experimental and Clinical Medicine, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Lorenzo Tofani
- Division of Rheumatology, Deptartment of Experimental and Clinical Medicine, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy.,Department of Statistics, Computer Science, Applications, University of Florence, Florence
| | - Enrico De Lorenzis
- Department of Rheumatology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Roma, Italy
| | - Gemma Lepri
- Division of Rheumatology, Deptartment of Experimental and Clinical Medicine, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Silvia Bellando-Randone
- Division of Rheumatology, Deptartment of Experimental and Clinical Medicine, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Amelia Spinella
- Scleroderma Unit, Rheumatology Unit, Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria di Modena, Modena
| | - Dilia Giuggioli
- Scleroderma Unit, Rheumatology Unit, Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria di Modena, Modena
| | - Francesco Masini
- Department of Medicine of Precision, University of Campania L. Vanvitelli, Naples
| | - Giovanna Cuomo
- Department of Medicine of Precision, University of Campania L. Vanvitelli, Naples
| | - Federico Lavorini
- Department of Biomedical, Experimental and Clinical Sciences, University of Florence.,Department of CardioThoracoVascular, Careggi University Hospital, Florence
| | - Stefano Colagrande
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, Careggi University Hospital, University of Florence, Florence, Italy
| | - Horst Olschewski
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria.,Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Marco Matucci-Cerinic
- Division of Rheumatology, Deptartment of Experimental and Clinical Medicine, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy.,Unit of Immunology, Rheumatology, Allergy and Rare diseases (UnIRAR), IRCCS San Raffaele Hospital, Milan, Italy
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Orlandi M, Meliante LA, Damiani A, Tofani L, Bruni C, Guiducci S, Matucci-Cerinic M, Bellando-Randone S, Tomassetti S. The Role of Bronchoalveolar Lavage in Systemic Sclerosis Interstitial Lung Disease: A Systematic Literature Review. Pharmaceuticals (Basel) 2022; 15:ph15121584. [PMID: 36559035 PMCID: PMC9781787 DOI: 10.3390/ph15121584] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/13/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
The role of Bronchoalveolar Lavage (BAL) in the evaluation of systemic sclerosis (SSc) interstitial lung disease (ILD) is still controversial. The aim of this systematic literature review was to investigate the use of BAL in SSc-ILD, and to focus on the pros and cons of its real-life application. Methods: PubMed, Cochrane, and Embase were questioned from inception until 31 December 2021. Results: Eighteen papers were finally analyzed. A positive correlation was observed between lung function and BAL cytology; in particular, BAL neutrophilia/granulocytosis was related to lower diffusing capacity for carbon monoxide (DLCO) values and lower forced vital capacity (FVC). Moreover, a positive correlation between BAL cellularity and high-resolution computed tomography (HRCT) findings has been reported by several authors. Cytokines, chemokines, growth factors, coagulation factors, and eicosanoids have all been shown to be present, more often and in higher quantities in SSc-ILD patients than in the health control and, in some cases, they were related to more severe pulmonary disease. There was no consensus regarding the role of BAL cellularity as a predictor of mortality.
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Affiliation(s)
- Martina Orlandi
- Scleroderma Unit, Department of Experimental and Clinical Medicine, Division of Rheumatology AOUC, University of Florence, 50134 Florence, Italy
| | - Laura Antonia Meliante
- Scleroderma Unit, Department of Experimental and Clinical Medicine, Division of Rheumatology AOUC, University of Florence, 50134 Florence, Italy
| | - Arianna Damiani
- Scleroderma Unit, Department of Experimental and Clinical Medicine, Division of Rheumatology AOUC, University of Florence, 50134 Florence, Italy
| | - Lorenzo Tofani
- Scleroderma Unit, Department of Experimental and Clinical Medicine, Division of Rheumatology AOUC, University of Florence, 50134 Florence, Italy
| | - Cosimo Bruni
- Scleroderma Unit, Department of Experimental and Clinical Medicine, Division of Rheumatology AOUC, University of Florence, 50134 Florence, Italy
| | - Serena Guiducci
- Scleroderma Unit, Department of Experimental and Clinical Medicine, Division of Rheumatology AOUC, University of Florence, 50134 Florence, Italy
- Correspondence: ; Tel.: +39-055-794-7066
| | - Marco Matucci-Cerinic
- Scleroderma Unit, Department of Experimental and Clinical Medicine, Division of Rheumatology AOUC, University of Florence, 50134 Florence, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, 20132 Milan, Italy
| | - Silvia Bellando-Randone
- Scleroderma Unit, Department of Experimental and Clinical Medicine, Division of Rheumatology AOUC, University of Florence, 50134 Florence, Italy
| | - Sara Tomassetti
- Department of Clinical and Experimental Medicine, University of Florence, and Division of Interventional Pulmonology, Careggi University Hospital, 50134 Florence, Italy
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Silvano A, Seravalli V, Strambi N, Tartarotti E, Tofani L, Calosi L, Parenti A, Di Tommaso M. Tryptophan degradation enzymes and Angiotensin (1-7) expression in human placenta. J Reprod Immunol 2022; 153:103692. [DOI: 10.1016/j.jri.2022.103692] [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] [Received: 04/14/2022] [Revised: 07/14/2022] [Accepted: 08/05/2022] [Indexed: 11/26/2022]
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Bandini G, Cometi L, Accogli E, Domanico A, Tofani L, Bruni C, Bellando-Randone S, Lepri G, Orlandi M, Guiducci S, El-Aoufy K, Ciuti G, Fabbri A, Matucci-Cerinic M, Moggi-Pignone A. Ultrasound evaluation of bowel vasculopathy in systemic sclerosis. Eur J Intern Med 2022; 100:62-68. [PMID: 35058148 DOI: 10.1016/j.ejim.2022.01.026] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/05/2022] [Accepted: 01/13/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Gastrointestinal (GI) manifestations are frequent in systemic sclerosis (SSc) with an impact on quality of life and morbidity. Bowel vasculopathy is a key pathogenetic factor responsible for GI involvement. OBJECTIVES To compare abdominal ultrasound (US) and Color Doppler Ultrasonography (CDU) features of splanchnic vessels of SSc patients with healthy controls. METHODS The charts of SSc patients who underwent an abdominal US and CDU study were retrospectively analyzed. For Superior Mesenteric Artery (SMA) and Inferior Mesenteric Artery (IMA) caliber, Peak Systolic Velocity (PSV), Reverse Velocity (RV), End-Diastolic Velocity (EDV), Mean Velocity (mV), Blood-flow, Resistive Index (RI) and Pulsatility Index (PI) were recorded. RESULTS 28 SSc patients and 28 controls were enrolled. In SSc, caliber of SMA was significantly smaller than in controls (5.75 ± 0.62 mm vs. 6.45 ± 0.60 mm, p < 0.0001 - p adj =0.0002). The flow study of SMA and IMA showed a significant reduction of RV (SMA: 7.25 ± 6.37 cm/s vs. 18.52 ± 6.16 cm/s, p < 0.0001 - p adj <0.0001; IMA: 2.69 ± 6.10 cm/s vs. 17.06 ± 5.75 cm/s, p < 0.0001 - p adj <0.0001) and PI (SMA: 3.33 ± 0.75 vs. 4.53 ± 1.03, p < 0.0001 - p adj =0.0002; IMA: 3.54 ± 0.95 vs. 6.08 ± 1.53, p < 0.0001 - p adj <0.0001) in SSc patients than controls. CONCLUSION involvement of splanchnic vessels in SSc may be non-invasively investigated with abdominal US and CDU. Morphological and functional changes of Doppler parameters observed in SMA and IMA clearly demonstrate that these vessels are affected by SSc vasculopathy.
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Affiliation(s)
- Giulia Bandini
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Internal Medicine AOUC, Viale San Luca, Florence 50134, Italy; Institute of Clinical Physiology, National Research Council, Pisa, Italy; Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy.
| | - Laura Cometi
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology AOUC, Florence, Italy; Institute of Clinical Physiology, National Research Council, Pisa, Italy; Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
| | - Esterita Accogli
- Department of Internal Medicine, Centre of Research and Learning in Ultrasound, Maggiore Hospital, Bologna, Italy; Institute of Clinical Physiology, National Research Council, Pisa, Italy; Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
| | - Andrea Domanico
- Department of Internal Medicine, Centre of Research and Learning in Ultrasound, Maggiore Hospital, Bologna, Italy; Institute of Clinical Physiology, National Research Council, Pisa, Italy; Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
| | - Lorenzo Tofani
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology AOUC, Florence, Italy; Institute of Clinical Physiology, National Research Council, Pisa, Italy; Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
| | - Cosimo Bruni
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology AOUC, Florence, Italy; Institute of Clinical Physiology, National Research Council, Pisa, Italy; Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
| | - Silvia Bellando-Randone
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology AOUC, Florence, Italy; Institute of Clinical Physiology, National Research Council, Pisa, Italy; Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
| | - Gemma Lepri
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology AOUC, Florence, Italy; Institute of Clinical Physiology, National Research Council, Pisa, Italy; Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
| | - Martina Orlandi
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology AOUC, Florence, Italy; Institute of Clinical Physiology, National Research Council, Pisa, Italy; Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
| | - Serena Guiducci
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology AOUC, Florence, Italy; Institute of Clinical Physiology, National Research Council, Pisa, Italy; Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
| | - Khadija El-Aoufy
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology AOUC, Florence, Italy; Institute of Clinical Physiology, National Research Council, Pisa, Italy; Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
| | - Gabriele Ciuti
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Internal Medicine AOUC, Viale San Luca, Florence 50134, Italy; Institute of Clinical Physiology, National Research Council, Pisa, Italy; Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
| | - Alessia Fabbri
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Internal Medicine AOUC, Viale San Luca, Florence 50134, Italy; Institute of Clinical Physiology, National Research Council, Pisa, Italy; Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology AOUC, Florence, Italy; Unit of Immunology, Rheumatology, Allergy and Rare diseases (UnIRAR), IRCCS San Raffaele Hospital, Milan, Italy; Institute of Clinical Physiology, National Research Council, Pisa, Italy; Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
| | - Alberto Moggi-Pignone
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Internal Medicine AOUC, Viale San Luca, Florence 50134, Italy; Institute of Clinical Physiology, National Research Council, Pisa, Italy; Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
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Bruni C, Tofani L, Fretheim H, Liem S, Velauthapillai A, Bjørkekjær HJ, Barua I, Galetti I, Garaiman A, Becker MO, Hoffmann-Vold AM, De Vries-Bouwstra J, Vonk M, Distler JHW, Matucci-Cerinic M, Distler O. POS0388 DEVELOPING A SCREENING TOOL FOR THE DETECTION OF INTERSTITIAL LUNG DISEASE IN SYSTEMIC SCLEROSIS: THE ILD-RISC RISK SCORE. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundHigh resolution computed tomography (HRCT) is the gold standard for the diagnosis of systemic sclerosis associated interstitial lung disease (SSc-ILD). Although there is agreement in performing HRCT as a screening test at time of SSc diagnosis, some physicians do not regularly perform baseline HRCTs. In addition, it is unclear according to which criteria HRCTs should be repeated during the follow-up of baseline ILD negative patients.ObjectivesTo develop a risk score for the presence of SSc-ILD (the ILD-RISC), to guide physicians in ordering both baseline and follow-up HRCTs.MethodsThe steering board included six SSc-ILD experts from referral centers, two fellows and a patient research partner. Items for regression analysis were selected according to face validity, feasibility, scientific background, and personal experience using the nominal group technique (NGT). The prediction model for the presence of ILD was developed from baseline visits of SSc patients from the six centers using multivariable logistic regression with backward selection. Patients were randomly divided into a derivation and validation cohort consisting of 66% and 34% of patients respectively. Patients with missing data in the selected covariates and in the ILD status (outcome) were excluded. After identifying a cut-off favoring sensitivity >85% from the ROC curve analysis, the derived ILD-RISC score was applied first in the validation cohort and then longitudinally in a cohort of SSc patients with negative baseline HRCT.ResultsThe steering board selected 13 variables deemed important in the identification of SSc-ILD: sex, age, disease duration from first non-Raynaud’s phenomenon symptom, skin subset (diffuse/limited), presence of esophageal symptoms, digital ulcers (DU) ever, arthritis ever, smoking ever, increased inflammatory markers, NYHA functional class, SSc autoantibody status (SSc_Atb), FVC% and DLCO%. Among 780/3240 patients fulfilling the inclusion criteria, 533 (43% ILD) and 247 (48% ILD) respectively constituted the derivation and the validation cohort. In the derivation cohort, a model including FVC%, DLCO%, DU ever, age and SSc_Atb (Table 1A) showed an OR of 133.9 (95% CI 53.4-335.9) and an AUC of 79.1% (95% CI 75.3-83.0%) for the presence of ILD on HRCT (Figure 1). An ILD-RISC score ≥0.3 showed sensitivity of 85.6% and specificity of 53.6%, NPV of 83.2% and PPV of 58.2%, which were replicated in the validation cohort (Table 1B). Among 819 patients with negative baseline HRCT, 170 (20.8%) developed ILD during a 3.8±3.0 years follow up (1988 visits). Longitudinally, the ILD-RISC score showed comparable sensitivity and specificity (Table 1B).Table 1.A)ILD-RISC MODEL VARIABLESOR95% CIp valueDigital ulcers, ever2.0581.347-3.145<0.001Age1.0261.010-1.0420.001SSc_ATBAnti-centromere0.3340.198-0.563<0.001Anti-topoisomerase I2.3791.326-4.2670.004Anti-RNA-polymerase III1.4070.636-3.1130.399Anti-Pm/Scl2.5560.916-7.1350.073None of the aboveComparatorFVC%0.9900.979-1.0020.091DLCO%0.9710.960-0.982<0.001B)ILD-RISC SCORE PERFORMANCEDerivation cohortValidation cohortLongitudinal cohortAll Patients/ILD patients533/229247/119819/170AUC %, 95% CI79.1 (75.3 – 83.0)76.4 (71.0 – 82.7)72.6 (68.9 – 76.2)Sensitivity %, 95% CI85.6 (80.4 – 89.9)85.7 (78.1 – 91.5)80.4 (73.9 – 86.0)Specificity %, 95% CI53.6 (47.8 – 59.3)49.2 (40.3 – 58.2)50.5 (48.2 – 52.9)Negative Predictive Value %, 95% CI83.2 (77.2 – 88.1)78.8 (68.2 – 87.1)96.3 (94.9 – 97.4)Positive Predictive Value %, 95% CI58.2 (52.7 – 63.5)61.1 (53.2 – 68.5)13.9 (11.8 – 16.1)ConclusionWe developed and validated the ILD-RISC score to predict the presence of ILD at time of diagnosis and evaluated its performance during follow-up. The ILD-RISC may be useful in routine practice when resources for HRCTs might be limited. In particular, it may also help to decide when to order HRCTs at follow up, thus limiting unnecessary HRCTs and reducing the burden for patients and institutions.Disclosure of InterestsCosimo Bruni Speakers bureau: Actelion, Consultant of: Boehringer-Ingelheim, Eli-Lilly, Grant/research support from: New Horizon fellowship, FOREUM, EUSTAR, GILS, Lorenzo Tofani: None declared, Håvard Fretheim: None declared, Sophie Liem: None declared, Arthiha Velauthapillai: None declared, Hilde Jenssen Bjørkekjær: None declared, Imon Barua: None declared, Ilaria Galetti: None declared, Alexandru Garaiman: None declared, Mike O. Becker Speakers bureau: Mepha, MSD, Novartis, GSK, Bayer and Vifor, Consultant of: Mepha, MSD, Novartis, GSK, Bayer and Vifor, Grant/research support from: Mepha, MSD, Novartis, GSK, Bayer and Vifor, Anna-Maria Hoffmann-Vold Consultant of: Actelion, ARXX therapeutics, Bayer, Janssen, MSD, Lilly, Roche, Boehringer-Ingelheim, Medscape., Jeska de Vries-Bouwstra Speakers bureau: Payment for presentations and educational events by Boehringer Ingelheim and Janssen, Consultant of: Janssen and Boehringer Ingelheim, Abbvie, Grant/research support from: Roche, Galapagos and Janssen, ZonMW and ReumaNederland, Madelon Vonk: None declared, Jörg H.W. Distler Shareholder of: J.H.W.D. is stock owner of 4D Science and Scientific head of FibroCure., Grant/research support from: J.H.W.D. has received research funding from Anamar, Active Biotech, Array Biopharma, aTyr, BMS, Bayer Pharma, Boehringer Ingelheim, Celgene, Galapagos, GSK, Inventiva, Novartis, Sanofi-Aventis, RedX, UCB., Marco Matucci-Cerinic Speakers bureau: Biogen, Bayer, Boehringer-Ingelheim, CSL Behring, Eli-Lilly., Consultant of: Actelion, Biogen, Bayer, Boehringer-Ingelheim, CSL Behring, Eli-Lilly., Grant/research support from: Actelion, Oliver Distler Speakers bureau: Bayer, Boehringer Ingelheim, Janssen, Medscape, Consultant of: Abbvie, Acceleron, Alcimed, Amgen, AnaMar, Arxx, AstraZeneca, Baecon, Blade, Bayer, Boehringer Ingelheim, Corbus, CSL Behring, 4P Science, Galapagos, Glenmark, Horizon, Inventiva, Kymera, Lupin, Miltenyi Biotec, Mitsubishi Tanabe, MSD, Novartis, Prometheus, Roivant, Sanofi and Topadur, Grant/research support from: Kymera, Mitsubishi Tanabe, Boehringer Ingelheim
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Ceccherini MT, Bellando-Randone S, Guiducci S, Romano E, Carboni D, El Aoufy K, Lepri G, Cometi L, Tofani L, Matucci-Cerinic M, Melchiorre D. AB0747 Oral microbiome in rheumatic diseases.What involvement? Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.5185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundThe concept of core-microbiome in health is useful for investigating the possible role of the oral microbiome in autoimmune disease, such as Rheumatoid Arthritis, Spondyloarthritis, Sjogren Syndrome or Systemic Sclerosis (SSc), whose pathogenesis has not been fully understood. Environmental factors and certain genetic backgrounds have been proposed. Among the various environmental factors, the microbiota stands out, the entire composition of microorganisms, mainly bacteria but also fungi and viruses, which populate the human body.ObjectivesThe aim of the study was to verify whether there were quantitative differences between the microorganisms present in the oral cavity, in particular between the lactobacillus spp., of patients with SSc compared to those present in the oral cavity of healthy subjects taken as controls.MethodsTwenty-nine SSc female patients (mean age 62.) classified according to the ACR/EULAR2013 criteria and twenty-three female healthy subjects (HS, mean age 57.6) were enrolled and underwent tongue and gum swab sampling. Quantitative PCR was conducted in triplicates using Lactobacillus specific primers rpoB1, rpoB1o and rpoB2 for RNA-polymerase β subunit gene.ResultsOur data showed Lactobacillusspp.rpoB sequences significantly lower in the tongue of SSc patients than in HS (p=0.0211).The statistical analysis in HS highlighted a significant lower amount of rpoB on the gums than on the tongue.ConclusionOur preliminary data show that the number of Lactobacillus on the tongue in SSc patients is about half that of HS. These data make it more likely that Lactobacillus in SSc patients may play a protective role. Further investigations will also be needed in other autoimmune diseases.References[1]Zaura E, Keijser BJ, Huse SM, Crielaard W Defining the healthy “core microbiome” of oral microbial communities. BMC Microbiol. 2009 Dec 15;9:259. doi: 10.1186/1471-2180-9-259.[2]Nikitakis NG, Papaioannou W, Sakkas LI, Kousvelari E.The autoimmunity-oral microbiome connection. Oral Diseases (2017) 23, 828-839.Disclosure of InterestsNone declared
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Buccione E, Bambi S, Rasero L, Tofani L, Piazzini T, Della Pelle C, El Aoufy K, Ricci Z, Romagnoli S, Villa G. Regional Citrate Anticoagulation and Systemic Anticoagulation during Pediatric Continuous Renal Replacement Therapy: A Systematic Literature Review. J Clin Med 2022; 11:jcm11113121. [PMID: 35683511 PMCID: PMC9181744 DOI: 10.3390/jcm11113121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 05/24/2022] [Accepted: 05/30/2022] [Indexed: 12/20/2022] Open
Abstract
Background: Clotting is a major drawback of continuous renal replacement therapy (CRRT) performed on critically ill pediatric patients. Although anticoagulation is recommended to prevent clotting, limited results are available on the effect of each pharmacological strategy in reducing filter clotting in pediatric CRRT. This study defines which anticoagulation strategy, between regional citrate anticoagulation (RCA) and systemic anticoagulation with heparin, is safer and more efficient in reducing clotting, patient mortality, and treatment complications during pediatric CRRT. Methods: A systematic literature review was run considering papers published in English until December 2021 and describing patients’ and treatments’ complications in CRRT performed with heparin and RCA on patients aged less than 18 years. Results: Eleven studies were considered, cumulatively comprising 1.706 CRRT sessions (62% with systemic anticoagulation and 38% with RCA). Studies have consistently identified RCA’s superiority over systemic anticoagulation with heparin in prolonging circuit life. The pooled estimate (95% CI) of filter clotting risk showed that RCA is a protective factor for clotting risk (RR = 0.204). Conclusions: RCA has a potential role in prolonging circuit life and seems superior to systemic anticoagulation with heparin in decreasing the risk of circuit clotting during CRRT performed in critically ill pediatric patients.
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Affiliation(s)
- Emanuele Buccione
- Neonatal Intensive Care Unit, 65124 Pescara, Italy
- Correspondence: ; Tel.: +39-349-809-8954
| | - Stefano Bambi
- Health Sciences Department, University of Florence, 50139 Florence, Italy; (S.B.); (L.R.)
| | - Laura Rasero
- Health Sciences Department, University of Florence, 50139 Florence, Italy; (S.B.); (L.R.)
| | - Lorenzo Tofani
- Section of Anesthesiology, Intensive Care and Pain Medicine, Department of Health Sciences, University of Florence, 50139 Florence, Italy; (L.T.); (T.P.); (Z.R.); (S.R.); (G.V.)
| | - Tessa Piazzini
- Section of Anesthesiology, Intensive Care and Pain Medicine, Department of Health Sciences, University of Florence, 50139 Florence, Italy; (L.T.); (T.P.); (Z.R.); (S.R.); (G.V.)
| | | | - Khadija El Aoufy
- Department of Experimental and Clinical Medicine, Azienda Ospedaliero Universitaria Careggi, 50134 Florence, Italy;
| | - Zaccaria Ricci
- Section of Anesthesiology, Intensive Care and Pain Medicine, Department of Health Sciences, University of Florence, 50139 Florence, Italy; (L.T.); (T.P.); (Z.R.); (S.R.); (G.V.)
- Pediatric Intensive Care Unit, Meyer Children’s University Hospital, 50139 Florence, Italy
| | - Stefano Romagnoli
- Section of Anesthesiology, Intensive Care and Pain Medicine, Department of Health Sciences, University of Florence, 50139 Florence, Italy; (L.T.); (T.P.); (Z.R.); (S.R.); (G.V.)
- Department of Anesthesia and Intensive Care, Azienda Ospedaliero Universitaria Careggi, 50139 Florence, Italy
| | - Gianluca Villa
- Section of Anesthesiology, Intensive Care and Pain Medicine, Department of Health Sciences, University of Florence, 50139 Florence, Italy; (L.T.); (T.P.); (Z.R.); (S.R.); (G.V.)
- Department of Anesthesia and Intensive Care, Azienda Ospedaliero Universitaria Careggi, 50139 Florence, Italy
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21
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Adembri C, Nure E, Tofani L, Agnes S, Novelli A, Sganga G. Anidulafungin biliary passage in liver transplant patients. Transpl Infect Dis 2022; 24:e13848. [PMID: 35579962 DOI: 10.1111/tid.13848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 04/23/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Chiara Adembri
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Erida Nure
- Liver Transplantation, Fondazione Policlinico Universitario A, Gemelli IRCCS, Rome, Italy
| | - Lorenzo Tofani
- Department of Statistics, Informatics, Applications, University of Florence, Florence, Italy
| | - Salvatore Agnes
- Liver Transplantation, Fondazione Policlinico Universitario A, Gemelli IRCCS, Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Novelli
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Gabriele Sganga
- Emergency Surgery and Trauma, Fondazione Policlinico Universitario A, Gemelli IRCCS, Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
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22
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Galluzzo M, Talamonti M, Cioni A, Maffei V, Shumak RG, Tofani L, Bianchi L, Campione E. Efficacy of Tildrakizumab for the Treatment of Difficult-to-Treat Areas: Scalp, Nail, Palmoplantar and Genital Psoriasis. J Clin Med 2022; 11:jcm11092631. [PMID: 35566756 PMCID: PMC9100809 DOI: 10.3390/jcm11092631] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [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: 04/21/2022] [Revised: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 12/14/2022] Open
Abstract
Tildrakizumab, an IL-23 inhibitor, is effective and safe for the improvement of moderate-to-severe chronic plaque psoriasis. However, little evidence is available on the use of this biologic in psoriasis in difficult-to-treat locations. In this retrospective analysis, we treated patients with 100 mg tildrakizumab at Day 0, after 4 weeks and every 12 weeks thereafter. Disease severity and treatment response was assessed by the Psoriasis Area and Severity Index (PASI), the static Physician’s Global Assessment of Genitalia (sPGA-G), the Psoriasis Scalp Severity Index (PSSI), Nail Psoriasis Severity Index (NAPSI) and the Palmoplantar Psoriasis Area and Severity Index (ppPASI) at baseline and after 4, 12 and 28 weeks. We followed 18 patients (mean age 49.1 ± 12.7 years, 61.1% male) with psoriasis localized to the genital region (N = 7), scalp (N = 6), nails (N = 5) and palmar/plantar areas (N = 7). PASI score decreased from 11.5 at baseline to 3.1 and 2.4 at 12 and 28 weeks. Tildrakizumab treatment decreased sPGA-G (3.3 to 0.2), PSSI (36.2 to 2.7), NAPSI (48.4 to 15.7) and ppPASI (5.3 to 0) from baseline to 28 weeks, respectively. Data from this real-life retrospective analysis shows that tildrakizumab is an effective option for the management of psoriasis in difficult-to-treat areas.
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Affiliation(s)
- Marco Galluzzo
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.T.); (A.C.); (V.M.); (R.G.S.); (L.T.); (L.B.); (E.C.)
- Dermatology Unit, Fondazione Policlinico “Tor Vergata”, 00133 Rome, Italy
- Correspondence: ; Tel.: +39-06-2090-2743
| | - Marina Talamonti
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.T.); (A.C.); (V.M.); (R.G.S.); (L.T.); (L.B.); (E.C.)
- Dermatology Unit, Fondazione Policlinico “Tor Vergata”, 00133 Rome, Italy
| | - Arnaldo Cioni
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.T.); (A.C.); (V.M.); (R.G.S.); (L.T.); (L.B.); (E.C.)
- Dermatology Unit, Fondazione Policlinico “Tor Vergata”, 00133 Rome, Italy
| | - Virginia Maffei
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.T.); (A.C.); (V.M.); (R.G.S.); (L.T.); (L.B.); (E.C.)
- Dermatology Unit, Fondazione Policlinico “Tor Vergata”, 00133 Rome, Italy
| | - Ruslana Gaeta Shumak
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.T.); (A.C.); (V.M.); (R.G.S.); (L.T.); (L.B.); (E.C.)
- Dermatology Unit, Fondazione Policlinico “Tor Vergata”, 00133 Rome, Italy
| | - Lorenzo Tofani
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.T.); (A.C.); (V.M.); (R.G.S.); (L.T.); (L.B.); (E.C.)
- Dermatology Unit, Fondazione Policlinico “Tor Vergata”, 00133 Rome, Italy
| | - Luca Bianchi
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.T.); (A.C.); (V.M.); (R.G.S.); (L.T.); (L.B.); (E.C.)
- Dermatology Unit, Fondazione Policlinico “Tor Vergata”, 00133 Rome, Italy
| | - Elena Campione
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.T.); (A.C.); (V.M.); (R.G.S.); (L.T.); (L.B.); (E.C.)
- Dermatology Unit, Fondazione Policlinico “Tor Vergata”, 00133 Rome, Italy
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23
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Caldarola G, Galluzzo M, Bernardini N, Calabrese L, Grimaldi M, Moretta G, Pagnanelli G, Shumak RG, Talamonti M, Tofani L, Pallotta S, Peris K, Potenza C, De Simone C, Campione E. Tildrakizumab in moderate-to-severe plaque psoriasis: a multi-center, retrospective, real-life study. Dermatol Ther 2022; 35:e15488. [PMID: 35384168 PMCID: PMC9287013 DOI: 10.1111/dth.15488] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/02/2022] [Accepted: 04/01/2022] [Indexed: 12/01/2022]
Abstract
New biologic agents targeting interleukin (IL)23/T‐helper17 axis, such as tildrakizumab, have been developed for the treatment of plaque psoriasis. To analyze the efficacy and safety of tildrakizumab in a real life setting of patients affected by moderate‐to‐severe psoriasis over a 28‐week treatment period. A multicentric retrospective study was conducted in patients who initiated tildrakizumab between February 2020 and March 2021. Psoriasis Area and Severity Index—PASI was measured at baseline and after 4, 16 and 28 weeks. The percentage change in PASI value from baseline to the considered time‐points, proportion of patients with absolute PASI <3 at week 28 and the percentages of achieving a PASI75 or PASI90 response were assessed. Data about potential safety issues and adverse events (AEs) were collected. Statistical analysis were performed for establish clinical efficacy and for variables predicting clinical response. Fifty nine patients with psoriasis were included. Overall mean PASI percentage reduction was of 88% from baseline to week 28 and 47 out of 59 patients (79.7%) at week 28 had an absolute PASI <3. PASI75 and PASI90 responses at week 28 were achieved by 48 (81.40%) patients and 38 (64.4.0%) patients, respectively. No substantial associations between gender, body mass index ‐ BMI, PASI at baseline and prior exposition to biological therapies and the efficacy endpoints were retrieved. No serious safety issues or discontinuations related to adverse events were reported. In our real‐life study, tildrakizumab showed high efficacy and a favorable safety profile, regardless of patient‐ and disease‐related factors.
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Affiliation(s)
- Giacomo Caldarola
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy.,UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
| | - Marco Galluzzo
- Department of Systems Medicine, University of Rome "Tor Vergata", Italy.,Dermatology Unit, Fondazione Policlinico "Tor Vergata", Rome, Italy
| | - Nicoletta Bernardini
- Department of Medical-Surgical Sciences and Biotechnologies, Dermatology Unit "Daniele Innocenzi", Sapienza University of Rome, Rome, Italy
| | - Laura Calabrese
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy.,UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
| | - Marta Grimaldi
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy.,UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
| | - Gaia Moretta
- Istituto Dermopatico dell'Immacolata - IRCCS, Roma, Italy
| | | | - Ruslana Gaeta Shumak
- Department of Systems Medicine, University of Rome "Tor Vergata", Italy.,Dermatology Unit, Fondazione Policlinico "Tor Vergata", Rome, Italy
| | - Marina Talamonti
- Department of Systems Medicine, University of Rome "Tor Vergata", Italy.,Dermatology Unit, Fondazione Policlinico "Tor Vergata", Rome, Italy
| | - Lorenzo Tofani
- Department of Systems Medicine, University of Rome "Tor Vergata", Italy.,Dermatology Unit, Fondazione Policlinico "Tor Vergata", Rome, Italy
| | | | - Ketty Peris
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy.,UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
| | - Concetta Potenza
- Department of Medical-Surgical Sciences and Biotechnologies, Dermatology Unit "Daniele Innocenzi", Sapienza University of Rome, Rome, Italy
| | - Clara De Simone
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy.,UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
| | - Elena Campione
- Department of Systems Medicine, University of Rome "Tor Vergata", Italy.,Dermatology Unit, Fondazione Policlinico "Tor Vergata", Rome, Italy
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24
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Huri M, Seravalli V, Lippi C, Tofani L, Galli A, Petraglia F, Di Tommaso M. Intrahepatic cholestasis of pregnancy - Time to redefine the reference range of total serum bile acids: A cross-sectional study. BJOG 2022; 129:1887-1896. [PMID: 35373886 PMCID: PMC9543426 DOI: 10.1111/1471-0528.17174] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 03/21/2022] [Accepted: 03/28/2022] [Indexed: 12/02/2022]
Abstract
Objective To establish pregnancy‐specific reference ranges for fasting and postprandial total serum bile acid (TSBA) concentrations. Design Cross‐sectional study. Setting Tertiary‐care university hospital. Population Healthy pregnant women at term admitted to the Obstetrics Department over a period of 1 year. Exclusion criteria were an established diagnosis of intrahepatic cholestasis of pregnancy (ICP) or any coexisting condition of increased risk for ICP. Methods Both fasting (after 8–14 h of fasting) and postprandial (2 h after meal) TSBA concentrations were measured in 612 women (with 528 fasting samples and 377 postprandial samples) by automated enzymatic spectrophotometric assay. Main outcome measures Fasting and postprandial TSBA concentrations in 612 women. Results Reference intervals of 4.4–14.1 μmol/L for fasting TSBA and 4.7–20.2 μmol/L for postprandial TSBA were established. The postprandial values were significantly higher than the fasting values, with a median increase of 1.0 μmol/L (p < 0.0001). A correlation between fasting TSBA concentrations and postprandial concentrations was found, as well as correlations with fetal sex, parity and assisted reproductive technologies. A seasonal pattern was noticed for both fasting and postprandial TSBA, with the highest values measured in the winter season (p < 0.01 and 0.02, respectively) Conclusions Normal pregnancy is associated with mild hypercholanaemia, and therefore a higher threshold should be considered for the diagnosis of ICP. We suggest using the upper reference limits observed in our healthy pregnant population (14 μmol/L for fasting TSBA and 20 μmol/L for postprandial TSBA). As the fasting measurement is more specific for the diagnosis, and the postprandial measurement is essential for the assessment of severity, it is recommended to measure both values rather than use random sampling. Tweetable abstract Normal pregnancy is associated with mild hypercholanaemia, a higher threshold should be considered for the diagnosis of ICP. Normal pregnancy is associated with mild hypercholanaemia, a higher threshold should be considered for the diagnosis of ICP. Linked article: This article is commented on by Ovadia et al., pp. 1897–1898. in this issue. To view this minicommentary visit https://doi.org/10.1111/1471‐0528.17171
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Affiliation(s)
- Mor Huri
- Obstetrics and Gynaecology Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Viola Seravalli
- Obstetrics and Gynaecology Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Camilla Lippi
- Obstetrics and Gynaecology Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Lorenzo Tofani
- Department of Statistics, Computer Science, Applications, University of Florence, Florence, Italy
| | - Andrea Galli
- Gastroenterology Unit, Department of Experimental and Clinical Biochemical Sciences, University of Florence, Florence, Italy
| | - Felice Petraglia
- Obstetrics and Gynaecology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Mariarosaria Di Tommaso
- Obstetrics and Gynaecology Unit, Department of Health Sciences, University of Florence, Florence, Italy
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25
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Di Raimondo C, Rao L, Lozzi F, Lombardo P, Silvaggio D, Vellucci L, Tofani L, Campione E, Bianchi L. Cemiplimab and ruxolitinib in concomitant cutaneous squamous cell carcinoma and myelofibrosis. Dermatol Ther 2022; 35:e15421. [DOI: 10.1111/dth.15421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 03/02/2022] [Indexed: 11/29/2022]
Affiliation(s)
| | - Ludovico Rao
- Department of Dermatology University of Roma Tor Vergata Rome Italy
| | - Flavia Lozzi
- Department of Dermatology University of Roma Tor Vergata Rome Italy
| | - Paolo Lombardo
- Department of Dermatology University of Roma Tor Vergata Rome Italy
| | | | - Laura Vellucci
- Department of Dermatology University of Roma Tor Vergata Rome Italy
| | - Lorenzo Tofani
- Department of Dermatology University of Roma Tor Vergata Rome Italy
| | - Elena Campione
- Department of Dermatology University of Roma Tor Vergata Rome Italy
| | - Luca Bianchi
- Department of Dermatology University of Roma Tor Vergata Rome Italy
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26
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Bruni C, Buch MH, Furst DE, De Luca G, Djokovic A, Dumitru RB, Giollo A, Polovina M, Steelandt A, Bratis K, Suliman YA, Milinkovic I, Baritussio A, Hasan G, Xintarakou A, Isomura Y, Markousis-Mavrogenis G, Tofani L, Mavrogeni S, Gargani L, Caforio ALP, Tschöpe C, Ristic A, Klingel K, Plein S, Behr ER, Allanore Y, Kuwana M, Denton CP, Khanna D, Krieg T, Marcolongo R, Galetti I, Zanatta E, Tona F, Seferovic P, Matucci-Cerinic M. Primary systemic sclerosis heart involvement: A systematic literature review and preliminary data-driven, consensus-based WSF/HFA definition. J Scleroderma Relat Disord 2022; 7:24-32. [PMID: 35386946 PMCID: PMC8922675 DOI: 10.1177/23971983211053246] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 09/23/2021] [Indexed: 02/03/2023]
Abstract
Introduction Primary heart involvement in systemic sclerosis may cause morpho-functional and electrical cardiac abnormalities and is a common cause of death. The absence of a clear definition of primary heart involvement in systemic sclerosis limits our understanding and ability to focus on clinical research. We aimed to create an expert consensus definition for primary heart involvement in systemic sclerosis. Methods A systematic literature review of cardiac involvement and manifestations in systemic sclerosis was conducted to inform an international and multi-disciplinary task force. In addition, the nominal group technique was used to derive a definition that was then subject to voting. A total of 16 clinical cases were evaluated to test face validity, feasibility, reliability and criterion validity of the newly created definition. Results In total, 171 publications met eligibility criteria. Using the nominal group technique, experts added their opinion, provided statements to consider and ranked them to create the consensus definition, which received 100% agreement on face validity. A median 60(5-300) seconds was taken for the feasibility on a single case. Inter-rater agreement was moderate (mKappa (95% CI) = 0.56 (0.46-1.00) for the first round and 0.55 (0.44-1.00) for the second round) and intra-rater agreement was good (mKappa (95% CI) = 0.77 (0.47-1.00)). Criterion validity showed a 78 (73-84)% correctness versus gold standard. Conclusion A preliminary primary heart involvement in systemic sclerosis consensus-based definition was created and partially validated, for use in future clinical research.
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Affiliation(s)
- Cosimo Bruni
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy,Cosimo Bruni, Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Via delle Oblate 4, 50141 Florence, Italy.
| | - Maya H Buch
- Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK,NIHR Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Daniel E Furst
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy,Department Rheumatology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Giacomo De Luca
- Unit of Immunology, Rheumatology Allergy and Rare diseases, IRCSS San Raffaele Hospital, Vita Salute San Raffaele University, Milano, Italy
| | - Aleksandra Djokovic
- Department of Cardiology, University Hospital Centre Bezanijska Kosa, Belgrade, Serbia,School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Raluca B Dumitru
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Alessandro Giollo
- Rheumatology Section, Department of Medicine, University of Verona, Verona, Italy
| | - Marija Polovina
- Department of Cardiology, University Hospital Centre Bezanijska Kosa, Belgrade, Serbia
| | - Alexia Steelandt
- Rheumatology Department, Paris University, Cochin Hospital, Paris, France
| | - Kostantinos Bratis
- Division of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Yossra Atef Suliman
- Department of Rheumatology and Rehabilitation, Faculty of Medicine, Assuit University Hospital, Assuit, Arab Republic of Egypt
| | - Ivan Milinkovic
- Department of Cardiology, University Hospital Centre Bezanijska Kosa, Belgrade, Serbia
| | - Anna Baritussio
- Cardiology and Cardio-Immunology Outpatient Clinic, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Ghadeer Hasan
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | | | - Yohei Isomura
- Department of Allergy and Rheumatology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | | | - Lorenzo Tofani
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Sophie Mavrogeni
- Onassis Cardiac Surgery Centre and Kapodistrian University of Athens, Athens, Attica, Greece
| | - Luna Gargani
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Alida LP Caforio
- Cardiology and Cardio-Immunology Outpatient Clinic, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy,European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), Brussels, Belgium
| | - Carsten Tschöpe
- Department of Internal Medicine and Cardiology, Charité Campus Virchow-Klinikum, Charité – University Medicine Berlin, Berlin, Germany
| | - Arsen Ristic
- Department of Cardiology, University Hospital Centre Bezanijska Kosa, Belgrade, Serbia
| | - Karin Klingel
- Institute for Pathology and Neuropathology, Cardiopathology, University of Tuebingen, Tuebingen, Germany
| | - Sven Plein
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Elijah R Behr
- Cardiology Clinical Academic Group, Institute of Molecular and Clinical Sciences, St George’s University of London, London, UK,St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Yannick Allanore
- Rheumatology Section, Department of Medicine, University of Verona, Verona, Italy
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | | | - Dinesh Khanna
- University of Michigan Scleroderma Program, Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Thomas Krieg
- Translational Matrix Biology, Medical Faculty, University of Cologne, Cologne, Germany
| | - Renzo Marcolongo
- Cardiology and Cardio-Immunology Outpatient Clinic, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy,Haematology and Clinical Immunology Unit, University Hospital of Padua, Padua, Italy
| | - Ilaria Galetti
- Federation of European Scleroderma Associations (FESCA), Brussels, Belgium
| | - Elisabetta Zanatta
- Department of Medicine, Division of Rheumatology, University of Padua, Padova, Italy
| | - Francesco Tona
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Petar Seferovic
- Department of Cardiology, University Hospital Centre Bezanijska Kosa, Belgrade, Serbia,School of Medicine, University of Belgrade, Belgrade, Serbia,Serbian Academy of Sciences and Arts, Belgrade, Serbia
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy,Unit of Immunology, Rheumatology Allergy and Rare diseases, IRCSS San Raffaele Hospital, Vita Salute San Raffaele University, Milano, Italy,Department of Geriatric Medicine, Division of Rheumatology, Careggi University Hospital, Florence, Italy
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27
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Caforio ALP, De Luca G, Baritussio A, Seguso M, Gallo N, Bison E, Cattini MG, Pontara E, Gargani L, Pepe A, Campochiaro C, Plebani M, Iliceto S, Peretto G, Esposito A, Tofani L, Moggi-Pignone A, Dagna L, Marcolongo R, Matucci-Cerinic M, Bruni C. Serum Organ-Specific Anti-Heart and Anti-Intercalated Disk Autoantibodies as New Autoimmune Markers of Cardiac Involvement in Systemic Sclerosis: Frequency, Clinical and Prognostic Correlates. Diagnostics (Basel) 2021; 11:2165. [PMID: 34829512 PMCID: PMC8625508 DOI: 10.3390/diagnostics11112165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/09/2021] [Accepted: 11/17/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Heart involvement (HInv) in systemic sclerosis (SSc) may relate to myocarditis and is associated with poor prognosis. Serum anti-heart (AHA) and anti-intercalated disk autoantibodies (AIDA) are organ and disease-specific markers of isolated autoimmune myocarditis. We assessed frequencies, clinical correlates, and prognostic impacts of AHA and AIDA in SSc. METHODS The study included consecutive SSc patients (n = 116, aged 53 ± 13 years, 83.6% females, median disease duration 7 years) with clinically suspected heart involvement (symptoms, abnormal ECG, abnormal troponin I or natriuretic peptides, and abnormal echocardiography). All SSc patients underwent CMR. Serum AHA and AIDA were measured by indirect immunofluorescence in SSc and in control groups of non-inflammatory cardiac disease (NICD) (n = 160), ischemic heart failure (IHF) (n = 141), and normal blood donors (NBD) (n = 270). AHA and AIDA status in SSc was correlated with baseline clinical, diagnostic features, and outcome. RESULTS The frequency of AHA was higher in SSc (57/116, 49%, p < 0.00001) than in NICD (2/160, 1%), IHF (2/141, 1%), or NBD (7/270, 2.5%). The frequency of AIDA was higher (65/116, 56%, p < 0.00001) in SSc than in NICD (6/160, 3.75%), IHF (3/141, 2%), or NBD (1/270, 0.37%). AHAs were associated with interstitial lung disease (p = 0.04), history of chest pain (p = 0.026), abnormal troponin (p = 0.006), AIDA (p = 0.000), and current immunosuppression (p = 0.01). AHAs were associated with death (p = 0.02) and overall cardiac events during follow-up (p = 0.017). CONCLUSIONS The high frequencies of AHA and AIDA suggest a high burden of underdiagnosed autoimmune HInv in SSc. In keeping with the negative prognostic impact of HInv in SSc, AHAs were associated with dismal prognosis.
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Affiliation(s)
- Alida Linda Patrizia Caforio
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35122 Padua, Italy; (A.B.); (E.B.); (M.G.C.); (E.P.); (S.I.)
| | - Giacomo De Luca
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, 20132 Milan, Italy; (G.D.L.); (C.C.); (L.D.); (M.M.-C.)
| | - Anna Baritussio
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35122 Padua, Italy; (A.B.); (E.B.); (M.G.C.); (E.P.); (S.I.)
| | - Mara Seguso
- Department of Laboratory Medicine, University of Padua, 35122 Padua, Italy; (M.S.); (N.G.); (M.P.)
| | - Nicoletta Gallo
- Department of Laboratory Medicine, University of Padua, 35122 Padua, Italy; (M.S.); (N.G.); (M.P.)
| | - Elisa Bison
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35122 Padua, Italy; (A.B.); (E.B.); (M.G.C.); (E.P.); (S.I.)
| | - Maria Grazia Cattini
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35122 Padua, Italy; (A.B.); (E.B.); (M.G.C.); (E.P.); (S.I.)
| | - Elena Pontara
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35122 Padua, Italy; (A.B.); (E.B.); (M.G.C.); (E.P.); (S.I.)
| | - Luna Gargani
- Institute of Clinical Physiology, National Council of Research, 56124 Pisa, Italy;
| | - Alessia Pepe
- Department of Medicine, Institute of Radiology, University of Padova, 35122 Padova, Italy;
| | - Corrado Campochiaro
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, 20132 Milan, Italy; (G.D.L.); (C.C.); (L.D.); (M.M.-C.)
| | - Mario Plebani
- Department of Laboratory Medicine, University of Padua, 35122 Padua, Italy; (M.S.); (N.G.); (M.P.)
| | - Sabino Iliceto
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35122 Padua, Italy; (A.B.); (E.B.); (M.G.C.); (E.P.); (S.I.)
| | - Giovanni Peretto
- Unit of Arrhythmology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, 20132 Milan, Italy;
| | - Antonio Esposito
- Clinical and Experimental Radiology Unit, Expirimental Imaging Center, IRCCS San Raffaele Scientific Institute, Ospedale San Raffaele University, 20132 Milan, Italy;
| | - Lorenzo Tofani
- Division of Rheumatology, Department of Experimental and Clinical Medicine, Department of Geriatric Medicine AOUC, University of Florence, 50121 Florence, Italy; (L.T.); (C.B.)
| | - Alberto Moggi-Pignone
- Division of Internal Medicine Unit IV AOUC, Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy;
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, 20132 Milan, Italy; (G.D.L.); (C.C.); (L.D.); (M.M.-C.)
| | - Renzo Marcolongo
- Haematology and Clinical Immunology, Department of Medicine, University of Padua, 35122 Padua, Italy;
| | - Marco Matucci-Cerinic
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, 20132 Milan, Italy; (G.D.L.); (C.C.); (L.D.); (M.M.-C.)
- Division of Rheumatology, Department of Experimental and Clinical Medicine, Department of Geriatric Medicine AOUC, University of Florence, 50121 Florence, Italy; (L.T.); (C.B.)
| | - Cosimo Bruni
- Division of Rheumatology, Department of Experimental and Clinical Medicine, Department of Geriatric Medicine AOUC, University of Florence, 50121 Florence, Italy; (L.T.); (C.B.)
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Adembri C, Tofani L. The importance of identifying the direction of the association between preoperative inflammatory mediators and postoperative delirium. Comment on Brit J Anaesth 2021; 127: 424-434. Br J Anaesth 2021; 128:e41-e42. [PMID: 34753593 DOI: 10.1016/j.bja.2021.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 09/22/2021] [Accepted: 10/08/2021] [Indexed: 12/28/2022] Open
Affiliation(s)
- Chiara Adembri
- Department of Health Sciences, Section of Anaesthesia and Intensive Care, University of Florence, Florence, Italy.
| | - Lorenzo Tofani
- Department of Statistics, Informatics, Applications, University of Florence, Florence, Italy; Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), Section of Pharmacology and Toxicology, University of Florence, Florence, Italy; Department of Clinical and Experimental Medicine, University of Florence, Division of Rheumatology AOUC, Florence, Italy
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29
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Agostini E, De Luca G, Bruni C, Bartoli F, Tofani L, Campochiaro C, Pacini G, Moggi-Pignone A, Guiducci S, Bellando-Randone S, Shoenfeld Y, Dagna L, Matucci-Cerinic M. Intravenous immunoglobulins reduce skin thickness in systemic sclerosis: evidence from Systematic Literature Review and from real life experience. Autoimmun Rev 2021; 20:102981. [PMID: 34718166 DOI: 10.1016/j.autrev.2021.102981] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 07/17/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Intravenous immunoglobulins (IVIG) are a new therapeutic approach in systemic sclerosis SSc. An immunomodulatory and antifibrotic activity has been postulated. IVIG are generally well tolerated and have only rare side effects. Our retrospective study focused its attention on SSc, an autoimmune connective tissue disease, characterized by several complications which has a significant impact on patient's quality of life. The pathophysiology comprises fibrotic, vascular and immunological aspects. AIM The aim of this study was to verify the effectiveness of IVIG on SSc skin involvement. Moreover, a systematic review of the literature (SLR) of the results obtained to date on the use of Intravenous immunoglobulin (IVIG) in SSc has been also performed. PATIENTS AND METHODS The data of 24 patients (21 women, 3 male) with refractory diffuse SSc skin involvement were evaluated (mean age was 52.13 years). IVIG infusion at a dosage of 2 g/Kg body weight for 4 consecutive days/month, was started between 2002 and 2019. Skin involvement was evaluated with the modified Rodnan Skin Score (mRSS) before therapy and then again after 6 and 12 months. To perform the SLR, the PubMed, Medline, Embase, and Web of Science database were searched from 1990 to 2020 (keywords: IVIG, systemic sclerosis). Three assessors (E.A., C.B. & M.M.C) identified the criteria to scan all papers. RESULTS From the total SLR (106 results), 17 papers were identified after the separation of the clinical cases from the studies (total number of treated patients 183). The studies were classified according to the organ involvement considered in each study, as well as the prescribed dose (high or low doses), and the therapeutic regimens. In the selected papers, the organs mainly involved were the skin, the gastrointestinal, the joint and the cardiovascular systems. Only in one case, plasmapheresis was associated to IVIG. All papers reported significant reduction of the skin involvement, although generally the strength of the works was limited the lack of control cases or by the low number of patients involved. From the real life experience, a statistically significant reduction of mRSS was obtained at 6 months follow-up (average value of -6.61 ± 5.2, p < 0.001), and it was further maintained with a significant stabilization after 12-months (-11.45 ± 9.63, p < 0.002). DISCUSSION This SLR and the data of the retrospective study suggest that IVIG may improve skin involvement reducing mRSS in particular in those patients that were refractory to other standard of care therapies and represents a therapeutic option in patients with concomitant myositis. The literature review revealed encouraging perspectives on the use of this therapy, given the effectiveness found in the selected works.
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Affiliation(s)
- Elana Agostini
- Dept. Experimental and Clinical Medicine, University of Florence, Italy; Division of Rheumatology, AOUC, Florence, Italy
| | - Giacomo De Luca
- Unit of Immunology, Rheumatology, Allergy and Rare diseases (UnIRAR), IRCCS San Raffaele Hospital, 20132 Milan, Italy; Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Cosimo Bruni
- Dept. Experimental and Clinical Medicine, University of Florence, Italy; Division of Rheumatology, AOUC, Florence, Italy
| | - Francesca Bartoli
- Dept. Experimental and Clinical Medicine, University of Florence, Italy; Division of Rheumatology, AOUC, Florence, Italy
| | - Lorenzo Tofani
- Dept. Experimental and Clinical Medicine, University of Florence, Italy; Division of Rheumatology, AOUC, Florence, Italy
| | - Corrado Campochiaro
- Unit of Immunology, Rheumatology, Allergy and Rare diseases (UnIRAR), IRCCS San Raffaele Hospital, 20132 Milan, Italy; Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Giovanni Pacini
- Dept. Experimental and Clinical Medicine, University of Florence, Italy; Division of Rheumatology, AOUC, Florence, Italy
| | - Alberto Moggi-Pignone
- Dept. Experimental and Clinical Medicine, University of Florence, Italy; Division of Internal Medicine, AOUC, Florence, Italy
| | - Serena Guiducci
- Dept. Experimental and Clinical Medicine, University of Florence, Italy; Division of Rheumatology, AOUC, Florence, Italy
| | - Silvia Bellando-Randone
- Dept. Experimental and Clinical Medicine, University of Florence, Italy; Division of Rheumatology, AOUC, Florence, Italy
| | - Yehuda Shoenfeld
- Ariel University, Israel; Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel; Saint Petersburg State University, Saint-Petersburg, Russia
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare diseases (UnIRAR), IRCCS San Raffaele Hospital, 20132 Milan, Italy; Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Marco Matucci-Cerinic
- Dept. Experimental and Clinical Medicine, University of Florence, Italy; Unit of Immunology, Rheumatology, Allergy and Rare diseases (UnIRAR), IRCCS San Raffaele Hospital, 20132 Milan, Italy; Division of Rheumatology, AOUC, Florence, Italy.
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30
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Tersigni C, Boiardi G, Tofani L, Venturini E, Montagnani C, Bortone B, Bianchi L, Chiappini E, Cassetta MI, Fallani S, Novelli A, Galli L. Real-life isoniazid and rifampicin plasma concentrations in children: a tool for therapeutic drug monitoring of tuberculosis. BMC Infect Dis 2021; 21:1087. [PMID: 34674665 PMCID: PMC8529739 DOI: 10.1186/s12879-021-06764-7] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 05/17/2021] [Indexed: 11/18/2022] Open
Abstract
Background Low plasma levels of first-line antitubercular drugs can be counted among the main causes of poor response to antitubercular therapy, and therapeutic drug monitoring has been proposed as a method to promote tailored treatments for both child and adult patients. The main aim of the study was to evaluate serum concentrations of isoniazid (INH) and rifampicin (RIF) and to investigate reasons for sub-therapeutic plasma concentrations in order to fix dosages. Methods Children with TB were prospectively enrolled from January to August 2019. Two venous blood samples were collected (the first at least 15 days after the beginning of antitubercular treatment, and the second between 1 and 8 weeks later). Plasma concentrations were determined by a validated high-performance liquid chromatography method. Results In all, 45 children were included. Seventy blood samples for INH plasma concentration were collected between 120 and 240 min after drug intake. Adjusting for dose (mg/kg/day) and time of INH administration, when considering three different age groups (≤ 2 years, 2–12 years, > 12 years), a statistically significant lower INH plasma concentration was observed in younger children compared to the older age groups in the multivariate analysis (p < 0.001 and p < 0.001). A total of 68 blood samples were evaluated for RIF concentrations. Both for INH and RIF a statistically significant lower plasma concentration was also observed in adolescents (p < 0.001). Fifteen children (15/45, 33%) presented drug concentrations under the referral therapeutic range. Conclusions Based on our findings, monitoring patients’ drug plasma concentrations in children under 2 years of age and in adolescents can make treatment more patient-tailored.
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Affiliation(s)
- Chiara Tersigni
- Post Graduate School of Pediatrics, University of Florence, Florence, Italy
| | | | - Lorenzo Tofani
- Department of Health Sciences, Clinical Pharmacology and Oncology Section, University of Florence, Florence, Italy
| | | | - Carlotta Montagnani
- Infectious Diseases Unit, Meyer Children's University Hospital, Florence, Italy
| | - Barbara Bortone
- Infectious Diseases Unit, Meyer Children's University Hospital, Florence, Italy
| | - Leila Bianchi
- Infectious Diseases Unit, Meyer Children's University Hospital, Florence, Italy
| | - Elena Chiappini
- Infectious Diseases Unit, Meyer Children's University Hospital, Florence, Italy.,Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
| | - Maria Iris Cassetta
- Department of Health Sciences, Clinical Pharmacology and Oncology Section, University of Florence, Florence, Italy
| | - Stefania Fallani
- Department of Health Sciences, Clinical Pharmacology and Oncology Section, University of Florence, Florence, Italy
| | - Andrea Novelli
- Department of Health Sciences, Clinical Pharmacology and Oncology Section, University of Florence, Florence, Italy
| | - Luisa Galli
- Infectious Diseases Unit, Meyer Children's University Hospital, Florence, Italy. .,Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy.
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31
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Orlandi M, Landini N, Sambataro G, Nardi C, Tofani L, Bruni C, Bellando-Randone S, Blagojevic J, Melchiorre D, Hughes M, Denton CP, Luppi F, Ruaro B, Della Casa F, Rossi FW, De Luca G, Campochiaro C, Spinicci M, Zammarchi L, Tomassetti S, Caminati A, Cavigli E, Albanesi M, Melchiorre F, Palmucci S, Vegni V, Guiducci S, Moggi-Pignone A, Allanore Y, Bartoloni A, Confalonieri M, Dagna L, De Cobelli F, De Paulis A, Harari S, Khanna D, Kuwana M, Taliani G, Lavorini F, Miele V, Morana G, Pesci A, Vancheri C, Colagrande S, Matucci-Cerinic M. THE ROLE OF CHEST CT IN DECIPHERING INTERSTITIAL LUNG INVOLVEMENT: SYSTEMIC SCLEROSIS VERSUS COVID-19. Rheumatology (Oxford) 2021; 61:1600-1609. [PMID: 34320649 DOI: 10.1093/rheumatology/keab615] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [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: 04/28/2021] [Revised: 07/09/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To identify the main computed tomography (CT) features that may help distinguishing a progression of interstitial lung disease (ILD) secondary to Systemic sclerosis (SSc) from COVID-19 pneumonia. METHODS This multicentric study included 22 international readers divided in the radiologist group (RAD) and non-radiologist group (nRAD). A total of 99 patients, 52 with COVID-19 and 47 with SSc-ILD, were included in the study. RESULTS Fibrosis inside focal ground glass opacities (GGO) in the upper lobes; fibrosis in the lower lobe GGO; reticulations in lower lobes (especially if bilateral and symmetrical or associated with signs of fibrosis) were the CT features most frequently associated with SSc-ILD. The CT features most frequently associated with COVID- 19 pneumonia were: consolidation (CONS) in the lower lobes, CONS with peripheral (both central/peripheral or patchy distributions), anterior and posterior CONS and rounded-shaped GGOs in the lower lobes. After multivariate analysis, the presence of CONS in the lower lobes (p < 0.0001) and signs of fibrosis in GGO in the lower lobes (p < 0.0001) remained independently associated with COVID-19 pneumonia or SSc-ILD, respectively. A predictive score was created which resulted positively associated with the COVID-19 diagnosis (96.1% sensitivity and 83.3% specificity). CONCLUSION The CT differential diagnosis between COVID-19 pneumonia and SSc-ILD is possible through the combination the proposed score and the radiologic expertise. The presence of consolidation in the lower lobes may suggest a COVID-19 pneumonia while the presence of fibrosis inside GGO may indicate a SSc-ILD.
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Affiliation(s)
- Martina Orlandi
- Department of Clinical and Experimental Medicine, University of Florence, University of Florence, Division of Rheumatology AOUC, Florence, Italy
| | - Nicholas Landini
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence - AOUC, Largo Brambilla 3, 50134, Florence, Italy.,Department of Radiology, Ca' Foncello General Hospital, Piazzale Ospedale, 1, 31100, Treviso, Italy
| | - Gianluca Sambataro
- Regional Referral Centre for Rare Lung Diseases, A. O. U. "Policlinico G. Rodolico - San Marco" Dept. ofClinical and Experimental Medicine, University of Catania, Catania, Italy.,Artroreuma S.R.L., Rheumatology Outpatient Clinic Associated with the National Health System, Mascalucia(Catania), Italy
| | - Cosimo Nardi
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence - AOUC, Largo Brambilla 3, 50134, Florence, Italy
| | - Lorenzo Tofani
- Department of Clinical and Experimental Medicine, University of Florence, University of Florence, Division of Rheumatology AOUC, Florence, Italy
| | - Cosimo Bruni
- Department of Clinical and Experimental Medicine, University of Florence, University of Florence, Division of Rheumatology AOUC, Florence, Italy
| | - Silvia Bellando-Randone
- Department of Clinical and Experimental Medicine, University of Florence, University of Florence, Division of Rheumatology AOUC, Florence, Italy
| | - Jelena Blagojevic
- Department of Clinical and Experimental Medicine, University of Florence, University of Florence, Division of Rheumatology AOUC, Florence, Italy
| | - Daniela Melchiorre
- Department of Clinical and Experimental Medicine, University of Florence, University of Florence, Division of Rheumatology AOUC, Florence, Italy
| | - Michael Hughes
- Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | | | - Fabrizio Luppi
- Respiratory Unit, University of Milano-Bicocca, S. Gerardo Hospital, Monza, Italy
| | - Barbara Ruaro
- Department of Pulmonology, University Hospital of Cattinara, Trieste, Italy
| | - Francesca Della Casa
- Division of Autoimmune & Allergic Diseases, Department of Translational Medical Sciences. University ofNaples Federico II, Napoli, Italy
| | - Francesca W Rossi
- Division of Autoimmune & Allergic Diseases, Department of Translational Medical Sciences. University ofNaples Federico II, Napoli, Italy
| | - Giacomo De Luca
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, VitaSalute San Raffaele University, Milan, Italy
| | - Corrado Campochiaro
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, VitaSalute San Raffaele University, Milan, Italy
| | - Michele Spinicci
- Department of Experimental and Clinical Medicine, University of Florence, and Infectious and TropicalDiseases Unit, AOUC, Florence, Italy
| | - Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, and Infectious and TropicalDiseases Unit, AOUC, Florence, Italy
| | - Sara Tomassetti
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | | | - Edoardo Cavigli
- SOD Radiodiagnostica Emergenza-Urgenza, AOU Careggi, Florence, Italy
| | - Marco Albanesi
- SOD Radiodiagnostica Emergenza-Urgenza, AOU Careggi, Florence, Italy
| | - Fabio Melchiorre
- Department of Radiology Sant'Andrea Hospital Vercelli, ASLVC Italy
| | - Stefano Palmucci
- Radiodiagnostic and Radiotherapy Unit, Department of Medical Surgical Sciences and Advanced Technologies"GF Ingrassia", University of Catania, Italy
| | | | - Serena Guiducci
- Department of Clinical and Experimental Medicine, University of Florence, University of Florence, Division of Rheumatology AOUC, Florence, Italy
| | - Alberto Moggi-Pignone
- Department of Experimental and Clinical Medicine, AOU Careggi Hospital, University of Florence MedicalSchool, Florence, Italy
| | - Yannick Allanore
- Department of Rheumatology A, Descartes University, APHP, Cochin Hospital, Paris, France
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, and Infectious and TropicalDiseases Unit, AOUC, Florence, Italy
| | - Marco Confalonieri
- Department of Pulmonology, University Hospital of Cattinara, Trieste, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, VitaSalute San Raffaele University, Milan, Italy
| | - Francesco De Cobelli
- Department of Radiology IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan,Italy
| | - Amato De Paulis
- Division of Autoimmune & Allergic Diseases, Department of Translational Medical Sciences. University ofNaples Federico II, Napoli, Italy
| | - Sergio Harari
- U.O. di Pneumologia, Ospedale San Giuseppe MultiMedica, IRCCS.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Italy
| | - Dinesh Khanna
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Gloria Taliani
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Federico Lavorini
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Vittorio Miele
- SOD Radiodiagnostica Emergenza-Urgenza, AOU Careggi, Florence, Italy
| | - Giovanni Morana
- Department of Radiology, Ca' Foncello General Hospital, Piazzale Ospedale, 1, 31100, Treviso, Italy
| | - Alberto Pesci
- Respiratory Unit, University of Milano-Bicocca, S. Gerardo Hospital, Monza, Italy
| | - Carlo Vancheri
- Regional Referral Centre for Rare Lung Diseases, A. O. U. "Policlinico G. Rodolico - San Marco" Dept. ofClinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Stefano Colagrande
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence - AOUC, Largo Brambilla 3, 50134, Florence, Italy
| | - Marco Matucci-Cerinic
- Department of Clinical and Experimental Medicine, University of Florence, University of Florence, Division of Rheumatology AOUC, Florence, Italy.,Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, VitaSalute San Raffaele University, Milan, Italy
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Bruni C, Gentileschi S, Pacini G, Bardelli M, Tofani L, Bartoli F, Baldi C, Cometi L, Fiori G, Nacci F, Cantarini L, Guiducci S, Moggi-Pignone A, Frediani B, Matucci-Cerinic M. Switching from originator adalimumab to biosimilar SB5 in a rheumatology cohort: persistence on treatment, predictors of drug interruption and safety analysis. Ther Adv Musculoskelet Dis 2021; 13:1759720X211033679. [PMID: 35116080 PMCID: PMC8804457 DOI: 10.1177/1759720x211033679] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 06/29/2021] [Indexed: 12/11/2022] Open
Abstract
Aims: Medical and non-medical switching strategies have been adopted in Europe in
the last few years. We aimed to investigate persistence on treatment with a
SB5 Adalimumab (SB5) biosimilar after switching from Adalimumab (ADA)
originator among patients with inflammatory rheumatic musculoskeletal
diseases (iRMD), identifying possible predictors of drug interruption and
describing adverse events. Method: iRMD patients previously switched to SB5 after at least 6 months of ADA were
enrolled. Data on concomitant medications, disease flares, and persistence
on SB5 up to the last available follow up were collected retrospectively.
Kaplan–Meier and Cox regression models were used. Result: A total of 172 patients (106 females, ADA duration 5.8 ± 3.8 years) were
enrolled, including 34 rheumatoid arthritis, 59 psoriatic arthritis, and 61
axial spondyloarthritis patients. In a 10 ± 3 months follow up, 65 (37.8%)
patients presented with adverse events, with 46 (26.7%) showing a clinically
defined disease flare (no disease activity and patient reported outcomes
assessment were available); 24 patients interrupted SB5 permanently (among
them, 11 back-switched to ADA and 8 were prescribed a different biological
therapy). Probability of persistence on SB5 was 94.7% at 6 months and 85.1%
at 12 months. Baseline corticosteroid [hazard ratio (HR) 3.209, 95%
confidence interval (CI) 1.193–8.635, p = 0.021] and
therapy with nonsteroidal anti-inflammatory drugs (NSAIDs) (HR 2.876, 95% CI
1.229–6.727, p = 0.015), as well as the baseline
corticosteroid dose (HR 1.200, 95%CI 1.026–1.403,
p = 0.022) were predictors of drug interruption. Conclusion: Our data on persistence of treatment and adverse events are in line with
previous reports. Further large cohort studies may confirm baseline
corticosteroid and NSAIDs use as predictors of SB5 interruption, helping to
identify patients at higher risk of failure after switching.
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Affiliation(s)
- Cosimo Bruni
- Department Experimental and Clinical Medicine & Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Via delle Oblate 4, Florence, 50141, Italy
- Department Experimental and Clinical Medicine & Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Stefano Gentileschi
- Department of Medical Sciences, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Siena, Italy
| | - Giovanni Pacini
- Department Experimental and Clinical Medicine & Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Marco Bardelli
- Department of Medical Sciences, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Siena, Italy
| | - Lorenzo Tofani
- Department Experimental and Clinical Medicine & Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Francesca Bartoli
- Department Experimental and Clinical Medicine & Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Caterina Baldi
- Department of Medical Sciences, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Siena, Italy
| | - Laura Cometi
- Department Experimental and Clinical Medicine & Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Ginevra Fiori
- Department Experimental and Clinical Medicine & Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Francesca Nacci
- Department Experimental and Clinical Medicine & Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Luca Cantarini
- Department of Medical Sciences, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Siena, Italy
| | - Serena Guiducci
- Department Experimental and Clinical Medicine & Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Alberto Moggi-Pignone
- Department of Experimental and Clinical Medicine, Division of Internal Medicine Unit III, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Bruno Frediani
- Department of Medical Sciences, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Siena, Italy
| | - Marco Matucci-Cerinic
- Department Experimental and Clinical Medicine & Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare diseases (UnIRAR), IRCCS San Raffaele Hospital, Milan, Italy
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Melchiorre D, Ceccherini MT, Romano E, Cometi L, El-Aoufy K, Bellando-Randone S, Roccotelli A, Bruni C, Moggi-Pignone A, Carboni D, Guiducci S, Lepri G, Tofani L, Pietramellara G, Matucci-Cerinic M. Oral Lactobacillus Species in Systemic Sclerosis. Microorganisms 2021; 9:1298. [PMID: 34203626 PMCID: PMC8232208 DOI: 10.3390/microorganisms9061298] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/07/2021] [Accepted: 06/11/2021] [Indexed: 11/16/2022] Open
Abstract
In systemic sclerosis (SSc), the gastrointestinal tract (GIT) plays a central role in the patient's quality of life. The microbiome populates the GIT, where a relationship between the Lactobacillus and gastrointestinal motility has been suggested. In this study, the analysis of oral Lactobacillus species in SSc patients and healthy subjects using culture-independent molecular techniques, together with a review of the literature on microbiota and lactobacilli in SSc, has been carried out. Twenty-nine SSc female patients (mean age 62) and twenty-three female healthy subjects (HS, mean age 57.6) were enrolled and underwent tongue and gum swab sampling. Quantitative PCR was conducted in triplicate using Lactobacillus specific primers rpoB1, rpoB1o and rpoB2 for the RNA-polymerase β subunit gene. Our data show significantly (p = 0.0211) lower LactobacillusspprpoB sequences on the tongue of patients with SSc compared to HS. The mean value of the amount of Lactobacillus ssprpoB gene on the gumsofSSc patients was minor compared to HS. A significant difference between tongue and gums (p = 0.0421) was found in HS but not in SSc patients. In conclusion, our results show a lower presence of Lactobacillus in the oral cavity of SSc patients. This strengthens the hypothesis that Lactobacillus may have both a protective and therapeutic role in SSc patients.
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Affiliation(s)
- Daniela Melchiorre
- Department of Experimental and Clinical Medicine, Department of Geriatric Medicine, Division of Rheumatology, University of Firenze, 50124 Firenze, Italy; (E.R.); (L.C.); (K.E.-A.); (S.B.-R.); (C.B.); (A.M.-P.); (D.C.); (S.G.); (G.L.); (L.T.); (M.M.-C.)
| | - Maria Teresa Ceccherini
- Department of Agriculture, Food, Environment and Forestry (DAGRI)-University ofFirenze, 50144 Firenze, Italy; (M.T.C.); (A.R.); (G.P.)
| | - Eloisa Romano
- Department of Experimental and Clinical Medicine, Department of Geriatric Medicine, Division of Rheumatology, University of Firenze, 50124 Firenze, Italy; (E.R.); (L.C.); (K.E.-A.); (S.B.-R.); (C.B.); (A.M.-P.); (D.C.); (S.G.); (G.L.); (L.T.); (M.M.-C.)
| | - Laura Cometi
- Department of Experimental and Clinical Medicine, Department of Geriatric Medicine, Division of Rheumatology, University of Firenze, 50124 Firenze, Italy; (E.R.); (L.C.); (K.E.-A.); (S.B.-R.); (C.B.); (A.M.-P.); (D.C.); (S.G.); (G.L.); (L.T.); (M.M.-C.)
| | - Khadija El-Aoufy
- Department of Experimental and Clinical Medicine, Department of Geriatric Medicine, Division of Rheumatology, University of Firenze, 50124 Firenze, Italy; (E.R.); (L.C.); (K.E.-A.); (S.B.-R.); (C.B.); (A.M.-P.); (D.C.); (S.G.); (G.L.); (L.T.); (M.M.-C.)
| | - Silvia Bellando-Randone
- Department of Experimental and Clinical Medicine, Department of Geriatric Medicine, Division of Rheumatology, University of Firenze, 50124 Firenze, Italy; (E.R.); (L.C.); (K.E.-A.); (S.B.-R.); (C.B.); (A.M.-P.); (D.C.); (S.G.); (G.L.); (L.T.); (M.M.-C.)
| | - Angela Roccotelli
- Department of Agriculture, Food, Environment and Forestry (DAGRI)-University ofFirenze, 50144 Firenze, Italy; (M.T.C.); (A.R.); (G.P.)
| | - Cosimo Bruni
- Department of Experimental and Clinical Medicine, Department of Geriatric Medicine, Division of Rheumatology, University of Firenze, 50124 Firenze, Italy; (E.R.); (L.C.); (K.E.-A.); (S.B.-R.); (C.B.); (A.M.-P.); (D.C.); (S.G.); (G.L.); (L.T.); (M.M.-C.)
| | - Alberto Moggi-Pignone
- Department of Experimental and Clinical Medicine, Department of Geriatric Medicine, Division of Rheumatology, University of Firenze, 50124 Firenze, Italy; (E.R.); (L.C.); (K.E.-A.); (S.B.-R.); (C.B.); (A.M.-P.); (D.C.); (S.G.); (G.L.); (L.T.); (M.M.-C.)
| | - Davide Carboni
- Department of Experimental and Clinical Medicine, Department of Geriatric Medicine, Division of Rheumatology, University of Firenze, 50124 Firenze, Italy; (E.R.); (L.C.); (K.E.-A.); (S.B.-R.); (C.B.); (A.M.-P.); (D.C.); (S.G.); (G.L.); (L.T.); (M.M.-C.)
| | - Serena Guiducci
- Department of Experimental and Clinical Medicine, Department of Geriatric Medicine, Division of Rheumatology, University of Firenze, 50124 Firenze, Italy; (E.R.); (L.C.); (K.E.-A.); (S.B.-R.); (C.B.); (A.M.-P.); (D.C.); (S.G.); (G.L.); (L.T.); (M.M.-C.)
| | - Gemma Lepri
- Department of Experimental and Clinical Medicine, Department of Geriatric Medicine, Division of Rheumatology, University of Firenze, 50124 Firenze, Italy; (E.R.); (L.C.); (K.E.-A.); (S.B.-R.); (C.B.); (A.M.-P.); (D.C.); (S.G.); (G.L.); (L.T.); (M.M.-C.)
| | - Lorenzo Tofani
- Department of Experimental and Clinical Medicine, Department of Geriatric Medicine, Division of Rheumatology, University of Firenze, 50124 Firenze, Italy; (E.R.); (L.C.); (K.E.-A.); (S.B.-R.); (C.B.); (A.M.-P.); (D.C.); (S.G.); (G.L.); (L.T.); (M.M.-C.)
| | - Giacomo Pietramellara
- Department of Agriculture, Food, Environment and Forestry (DAGRI)-University ofFirenze, 50144 Firenze, Italy; (M.T.C.); (A.R.); (G.P.)
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, Department of Geriatric Medicine, Division of Rheumatology, University of Firenze, 50124 Firenze, Italy; (E.R.); (L.C.); (K.E.-A.); (S.B.-R.); (C.B.); (A.M.-P.); (D.C.); (S.G.); (G.L.); (L.T.); (M.M.-C.)
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Maddali Bongi S, Passalacqua M, Landi G, Mikhaylova S, Tofani L, Del Rosso A, El Aoufy K, Baccini M, Matucci-Cerinic M, Melchiorre D. Rehabilitation of the face and temporomandibular joint in systemic sclerosis. Ther Adv Musculoskelet Dis 2021; 13:1759720X211020171. [PMID: 34163540 PMCID: PMC8191075 DOI: 10.1177/1759720x211020171] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 05/04/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Systemic sclerosis (SSc) alterations of the face and of the mouth cause aesthetic modifications and disability, impairing self-esteem and quality of life (QoL). The aim of this study was to verify the effects of two rehabilitation protocols on facial mimic and mouth opening. METHODS A total of 47 SSc patients (40 females and 7 males, mean age ± SD 59.08 ± 10.31 years), were consecutively selected: 22 were randomly assigned to protocol 1 [home exercises for temporomandibular joint (TMJ), mimic, masticatory and cervical spine muscles] and 25 to protocol 2 (home exercises and combined physiotherapeutic procedures performed by a physiotherapist). Each treatment had a duration of 12 weeks with a follow up of 8 weeks. TMJ dysfunction, orofacial involvement, disability, QoL, and safety were assessed at enrollment (T0), at the end of the treatment (T1), and at follow up (T2). RESULTS Both Protocol 1 and Protocol 2 induced significant improvements of some clinical and clinimetric parameters, but better results were obtained with Protocol 2. In the comparison between the effects of Protocol 1 and Protocol 2 at T1 and T2, a significant difference was observed only for Mouth Handicap in SSc [MHISS; Total (p = 0.00178] and for MHISS Mouth opening (p = 0.0098) at T1. No significant difference of indices of short-form 36 was observed. CONCLUSION The present data suggest that TMJ involvement in SSc may be managed by rehabilitation treatments. The action of a physiotherapist prescribing and personalizing exercises may induce better therapeutic effects.
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Affiliation(s)
| | - Mauro Passalacqua
- AMURR, Associazione Multidisciplinare Riabilitazione Reumatologica, Florence, Italy
| | - Giovanna Landi
- AMURR, Associazione Multidisciplinare Riabilitazione Reumatologica, Florence, Italy
| | - Svetlana Mikhaylova
- Physical and Rehabilitative Medicine, University of Pisa, Pisa, Toscana, Italy
| | - Lorenzo Tofani
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Angela Del Rosso
- AMURR, Associazione Multidisciplinare Riabilitazione Reumatologica, Florence, Italy
| | - Khadija El Aoufy
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Marco Baccini
- AMURR, Associazione Multidisciplinare Riabilitazione Reumatologica, Florence, Italy
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Daniela Melchiorre
- Researcher in Rheumatology, Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Largo Brambilla 3, Florence, 50134, Italy
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Cometi L, Bruni C, Tofani L, Tesei G, Nacci F, Fiori G, Bartoli F, Matucci-Cerinic M. AB0256 BARICITINIB (BARI) VERSUS BIOLOGICS IMPACT ON STEROID TAPERING IN RHEUMATOID ARTHRITIS (RA). Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Biologic and target synthetic disease modifying anti-rheumatic drugs (bDMARDs and tcDMARDs) are recommended to control RA disease activity, pain and steroid use. Following randomized clinical trials (RCTs) and their post-hoc analyses, the Janus Kinase Inhibitor tsDMARDs BARI was superior to reference bDMARD Adalimumab in reducing disease activity, pain and functional disability. In addition, BARI monotherapy also determined more significant pain reduction and functional improvement when compared to Tocilizumab monotherapy (3).Objectives:to confirm RCT results in a real-life clinical setting, with focus on disease activity, pain, functional disability and steroid tapering, when comparing BARI to bDMARDs for the treatment of active RA.Methods:RA patients starting BARI or a bDMARD for active RA were retrospectively evaluated from June 2019 to June 2020. Disease activity (DAS28CRP, SDAI, CDAI), pain visual analogic scale (pain_VAS), functional disability (HAQ) assessments and mean prednisone dosage (pred_dose) were collected at baseline (BL), 3 months (3M) and 6 months (6M) after BARI/bDMARD initiation. The changes of the outcome measures were evaluated between BL-3M, 3M-6M and BL-6M, as well as between BARI and bDMARDs groups. Finally, we assessed the variables associated with prednisone tapering in the whole population.Results:90 out of 100 RA patients evaluated (baseline: age 57±12 years, disease duration 131±100 months, DAS28PCR 4.8±1.0, pain_VAS 61±23 mm, prednisone dose 5.5±5.3 mg) were eligible for the study; 49 received BARI and 41 bDMARDs (17 abatacept, 12 TNF inhibitors, 11 tocilizumab, 1 rituximab). At BL, the two groups did not differ statistically in terms of age, sex, disease duration, disease activity, pain_VAS, previous bDMARD failure or ts/bDMARD naive, concomitant conventional synthetic DMARDs treatment, pred_dose. Both BARI and bDMARDs determined a significant reduction in activity scales and HAQ when comparing BL-3M and BL-6M, with only pain_VAS and pred_dose showing a significant decrease in the 3M-6M interval. When comparing the two groups, BARI showed a significantly higher reduction of pred_dose (-3.2±5.1 vs -1.7±3.7 mg at BL-3M, and -4.1±5.3 vs -1.9±4.6 mg at BL-6M), which was not significant after adjusting for BL pred_dose. No other difference was seen when the two groups, including the numerically higher reduction of pain_VAS in the BARI group (-29±28 vs -20±27 mm at BL-3M and -35±25 vs -30±28 mm at BL-6M comparison). The analysis of the predictors for steroid tapering (Δmean_pred) in the two intervals, showed that BL DAS28PCR, DAS28PCR BL-3M change and BL pred_dose were associated with BL-3M Δmean_pred, while 3M pain_VAS and 3M pred_dose were associated with 3M-6M Δmean_pred.Conclusion:Although limited by the small samples and the retrospective nature, our real-life comparison shows similar efficacy of BARI and bDMARDs in terms of disease activity control, functional disability and pain. In addition, the treatment with BARI or bDMARD did not influence the steroid tapering, which was driven mostly by its initial dose, disease activity and pain. Larger real-life multi-center studies are warranted to confirm our results.References:[1]Taylor PC et al. Baricitinib versus Placebo or Adalimumab in Rheumatoid Arthritis. N Engl J Med. 2017 Feb 16;376(7):652-662.[2]Fautrel B et al. Effect of Baricitinib and Adalimumab in Reducing Pain and Improving Function in Patients with Rheumatoid Arthritis in Low Disease Activity: Exploratory Analyses from RA-BEAM. J Clin Med. 2019 Sep 5;8(9):1394.[3]Fautrel B et al. Comparative effectiveness of improvement in pain and physical function for baricitinib versus adalimumab, tocilizumab and tofacitinib monotherapies in rheumatoid arthritis patients who are naïve to treatment withDisclosure of Interests:Laura Cometi: None declared, Cosimo Bruni Speakers bureau: Actelion, Consultant of: Eli Lilly, Grant/research support from: Fondazione Italiana Ricerca sull’Artrite (FIRA), Gruppo Italiano lotta alla Sclerodermia (GILS), New Horizon Fellowship, European Scleroderma Trials and Research (EUSTAR) group, Foundation for Research in Rheumatology (FOREUM)., Lorenzo Tofani: None declared, Giulia Tesei: None declared, Francesca Nacci: None declared, Ginevra Fiori: None declared, Francesca Bartoli: None declared, Marco Matucci-Cerinic Speakers bureau: Biogen Italia, Actelion, Bayer, Boehringer Ingelheim, CSL Behring, Eli-Lilly, Consultant of: Biogen Italia, Actelion, Bayer, Boehringer Ingelheim, CSL Behring, Eli-Lilly, Grant/research support from: Biogen Italia, Actelion, Bayer, Boehringer Ingelheim, CSL Behring, Eli-Lilly,
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Lepri G, Bruni C, Tofani L, Moggi Pignone A, Orlandi M, Sara T, Hughes M, Del Galdo F, Irace R, Distler O, Riccieri V, Allanore Y, Gheorghiu AM, Siegert E, De Vries-Bouwstra J, Hachulla E, Tikly M, Damjanov N, Spertini F, Mouthon L, Hoffmann-Vold AM, Gabrielli A, Guiducci S, Matucci-Cerinic M, Furst D, Bellando Randone S. POS0317 THE PERFORMANCE OF DIFFUSING CAPACITY FOR MONOXIDE CARBON (DLCO) AND FORCED VITAL CAPACITY (FVC) IN PREDICTING THE ONSET OF SYSTEMIC SCLEROSIS (SSc)-INTERSTITIAL LUNG DISEASE (ILD) IN THE EUROPEAN SCLERODERMA TRIALS AND RESEARCH (EUSTAR) DATABASE. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:In SSc, ILD is a major cause of morbidity and mortality. High resolution computed tomography (HRCT) is the gold standard for the diagnosis. Predictors of ILD onset are eagerly awaited to improve SSc-ILD management. Pulmonary function test (PFTs) are routinely performed to measure lung function changes.Objectives:Our aim was to investigate the performance of DLCO (diffusing capacity of lung carbon monoxide) and FVC (forced vital capacity) in predicting the development of SSc-ILD.Methods:The longitudinal data of DLCO, FVC and ILD on HRCT of SSc patients from the EUSTAR database were evaluated at baseline (t0), after 12 (±4) (t1) and 24 (±4) (t2) months. Patients with negative HRCT for any sign of ILD both at t0 and t1 were included. Patients who presented or developed pulmonary hypertension during the study period were excluded. At baseline, demographic data, disease duration from Raynaud’s onset, disease subsets, autoantibodies and other laboratory and instrumental data were recorded.Results:474/17805 patients were eligible for the study (403 females, 71 males): 26.0% dcSSc, 58.3% lcSSc, 220 (48.0%) patients with positive anticentromere antibodies (ACA) and 117 (25.4%) with positive antitopoisomerase I antibodies (Topo-I abs). Among all enrolled patients, 46 (9.7%) developed HRCT signs of ILD at t2. Patients with Topo-I abs showed an association with ILD development at t2 (16.7% vs 7.8%, p=0.0031), contrarily ACA positive patients were negatively associated with ILD appearance after 2 years of follow-up (4.4% vs 14.4%, p=0.0001). Positive t2 HRCT patients had a significant lower value of DLCO and FVC at all three assessments when compared to patients with a negative HRCT at t2 (Table 1) and both t0 DLCO and FVC values negatively correlated with ILD development (Table 1). The mean t0 to t1 change (Δ) of DLCO in patients with negative t2 HRTC and positive t2 HRCT were -0.5 (±12.6) and -1.0 (±15.1), respectively. The mean t0 to t1 ΔFVC in patients with negative t2 HRTC and positive t2 HRCT were -0.2 (±10.6) and 0.1 (±11.5), respectively. None of them predicted the appearance of ILD at t2 (ΔDLCO: OR (IC) 0.997 (0.97-1.02), p=0.8024; ΔFVC OR (IC) 1.002 (0.97-1.03), p=0.8664). The data showed an association between t0 DLCO value<80% and ILD appearance after 2 years of follow-up [OR(IC): 3.09(1.49-6.40), p=0.0023]. Such association was not observed for t0 FVC value<80% [OR(IC): 1.95(0.81-4.68), p=0.1329]. The predictive capability of t0 DLCO<80% was moderate but stronger than FVC<80% [AU ROC: 0.62 (0.56-0.69), 0.53 (0.48-0.59) respectively, p=0.0205].Conclusion:Our data suggest that an impaired baseline DLCO (<80%) may have a predictive value for the development of ILD on HRCT after 2 years of follow-up. Further rigorous prospective studies are warranted to understand the role of DLCO evaluation in the course of SSc.Table 1.DLCO and FVC values at t0, t1 and t2 values in patients with positive or negative HRCT for ILD at t2 and their statistical differences.Patients without ILD at t2 (mean±SD)Patients with ILD at t2 (mean±SD)OR (95%CL)p-valueDLCO at t079.0 ± 16.669.9 ± 17.40.97 (0.95 - 0.99)0.0006DLCO at t178.4 ± 16.868.9 ± 18.60.97 (0.95 - 0.98)0.0005DLCO at t278.0 ± 17.065.1 ± 19.10.95 (0.93 - 0.97)<0.0001FVC at t0102.2 ± 17.394.6 ± 16.20.97 (0.96 - 0.99)0.0052FVC at t1101.9 ± 17.994.7 ± 16.50.98 (0.96 - 0.99)0.0092FVC at t2101.6 ± 17.694.5 ± 20.00.98 (0.96 - 1)0.0126Disclosure of Interests:Gemma Lepri: None declared, Cosimo Bruni Speakers bureau: CB reports personal fees from Actelion, personal fees from Eli Lilly, Grant/research support from: CB reports personal fees from Actelion, personal fees from Eli Lilly, grants from European Scleroderma Trial and Research (EUSTAR) group, grants from New Horizon Fellowship, grants from Foundation for Research in Rheumatology (FOREUM), grants from Fondazione Italiana per la Ricerca sull’Artrite (FIRA), outside the submitted work, Lorenzo Tofani: None declared, Alberto Moggi Pignone: None declared, Martina Orlandi: None declared, Tomasetti Sara Speakers bureau: Speaker’s fees for Roche and Boehringer Ingelheim, Mike Hughes: None declared, Francesco Del Galdo: None declared, Rosaria Irace: None declared, Oliver Distler Grant/research support from: OD (last three years) has/had consultancy relationship and/or has received research funding in the area of potential treatments for systemic sclerosis and its complications from (last three years): Abbvie, Acceleron Pharma, Amgen, AnaMar, Arxx Therapeutics, Baecon Discovery, Blade Therapeutics, Bayer, Boehringer Ingelheim, ChemomAb, Corbus Pharmaceuticals, CSL Behring, Galapagos NV, Glenmark Pharmaceuticals, GSK, Horizon (Curzion) Pharmaceuticals, Inventiva, iQvia, Italfarmaco, iQone, Kymera Therapeutics, Lilly, Medac, Medscape, Mitsubishi Tanabe Pharma, MSD, Novartis, Pfizer, Roche, Sanofi, Serodapharm, Topadur, Target Bioscience and UCB. Patent issued “mir-29 for the treatment of systemic sclerosis” (US8247389, EP2331143)., Valeria Riccieri: None declared, Yannick Allanore Speakers bureau: YA received personal fees from Boehringer, Sanofi, Menarini and Medsenic and grants from Alpine with regards to the management of systemic sclerosis, Grant/research support from: YA received personal fees from Boehringer, Sanofi, Menarini and Medsenic and grants from Alpine with regards to the management of systemic sclerosis, Ana Maria Gheorghiu: None declared, Elise Siegert: None declared, Jeska de Vries-Bouwstra: None declared, Eric Hachulla: None declared, Mohammed Tikly: None declared, Nemanja Damjanov: None declared, Francois Spertini: None declared, Luc Mouthon: None declared, Anna-Maria Hoffmann-Vold Speakers bureau: AMHV: received consulting fees from Actelion, ARXX, Bayer, Boehringer Ingelheim, Lilly, Medscape, Merck Sharp & Dohme and Roche; and grants from Boehringer Ingelheim., Consultant of: AMHV: received consulting fees from Actelion, ARXX, Bayer, Boehringer Ingelheim, Lilly, Medscape, Merck Sharp & Dohme and Roche; and grants from Boehringer Ingelheim., Grant/research support from: AMHV: received consulting fees from Actelion, ARXX, Bayer, Boehringer Ingelheim, Lilly, Medscape, Merck Sharp & Dohme and Roche; and grants from Boehringer Ingelheim., Armando Gabrielli: None declared, Serena Guiducci: None declared, Marco Matucci-Cerinic Speakers bureau: has received consulting fees or honorarium from Actelion, Janssen, Inventiva, Bayer, Biogen, Boehringer, CSL Behring, Corbus, Galapagos, Mitsubishi, Samsung, Regeneron, Acceleron, MSD, Chemomab, Lilly, Pfizer, Roche, Grant/research support from: has received consulting fees or honorarium from Actelion, Janssen, Inventiva, Bayer, Biogen, Boehringer, CSL Behring, Corbus, Galapagos, Mitsubishi, Samsung, Regeneron, Acceleron, MSD, Chemomab, Lilly, Pfizer, Roche, Daniel Furst: None declared, Silvia Bellando Randone: None declared
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Landini N, Orlandi M, Occhipinti M, Nardi C, Tofani L, Bellando-Randone S, Bruni C, Matucci-Cerinic M, Morana G, Colagrande S. POS0264 THE EMERGING ROLE OF MAGNETIC RESONANCE IMAGING IN INTERSTITIAL LUNG DISEASE IN SYSTEMIC SCLEROSIS: EVIDENCE FOR ULTRA SHORT TE AND COMPRESSED SENSING VIBE ACQUISITIONS AS PROMISING TOOLS FOR THE EVALUATION OF PARENCHYMAL ALTERATIONS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Interstitial lung disease (ILD) is a frequent complication and the major cause of death in Systemic sclerosis (SSc). Computed tomography (CT) is the gold standard imaging technique to assess ILD but is burdened by exposure to ionizing radiations that limits its use for the follow-up. MRI sequences with Ultra Short Echo Time (UTE) are promising for ILD.Objectives:We tested two MRI sequences, UTE Spiral VIBE and Compressing Sensing (CS) VIBE, in SSc-ILD, in comparison to chest CT.Methods:SSc patients with suspected-ascertained ILD were evaluated for undergoing CT-MRI examinations in the same day. Two radiologists visually scored the extent of ground glass opacities (GGO), reticulations, honeycombing and consolidations on CT-MRI. The sum of alteration was assumed as ILD extent. A quantitative texture analysis (qCT) was also performed on CT. Cohen’s k was adopted for interreader concordance in ILD detection. MRI sensitivity and specificity in ILD detection were evaluated. Lin’s concordance was adopted to compare extent analysis between readers and between CT (visual and qCT analysis) and MRI sequences.Results:54 patients performed both CT and MRI. MRI interreader concordance was moderate in ILD detection, while ILD and GGO extent analysis showed good or very good concordance. UTE Spiral VIBE had a sensitivity and specificity in ILD detection of 95.8% and 77.8%, while alterations extent analysis obtained a very good concordance with CT for ILD and GGO. CS VIBE showed a sensitivity and specificity in ILD detection of 46.7% and 95.0%, but a slight or fair concordance with CT in all alterations’ extent analysis.Conclusion:MRI UTE Spiral VIBE sequences are helpful in the evaluation of SSc-ILD. Larger cohorts of patients will be needed to confirm that MRI may be useful in clinical practice, reducing the radiological load of chest CTReferences:[1]Romei C, Turturici L, Tavanti L, et al. The use of chest magnetic resonance imaging in interstitial lung disease: a systematic review. Eur Respir Rev. 2018;27(150):180062. Doi:10.1183/16000617.0062-2018[2]Miller GW, Mugler JP, Sá RC, Altes TA, Prisk GK, Hopkins SR. Advances in functional and structural imaging of the human lung using proton MRI. NMR Biomed. 2014;27(12):1542-1556. doi:10.1002/nbm.3156[3]Pinal-Fernandez I, Pineda-Sanchez V, Pallisa-Nuñez E, et al. Fast 1.5 T chest MRI for the assessment of interstitial lung disease extent secondary to systemic sclerosis. Clin Rheumatol. 2016;35(9):2339-2345. doi:10.1007/s10067-016-3267-0[4]Ohno Y, Koyama H, Yoshikawa T, et al. Pulmonary high-resolution ultrashort TE MR imaging: Comparison with thin-section standard- and low-dose computed tomography for the assessment of pulmonary parenchyma diseases: Pulmonary MRI with UTE in Pulmonary Disease. J Magn Reson Imaging. 2016;43(2):512-532. doi:10.1002/jmri.25008Disclosure of Interests:None declared
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Cometi L, Bandini G, El Aoufy K, Domanico A, Tofani L, Bruni C, Bellando Randone S, Guiducci S, Moggi Pignone A, Accogli E, Matucci-Cerinic M. OP0176 ULTRASOUND (US) EVALUATION OF BOWEL VASCULOPATHY IN SYSTEMIC SCLEROSIS (SSC). Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Gastrointestinal involvement is one of the most frequent features of SSc, affecting nearly 90% of patients, with a great impact on quality of life and morbidity. One of the key pathological factors of SSc bowel involvement is vasculopathy (1), although little is known about its pathophysiology and no treatments are currently available.Objectives:to assess with abdominal US the superior mesenteric artery (SMA) and the inferior mesenteric artery (IMA) vessel characteristics and blood flow in SSc, compared to healthy controls (HC).Methods:we performed fasting abdominal US in SSc patients fulfilling the ACR/EULAR 2013 classification criteria and HC. Patients with a history of peripheral /coronary arterial disease were excluded. For both SMA and IMA, caliber (mm), Peak Systolic Velocity – PSV (cm/sec), Reverse Velocity – RV (cm/sec), End-Diastolic Velocity – EDV (cm/sec), Mean Velocity – mV (cm/sec), Blood-flow (cm/sec), Resistive Index – RI and Pulsatility Index – PI were measured.Results:28 SSc patients [25 females (89.3%), mean age 48.75 ± 12.39 years; 6 (22.22%) anti-centromere and 19 (70.37%) positive for anti-topoisomerase I antibodies] and 28 HC [18 females (64.3%), mean age 36.25 ± 12.08 years] were evaluated. In SSc, the SMA caliber was significantly smaller than in HC (5.75 ± 0.62 vs. 6.45 ± 0.60 mm, p<0.0001), while IMA dimensions did not differ.The SMA study revealed SSc patients had a significant reduction of RV (7.25 ± 6.37 vs. 18.52 ± 6.16 cm/sec, p<0.0001) and PI (3.33 ± 0.75 vs. 4.53 ± 1.03, p<0.0001) when compared to HC. In addition, in SSc the mV of SMA was significantly lower than in HC (38.03 ± 13.90 vs. 28.32 ±9.25 cm/sec, p=0.0035), as well as the RI (0.88 ± 0.04 vs. 0.91 ± 0.03, p=0.0034); EDV was significantly increased (16.34 ± 7.03 vs. 12.64 ± 5.46 cm/sec, p=0.0321). Similarly to SMA, also in IMA RV and PI were significantly lower that controls (RV: 2.69 ± 6.10 vs. 17.06 ± 5.75 cm/sec, p<0.0001; PI: 3.54 ± 0.95 vs. 6.08 ± 1.53, p<0.0001). Moreover SSc patients presented a significant reduction of PSV and RI of IMA (PSV: 72.27 ± 27.23 vs. 93.81 ± 25.73 cm/sec, p=0.0084; RI: 0.88 ± 0.04 vs. 0.91 ± 0.03, p=0.0132) when compared to HC. Although the HC group was significantly younger than the SSc group (p=0.0003), all the results were confirmed after adjustment for age (Table 1).Table 1.comparison of the characteristics of SMA and IMA between SSc patients and HC.SScHCp-valueAge adjusted p-valueSMANMean ± SDNMean ± SDCaliber (mm)285.75 ± 0.62286.45 ± 0.60<0.00010.0002PSV (cm/sec)28137.50 ± 34.5028135.26 ± 33.810.80750.7297RV (cm/sec)287.25 ± 6.372818.52 ± 6.16<0.0001<0.0001EDV (cm/sec)2816.34 ± 7.032812.64 ± 5.460.03210.0650mV (cm/sec)2838.03 ± 13.902828.32 ±9.250.00350.0150Blood-flow (cm/sec)281073.1 ± 831.1628913.36 ± 272.870.34090.4781PI283.33 ± 0.75284.53 ± 1.03<0.00010.0002RI280.88 ± 0.04280.91 ± 0.030.00340.0141IMACaliber (mm)262.71 ± 0.47242.79 ± 0.370.48720.5385PSV (cm/sec)2372.27 ± 27.232393.81 ± 25.730.00840.0044RV (cm/sec)232.69 ± 6.102317.06 ± 5.75<0.0001<0.0001EDV (cm/sec)237.87 ± 2.01237.95 ± 2.100.89210.9250mV (cm/sec)2317.83 ± 5.332314.75 ± 5.080.05140.3938Blood-flow (cm/sec)23106.70 ± 47.992084.00 ± 30.130.06760.3056PI233.54 ± 0.95236.08 ± 1.53<0.0001<0.0001RI230.88 ± 0.04230.91 ± 0.030.01320.0205SMA=superior mesentheric artery, IMA=inferior mesentheric artery, PSV=Peak Systolic Velocity, RV=Reverse Velocity, EDV=End-Diastolic Velocity, mV=Mean Velocity, PI=Pulsatility Index, RI=Resistive Index.Conclusion:this preliminary study shows, for the first time, the presence of a significant reduction of RV, PI and RI in the intestinal arteries of SSc patients when compared to HC. These data show an increased stiffness of the gastrointestinal arterial wall, in agreement with the typical SSc vasculopathy. A larger cohort is needed to confirm the results and explore the possible relationship with other clinical features of the disease.References:[1]Sjogren, RW.Gastrointestinal features of scleroderma. Curr Opin Rheumatol 1996;8:569-75.Disclosure of Interests:None declared
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Bruni C, Mattolini L, Tofani L, Gargani L, Landini N, Lepri G, Orlandi M, Guiducci S, Bellando Randone S, Matucci-Cerinic M. POS0842 LUNG ULTRASOUND TO ASSESS THE SEVERITY OF INTERSTITIAL LUNG DISEASE IN SYSTEMIC SCLEROSIS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Interstitial lung disease (ILD) is one of the most common complications and one of the main causes of morbidity and mortality in Systemic Sclerosis (SSc). High-resolution computed tomography (HRCT) is the gold standard for the diagnosis of ILD and it allows its quantification. Among semi-quantitative methods, Goh et al proposed a semi-quantitative scoring system to visually quantify ILD extent, with categorical cut-off of 20% to distinguish limited and extensive parenchymal involvement with prognostic implications. More recently, the use of radiomics has allowed the objective quantification of ILD through the use of dedicated software, which calculate different parameters of lung density.Given the exposure to ionizing radiation that the procedure entails, other methods of ILD evaluation are being studied, among which lung ultrasound (LUS) identifies the B-lines as a main feature of ILD. So far, different evidences have proposed the use of LUS for the screening of ILD, even in the early phases of the disease and in subclinical lung involvement.Objectives:the aim of this study is to test the role of LUS in quantifying the severity of SSc-ILD, evaluated with both semi-quantitative visual radiological and quantitative radiomic scores.Methods:Adult SSc patients classified according to the ACR/EULAR 2013 criteria patients were assessed with pulmonary function test (PFTs), lung ultrasound and HRCT over 60 days. CT images were analysed qualitatively (by presence/absence of ILD), semi-quantitatively (categorical Goh score <20% vs> 20% of extent and the continuous extent Goh score made from 5 levels’ assessment– 0 to 100%) and quantitatively [with the densitometric radiomic data obtained through the Horos software - Mean lung attenuation (MLA), Standard Deviation (SD), Kurtosis, Skewness and Lung volume (LV)]. LUS was used to quantify the B-lines detected in each patient by scanning a total of 13 intercostal spaces, on both anterior and posterior chest wall.Results:Among 59 SSc patients (81% women, mean age 48±14 years, 45% anti-Scl70 positive), 23 (39%) presented ILD on HRCT, of which 14 limited and 9 extensive. The mean visual semi-quantitative score was 6%, ranging from 0 to 66%. Our data showed a significantly different number of B-Lines in ILD vs non-ILD patients (median 38 vs 9, p <.005), a result which was further confirmed among non-ILD vs ILD> 20% (median 47 vs 9, p=.001) and ILD <20% (median 36 vs 9, p=.001) patients. Conversely, the number of B-lines was not statistically different between patients with ILD <20% and >20% (median 47 vs 36, p=.78). We observed a significant negative correlation between the number of B-lines and FVC (r=-.472, p<.05) TLC (r=-.436, p=.003), DLco (r=-.515, p<.001), DLCO/VA (r=.-306, p=.03). Finally, the number of B-lines showed a statistically significant correlation with the Goh score on 5 levels (r=.437, p=.001), MLA (r=.571, p<.001), kurtosis (r=-.285, p=.028), skewness (r=-.370, p = .004) and LV (r=-.277, p=.033). All data were confirmed analysing anterior and posterior B-Lines separately.Conclusion:Our study confirms that LUS represents a useful tool for the identification of SSc-ILD. In addition, we showed that LUS may be useful also for the quantification of the severity of SSc-ILD, by correlating with PFT parameters, radiomics parameters and visual radiological evaluation. Together with the PFTs, LUS could be used to increase the accuracy of the screening and, potentially, of the follow-up of SSc-ILD patients.Disclosure of Interests:Cosimo Bruni: None declared, Lavinia Mattolini: None declared, Lorenzo Tofani: None declared, Luna Gargani Consultant of: GE Healthcare, Philips Healthcare and Caption Health, Nicholas Landini: None declared, Gemma Lepri: None declared, Martina Orlandi: None declared, Serena Guiducci: None declared, Silvia Bellando Randone: None declared, Marco Matucci-Cerinic: None declared
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Samoni S, Villa G, De Rosa S, Husain-Syed F, Guglielmetti G, Tofani L, De Cal M, Nalesso F, Meola M, Ronco C. Ultrasonographic Intraparenchymal Renal Resistive Index Variation for Assessing Renal Functional Reserve in Patients Scheduled for Cardiac Surgery: A Pilot Study. Blood Purif 2021; 51:147-154. [PMID: 34044391 DOI: 10.1159/000516438] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 04/09/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Cardiac surgery-associated acute kidney injury (CSA-AKI) is a common complication in patients undergoing cardiac surgery. Preoperative renal functional reserve (RFR) has been demonstrated to be highly predictive of CSA-AKI. We have previously demonstrated that intraparenchymal renal resistive index variation (IRRIV) measured by ultrasound (US) can identify the presence of RFR in healthy individuals. This study aimed (1) to examine the correlation between the US IRRIV test and RFR measured through the protein loading test in patients undergoing elective cardiac surgery and (2) to determine the value of the 2 methods for predicting occurrence of AKI or subclinical AKI after cardiac surgery. METHODS Consecutive patients scheduled for cardiac surgery were enrolled for this pilot study. The protein loading test and the IRRIV test were performed in all patients 2 days before cardiac surgery. Correlation between IRRIV and RFR was tested using Pearson correlation analysis. Association between presence of RFR and positive IRRIV test, presence of RFR and AKI and subclinical AKI, and positive IRRIV test and AKI and subclinical AKI was evaluated using logistic regression analysis. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the values of IRRIV for predicting RFR, RFR for predicting AKI and subclinical AKI, and IRRIV for predicting AKI and subclinical AKI. RESULTS Among the 31 patients enrolled, significant association was found between IRRIV and RFR (r = 0.81; 95% CI: 0.63-0.90; p < 0.01). The association between RFR and IRRIV was described in 27/31 (87.1%) patients. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the IRRIV test were 100, 84, 60, and 100%, respectively. In ROC curve analysis, the area under the curve (AUC) was 0.80 (95% CI: 0.64-0.96). After cardiac surgery, 1/31 (3.2%) patient had AKI and 12/31 (38.7%) had subclinical AKI. RFR predicted subclinical AKI (odds ratio [OR] = 0.93; 95% CI: 0.87-0.98; p = 0.02). The sensitivity, specificity, PPV, and NPV of the RFR were 61, 88.8, 80, and 76%, respectively; the AUC was 0.75 (95% CI: 0.59-0.91). IRRIV predicts subclinical AKI (OR = 0.79; 95% CI: 0.67-0.93; p = 0.005). The sensitivity, specificity, PPV, and NPV of the IRRIV test were 46.1, 100, 100, and 72%, respectively; the AUC was 0.73 (95% CI: 0.58-0.87). CONCLUSION This pilot study suggests that a positive IRRIV test can significantly predict the presence of RFR in patients scheduled for cardiac surgery. RFR measured by the protein loading test or by the US IRRIV test can predict the occurrence of subclinical postoperative AKI. The findings of this study need to be confirmed in large patient cohorts.
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Affiliation(s)
- Sara Samoni
- Department of Nephrology and Dialysis, ASST Lariana, S. Anna Hospital, Como, Italy
| | - Gianluca Villa
- Department of Anesthesia and Intensive Care, Section of Oncological Anesthesia and Intensive Care, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Silvia De Rosa
- Department of Anesthesia and Intensive Care, San Bortolo Hospital, Vicenza, Italy
| | - Faeq Husain-Syed
- Department of Internal Medicine II, Division of Nephrology, Pulmonology and Critical Care Medicine, University Hospital Giessen and Marburg, Giessen, Germany
| | - Gabriele Guglielmetti
- Department of Translational Medicine, Nephrology and Kidney Transplantation Unit, University of Piemonte Orientale, "Maggiore della Carità" University Hospital, Novara, Italy
| | - Lorenzo Tofani
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Massimo De Cal
- Department of Nephrology, Dialysis and Transplantation and International Renal Research Institute Vicenza (IRRIV), San Bortolo Hospital, Vicenza, Italy
| | - Federico Nalesso
- Department of Medicine, Nephrology, Dialysis and Transplantation Unit, University of Padua, Padua, Italy
| | - Mario Meola
- Institute of Life Sciences, Sant'Anna School of Advanced Studies, Pisa, Italy
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplantation and International Renal Research Institute Vicenza (IRRIV), San Bortolo Hospital, Vicenza, Italy.,Department of Medicine (DIMED), University of Padua, Padua, Italy
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Gelsomino F, Tiseo M, Barbieri F, Riccardi F, Cavanna L, Frassoldati A, Delmonte A, Longo L, Dazzi C, Cinieri S, Colantonio I, Sperandi F, Lamberti G, Brocchi S, Tofani L, Boni L, Ardizzoni A. Correction to: Phase 2 study of NAB-paclitaxel in SensiTivE and refractory relapsed small cell lung cancer (SCLC) (NABSTER TRIAL). Br J Cancer 2021; 125:306. [PMID: 34012035 PMCID: PMC8292309 DOI: 10.1038/s41416-021-01439-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Tesei G, Cometi L, Nacci F, Terenzi R, Tofani L, Capassoni M, Bartoli F, Fiori G, Matucci-Cerinic M, Bruni C. Baricitinib in the treatment of rheumatoid arthritis: clinical and ultrasound evaluation of a real-life single-centre experience. Ther Adv Musculoskelet Dis 2021; 13:1759720X211014019. [PMID: 34025783 PMCID: PMC8120535 DOI: 10.1177/1759720x211014019] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 04/12/2021] [Indexed: 01/01/2023] Open
Abstract
Background: Ultrasound (US) is useful in monitoring RA patients, with the US7 score allowing grey-scale and power-Doppler (PD) semi-quantitative evaluation of synovitis and teno-synovitis. We evaluated real-life efficacy and safety of Baricitinib, an oral selective JAK1-2 inhibitor, in RA patients using clinical, clinimetric, and US assessments. Methods: Disease activity score in 28 joints calculated with C-reactive protein (DAS28-CRP), disease activity score in 28 joints calculated with erythrocyte sedimentation rate (DAS28-ESR), clinical disease activity index (CDAI), simplified disease activity index (SDAI), visual analogue scale (VAS)-pain, health assessment questionnaire (HAQ), COCHIN scale, adverse events (AE), concomitant medications, laboratory parameters, and US7 were performed/recorded at baseline, 1, 3, and 6 months in RA patients starting Baricitinib. Responder/non-responder status was determined according to the EULAR Response Criteria at 3 months. SDAI clinical remission or low disease activity (LDA) were calculated at 3 and 6 months. Results: In 43 enrolled patients, a significant improvement in disease activity and US7 components (except tendon PD) and a reduction of steroid dosage were observed. Responders at 3 months showed a significantly higher reduction of CDAI, SDAI, COCHIN scale, VAS-pain, and US7 synovialPD, compared with non-responders. At 3 and 6 months, remission/LDA was achieved by 12.8/53.8% and 21.6/51.3% patients, respectively. The csDMARD co-treatment was independently associated with remission/LDA at 3 months. Safety-related drop-outs were in line with literature data. The steroid dosage was associated with AE development at 6 months. Conclusion: The real-life data, also obtained with US evaluation, confirmed the Baricitinib efficacy in RA disease control, as well as the utility of assessment during the follow up of disease activity.
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Affiliation(s)
- Giulia Tesei
- Department Experimental and Clinical Medicine & Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, Firenze, ItalyOspedale Infermi, Medicina e Reumatologia, Rimini, Italia
| | - Laura Cometi
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Via delle Oblate 4, Firenze, 50141, Italy
| | - Francesca Nacci
- Department Experimental and Clinical Medicine & Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | | | - Lorenzo Tofani
- Department Experimental and Clinical Medicine & Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Marco Capassoni
- Department Experimental and Clinical Medicine & Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Francesca Bartoli
- Department Experimental and Clinical Medicine & Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Ginevra Fiori
- Department Experimental and Clinical Medicine & Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Marco Matucci-Cerinic
- Department Experimental and Clinical Medicine & Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Cosimo Bruni
- Department Experimental and Clinical Medicine & Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
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Galluccio F, D’Angela D, Polistena B, Porta F, Barskova T, Tofani L, Spandonaro F, Matucci-Cerinic M. Comparison of three treatment protocols with intra-articular low or intermediate molecular weight hyaluronic acid in early symptomatic knee osteoarthritis. Ther Adv Musculoskelet Dis 2021; 13:1759720X21994024. [PMID: 33959197 PMCID: PMC8064515 DOI: 10.1177/1759720x21994024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 01/05/2021] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Viscosupplementation with hyaluronic acid (HA) is indicated for non-responders to non-pharmacological therapy, to analgesics or when non-steroidal anti-inflammatory drugs (NSAIDs) are contraindicated. The aim of this study is to compare the efficacy, safety and costs of three different HA treatments (Sinovial® Forte, sinovial one and hyalgan). PATIENTS AND METHODS Ninety patients with grade I/II Kellgren-Lawrence knee osteoarthritis were included in three groups, the first was treated with hyalgan (weekly for 5 weeks), the second with Sinovial® Forte (weekly for 3 weeks) and the third group with a single injection of sinovial one. RESULTS All three treatments were effective, with an average reduction in the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) score of 18.9 points for hyalgan, 18.04 points for Sinovial® Forte and 17.92 points for sinovial one. The comparison of the three groups did not show any statistical difference in terms of efficacy. National health system (NHS) and social costs are, respectively, €419.12 and €853.43 for hyalgan, €338.64 and €599.22 for Sinovial® Forte, €221.56 and €308.42 for sinovial one. CONCLUSION All three treatments were equally effective with no statistically significant differences; thus, the treatment with sinovial one may be considered as clinically effective as the other two regimens, but with a very efficient cost profile in early symptomatic knee osteoarthritis.
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Affiliation(s)
- Felice Galluccio
- Department of Clinical and Experimental Medicine, University of Florence and Department of Geriatric Medicine, Div. of Rheumatology AOUC, Florence, Italy
| | - Daniela D’Angela
- C.R.E.A. Sanità (Consortium for Applied Economic Research in Healthcare), Department of Economic and Finance, University Tor Vergata, Rome, Italy
| | - Barbara Polistena
- C.R.E.A. Sanità (Consortium for Applied Economic Research in Healthcare), Department of Economic and Finance, University Tor Vergata, Rome, Italy
| | - Francesco Porta
- Department of Clinical and Experimental Medicine, University of Florence and Department of Geriatric Medicine, Div. of Rheumatology AOUC, Florence, Italy
| | - Tatiana Barskova
- Department of Clinical and Experimental Medicine, University of Florence and Department of Geriatric Medicine, Div. of Rheumatology AOUC, Florence, Italy
| | - Lorenzo Tofani
- Department of Clinical and Experimental Medicine, University of Florence and Department of Geriatric Medicine, Div. of Rheumatology AOUC, Florence, Italy
| | - Federico Spandonaro
- C.R.E.A. Sanità (Consortium for Applied Economic Research in Healthcare), Department of Economic and Finance, University Tor Vergata, Rome, Italy
| | - Marco Matucci-Cerinic
- Department of Clinical and Experimental Medicine, University of Florence and Department of Geriatric Medicine, Div. of Rheumatology AOUC, SOD Reumatologia, via delle Oblate 4, Firenze (FI), 50139, Italy
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DI Filippo A, Adembri C, Paparella L, Esposito C, Tofani L, Perez Y, DI Giacinto I, Micaglio M, Sorbello M. Risk factors for difficult Laryngeal Mask Airway LMA-Supreme™ (LMAS) placement in adults: a multicentric prospective observational study in an Italian population. Minerva Anestesiol 2021; 87:533-540. [PMID: 33591142 DOI: 10.23736/s0375-9393.20.15001-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Supraglottic airway devices (SADs) are precious tools for airway management in both routine and rescue situations; few studies have analyzed the risk factors for their difficult insertion. METHODS The aim of this study was to identify the risk factors for difficult insertion for a specific SAD, the Laryngeal Mask Airway LMA-Supreme™ (LMAS). This was a prospective multicentric observational study on a cohort of Italian adult patients receiving general anesthesia for elective surgery. The possible causes of difficulty in LMAS placement (difficulty in insertion or unsatisfactory ventilation) were identified based on literature and on the opinion of international airway management experts. A dedicated datasheet was prepared to collect patients' data, including anthropometric-parameters and parameters for the prediction of difficult airway management, as well as technical choices for the use of LMAS. Data were analyzed to discover the risk factors for difficult LMAS placement and the association between each risk factor and the proportion of incorrect positioning was evaluated through the relative risk and its confidence interval. RESULTS Four hundred thirty-two patients were enrolled; seventy required two or more attempts to insert the LMAS; nine required a change of strategy. At multivariate analysis, the following factors were significantly associated with difficult LMAS placement: Mallampati III-IV with either phonation or not; inter-incisor distance < 3 cm; reduced neck mobility; no administration of neuromuscular blocking agents (NMBAs). CONCLUSIONS The alignment of the laryngeal and pharyngeal axes seems to facilitate the procedure, together with NMBA administration; on the contrary, Mallampati grade III-IV are associated with difficult LMAS placement.
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Affiliation(s)
- Alessandro DI Filippo
- Section of Anesthesiology and Intensive Care, Department of Health Sciences, University of Florence, Florence, Italy.,Careggi University Hospital, Florence, Italy
| | - Chiara Adembri
- Section of Anesthesiology and Intensive Care, Department of Health Sciences, University of Florence, Florence, Italy - .,Careggi University Hospital, Florence, Italy
| | | | - Clelia Esposito
- Department of Anesthesiology, Resuscitation and Postoperative Intensive Care, AORN Ospedali dei Colli, Naples, Italy
| | - Lorenzo Tofani
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Ylenia Perez
- Section of Anesthesiology and Intensive Care, Department of Health Sciences, University of Florence, Florence, Italy
| | - Ida DI Giacinto
- Department of Organ Failure and Transplantation, St.Orsola-Malpighi University Hospital, Bologna, Italy
| | | | - Massimiliano Sorbello
- Anestesiology and Intensive Care Unit, Vittorio Emanuele San Marco University Hospital, Catania, Italy
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Cometi L, Bruni C, Passavanti S, Tofani L, Bartoli F, Fiori G, Nacci F, Lepri G, Orlandi M, Melchiorre D, Antonuzzo L, Matucci-Cerinic M, Moggi-Pignone A. Risk of Malignancy and Biologic Therapy in Rheumatic Inflammatory Diseases: A Single-center Experience. Rheumatol Immunol Res 2020; 1:39-45. [PMID: 36465081 PMCID: PMC9524767 DOI: 10.2478/rir-2020-0001] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 07/31/2020] [Indexed: 06/17/2023]
Abstract
OBJECTIVES Biologic disease modifying anti-rheumatic drugs (bDMARDs) have significantly improved the care of patients with rheumatic muscle-skeletal disorders (RMDs). Considering their immunosuppressive action, a theoretical increase of malignancy risk has been a major concern in the last few decades. The objective of this study is to analyze the incidence of malignancies in a cohort of patients affected by rheumatoid arthritis (RA), psoriathic arthritis (PsA), and ankylosing spondylitis (AS) treated with bDMARDs. METHODS The charts of bDMARD-treated RMD patients were reviewed, and data about bDMARD exposure and malignant cancers (excluding non-melanoma skin cancer) were collected. RESULTS 921 patients were included (median age: 50.59 years, 66.67% females); 1374 bDMARD treatments were administered, 87.12% were tumor necrosis factor inhibitors. A total of 21 malignant neoplasms were detected in 21 patients (61.90% females, median age at cancer diagnosis: 64.99 years), 66.67% in RA patients, 19.05% in PsA, and 14.28% in AS. Among them, 10 patients (47.62%) were treated with etanercept, 6 patients (28.57%) with adalimumab, and 1 case each with tocilizumab, certolizumab, golimumab, infliximab, and abatacept. The most common malignancies that we found were lung cancers, ductal mammary carcinomas, melanomas, and lymphomas. The incidence rate (IR) of malignancies in our cohort was 3.47 per 1000 person-years (p-y); the higher IRs were in RA patients (5.13 per 1000 p-y), in males (4.21 per 1000 p-y), and in patients aged >70 years (10.14 per 1000 p-y). CONCLUSIONS The results of our study showed IR of malignancies in RMD patients treated with bDMARDs that is in agreement with literature data.
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Affiliation(s)
- Laura Cometi
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Cosimo Bruni
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Saverio Passavanti
- Department of Internal Medicine, Division of Internal Medicine Unit III, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Lorenzo Tofani
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Francesca Bartoli
- Department of Geriatric Medicine, Division of Rheumatology Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Ginevra Fiori
- Department of Geriatric Medicine, Division of Rheumatology Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Francesca Nacci
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Gemma Lepri
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Martina Orlandi
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Daniela Melchiorre
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
- Department of Geriatric Medicine, Division of Rheumatology Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Lorenzo Antonuzzo
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
- Department of Geriatric Medicine, Division of Rheumatology Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Alberto Moggi-Pignone
- Department of Internal Medicine, Division of Internal Medicine Unit III, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
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46
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Pietrobono S, Anichini G, Sala C, Manetti F, Almada LL, Pepe S, Carr RM, Paradise BD, Sarkaria JN, Davila JI, Tofani L, Battisti I, Arrigoni G, Ying L, Zhang C, Li H, Meves A, Fernandez-Zapico ME, Stecca B. ST3GAL1 is a target of the SOX2-GLI1 transcriptional complex and promotes melanoma metastasis through AXL. Nat Commun 2020; 11:5865. [PMID: 33203881 PMCID: PMC7673140 DOI: 10.1038/s41467-020-19575-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 10/21/2020] [Indexed: 12/30/2022] Open
Abstract
Understanding the molecular events controlling melanoma progression is of paramount importance for the development of alternative treatment options for this devastating disease. Here we report a mechanism regulated by the oncogenic SOX2-GLI1 transcriptional complex driving melanoma invasion through the induction of the sialyltransferase ST3GAL1. Using in vitro and in vivo studies, we demonstrate that ST3GAL1 drives melanoma metastasis. Silencing of this enzyme suppresses melanoma invasion and significantly reduces the ability of aggressive melanoma cells to enter the blood stream, colonize distal organs, seed and survive in the metastatic environment. Analysis of glycosylated proteins reveals that the receptor tyrosine kinase AXL is a major effector of ST3GAL1 pro-invasive function. ST3GAL1 induces AXL dimerization and activation that, in turn, promotes melanoma invasion. Our data support a key role of the ST3GAL1-AXL axis as driver of melanoma metastasis, and highlight the therapeutic potential of targeting this axis to treat metastatic melanoma.
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Affiliation(s)
- Silvia Pietrobono
- Core Research Laboratory - Institute for Cancer Research and Prevention (ISPRO), Viale Pieraccini 6, 50139, Florence, Italy
| | - Giulia Anichini
- Core Research Laboratory - Institute for Cancer Research and Prevention (ISPRO), Viale Pieraccini 6, 50139, Florence, Italy
- Department of Medical Biotechnologies, University of Siena, Viale M. Bracci 16, 53100, Siena, Italy
| | - Cesare Sala
- Department of Clinical and Experimental Medicine, University of Florence, Viale Morgagni 50, 50134, Florence, Italy
| | - Fabrizio Manetti
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, Via A. Moro 2, 53100, Siena, Italy
| | - Luciana L Almada
- Schulze Center for Novel Therapeutics, Division of Oncology Research, Department of Oncology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Sara Pepe
- Core Research Laboratory - Institute for Cancer Research and Prevention (ISPRO), Viale Pieraccini 6, 50139, Florence, Italy
- Department of Medical Biotechnologies, University of Siena, Viale M. Bracci 16, 53100, Siena, Italy
| | - Ryan M Carr
- Schulze Center for Novel Therapeutics, Division of Oncology Research, Department of Oncology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Brooke D Paradise
- Schulze Center for Novel Therapeutics, Division of Oncology Research, Department of Oncology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Jann N Sarkaria
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Jaime I Davila
- Department of Health Sciences Research, Mayo Clinic, Rochester, Rochester, MN, 55905, USA
| | - Lorenzo Tofani
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy
| | - Ilaria Battisti
- Proteomics Center, University of Padova and Azienda Ospedaliera di Padova, Via G. Oris 2B, 35129, Padova, Italy
| | - Giorgio Arrigoni
- Proteomics Center, University of Padova and Azienda Ospedaliera di Padova, Via G. Oris 2B, 35129, Padova, Italy
- Department of Biomedical Sciences, University of Padova, Via U. Bassi 58B, 35131, Padova, Italy
| | - Li Ying
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Cheng Zhang
- Department of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, MN, 55905, USA
| | - Hu Li
- Department of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, MN, 55905, USA
| | - Alexander Meves
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Martin E Fernandez-Zapico
- Schulze Center for Novel Therapeutics, Division of Oncology Research, Department of Oncology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Barbara Stecca
- Core Research Laboratory - Institute for Cancer Research and Prevention (ISPRO), Viale Pieraccini 6, 50139, Florence, Italy.
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47
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Bruni C, Gentileschi S, Pacini G, Baldi C, Capassoni M, Tofani L, Bardelli M, Cometi L, Cantarini L, Nacci F, Vietri M, Bartoli F, Fiori G, Frediani B, Matucci-Cerinic M. The switch from etanercept originator to SB4: data from a real-life experience on tolerability and persistence on treatment in joint inflammatory diseases. Ther Adv Musculoskelet Dis 2020; 12:1759720X20964031. [PMID: 33133246 PMCID: PMC7576915 DOI: 10.1177/1759720x20964031] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 09/09/2020] [Indexed: 12/11/2022] Open
Abstract
Aims: Switching from originator to biosimilar is part of current practice in inflammatory rheumatic musculoskeletal diseases (iRMDs) such as rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondylarthritis (axSpA), with evidences derived from both etanercept (ETN) to SB4-switching randomized controlled trials and real-life registries. We investigated the safety and treatment persistence of ETN/SB4 in a multi-iRMD cohort derived from two rheumatology departments in our region. Methods: Adult patients with iRMDs, treated with ETN for at least 6 months and switched to SB4 in stable clinical condition, were eligible for this retrospective evaluation. Retrospective data on adverse events, loss of efficacy and persistence on treatment were collected until latest available follow-up. Results: A total of 220 patients (85 RA, 81 PsA, 33 axSpA, 14 juvenile idiopathic arthritis and seven other conditions; 142 females, mean age 58 ± 7 years, disease duration 12 ± 4 years, ETN duration 7 ± 4 years) were enrolled, with median follow-up of 12.1 (9.7–15.8) months. A total of 50 patients (22.7%) presented with at least one adverse event, with 36 (16.4%) disease flares and 30 (13.6%: 11 for safety and 19 loss of efficacy) SB4 withdrawals. Cumulative SB4 treatment persistence was 99.1%, 88.6% and 64.6% at 6, 12 and 18 months respectively. Back-switch to ETN was performed in 17/30 cases, the remaining cases were managed with change of biologic disease modifying or conventional synthetic anti-rheumatic drug. Age was the only significant predictor of SB4 interruption at 6 months. Conclusion: Our real-life data confirm the safety profile of switching from ETN to SB4, with slightly higher treatment persistence rates compared with other real-life registries.
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Affiliation(s)
- Cosimo Bruni
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Firenze, Via delle Oblate 4, 50141, Firenze, Italy
| | - Stefano Gentileschi
- Department of Medical Sciences, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Siena, Italy
| | - Giovanni Pacini
- Department Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Caterina Baldi
- Department of Medical Sciences, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Siena, Italy
| | - Marco Capassoni
- Department Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Lorenzo Tofani
- Department Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Marco Bardelli
- Department of Medical Sciences, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Siena, Italy
| | - Laura Cometi
- Department Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Luca Cantarini
- Department of Medical Sciences, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Siena, Italy
| | - Francesca Nacci
- Department Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Michele Vietri
- Department Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Francesca Bartoli
- Department Geriatric Medicine, Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Ginevra Fiori
- Department Geriatric Medicine, Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Bruno Frediani
- Department of Medical Sciences, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Siena, Italy
| | - Marco Matucci-Cerinic
- Department Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
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48
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Linari S, Melchiorre D, Pieri L, Tofani L, Fanelli A, Brogi M, Castaman G. Low bone mass and hypovitaminosis D in haemophilia: A single-centre study in patients with severe and moderate haemophilia A and B. Haemophilia 2020; 26:898-906. [PMID: 32842167 DOI: 10.1111/hae.14127] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 04/06/2020] [Revised: 07/16/2020] [Accepted: 07/24/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Haemophilia (H) is frequently associated with a multifactorial reduction in bone mineral density (BDM), but little is known about possible differences between HA and HB according to their severity. AIM To evaluate the association between low bone mineral density (BMD), 25-hydroxyvitamin D [25(OH)D] concentrations and bone turnover markers in patients with HA and HB younger or older than 50 years. METHODS In 78 patients <50 years and 33 patients >50 years with severe (S) or moderate (M) HA and HB, BMD was measured by dual-energy X-ray absorptiometry at femoral neck (FN) and lumbar spine and then correlated to annual bleeding rate (ABR), World Federation of Haemophilia orthopaedic joint scale (WFH score), 25(OH)D concentrations, parathyroid hormone (PTH), amino-terminal telopeptide of type 1 collagen (NTx), urinary pyridinolines, osteocalcin and bone-specific alkaline phosphatase. RESULTS Overall, a high prevalence of hypovitaminosis D was diagnosed. In patients <50 years, low FN-BMD was significantly more frequent in HA than in HB, while PTH, pyridinolines, ABR and WFH score were associated with H type and severity. In patients >50 years, similarly low FN-BMD was observed in HA and HB, while ABR and WFH score were associated with H type and severity, being milder in HB. CONCLUSIONS Low bone mass is a frequent comorbidity in haemophilic patients of all ages, apart from those with MHB. Clinical and laboratory assessments confirm a higher bone impairment and faster bone resorption in HA compared with HB. Looking at H type and severity, MHB seems to have a normal bone metabolism and a less severe disease.
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Affiliation(s)
- Silvia Linari
- Center for Bleeding Disorders and Coagulation, Careggi University Hospital, Firenze, Italy
| | - Daniela Melchiorre
- Department of Experimental, Clinical Medicine and Rheumatology, Careggi University Hospital, Firenze, Italy
| | - Lisa Pieri
- Center for Bleeding Disorders and Coagulation, Careggi University Hospital, Firenze, Italy
| | - Lorenzo Tofani
- Department of Experimental, Clinical Medicine and Rheumatology, Careggi University Hospital, Firenze, Italy
| | | | - Marco Brogi
- Central Laboratory, Careggi University Hospital, Firenze, Italy
| | - Giancarlo Castaman
- Center for Bleeding Disorders and Coagulation, Careggi University Hospital, Firenze, Italy
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49
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Faraone A, Poggi A, Cappugi C, Tofani L, Riccobono E, Giani T, Fortini A. Inappropriate use of carbapenems in an internal medicine ward: Impact of a carbapenem-focused antimicrobial stewardship program. Eur J Intern Med 2020; 78:50-57. [PMID: 32303455 DOI: 10.1016/j.ejim.2020.03.017] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 02/21/2020] [Accepted: 03/19/2020] [Indexed: 01/21/2023]
Abstract
PURPOSE Carbapenem consumption is a major driver for selection and spread of carbapenem-resistant Enterobacterales (CRE). We assessed the impact of a carbapenem-focused multimodal antimicrobial stewardship program (ASP) in the internal medicine unit of a medium-size acute-care hospital. METHODS We compared the percentage of inappropriate carbapenem prescriptions and the proportion of carbapenem treated patients registered in a 12-month pre-intervention and in a 24-month post-intervention period by using an interrupted time series analysis. The consumption of carbapenems, expressed in defined daily doses (DDD), was also assessed. As a secondary objective, the incidence of infections by carbapenem-resistant Klebsiella pneumoniae (CRKP) and the percentage of CRKP invasive isolates in the same time periods were compared. RESULTS After the ASP intervention, the mean monthly percentage of inappropriate carbapenem prescriptions dropped from 59% to 25%, and the mean monthly proportion of carbapenem treated patients decreased from 3% to 1%. The interrupted time series analysis confirmed a significant decrease in the percentage of inappropriate carbapenem prescriptions (-41.6%, p = 0.0262) and in the proportion of carbapenem treated patients (-2.1%, p < 0.0001). Carbapenem consumption decreased from 5.2 to 1.6 DDD x 100 patient-days. The incidence of CRKP infections remained unchanged (29.1 × 100,000 patient-days vs 28.9 × 100,000 patient-days, p = 0.9864) and the percentage of CRKP invasive isolates decreased, though not significantly, from 36.4% to 13.3% (p = 0.3478). CONCLUSIONS The implementation of a carbapenem-focused ASP was effective at limiting the inappropriate use of carbapenems and was associated with a significant decrease in carbapenem consumption. Such effects were sustained during a 24-month post-intervention period.
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Affiliation(s)
- Antonio Faraone
- Department of Internal Medicine, San Giovanni di Dio Hospital, Via di Torregalli 3, Florence, 50143, Italy.
| | | | - Chiara Cappugi
- Department of Internal Medicine, Florence Careggi University Hospital, Florence, Italy
| | - Lorenzo Tofani
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Eleonora Riccobono
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Tommaso Giani
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Alberto Fortini
- Department of Internal Medicine, San Giovanni di Dio Hospital, Via di Torregalli 3, Florence, 50143, Italy
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50
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Talamonti M, Tofani L, Bianchi L, Galluzzo M. Optimizing care for psoriatic patients requiring systemic therapies: how will COVID-19 disease transform risk perceptions? Arch Dermatol Res 2020; 313:127-128. [PMID: 32647977 PMCID: PMC7344026 DOI: 10.1007/s00403-020-02103-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Received: 05/22/2020] [Revised: 06/05/2020] [Accepted: 06/30/2020] [Indexed: 01/15/2023]
Affiliation(s)
- M Talamonti
- Dermatology Unit, Fondazione Policlinico Tor Vergata, Rome, Italy.
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.
| | - L Tofani
- Dermatology Unit, Fondazione Policlinico Tor Vergata, Rome, Italy
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - L Bianchi
- Dermatology Unit, Fondazione Policlinico Tor Vergata, Rome, Italy
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - M Galluzzo
- Dermatology Unit, Fondazione Policlinico Tor Vergata, Rome, Italy
- Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
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