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Nagy G, Géher P, Tamási L, Drescher E, Keszthelyi P, Pulai J, Czirják L, Szekanecz Z, Kiss G, Kovács L. Real-world evidence on methotrexate-free subcutaneous tocilizumab therapy in patients with rheumatoid arthritis: 24-week data from the SIMPACT study. Rheumatol Adv Pract 2022; 6:rkac038. [PMID: 35663154 PMCID: PMC9154320 DOI: 10.1093/rap/rkac038] [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: 03/08/2022] [Accepted: 05/04/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
The SIMPACT study aimed to evaluate the efficacy and safety of methotrexate (MTX)-free subcutaneous tocilizumab (TCZ) therapy in rheumatoid arthritis (RA) patients.
Methods
SIMPACT was an open-label, non-controlled, non-randomised, non-interventional study, where RA patients, for whom the treating physicians ordered subcutaneous TCZ, were observed during a 24-week treatment period in Hungarian centres. While the use of methotrexate (MTX) was avoided during the study period, other conventional synthetic disease modifying anti-rheumatoid drugs (DMARDs), oral steroid and non-steroid anti-inflammatory agents were allowed. Study endpoints included the change in Disease Activity Score-28 (DAS28) and Clinical Activity Index (CDAI) scores, the proportion of patients achieving remission in the whole population and in subgroups defined based on prior RA treatment history—and age, weight or gender post-hoc. The extent of supplementary medication use was monitored.
Results
337 RA patients were enrolled in 18 study centres. TCZ therapy significantly decreased the disease activity measured both by DAS28 (p = 0.0001) and CDAI (p = 0.0001). Clinical response was more pronounced in biological-naïve patients, and was lower in patients above 75 years. In the whole population DAS28 ESR or CRP and CDAI remission rates were 70.10%, 78.95% and 33.59%, respectively. Below 45 years CDAI remission rate doubled (67.86%). Significant decrease in the frequency of co-administered medication was reported including oral steroids and DMARDs.
Conclusion
Real-world clinical evidence on subcutaneous TCZ reported here is in-line with the efficacy outcomes of randomised clinical trials (RCTs). Subgroup analysis revealed that TCZ was more effective in biological-naïve and <75 years patients.
Trial registration
ClinicalTrials.gov, http://www.clinicaltrials.gov, NCT02402686
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Affiliation(s)
- György Nagy
- Dept. of Rheumatology & Clinical Immunology, Dept. of Internal Medicine & Oncology, Semmelweis University, Budapest, Hungary
- Dept. of Genetics, Cell & Immunobiology, Semmelweis University, Budapest, Hungary
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Pál Géher
- Dept. of Rheumatology & Clinical Immunology, Dept. of Internal Medicine & Oncology, Semmelweis University, Budapest, Hungary
| | - László Tamási
- Dept. of Rheumatology, BAZ County Central Hospital, Miskolc, Hungary
| | - Edit Drescher
- Dept. of Rheumatology, Csolnoky Ferenc Hospital, Veszprém, Hungary
| | - Péter Keszthelyi
- Dept. of Rheumatology, Békés County Central Hospital, Gyula, Hungary
| | - Judit Pulai
- Dept. of Rheumatology, Fejér County Saint George Hospital, Székesfehérvár, Hungary
| | - László Czirják
- Rheumatology & Immunology Clinic, Univ. of Pécs Clinical Centre, Pécs, Hungary
| | - Zoltán Szekanecz
- Dept. of Int. Medicine, Rheumatology, Univ. of Debrecen Clinical Centre, Debrecen, Hungary
| | | | - László Kovács
- Rheumatology & Immunology Clinic, Univ. of Szeged Clinical Centre, Szeged, Hungary
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Péntek M, Rojkovich B, Czirják L, Géher P, Keszthelyi P, Kovács A, Kovács L, Szabó Z, Szekanecz Z, Tamási L, Tóth ÁE, Ujfalussy I, Hevér NV, Strbák B, Baji P, Brodszky V, Gulácsi L. Acceptability of less than perfect health states in rheumatoid arthritis: the patients' perspective. Eur J Health Econ 2014; 15 Suppl 1:S73-82. [PMID: 24832838 DOI: 10.1007/s10198-014-0596-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 03/31/2014] [Indexed: 05/15/2023]
Abstract
Some health problems are considered by many individuals as a 'normal' part of ageing. Our aim was to investigate whether patients with rheumatoid arthritis (RA) consider different types and levels of health losses as acceptable beyond a certain age. A multicenter cross-sectional survey was performed involving RA patients at the initiation of the first biological therapy. The EQ-5D and the Health Assessment Questionnaire Disability Index (HAQ-DI) questionnaires were used to describe domain-specific health states. Patients were asked to indicate for each domain from what age and onward (between ages 30 and 80 years in 10 year intervals) they considered moderate and severe problems acceptable or alternatively never acceptable. Seventy-seven RA patients (females 86%, mean age 50.3, disease duration 9.1 years) completed the questionnaire. Disease activity (DAS28), EQ-5D and HAQ-DI scores were mean 6.00 (SD 0.85), 0.35 (SD 0.36), 1.48 (SD 0.66), respectively. The majority of the patients considered age 70 and beyond as acceptable to have some health problems (EQ-5D: self-care 42%, pain/discomfort 34%, mobility 33%, usual activities 33%, anxiety/depression 27%), whilst at ages 30 and 40 as not acceptable. Severe health problems were mostly (57-69%) considered never acceptable, except the 'Usual activities' domain (acceptable from age 80 by 50.6%). The great majority of the patients (77-96%) were younger than what they indicated as the acceptability age limit. Similar results were found for the HAQ-DI. This small experimental study suggests that RA patients consider some health problems acceptable. This acceptability is age related and varies by health areas. Further larger studies are needed to explore explanatory variables and to compare with other diseases. Owing to the impact acceptability might have on RA patients' self-evaluation of current health state and decision-making, the topic deserves methodological improvement and further investigation.
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Affiliation(s)
- Márta Péntek
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8., 1093, Budapest, Hungary,
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Képíró L, Széll M, Kovács L, Keszthelyi P, Kemény L, Gyulai R. Genetic risk and protective factors of TNFSF15 gene variants detected using single nucleotide polymorphisms in Hungarians with psoriasis and psoriatic arthritis. Hum Immunol 2013; 75:159-62. [PMID: 24269700 DOI: 10.1016/j.humimm.2013.11.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 11/05/2013] [Accepted: 11/11/2013] [Indexed: 02/04/2023]
Abstract
The aim of this study was to examine the role of single nucleotide polymorphisms (SNPs) and haplotypes of the tumor necrosis factor ligand superfamily member 15 (TNFSF15) gene in Hungarians with psoriasis and psoriatic arthritis. A case-control study was performed, and five TNFSF15 SNPs (rs3810936, rs6478108, rs6478109, rs7848647, rs7869487) were genotyped in 319 patients with psoriasis, 105 of whom also have psoriatic arthritis, and in 200 healthy individuals. Three haplotypes (A, B, C) based on these five SNPs were also analyzed. Our findings suggest that the rs6478109 SNP may be a genetic risk factor in psoriasis (p=0.0046), while haplotype C may be protective (p=0.0250). These results suggest that certain variants of the TNFSF15 gene contribute to the pathogenesis of the immune-mediated, multifactorial skin disease psoriasis, and that this difference is more readily apparent when groups of patients with and without psoriatic arthritis are examined separately.
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Affiliation(s)
- László Képíró
- Department of Dermatology and Allergology, University of Szeged, Hungary.
| | - Márta Széll
- MTA-SZTE Dermatological Research Group, University of Szeged, Hungary; Department of Medical Genetics, University of Szeged, Hungary
| | - László Kovács
- Department of Rheumatology, University of Szeged, Hungary
| | - Péter Keszthelyi
- Department of Rheumatology, Pándy Kálmán Békés County Hospital, Gyula, Hungary
| | - Lajos Kemény
- Department of Dermatology and Allergology, University of Szeged, Hungary; MTA-SZTE Dermatological Research Group, University of Szeged, Hungary
| | - Rolland Gyulai
- Department of Dermatology and Allergology, University of Szeged, Hungary; Department of Dermatology, Venereology and Oncodermatology, University of Pécs, Hungary
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Kádár G, Soós B, Laduver A, Keszthelyi P, Szekanecz Z, Kovács L. THU0196 Disease Course after the Permanent Cessation of Biological Therapy in Inflammatory Rheumatic Diseases. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Szekanecz E, Szamosi S, Gergely L, Keszthelyi P, Szekanecz Z, Szucs G. Incidence of lymphoma in systemic sclerosis: a retrospective analysis of 218 Hungarian patients with systemic sclerosis. Clin Rheumatol 2008; 27:1163-6. [PMID: 18500435 DOI: 10.1007/s10067-008-0925-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2008] [Revised: 04/26/2008] [Accepted: 04/28/2008] [Indexed: 10/22/2022]
Abstract
Recent results suggest that B cells may have multiple pathogenic roles in systemic sclerosis (SSc) and there may be increased incidence of B cell lymphomas in SSc. Here, we assessed the prevalence of lymphomas in a large SSc cohort. We analyzed data of 218 Hungarian patients undergoing follow-ups in our institutions between 1995 and 2007. During this follow-up period, there were three SSc patients, who eventually developed B cell lymphoma. The first case is a woman with diffuse cutaneous form of SSc (dcSSc) including pulmonary, cardiac, gastrointestinal, and renal manifestations and anti-topoisomerase I antibody positivity. B cell chronic lymphocytic leukemia (B-CLL) with Zap70 expression (Rai I stage) developed 2 years after the onset of SSc. The second case is a woman with dcSSc presenting with pulmonary, cardiac, and gastroesophageal manifestations. Twenty-one months after disease onset, a chronic small lymphocytic B cell non-Hodgkin's lymphoma was diagnosed from retroperitoneal lymph nodes. Our third case is a woman with dcSSc and no internal organ manifestations. She also developed Zap70-positive B-CLL, stage Rai I 9 months after the onset of SSc. Thus, there were three cases of B cell lymphoma among our 218 SSc patients (1.38%). The association of scleroderma and non-Hodgkin's lymphoma may be a rather uncommon feature; however, the incidence of lymphoma among Hungarian SSc patients may be 1.9-2.5 times higher than that in the general population. In our three patients, B cell lymphoma developed within 2 years after the onset of SSc. Altered B cell function implicated in the pathogenesis of SSc may lead to the development of lymphoid malignancies.
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Affiliation(s)
- Eva Szekanecz
- Department of Oncology, University of Debrecen Medical Center, Debrecen, Hungary
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Vas G, Keszthelyi P, Sátori O, Csiffáry D, Kárpáti Z. [Surgical treatment of superficial thrombophlebitis of the lower extremities]. Minerva Med 1975; 66:2033-36. [PMID: 1138212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Vas G, Keszthelyi P, Kárpáti Z. [Experience with surgery in patients over 70 years of age]. Orv Hetil 1975; 116:852-3. [PMID: 1121386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Vas G, Ligeti J, Csiffáry D, Sátori E, Keszthelyi P. Isolated perfusion of the extremities in occlusive arterial disease. J Cardiovasc Surg (Torino) 1974; 15:625-8. [PMID: 4452728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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