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Gerdes S, Staubach P, Dirschka T, Wetzel D, Weirich O, Niesmann J, da Mota R, Rothhaar A, Ardabili M, Vlasitz G, Feldwisch J, Osterling Koskinen L, Ohlman S, Peloso PM, Brun NC, Frejd FY. Izokibep for the treatment of moderate-to-severe plaque psoriasis: a phase II, randomized, placebo-controlled, double-blind, dose-finding multicentre study including long-term treatment. Br J Dermatol 2023; 189:381-391. [PMID: 37697683 DOI: 10.1093/bjd/ljad186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Monoclonal antibodies to interleukin (IL)-17 have shown strong efficacy in patients with psoriasis. Izokibep is a unique IL-17A inhibitor with a small molecular size and favourable distribution to sites of inflammation. OBJECTIVES To evaluate the dose response, efficacy and safety of izokibep in patients with plaque psoriasis. METHODS In this double-blind, randomized, phase II dose-finding study (AFFIRM-35) in adults with moderate-to-severe plaque psoriasis and inadequate response to two or more standard therapies, patients were randomized (1:1:1:1:1) to placebo or izokibep 2, 20, 80 or 160 mg every 2 weeks for 12 weeks. During the remainder of the 52-week core study, patients given placebo were switched to izokibep 80 mg, and dosing intervals were adapted based on Psoriasis Area and Severity Index (PASI) scores for all patients. The core study was followed by two optional consecutive 1-year extension periods for a total duration of 3 years. The primary endpoint was a 90% reduction in PASI score (PASI 90) at week 12. Additional efficacy outcomes and adverse event (AE) rates were evaluated. RESULTS In total, 109 patients were randomized [safety set, n = 108 (one exclusion criteria failure); full analysis set, n = 106]. At week 12, PASI 90 response rates were 0%, 5%, 19%, 71% and 59% for the placebo, 2-, 20-, 80- and 160-mg izokibep groups, respectively. Rapid dose-dependent improvements were also observed across other efficacy outcomes. During the placebo-controlled period, AEs in the izokibep groups were similar to placebo except for mild injection site reactions. AEs were generally mild to moderate and the drug was well tolerated. Izokibep maintained efficacy at the higher dosage groups for up to 3 years, with no new safety signals. CONCLUSIONS Data from this phase II study indicate that izokibep is well tolerated and efficacious in the treatment of plaque psoriasis. Higher doses or more frequent dosing could be explored to further enhance response rates.
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Affiliation(s)
- Sascha Gerdes
- Psoriasis Center, Department of Dermatology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Petra Staubach
- Department of Dermatology, Medical Center, Medical University Center, Mainz, Germany
| | - Thomas Dirschka
- Germany Private Practice for Dermatology, Wuppertal, Germany
| | | | | | | | - Rodrigo da Mota
- Private Practice Dr. Hilton & Partner for Dermatology, Düsseldorf, Germany
| | | | | | | | | | | | | | | | | | - Fredrik Y Frejd
- Affibody AB, Solna, Sweden
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
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Klint S, Feldwisch J, Gudmundsdotter L, Dillner Bergstedt K, Gunneriusson E, Höidén Guthenberg I, Wennborg A, Nyborg AC, Kamboj AP, Peloso PM, Bejker D, Frejd FY. Izokibep: Preclinical development and first-in-human study of a novel IL-17A neutralizing Affibody molecule in patients with plaque psoriasis. MAbs 2023; 15:2209920. [PMID: 37184136 DOI: 10.1080/19420862.2023.2209920] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
Psoriasis, an immune-mediated inflammatory disease, affects nearly 125 million people globally. The interleukin (IL)-17A homodimer is a key driver of psoriasis and other autoimmune diseases, including psoriatic arthritis, axial spondyloarthritis, hidradenitis suppurativa, and uveitis. Treatment with monoclonal antibodies (mAbs) against IL-17A provides an improvement in the Psoriasis Area and Severity Index compared to conventional systemic agents. In this study, the AffibodyⓇ technology was used to identify and optimize a novel, small, biological molecule comprising three triple helical affinity domains, izokibep (previously ABY-035), for the inhibition of IL-17A signaling. Preclinical studies show that izokibep, a small 18.6 kDa IL-17 ligand trap comprising two IL-17A-specific Affibody domains and one albumin-binding domain, selectively inhibits human IL-17A in vitro and in vivo with superior potency and efficacy relative to anti-IL-17A mAbs. A Phase 1 first-in-human study was conducted to establish the safety, pharmacokinetics, and preliminary efficacy of izokibep, when administered intravenously and subcutaneously as single doses to healthy subjects, and as single intravenous and multiple subcutaneous doses to patients with psoriasis (NCT02690142; EudraCT No: 2015-004531-13). Izokibep was well tolerated with no meaningful safety concerns identified in healthy volunteers and patients with psoriasis. Rapid efficacy was seen in all psoriasis patients after one dose which further improved in patients receiving multiple doses. A therapeutic decrease in joint pain was also observed in a single patient with concurrent psoriatic arthritis. The study suggests that izokibep has the potential to safely treat IL17A-associated diseases such as psoriasis, psoriatic arthritis, axial spondyloarthritis, hidradenitis suppurativa, and uveitis.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Fredrik Y Frejd
- Affibody AB, Solna, Sweden
- Department of Immunology, Genetics and Pathology, IGP, Uppsala University, Uppsala, Sweden
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Botson JK, Tesser JRP, Bennett R, Kenney HM, Peloso PM, Obermeyer K, Song Y, LaMoreaux B, Zhao L, Xin Y, Chamberlain J, Ramanathan S, Weinblatt ME, Peterson J. A multicentre, efficacy and safety study of methotrexate to increase response rates in patients with uncontrolled gout receiving pegloticase (MIRROR): 12-month efficacy, safety, immunogenicity, and pharmacokinetic findings during long-term extension of an open-label study. Arthritis Res Ther 2022; 24:208. [PMID: 36008814 PMCID: PMC9404640 DOI: 10.1186/s13075-022-02865-z] [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: 05/11/2022] [Accepted: 07/13/2022] [Indexed: 11/30/2022] Open
Abstract
Background Publications suggest immunomodulation co-therapy improves responder rates in uncontrolled/refractory gout patients undergoing pegloticase treatment. The MIRROR open-label trial showed a 6-month pegloticase + methotrexate co-therapy responder rate of 79%, compared to an established 42% pegloticase monotherapy responder rate. Longer-term efficacy/safety data are presented here. Methods Uncontrolled gout patients (serum urate [SU] ≥ 6 mg/dL and SU ≥ 6 mg/dL despite urate-lowering therapy [ULT], ULT intolerance, or functionally-limiting tophi) were included. Patients with immunocompromised status, G6PD deficiency, severe kidney disease, or methotrexate contraindication were excluded. Oral methotrexate (15 mg/week) and folic acid (1 mg/day) were administered 4 weeks before and during pegloticase therapy. Twelve-month responder rate (SU < 6 mg/dL for ≥ 80% during month 12), 52-week change from baseline in SU, and extended safety were examined. Efficacy analyses were performed for patients receiving ≥ 1 pegloticase infusion. Pharmacokinetics (PK)/anti-drug antibodies (ADAs) were examined and related to efficacy/safety findings. Results Fourteen patients were included (all male, 49.3 ± 8.7 years, 13.8 ± 7.4-year gout history, pre-therapy SU 9.2 ± 2.5 mg/dL). Three patients were non-responders and discontinued study treatment before 24 weeks, one patient exited the study per protocol at 24 weeks (enrolled prior to treatment extension amendment), and 10 remained in the study through week 52. Of the 10, 8 completed 52 weeks of pegloticase + methotrexate and were 12-month responders. The remaining two discontinued pegloticase + methotrexate at week 24 (met treatment goals) and stayed in the study under observation (allopurinol prescribed at physicians’ discretion); one remained a responder at 12 months. At 52 weeks, change from baseline in SU was − 8.2 ± 4.1 mg/dL (SU 1.1 ± 2.4 mg/dL, n = 10). Gout flares were common early in treatment but progressively decreased while on therapy (weeks 1–12, 13/14 [92.9%]; weeks 36–52, 2/8 [25.0%]). One patient recovered from sepsis (serious AE). Two non-responders developed high ADA titers; fewer patients had trough concentrations (Cmin) below the quantitation limit (BQL), and the median Cmin was higher (1.03 µg/mL vs. BQL) than pegloticase monotherapy trials. Conclusions Pegloticase + methotrexate co-therapy was well-tolerated over 12 months, with sustained SU lowering, progressive gout flare reduction, and no new safety concerns. Antibody/PK findings suggest methotrexate attenuates ADA formation, coincident with higher treatment response rates. Trial registration ClinicalTrials.gov, NCT03635957. Registered on 17 August 2018.
Supplementary Information The online version contains supplementary material available at 10.1186/s13075-022-02865-z.
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Affiliation(s)
- John K Botson
- Orthopedic Physicians Alaska, 3801 Lake Otis Parkway, Suite 300, Anchorage, AK, 99508, USA.
| | - John R P Tesser
- Arizona Arthritis & Rheumatology Associates, 4550 East Bell Road, Phoenix, AZ, 85032, USA
| | - Ralph Bennett
- Arizona Arthritis & Rheumatology Associates, 4550 East Bell Road, Phoenix, AZ, 85032, USA
| | - Howard M Kenney
- Arthritis Northwest, PLLC, 105 West 8th Avenue, Suite 6080W, Spokane, WA, 99204, USA
| | - Paul M Peloso
- Horizon Therapeutics Plc, 1 Horizon Way, Deerfield, IL, 60015, USA
| | - Katie Obermeyer
- Horizon Therapeutics Plc, 1 Horizon Way, Deerfield, IL, 60015, USA
| | - Yang Song
- Horizon Therapeutics Plc, 2 Tower Place, South San Francisco, CA, 94080, USA
| | - Brian LaMoreaux
- Horizon Therapeutics Plc, 1 Horizon Way, Deerfield, IL, 60015, USA
| | - Lin Zhao
- Horizon Therapeutics Plc, 1 Horizon Way, Deerfield, IL, 60015, USA
| | - Yan Xin
- Horizon Therapeutics Plc, 2 Tower Place, South San Francisco, CA, 94080, USA
| | - Jason Chamberlain
- Horizon Therapeutics Plc, 2 Tower Place, South San Francisco, CA, 94080, USA
| | - Srini Ramanathan
- Horizon Therapeutics Plc, 2 Tower Place, South San Francisco, CA, 94080, USA
| | - Michael E Weinblatt
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Jeff Peterson
- Western Washington Medical Group Arthritis Clinic, 1909 214th Street SE, Suite 211, Bothell, WA, 98021, USA
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Stauder SK, Peloso PM. Dual Energy CT Has Additional Prognostic Value over Clinical Measures in Gout Including Tophi: A Systematic Literature Review. J Rheumatol 2022; 49:1256-1268. [PMID: 35840151 DOI: 10.3899/jrheum.211246] [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] [Accepted: 06/30/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This Systematic Literature Review determined whether there is clinical utility for Dual Energy CT (DECT) to inform on prognosis for gout patients. With DECT, individualized treatment plans could be developed based on the patient's unique urate burden, with DECT used as a clinical outcome measure in gout management. METHODS To evaluate DECT as a reliable, valid, and sensitive prognostic instrument, a librarian-assisted search was undertaken in PubMed and EMBASE for articles on gout and DECT informing on reliability, validity (content, construct, criterion), sensitivity to change and minimum clinically important changes. RESULTS This systematic literature review showed that DECT has high intra- and inter-rater reliability. Tophus burden correlates with functional loss to show content validity. DECT volume is positively correlated with death and cardiovascular risk factors, and the risk for future gout flares. DECT has excellent sensitivity to change with effective urate lowering therapies. CONCLUSION DECT is a promising prognostic tool based on its high reliability, sensitivity to change, and emerging validity. Additional large, well-designed prospective cohort studies are needed to fully evaluate its prognostic utility. This systematic review suggests it's very likely DECT has additional prognostic information beyond clinical tophi assessment alone.
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Affiliation(s)
- Sally K Stauder
- Florida State University, Tallahassee, FL, USA, Horizon Therapeutics plc, Deerfield, IL, USA. The source(s) of support in the form of grants or industrial support: This study was supported by Horizon Therapeutics plc, Deerfield, IL, USA. S.K. Stauder, BS Neuroscience, MD Candidate Florida State University College of Medicine, Florida State University, Tallahassee, FL, USA; P.M. Peloso, MD, FRCPC, 1575 Winding Oaks Way, Unit 103, Naples, FL, USA. Conflict of interest: Sally K. Stauder has no conflicts of interest. Paul M. Peloso is former employee of Horizon and holds company stock. Statement of ethics and consent: Horizon Therapeutics funded the collection of retrospective de-identified chart data, contributed to the analysis, and data interpretation and the writing, review, and approval of the manuscript. Editorial assistance was provided by Amy Cohen, PhD, a Horizon employee. Corresponding author's name, address, and Paul M. Peloso, 1575 Winding Oaks Way, Naples, FL 34109, USA.
| | - Paul M Peloso
- Florida State University, Tallahassee, FL, USA, Horizon Therapeutics plc, Deerfield, IL, USA. The source(s) of support in the form of grants or industrial support: This study was supported by Horizon Therapeutics plc, Deerfield, IL, USA. S.K. Stauder, BS Neuroscience, MD Candidate Florida State University College of Medicine, Florida State University, Tallahassee, FL, USA; P.M. Peloso, MD, FRCPC, 1575 Winding Oaks Way, Unit 103, Naples, FL, USA. Conflict of interest: Sally K. Stauder has no conflicts of interest. Paul M. Peloso is former employee of Horizon and holds company stock. Statement of ethics and consent: Horizon Therapeutics funded the collection of retrospective de-identified chart data, contributed to the analysis, and data interpretation and the writing, review, and approval of the manuscript. Editorial assistance was provided by Amy Cohen, PhD, a Horizon employee. Corresponding author's name, address, and Paul M. Peloso, 1575 Winding Oaks Way, Naples, FL 34109, USA.
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Khanna PP, Khanna D, Cutter G, Foster J, Melnick J, Jaafar S, Biggers S, Rahman AKMF, Kuo HC, Feese M, Kivitz A, King C, Shergy W, Kent J, Peloso PM, Danila MI, Saag KG. Reducing Immunogenicity of Pegloticase With Concomitant Use of Mycophenolate Mofetil in Patients With Refractory Gout: A Phase II, Randomized, Double-Blind, Placebo-Controlled Trial. Arthritis Rheumatol 2021; 73:1523-1532. [PMID: 33750034 DOI: 10.1002/art.41731] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 02/18/2021] [Accepted: 03/09/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Pegloticase is used for the treatment of severe gout, but its use is limited by immunogenicity. This study was undertaken to evaluate whether mycophenolate mofetil (MMF) prolongs the efficacy of pegloticase. METHODS Participants were randomized 3:1 to receive 1,000 mg MMF twice daily or placebo for 14 weeks, starting 2 weeks before receiving pegloticase and continuing while receiving intravenous pegloticase 8 mg biweekly for 12 weeks. Participants then received pegloticase alone from week 12 to week 24. The primary end points were the proportion of patients who sustained a serum urate level of ≤6 mg/dl at 12 weeks and the rate of adverse events (AEs). Secondary end points included 24-week durability of serum urate level ≤6 mg/dl. Fisher's exact test and Wilcoxon's 2-sample test were used for analyses, along with Kaplan-Meier estimates and log rank tests. RESULTS A total of 32 participants received ≥1 dose of pegloticase. Participants were predominantly men (88%), with a mean age of 55.2 years, mean gout duration of 13.4 years, and mean baseline serum urate level of 9.2 mg/dl. At 12 weeks, a serum urate level of ≤6 mg/dl was achieved in 19 (86%) of 22 participants in the MMF arm compared to 4 (40%) of 10 in the placebo arm (P = 0.01). At week 24, the serum urate level was ≤6 mg/dl in 68% of MMF-treated patients versus 30% of placebo-treated patients (P = 0.06), and rates of AEs were similar between groups, with more infusion reactions occurring in the placebo arm (30% versus 0%). CONCLUSION Our findings indicate that MMF therapy with pegloticase is well tolerated and shows a clinically meaningful improvement in targeted serum urate level of ≤6 mg/dl at 12 and 24 weeks. This study suggests an innovative approach to pegloticase therapy in gout.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Alan Kivitz
- Altoona Center for Clinical Research, Duncansville, Pennsylvania, USA
| | | | | | - Jeff Kent
- Horizon Therapeutics, Lake Forest, Illinois, USA
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Botson JK, Tesser JRP, Bennett R, Kenney HM, Peloso PM, Obermeyer K, LaMoreaux B, Weinblatt ME, Peterson J. Pegloticase in Combination With Methotrexate in Patients With Uncontrolled Gout: A Multicenter, Open-label Study (MIRROR). J Rheumatol 2020; 48:767-774. [PMID: 32934137 DOI: 10.3899/jrheum.200460] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To examine the efficacy and safety of pegloticase in combination with methotrexate (MTX) in patients with uncontrolled gout in an exploratory, open-label clinical trial (ClinicalTrials.gov: NCT03635957) prior to a randomized, controlled trial. METHODS A multicenter, open-label efficacy and safety study of pegloticase with MTX co-treatment was conducted in patients with uncontrolled gout. Patients were administered oral MTX (15 mg/week) and folic acid (1 mg/day) 4 weeks prior to and throughout pegloticase treatment. The primary study outcome was the proportion of responders, defined as serum uric acid (sUA) < 6 mg/dL for ≥ 80% of the time during Month 6 (Weeks 20, 22, and 24). All analyses were performed on a modified intent-to-treat population, defined as patients who received ≥ 1 pegloticase infusion. RESULTS Seventeen patients were screened and 14 patients (all men, average age 49.3 ± 8.7 years) were enrolled. On Day 1, mean sUA was 9.2 ± 2.5 mg/dL, and 12 of the 14 patients had visible tophi. At the 6-month timepoint, 11/14 (78.6%, 95% CI 49.2-95.3%) met the responder definition, with 3 patients discontinuing after meeting protocol-defined treatment discontinuation rules (preinfusion sUA values > 6 mg/dL at 2 consecutive scheduled visits). All patients tolerated MTX. No new safety concerns were identified. CONCLUSION In this study, an increased proportion of patients maintained therapeutic response at 6 months when treated concomitantly with MTX and pegloticase as compared to the previously reported 42% using pegloticase alone. These results support the need for a randomized study of MTX or placebo with pegloticase to validate these open-label findings.
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Affiliation(s)
- John K Botson
- J.K. Botson, MD, RPh, Orthopedic Physicians Alaska, Anchorage, Alaska;
| | - John R P Tesser
- J.R. Tesser, MD, R. Bennett, MD, Arizona Arthritis & Rheumatology Associates, P.C., Phoenix, Arizona
| | - Ralph Bennett
- J.R. Tesser, MD, R. Bennett, MD, Arizona Arthritis & Rheumatology Associates, P.C., Phoenix, Arizona
| | - Howard M Kenney
- H.M. Kenney, MD, Arthritis Northwest, PLLC, Spokane, Washington
| | - Paul M Peloso
- P.M. Peloso, MD, MSc, K. Obermeyer, MS, B. LaMoreaux, MD, MS, Horizon Therapeutics, Lake Forest, Illinois
| | - Katie Obermeyer
- P.M. Peloso, MD, MSc, K. Obermeyer, MS, B. LaMoreaux, MD, MS, Horizon Therapeutics, Lake Forest, Illinois
| | - Brian LaMoreaux
- P.M. Peloso, MD, MSc, K. Obermeyer, MS, B. LaMoreaux, MD, MS, Horizon Therapeutics, Lake Forest, Illinois
| | | | - Jeff Peterson
- J. Peterson, MD, Western Washington Arthritis Clinic, Bothell, Washington, USA
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Khatri A, Klünder B, Peloso PM, Othman AA. Exposure-response analyses demonstrate no evidence of interleukin 17A contribution to efficacy of ABT-122 in rheumatoid or psoriatic arthritis. Rheumatology (Oxford) 2019; 58:352-360. [PMID: 30376130 DOI: 10.1093/rheumatology/key312] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Indexed: 11/13/2022] Open
Abstract
Objectives ABT-122 is a dual-variable-domain immunoglobulin that neutralizes both TNF-α and IL-17A. The objective of this work was to characterize exposure-response relationships for ABT-122 relative to adalimumab (TNF-α inhibitor) using ABT-122 phase 2 trials in patients with RA or PsA. Methods Patients received subcutaneous doses of ABT-122 ranging from 60 mg every other week (EOW) to 240 mg every week, adalimumab 40 mg EOW, or placebo (PsA patients only) for 12 weeks. Relationships between ABT-122 or adalimumab serum concentrations and time course of ACR20, ACR50 and ACR70 and PASI50, PASI75 and PASI90 responses were characterized using a non-linear mixed-effects Markov modelling approach. Results A total of 221 RA patients and 240 PsA patients were included in the analyses. At comparable molar exposures, there was no differentiation of efficacy between ABT-122 and adalimumab and there were no consistent differences between ABT-122 and adalimumab in the potency estimates for different efficacy endpoints based on the Markov models. Plateau of ABT-122 efficacy was achieved at exposures associated with the 120 mg EOW dose in patients with RA, which were comparable to molar exposures of adalimumab 40 mg EOW, and at the lowest dose of 120 mg every week in patients with PsA. Conclusion The exposure-response relationships for ABT-122 were not distinguishably different from those of adalimumab in patients with RA or PsA. Overall, there was no clear evidence that inhibition of the IL-17 pathway provided incremental benefit in the presence of TNF-α inhibition. Trial registration ClinicalTrials.gov, NCT02433340, NCT02349451.
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Affiliation(s)
- Amit Khatri
- Department of Clinical Pharmacology and Pharmacometrics, AbbVie Inc., North Chicago, IL, USA
| | - Ben Klünder
- Department of Clinical Pharmacology and Pharmacometrics, AbbVie Inc., North Chicago, IL, USA
| | - Paul M Peloso
- Department of Clinical Development, AbbVie Inc., North Chicago, IL, USA
| | - Ahmed A Othman
- Department of Clinical Pharmacology and Pharmacometrics, AbbVie Inc., North Chicago, IL, USA
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Leyland N, Taylor HS, Archer DF, Peloso PM, Soliman AM, Palac HL, Martinez M, Abrao MS. Elagolix reduced dyspareunia and improved health-related quality of life in premenopausal women with endometriosis-associated pain. Journal of Endometriosis and Pelvic Pain Disorders 2019. [DOI: 10.1177/2284026519872401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: The objective was to evaluate the effects of elagolix on dyspareunia in women with endometriosis-associated pain. Methods: Data were pooled from two similar, randomized, double-blind, placebo-controlled, 6-month phase 3 studies (Elaris Endometriosis-I and Elaris Endometriosis-II) of elagolix at two doses (150 mg QD and 200 mg BID) in women with endometriosis-associated pain. In this post hoc analysis, dyspareunia responders were defined as having a clinically meaningful decrease from baseline in the dyspareunia score and decreased or stable use of rescue analgesic agents, as recorded in a daily electronic diary. Sexual relationship was assessed using the 30-item Endometriosis Health Profile questionnaire sexual relationship module. Results: A total of 1384 women reported ⩾1 day of sexual activity at baseline (35 days prior to and including day 1 of treatment). Of these 1384 women, 1297 (94%) reported ⩾1 day of any dyspareunia (mild, moderate, or severe), of which 51% reported ⩾1 day of severe dyspareunia. Among sexually active women who reported any dyspareunia at baseline, both elagolix doses led to improvements in dyspareunia. Women in the 200-mg BID group showed more months at which the dyspareunia response rates were statistically significantly greater than placebo, particularly in a subgroup of women with severe dyspareunia at baseline. Compared to placebo, both elagolix doses led to statistically significantly greater improvements in the mean 30-item Endometriosis Health Profile sexual relationship module score. Conclusion: Up to 6 months of elagolix treatment improved dyspareunia in women with endometriosis-associated pain in a dose-dependent manner, with 200-mg BID dose showing the most significant improvements in dyspareunia and quality of sexual relationships compared with placebo.
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Affiliation(s)
- Nicholas Leyland
- Department of Obstetrics and Gynaecology, Hamilton Health Sciences, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | | | | | | | | | | | | | - Mauricio S Abrao
- Hospital das Clinicas Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
- BP-A Beneficencia Portuguesa de Sao Paulo, Sao Paulo, Brazil
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Mease PJ, Genovese MC, Weinblatt ME, Peloso PM, Chen K, Othman AA, Li Y, Mansikka HT, Khatri A, Wishart N, Liu J. Phase II Study of ABT-122, a Tumor Necrosis Factor- and Interleukin-17A-Targeted Dual Variable Domain Immunoglobulin, in Patients With Psoriatic Arthritis With an Inadequate Response to Methotrexate. Arthritis Rheumatol 2019; 70:1778-1789. [PMID: 29855175 PMCID: PMC6221045 DOI: 10.1002/art.40579] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 05/29/2018] [Indexed: 12/28/2022]
Abstract
Objective To investigate the safety and efficacy of ABT‐122, a tumor necrosis factor (TNF)– and interleukin‐17A (IL‐17A)–targeted dual variable domain immunoglobulin, in patients with active psoriatic arthritis (PsA) who have experienced an inadequate response to methotrexate. Methods Patients (n = 240) were randomized to receive ABT‐122 (120 or 240 mg every week), adalimumab (40 mg every other week), or placebo in a 12‐week double‐blind, parallel‐group study. The primary efficacy end point was the proportion of patients achieving ≥20% improvement in disease activity according to the American College of Rheumatology response criteria (ACR20) at week 12. Secondary and exploratory 12‐week end points included 50% improvement (ACR50) and 70% improvement (ACR70) response rates, and proportion of patients meeting the Psoriasis Area and Severity Index (PASI) response criteria for ≥75% (PASI75) and ≥90% (PASI90) improvement in skin scores among those with ≥3% of their body surface area affected by psoriasis. Results In both ABT‐122 dose groups, ACR20 response rates at week 12 (64.8–75.3%) were superior to that in patients receiving placebo (25.0%) (P < 0.001) but similar to that in patients receiving adalimumab (68.1%). ACR50 and ACR70 response rates were also superior in both ABT‐122 dose groups (36.6–53.4% and 22.5–31.5%, respectively) compared to the placebo group (12.5% and 4.2%, respectively) (P < 0.05). Among eligible patients in the placebo, adalimumab, ABT‐122 120 mg every week, and ABT‐122 240 mg every week treatment groups, PASI75 responses were achieved in 27.3%, 57.6%, 74.4%, and 77.6% of patients, respectively, whereas PASI90 responses were achieved in 18.2%, 45.5%, 48.8%, and 46.9% of patients, respectively. Frequencies of treatment‐emergent adverse events, including infections, were similar across all treatment groups, causing no discontinuations. No serious infections or systemic hypersensitivity reactions were reported with ABT‐122. Conclusion Dual neutralization of TNF and IL‐17A with ABT‐122 had efficacy and safety that was similar to, and not broadly differentiated from, that of adalimumab over a 12‐week treatment course in patients with PsA.
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Affiliation(s)
- Philip J Mease
- Swedish Medical Center and University of Washington, Seattle
| | | | | | | | - Kun Chen
- AbbVie Inc., North Chicago, Illinois
| | | | - Yihan Li
- AbbVie Inc., North Chicago, Illinois
| | | | | | | | - John Liu
- AbbVie Inc., North Chicago, Illinois
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10
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Genovese MC, Weinblatt ME, Mease PJ, Aelion JA, Peloso PM, Chen K, Li Y, Liu J, Othman AA, Khatri A, Mansikka HT, Leszczynski P. Dual inhibition of tumour necrosis factor and interleukin-17A with ABT-122: open-label long-term extension studies in rheumatoid arthritis or psoriatic arthritis. Rheumatology (Oxford) 2019; 57:1972-1981. [PMID: 30032191 DOI: 10.1093/rheumatology/key173] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Indexed: 11/15/2022] Open
Abstract
Objectives To evaluate the safety and maintenance of efficacy with ABT-122, a bi-specific monoclonal antibody targeting TNF and IL-17A, in patients with RA or PsA in open-label, 24-week extensions [open-label extensions (OLEs)] of 12-week, randomized, double-blind studies. Methods All patients received ABT-122 (RA, 120 mg; PsA, 240 mg) subcutaneously every other week on background MTX. Safety assessments included adverse events (AEs) and laboratory parameters. Efficacy was evaluated with ACR responses, 28-joint DAS using high-sensitivity CRP [DAS28 (hsCRP)], and Psoriasis Area and Severity Index (PsA study). Results The RA OLE study enrolled 158 patients; the PsA OLE study enrolled 168 patients. In the RA OLE study, the incidence of treatment emergent AEs (TEAEs; 41%) appeared similar to the double-blind study (36-43%). In the PsA OLE study, 57% of patients reported ⩾1 TEAE (double-blind study, 42-53%). Most TEAEs were mild or moderate in severity. There were no neutrophil abnormalities greater than grade 2. Grade 3 and/or 4 laboratory abnormalities were reported for lymphocytes, alanine aminotransferase, aspartate aminotransferase, bilirubin and haemoglobin; the number of these severe laboratory values was low (0.6-3.0%), except grade 3 lymphocyte count decreased (11.5%) in the RA study. In both OLE studies, efficacy assessed by ACR responses and other disease activity scores was maintained over the 24 weeks. Conclusion ABT-122 demonstrated acceptable tolerability and maintenance of efficacy for up to 36 weeks in patients with RA or PsA receiving background MTX. Trial registration ClinicalTrials.gov, http://clinicaltrials.gov, NCT02433340 and NCT02429895.
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Affiliation(s)
- Mark C Genovese
- Immunology and Rheumatology, Stanford University Medical Center, Palo Alto, CA, USA
| | | | - Philip J Mease
- Rheumatology and Internal Medicine, Swedish Medical Center and University of Washington, Seattle, WA, USA
| | - Jacob A Aelion
- Arthritis Clinic, Jackson, USA.,Department of Medicine, University of Tennessee, Memphis, TN, USA
| | - Paul M Peloso
- Clinical Development, AbbVie Inc., North Chicago, IL, USA
| | - Kun Chen
- Data and Statistical Sciences, AbbVie Inc., North Chicago, IL, USA
| | - Yihan Li
- Data and Statistical Sciences, AbbVie Inc., North Chicago, IL, USA
| | - John Liu
- Medical Safety Evaluation Pharmacovigilance and Patient Safety, AbbVie Inc., North Chicago, IL, USA
| | - Ahmed A Othman
- Clinical Pharmacology and Pharmacometrics, AbbVie Inc., North Chicago, IL, USA
| | - Amit Khatri
- Clinical Pharmacology and Pharmacometrics, AbbVie Inc., North Chicago, IL, USA
| | | | - Piotr Leszczynski
- Rheumatology and Rehabilitation, Poznan University of Medical Sciences, Poznan, Poland
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11
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Genovese MC, Weinblatt ME, Aelion JA, Mansikka HT, Peloso PM, Chen K, Li Y, Othman AA, Khatri A, Khan NS, Padley RJ. ABT-122, a Bispecific Dual Variable Domain Immunoglobulin Targeting Tumor Necrosis Factor and Interleukin-17A, in Patients With Rheumatoid Arthritis With an Inadequate Response to Methotrexate: A Randomized, Double-Blind Study. Arthritis Rheumatol 2018; 70:1710-1720. [PMID: 29855172 PMCID: PMC6704363 DOI: 10.1002/art.40580] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 05/29/2018] [Indexed: 12/28/2022]
Abstract
Objective Tumor necrosis factor (TNF) and interleukin‐17A (IL‐17A) may independently contribute to the pathophysiology of rheumatoid arthritis (RA). This study sought to evaluate the safety and efficacy of ABT‐122, a novel dual variable domain immunoglobulin targeting human TNF and IL‐17A, in patients with RA who have experienced an inadequate response to methotrexate. Methods Patients with active RA who were receiving treatment with methotrexate and had no prior exposure to biologic agents (n = 222) were enrolled in a 12‐week phase II randomized, double‐blind, active‐controlled, parallel‐group study. Patients were randomized to receive either ABT‐122 at dosages of 60 mg every other week, 120 mg every other week, or 120 mg every week or adalimumab at 40 mg every other week, administered subcutaneously. The primary efficacy end point was the proportion of patients achieving a ≥20% improvement response based on the American College of Rheumatology criteria for 20% improvement (ACR20) at week 12. Results Treatment‐emergent adverse events were similar across all treatment groups, with no serious infections or systemic hypersensitivity reactions reported with ABT‐122. ACR20 response rates at week 12 were 62%, 75%, and 80% with ABT‐122 60 mg every other week, 120 mg every other week, and 120 mg every week, respectively, compared with an ACR20 response rate of 68% with 40 mg adalimumab every other week. The corresponding response rates for ACR50 and ACR70 improvement in the ABT‐122 dose groups and adalimumab group were 35%, 46%, 47%, and 48%, respectively, and 22%, 18%, 36%, and 21%, respectively. Conclusion Over the 12‐week study period, dual inhibition of TNF and IL‐17A with ABT‐122 produced a safety profile consistent with that of adalimumb used for inhibition of TNF alone. The efficacy of ABT‐122 over 12 weeks at dosages of 120 mg every other week or 120 mg every week was not meaningfully differentiated from that of adalimumab at a dosage of 40 mg every other week in patients with RA receiving concomitant methotrexate.
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Affiliation(s)
| | | | - Jacob A Aelion
- University of Tennessee Heath Science Center, Memphis, Tennessee
| | | | | | - Kun Chen
- AbbVie Incorporated, North Chicago, Illinois
| | - Yihan Li
- AbbVie Incorporated, North Chicago, Illinois
| | | | - Amit Khatri
- AbbVie Incorporated, North Chicago, Illinois
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12
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Othman AA, Khatri A, Loebbert R, Peloso PM. Pharmacokinetics, Safety, and Tolerability of the Dual Inhibitor of Tumor Necrosis Factor-α and Interleukin 17A, ABBV-257, in Healthy Volunteers and Patients With Rheumatoid Arthritis. Clin Pharmacol Drug Dev 2018; 8:492-502. [PMID: 30156758 DOI: 10.1002/cpdd.611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 03/16/2018] [Accepted: 07/16/2018] [Indexed: 11/12/2022]
Abstract
The dual-variable domain immunoglobulin ABBV-257 binds tumor necrosis factor-α and interleukin 17A. Following single ascending doses ( 0.3, 1.0, and 3.0 mg/kg intravenously; 0.3 and 3.0 mg/kg subcutaneously) in a randomized, double-blind, placebo-controlled study in healthy subjects (n = 40; n = 29 evaluated for pharmacokinetics), maximum observed serum concentration (Cmax ) increased dose-proportionally, whereas area under the serum concentration-versus-time curve trended to more than dose-proportional increase. Absolute subcutaneous bioavailability was ∼80%, and the time to Cmax (tmax ) occurred 6 to 8 days after subcutaneous administration. The terminal-phase harmonic mean elimination half-life (t½ ) ranged from 5.5 to 11 days following intravenous and subcutaneous administration. In another randomized, placebo-controlled study, rheumatoid arthritis (RA) patients (n = 8) received ABBV-257 30 mg/kg subcutaneously every other week for 8 weeks. Following the fourth dose, Cmax was 7.69 μg/mL, and tmax occurred ∼4 days after dosing; t½ was ∼16 days. Most individuals (single-dose study, 97%; multiple-dose study, 83%) developed antidrug antibodies (ADAs). Generally, subjects with higher ADA titers had shorter ABBV-257 t½ and lower exposure. One serious adverse event (cerebral ischemia, considered unrelated to treatment, resolved with interventions) occurred in an RA patient who received ABBV-257. Because of the high incidence of ADA-mediated drug clearance, ABBV-257 is no longer being developed.
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13
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Balazcs E, Sieper J, Bickham K, Mehta A, Frontera N, Stryszak P, Popmihajlov Z, Peloso PM. A randomized, clinical trial to assess the relative efficacy and tolerability of two doses of etoricoxib versus naproxen in patients with ankylosing spondylitis. BMC Musculoskelet Disord 2016; 17:426. [PMID: 27737664 PMCID: PMC5062857 DOI: 10.1186/s12891-016-1275-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 09/29/2016] [Indexed: 12/17/2022] Open
Abstract
Background This study evaluated two doses of etoricoxib (60 and 90 mg) vs. naproxen 1000 mg in subjects with ankylosing spondylitis (AS). Methods This was a 2-part, double-blind, active comparator-controlled non-inferiority study in subjects ≥18 years of age with AS. In Part I, subjects were randomized to naproxen 1000 mg; etoricoxib 60 mg, and 90 mg. In Part II, naproxen and etoricoxib 90 mg subjects continued on the same treatment; subjects on etoricoxib 60 mg either continued on 60 mg or escalated to 90 mg. Part I (6 weeks) assessed the efficacy of A) etoricoxib 60 mg vs. naproxen and B) 90 mg vs. naproxen according to the time-weighted average change from baseline in Spinal Pain Intensity (SPI; 0–100 mm VAS) (primary endpoint). The non-inferiority margin was set at 8 mm for SPI. In Part II (20 weeks) we evaluated the potential benefit of increasing from 60 to 90 mg (predefined minimum clinically important difference = 6 mm in SPI) for inadequate responders (<50 % improvement from baseline in SPI) on etoricoxib 60 mg in Part I. Results In total, 1015 subjects were randomized to receive etoricoxib 60 mg (N = 702), etoricoxib 90 mg (N = 156), and naproxen 1000 mg (N = 157); 70.9 % were male and the mean age was 45.2 years. There were 919 subjects who completed Part I and all continued to Part II. In Part I, SPI change was non-inferior for both etoricoxib doses vs. naproxen. In both Part I and II, the incidence of adverse events (AEs), drug-related AEs, and serious adverse events (SAEs) were similar between the 3 treatment groups. Conclusion Both doses of etoricoxib were non-inferior to naproxen. All treatments were well tolerated. Etoricoxib 60 and 90 mg effectively control pain in patients with AS, with 60 mg once daily as the lowest effective dose for most patients. Trial registration Clinical Trials Registry # NCT01208207. Registered on 22 September 2010. Electronic supplementary material The online version of this article (doi:10.1186/s12891-016-1275-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eva Balazcs
- Department of Neuromusculoskeletal Rehabilitation, Dr. Bugyi István Kórház, Sima Ferenc, Szentes, Hungary
| | - Joachim Sieper
- Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
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14
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Peloso PM, Moore RA, Chen WJ, Lin HY, Gates DF, Straus WL, Popmihajlov Z. Osteoarthritis patients with pain improvement are highly likely to also have improved quality of life and functioning. A post hoc analysis of a clinical trial. Scand J Pain 2016; 13:175-181. [PMID: 28850528 DOI: 10.1016/j.sjpain.2016.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 12/15/2015] [Revised: 07/20/2016] [Accepted: 07/21/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND This analysis evaluated whether osteoarthritis patients achieving the greatest pain control and lowest pain states also have the greatest improvement in functioning and quality of life. METHODS Patients (n=419) who failed prior therapies and who were switched to etoricoxib 60mg were categorized as pain responders or non-responders at 4 weeks based on responder definitions established by the Initiative on Methods, Measurement, and Pain (IMMPACT) criteria, including changes from baseline of ≥15%, ≥30%, ≥50%, ≥70% and a final pain status of ≤3/10 (no worse than mild pain). Pain was assessed at baseline and 4 weeks using 4 questions from the Brief Pain Inventory (BPI) (worst pain, least pain, average pain, and pain right now), and also using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain subscale. We examined the relationship between pain responses with changes from baseline in two functional measures (the BPI Pain Interference questions and the WOMAC Function Subscale) as well as changes from baseline in quality of life (assessed on the SF-36 Physical and Mental Component Summaries). We also sought to understand whether these relationships were influenced by the choice of the pain instrument used to assess response. We contrast the mean difference in improvements in the functional and quality of life instruments based on pain responder status (responder versus non-responder) and the associated 95% confidence limits around this difference. RESULTS Patients with better pain responses were much more likely to have improved functional responses and improved quality of life, with higher mean changes in these outcomes versus pain non-responders, regardless of the choice of IMMPACT pain response definition (e.g., using any of 15%, 30%, 50%, 70% change from baseline) or the final pain state of ≤3/10. There was an evident gradient, where higher levels of pain response were associated with greater mean improvements in function and quality of life. The finding that greater pain responses led to greater functional improvements and quality of life gains was not dependent on the manner in which pain was evaluated. Five different pain instruments (e.g., the 4 questions on pain from the BPI pain questionnaire and the WOMAC pain subscale) consistently demonstrated that pain responders had statistically significantly greater improvements in function and quality of life compared to pain non-responders. This suggests these results are likely to be generalizable to any validated pain measure for osteoarthritis. CONCLUSIONS Pain is an efficient outcome measure for predicting broader patient response in osteoarthritis. Patients who do not achieve timely, acceptable pain states over 4 weeks were less likely to experience functional or quality of life improvements. IMPLICATIONS Good pain improvements in osteoarthritis with a valid pain instrument are a proxy for good improvements in both function and quality of life. Therefore proper osteoarthritis pain assessment can lead to efficient evaluations in the clinic.
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Affiliation(s)
| | - R Andrew Moore
- University of Oxford, Pain Research, Nuffield Division of Anaesthetics, The Churchill, Oxford, UK
| | | | - Hsiao-Yi Lin
- Taipei Veterans General Hospital, Taipei, Taiwan
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15
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Bickham K, Kivitz AJ, Mehta A, Frontera N, Shah S, Stryszak P, Popmihajlov Z, Peloso PM. Evaluation of two doses of etoricoxib, a COX-2 selective non-steroidal anti-inflammatory drug (NSAID), in the treatment of Rheumatoid Arthritis in a double-blind, randomized controlled trial. BMC Musculoskelet Disord 2016; 17:331. [PMID: 27502582 PMCID: PMC4977639 DOI: 10.1186/s12891-016-1170-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 07/13/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Treatment with non-steroidal anti-inflammatory drugs (NSAID) is a common component of treatment regimens for rheumatoid arthritis (RA). Etoricoxib is a COX-2 selective NSAID that has demonstrated efficacy in the treatment of RA at a dose of 90 mg. The current study further evaluated the efficacy of etoricoxib 60 mg and 90 mg in RA patients with active disease. METHODS This was a 2-part, double-blind, placebo-controlled study in RA (NCT01208181). Patients were required to have a diagnosis of RA (according to ARA 1987 revised classification criteria) and were to demonstrate symptom flare upon discontinuation of previous NSAID treatment prior to randomization. Part I was a 6-week, placebo-controlled period to assess the efficacy of etoricoxib 90 mg and etoricoxib 60 mg, each compared to placebo, as well as to each other. Part II was a 6-week period to evaluate the potential benefit of dose escalation from etoricoxib 60 mg to etoricoxib 90 mg after 6 weeks exposure to etoricoxib 60 mg in Part I compared to maintaining a steady dose of etoricoxib 60 mg throughout Parts I and II. Primary endpoints were Disease Activity Score evaluating 28 joints and C reactive protein level (DAS28-CRP) index and Patient Global Assessment of Pain (Pain) score (0-100 mm VAS) after 6 weeks of treatment in Part I. Adverse events were monitored throughout the study. RESULTS In total, 1404 patients were randomized in a 2:7:7:8 ratio; 1228 patients completed Part I and 713 patients continued to Part II. Both etoricoxib doses were superior to placebo on both primary efficacy endpoints (p = 0.004 for 60 mg and p = 0.034 for 90 mg for DAS28-CRP; p < 0.001 for both doses for PGAP) in Part I. Further in Part I, etoricoxib 90 mg was not significantly different from 60 mg for DAS28-CRP, but did demonstrate a small, but statistically significant decrease in baseline PGAP score vs. 60 mg (p = 0.019). In Part II, there was no significant decrease in PGAP score after increasing to 90 mg in subjects with inadequate pain relief on 60 mg as compared to subjects who stayed on 60 mg. The incidence of AEs and SAEs were similar between etoricoxib 60 mg and 90 mg in both Part I and II. CONCLUSION Both etoricoxib 90 mg and 60 mg are superior to placebo in relieving the symptoms of RA. Etoricoxib 90 mg vs 60 mg resulted in a statistically significant, though small, improvement in PGAP score, but not DAS28-CRP. Dose escalation from 60 mg to 90 mg in pain inadequate responders did not significantly improve efficacy. These results confirm the efficacy and tolerability of etoricoxib 90mg in patients with RA. In addition, this study demonstrated that etoricoxib 60 mg is also efficacious and well-tolerated in RA. CLINICAL TRIAL REGISTRATION NCT01208181 (registered September 22, 2010).
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Affiliation(s)
| | - Alan J Kivitz
- Altoona Center for Clinical Research, Duncansville, PA, USA
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16
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Kvien TK, Greenwald M, Peloso PM, Wang H, Mehta A, Gammaitoni A. Do COX-2 inhibitors provide additional pain relief and anti-inflammatory effects in patients with rheumatoid arthritis who are on biological disease-modifying anti-rheumatic drugs and/or corticosteroids? Post-hoc analyses from a randomized clinical trial with etoricoxib. BMC Musculoskelet Disord 2015; 16:26. [PMID: 25886874 PMCID: PMC4344787 DOI: 10.1186/s12891-015-0468-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 01/15/2015] [Indexed: 12/29/2022] Open
Abstract
Background Our objective was to evaluate the effect of background biological disease-modifying anti-rheumatic drugs (bDMARDs) and/or corticosteroids (CS) on response to nonsteroidal anti-inflammatory drugs (NSAIDs) in rheumatoid arthritis (RA) patients. Methods The following efficacy endpoints were evaluated using time-weighted change from baseline in a 12-week, randomized controlled clinical trial with etoricoxib: Patient Global Assessment of Pain, Swollen Joint Count, Tender Joint Count, Health Assessment Questionnaire. The following three treatment groups were evaluated: placebo, pooled etoricoxib 10/30/60 mg, and etoricoxib 90 mg. Screening values, values post flare, as well as changes after treatment were analyzed. Results Of the 1014 patients screened, 761 were randomized; 50% were on no background bDMARDs and/or CS therapy, 23% used bDMARDs, 34% used CS, and 8% used both bDMARDs and CS. It was demonstrated that RA patients on bDMARDs or CS had similar pain levels at screening as patients without this co-medication. They experienced flare upon NSAID withdrawal and demonstrated dose-dependent pain improvement with etoricoxib. Conclusion These results support that RA patients receiving bDMARDs or CS may still require the use of concomitant analgesics to treat pain. Clinicians should continue to monitor and treat pain even after initiating a bDMARD and/or CS. Trial Registration [clinicaltrials.gov; NCT00264147]
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Affiliation(s)
- Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Box 23, Vinderen, N-0319, Oslo, Norway.
| | | | - Paul M Peloso
- Clinical Research, Merck & Co., Inc., Kenilworth, NJ, USA.
| | - Hongwei Wang
- Clinical Research, Merck & Co., Inc., Kenilworth, NJ, USA.
| | - Anish Mehta
- Clinical Research, Merck & Co., Inc., Kenilworth, NJ, USA.
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Laires P, Laíns J, Miranda L, Cernadas R, Pereira DSJ, Gomes JM, Peloso PM, Taylor SD, Silva JC. Inadequate Pain Relief Among Patients With Primary Knee Osteoarthritis - Analysis From The Portuguese Sample Of The Survey Of Osteoarthritis Real World Therapies (Sort). Value Health 2014; 17:A386. [PMID: 27200873 DOI: 10.1016/j.jval.2014.08.2644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- P Laires
- Merck Sharp & Dohme, Oeiras, Portugal
| | - J Laíns
- Centro de Medicina e Reabilitação da Região Centro, Coimbra, Portugal
| | - L Miranda
- Instituto Português de Reumatologia, Lisbon, Portugal
| | | | | | - J M Gomes
- Clínica Reumatológica Dr. Melo Gomes, Lisbon, Portugal
| | - P M Peloso
- Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Whitehouse Station, NJ, USA
| | - S D Taylor
- Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Whitehouse Station, NJ, USA
| | - J C Silva
- Hospital Garcia de Orta, Almada, Portugal
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18
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Conaghan PG, Peloso PM, Everett SV, Rajagopalan S, Black CM, Mavros P, Arden NK, Phillips CJ, Rannou F, van de Laar MAFJ, Moore RA, Taylor SD. Inadequate pain relief and large functional loss among patients with knee osteoarthritis: evidence from a prospective multinational longitudinal study of osteoarthritis real-world therapies. Rheumatology (Oxford) 2014; 54:270-7. [PMID: 25150513 PMCID: PMC4301711 DOI: 10.1093/rheumatology/keu332] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [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] [Indexed: 12/11/2022] Open
Abstract
Objective. To estimate the prevalence of inadequate pain relief (IPR) among patients with symptomatic knee OA prescribed analgesic therapy and to characterize patients with IPR. Methods. Patients ≥50 years old with physician-diagnosed knee OA who had taken topical or oral pain medication for at least 14 days were recruited for this prospective non-interventional study in six European countries. Pain and function were assessed using the Brief Pain Inventory (BPI) and the WOMAC; quality of life (QoL) was assessed using the 12-item short form. IPR was defined as an average pain score of >4 out of 10 on BPI question 5. Results. Of 1187 patients enrolled, 68% were female and the mean age was 68 years (s.d. 9); 639 (54%) met the definition of IPR. Patient responses for the BPI average pain question were well correlated with responses on the WOMAC pain subscale (Spearman r = 0.64, P < 0.001). In multivariate logistic regression, patients with IPR had greater odds of being female [adjusted odds ratio (adjOR) 1.90 (95% CI 1.46, 2.48)] and having OA in both knees [adjOR 1.48 (95% CI 1.15, 1.90)], higher BMI, longer OA duration, depression or diabetes. Patients with IPR (vs non-IPR) were more likely to have worse QoL, greater function loss and greater pain interference. Conclusion. IPR is common among patients with knee OA requiring analgesics and is associated with large functional loss and impaired QoL. Patients at particular risk of IPR, as characterized in this study, may require greater attention towards their analgesic treatment options. Trial registration:https://clinicaltrials.gov/ (NCT01294696).
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Affiliation(s)
- Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK, Clinical Development, MRL, Merck & Co., Kenilworth, Global Health Outcomes, Merck & Co., Whitehouse Station, MedData Analytics, East Brunswick, NJ, College of Pharmacy, St Johns University, Queens, NY, USA, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Centre for Health Economics, Swansea University, Swansea, UK, Cochin Hospital, Rehabilitation Department, University of Paris, Paris, France, Department of Rheumatology and Clinical Immunology, University of Twente, Enschede, The Netherlands and Pain Research & Nuffield Department of Anaesthetics, Oxford University, Oxford, UK. Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK, Clinical Development, MRL, Merck & Co., Kenilworth, Global Health Outcomes, Merck & Co., Whitehouse Station, MedData Analytics, East Brunswick, NJ, College of Pharmacy, St Johns University, Queens, NY, USA, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Centre for Health Economics, Swansea University, Swansea, UK, Cochin Hospital, Rehabilitation Department, University of Paris, Paris, France, Department of Rheumatology and Clinical Immunology, University of Twente, Enschede, The Netherlands and Pain Research & Nuffield Department of Anaesthetics, Oxford University, Oxford, UK
| | - Paul M Peloso
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK, Clinical Development, MRL, Merck & Co., Kenilworth, Global Health Outcomes, Merck & Co., Whitehouse Station, MedData Analytics, East Brunswick, NJ, College of Pharmacy, St Johns University, Queens, NY, USA, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Centre for Health Economics, Swansea University, Swansea, UK, Cochin Hospital, Rehabilitation Department, University of Paris, Paris, France, Department of Rheumatology and Clinical Immunology, University of Twente, Enschede, The Netherlands and Pain Research & Nuffield Department of Anaesthetics, Oxford University, Oxford, UK
| | - Sharlette V Everett
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK, Clinical Development, MRL, Merck & Co., Kenilworth, Global Health Outcomes, Merck & Co., Whitehouse Station, MedData Analytics, East Brunswick, NJ, College of Pharmacy, St Johns University, Queens, NY, USA, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Centre for Health Economics, Swansea University, Swansea, UK, Cochin Hospital, Rehabilitation Department, University of Paris, Paris, France, Department of Rheumatology and Clinical Immunology, University of Twente, Enschede, The Netherlands and Pain Research & Nuffield Department of Anaesthetics, Oxford University, Oxford, UK
| | - Srinivasan Rajagopalan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK, Clinical Development, MRL, Merck & Co., Kenilworth, Global Health Outcomes, Merck & Co., Whitehouse Station, MedData Analytics, East Brunswick, NJ, College of Pharmacy, St Johns University, Queens, NY, USA, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Centre for Health Economics, Swansea University, Swansea, UK, Cochin Hospital, Rehabilitation Department, University of Paris, Paris, France, Department of Rheumatology and Clinical Immunology, University of Twente, Enschede, The Netherlands and Pain Research & Nuffield Department of Anaesthetics, Oxford University, Oxford, UK
| | - Christopher M Black
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK, Clinical Development, MRL, Merck & Co., Kenilworth, Global Health Outcomes, Merck & Co., Whitehouse Station, MedData Analytics, East Brunswick, NJ, College of Pharmacy, St Johns University, Queens, NY, USA, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Centre for Health Economics, Swansea University, Swansea, UK, Cochin Hospital, Rehabilitation Department, University of Paris, Paris, France, Department of Rheumatology and Clinical Immunology, University of Twente, Enschede, The Netherlands and Pain Research & Nuffield Department of Anaesthetics, Oxford University, Oxford, UK
| | - Panagiotis Mavros
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK, Clinical Development, MRL, Merck & Co., Kenilworth, Global Health Outcomes, Merck & Co., Whitehouse Station, MedData Analytics, East Brunswick, NJ, College of Pharmacy, St Johns University, Queens, NY, USA, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Centre for Health Economics, Swansea University, Swansea, UK, Cochin Hospital, Rehabilitation Department, University of Paris, Paris, France, Department of Rheumatology and Clinical Immunology, University of Twente, Enschede, The Netherlands and Pain Research & Nuffield Department of Anaesthetics, Oxford University, Oxford, UK
| | - Nigel K Arden
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK, Clinical Development, MRL, Merck & Co., Kenilworth, Global Health Outcomes, Merck & Co., Whitehouse Station, MedData Analytics, East Brunswick, NJ, College of Pharmacy, St Johns University, Queens, NY, USA, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Centre for Health Economics, Swansea University, Swansea, UK, Cochin Hospital, Rehabilitation Department, University of Paris, Paris, France, Department of Rheumatology and Clinical Immunology, University of Twente, Enschede, The Netherlands and Pain Research & Nuffield Department of Anaesthetics, Oxford University, Oxford, UK
| | - Ceri J Phillips
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK, Clinical Development, MRL, Merck & Co., Kenilworth, Global Health Outcomes, Merck & Co., Whitehouse Station, MedData Analytics, East Brunswick, NJ, College of Pharmacy, St Johns University, Queens, NY, USA, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Centre for Health Economics, Swansea University, Swansea, UK, Cochin Hospital, Rehabilitation Department, University of Paris, Paris, France, Department of Rheumatology and Clinical Immunology, University of Twente, Enschede, The Netherlands and Pain Research & Nuffield Department of Anaesthetics, Oxford University, Oxford, UK
| | - François Rannou
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK, Clinical Development, MRL, Merck & Co., Kenilworth, Global Health Outcomes, Merck & Co., Whitehouse Station, MedData Analytics, East Brunswick, NJ, College of Pharmacy, St Johns University, Queens, NY, USA, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Centre for Health Economics, Swansea University, Swansea, UK, Cochin Hospital, Rehabilitation Department, University of Paris, Paris, France, Department of Rheumatology and Clinical Immunology, University of Twente, Enschede, The Netherlands and Pain Research & Nuffield Department of Anaesthetics, Oxford University, Oxford, UK
| | - Mart A F J van de Laar
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK, Clinical Development, MRL, Merck & Co., Kenilworth, Global Health Outcomes, Merck & Co., Whitehouse Station, MedData Analytics, East Brunswick, NJ, College of Pharmacy, St Johns University, Queens, NY, USA, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Centre for Health Economics, Swansea University, Swansea, UK, Cochin Hospital, Rehabilitation Department, University of Paris, Paris, France, Department of Rheumatology and Clinical Immunology, University of Twente, Enschede, The Netherlands and Pain Research & Nuffield Department of Anaesthetics, Oxford University, Oxford, UK
| | - R Andrew Moore
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK, Clinical Development, MRL, Merck & Co., Kenilworth, Global Health Outcomes, Merck & Co., Whitehouse Station, MedData Analytics, East Brunswick, NJ, College of Pharmacy, St Johns University, Queens, NY, USA, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Centre for Health Economics, Swansea University, Swansea, UK, Cochin Hospital, Rehabilitation Department, University of Paris, Paris, France, Department of Rheumatology and Clinical Immunology, University of Twente, Enschede, The Netherlands and Pain Research & Nuffield Department of Anaesthetics, Oxford University, Oxford, UK
| | - Stephanie D Taylor
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK, Clinical Development, MRL, Merck & Co., Kenilworth, Global Health Outcomes, Merck & Co., Whitehouse Station, MedData Analytics, East Brunswick, NJ, College of Pharmacy, St Johns University, Queens, NY, USA, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Centre for Health Economics, Swansea University, Swansea, UK, Cochin Hospital, Rehabilitation Department, University of Paris, Paris, France, Department of Rheumatology and Clinical Immunology, University of Twente, Enschede, The Netherlands and Pain Research & Nuffield Department of Anaesthetics, Oxford University, Oxford, UK.
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Gross AR, Peloso PM, Galway E, Navasero N, Essen KV, Graham N, Goldsmith CH, Gzeer W, Shi Q, Haines TAC. Physician-delivered injection therapies for mechanical neck disorders: a systematic review update (non-oral, non-intravenous pharmacological interventions for neck pain). Open Orthop J 2013; 7:562-81. [PMID: 24155806 PMCID: PMC3806030 DOI: 10.2174/1874325001307010562] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 05/28/2013] [Accepted: 05/28/2013] [Indexed: 11/22/2022] Open
Abstract
Background: Controversy persists regarding medicinal injections for mechanical neck disorders (MNDs). Objectives: To determine the effectiveness of physician-delivered injections on pain, function/disability, quality of life, global perceived effect and patient satisfaction for adults with MNDs. Search Methods: We updated our previous searches of CENTRAL, MEDLINE and EMBASE from December 2006 through to March 2012. Selection Criteria: We included randomized controlled trials of adults with neck disorders treated by physician-delivered injection therapies. Data Collection and Analysis: Two authors independently selected articles, abstracted data and assessed methodological quality. When clinical heterogeneity was absent, we combined studies using random-effects models. Results: We included 12 trials (667 participants). No high or moderate quality studies were found with evidence of benefit over control. Moderate quality evidence suggests little or no difference in pain or function/disability between nerve block injection of steroid and bupivacaine vs bupivacaine alone at short, intermediate and long-term for chronic neck pain. We found limited very low quality evidence of an effect on pain with intramuscular lidocaine vs control for chronic myofascial neck pain. Two low quality studies showed an effect on pain with anaesthetic nerve block vs saline immediately post treatment and in the short-term. All other studies were of low or very low quality with no evidence of benefit over controls. Authors' Conclusions: Current evidence does not confirm the effectiveness of IM-lidocaine injection for chronic mechanical neck pain nor anaesthetic nerve block for cervicogenic headache. There is moderate evidence of no benefit for steroid blocks vs controls for mechanical neck pain.
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Affiliation(s)
- Paul M Peloso
- Merck, Immunology and Respiratory Therapeutic Area, K15-F4023, 2015 Galloping Hill Rd., Kenilworth, NJ 07033, USA
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Peloso PM, Khan M, Gross AR, Carlesso L, Santaguida L, Lowcock J, MacDermid JC, Walton D, Goldsmith CH, Langevin P, Shi Q. Pharmacological Interventions Including Medical Injections for Neck Pain: An Overview as Part of the ICON Project. Open Orthop J 2013; 7:473-93. [PMID: 24155805 PMCID: PMC3802125 DOI: 10.2174/1874325001307010473] [Citation(s) in RCA: 11] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 03/25/2013] [Accepted: 04/04/2013] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES To conduct an overview (review-of-reviews) on pharmacological interventions for neck pain. SEARCH STRATEGY Computerized databases and grey literature were searched from 2006 to 2012. SELECTION CRITERIA Systematic reviews of randomized controlled trials (RCT) in adults with acute to chronic neck pain reporting effects of pharmacological interventions including injections on pain, function/disability, global perceived effect, quality of life and patient satisfaction. DATA COLLECTION & ANALYSIS Two independent authors selected articles, assessed risk of bias and extracted data The GRADE tool was used to evaluate the body of evidence and an external panel provided critical review. MAIN RESULTS We found 26 reviews reporting on 47 RCTs. Most pharmacological interventions had low to very low quality methodologic evidence with three exceptions. For chronic neck pain, there was evidence of: a small immediate benefit for eperison hydrochloride (moderate GRADE, 1 trial, 157 participants);no short-term pain relieving benefit for botulinum toxin-A compared to saline (strong GRADE; 5 trial meta-analysis, 258 participants) nor for subacute/chronic whiplash (moderate GRADE; 4 trial meta-analysis, 183 participants) including reduced pain, disability or global perceived effect; andno long-term benefit for medial branch block of facet joints with steroids (moderate GRADE; 1 trial, 120 participants) over placebo to reduce pain or disability; REVIEWERS' CONCLUSIONS While in general there is a lack of evidence for most pharmacological interventions, current evidence is against botulinum toxin-A for chronic neck pain or subacute/chronic whiplash; against medial branch block with steroids for chronic facet joint pain; but in favour of the muscle relaxant eperison hydrochloride for chronic neck pain.
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Abstract
The objective of this study was to compare the pharmacokinetics of liquid and reconstituted lyophilized etanercept. This single-center, open-label study had a 2-period crossover design in which 36 healthy subjects were randomly assigned in a 1:1 ratio to etanercept (liquid/lyo or lyo/liquid). The treatments were separated by 28 days. Blood samples were obtained predose and at 10 predetermined time points postdose. Serum concentrations were determined by enzyme-linked immunosorbent assay. Noncompartmental pharmacokinetic parameters were analyzed using a standard crossover analysis of variance model. Thirty-three subjects completed both treatment periods. Geometric mean values (adjusted) of area under the serum drug concentration-time curve from time zero to the time of the final quantifiable sample, area under the serum drug concentration-time curve from time zero to infinity, and maximum concentration obtained with the 50-mg/mL liquid etanercept injection were 93.0%, 90.7%, and 98.5% of the respective parameters for 2 injections of 25 mg/mL reconstituted formulation. All associated confidence intervals were within the predefined equivalence interval of 80% to 125%. No differences in safety profiles of the 2 formulations were apparent. Liquid etanercept was bioequivalent to the reconstituted lyophilized etanercept formulation.
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Affiliation(s)
- John T Sullivan
- Amgen Inc, One Amgen Center Drive, Mailstop 38-4-C, Thousand Oaks, CA 91320, USA.
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Hauber AB, Arden NK, Mohamed AF, Johnson FR, Peloso PM, Watson DJ, Mavros P, Gammaitoni A, Sen SS, Taylor SD. A discrete-choice experiment of United Kingdom patients' willingness to risk adverse events for improved function and pain control in osteoarthritis. Osteoarthritis Cartilage 2013. [PMID: 23182815 DOI: 10.1016/j.joca.2012.11.007] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess patient preferences for treatment-related benefits and risks associated with the use of nonsteroidal anti-inflammatory drugs (NSAIDs) in the management of osteoarthritis (OA). DESIGN Using a chronic-illness panel in the United Kingdom, patients 45 years or older with a self-reported diagnosis of OA were eligible to participate in the study. Patient preferences were assessed using a discrete-choice experiment that compared hypothetical treatment profiles of benefits and risks consistent with NSAID use. Benefit outcomes (ambulatory pain, resting pain, stiffness, and difficulty doing daily activities) were presented on a 0-to-100 mm scale. Risk outcomes (bleeding ulcer, stroke, and myocardial infarction [MI]) were expressed as probabilities over a fixed time period. Each patient answered 10 choice tasks comparing different treatment profiles. Preference weights were estimated using a random-parameters logit model. RESULTS Final sample included 294 patients. Patients ranked reductions in ambulatory pain and difficulty doing daily activities (both: 6.32; 95% confidence interval [CI]: 5.0-7.6) as the most important benefit outcomes, followed by reductions in resting pain (2.80; 95% CI: 1.8-3.8) and stiffness (2.65; 95% CI: 0.9-4.4). Incremental changes (3%) in the risk of MI or stroke were assessed as the most important risk outcomes (10.00; 95% CI: 8.2-11.8; and 8.90; 95% CI: 7.3-10.5, respectively). CONCLUSION Patients ranked ambulatory pain as a more important benefit than resting pain; likely due to its impact on ability to do daily activities. For a 25-mm reduction, patients were willing to accept four times the risk of MI in ambulatory pain vs resting pain.
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Affiliation(s)
- A B Hauber
- Health Preference Assessment, RTI Health Solutions, Research Triangle Park, NC 27709-2194, USA.
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Viscusi ER, Frenkl TL, Hartrick CT, Rawal N, Kehlet H, Papanicolaou D, Gammaitoni A, Ko AT, Morgan LM, Mehta A, Curtis SP, Peloso PM. Perioperative use of etoricoxib reduces pain and opioid side-effects after total abdominal hysterectomy: a double-blind, randomized, placebo-controlled phase III study. Curr Med Res Opin 2012; 28:1323-35. [PMID: 22738802 DOI: 10.1185/03007995.2012.707121] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the effects of two different doses of etoricoxib delivered perioperatively compared with placebo and standard pain management on pain at rest, pain with mobilization, and use of additional morphine/opioids postoperatively. RESEARCH DESIGN AND METHODS In this double-blind, placebo-controlled, randomized clinical trial, we evaluated postoperative pain following total abdominal hysterectomy over 5 days in patients receiving placebo or etoricoxib administered 90 min prior to surgery and continuing postoperatively. Patients were randomly assigned to receive either placebo (n = 144), etoricoxib 90 mg/day (n = 142), or etoricoxib 120 mg/day (n = 144). Average Pain Intensity at Rest over days 1-3 (0- to 10-point numerical rating scale [NRS]) was the primary efficacy endpoint. Secondary endpoints included Average Pain Intensity upon Sitting, Standing, and Walking over days 1-3 (0- to 10-point NRS) as well as Average Total Daily Dose of Morphine over days 1-3. CLINICAL TRIAL REGISTRATION This trial is registered on www.clinicaltrials.gov (NCT00788710). RESULTS The least squares (LS) means (95% CI) for the primary endpoint were 3.26 (2.96, 3.55); 2.46 (2.16, 2.76); and 2.40 (2.11, 2.69) for placebo, etoricoxib 90 mg, and etoricoxib 120 mg, respectively, significantly different for both etoricoxib doses versus placebo (p < 0.001). Patients on etoricoxib 90 mg and 120 mg required ~30% less morphine per day than those on placebo (p < 0.001), which led to more rapid bowel recovery in the active treatment groups by ~10 hours vs. placebo. A greater proportion of patients on etoricoxib (10-30% greater than placebo) achieved mild levels of pain with movement, defined as pain ≤3/10. LIMITATIONS A key limitation for this study was that movement-evoked pain measurements were not designated as primary endpoints. CONCLUSION In patients undergoing total abdominal hysterectomy, etoricoxib 90 mg and 120 mg dosed preoperatively and then continued postoperatively significantly reduces both resting and movement-related pain, as well as reduced opioid (morphine) consumption that led to more rapid bowel recovery.
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Affiliation(s)
- Eugene R Viscusi
- Department of Anesthesiology, Thomas Jefferson University, Philadelphia, PA 19107, USA.
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Greenwald M, Peloso PM, Mandel D, Soto O, Mehta A, Frontera N, Boice JA, Zhan XJ, Curtis SP. Further assessment of the clinically effective dose range of etoricoxib: a randomized, double-blinded, placebo-controlled trial in rheumatoid arthritis. Curr Med Res Opin 2011; 27:2033-42. [PMID: 21905970 DOI: 10.1185/03007995.2011.614935] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To further assess the clinically active dose range of etoricoxib, a COX-2 selective inhibitor, in rheumatoid arthritis (RA). METHODS RA patients were randomized to etoricoxib 10, 30, 60, or 90 mg or placebo in a double-blind, 12-week study. DMARDs (methotrexate, biologics) or low-dose corticosteroids were allowed in stable doses. The primary endpoint was the proportion of patients completing the study and achieving an American College of Rheumatology 20% (ACR20) response. Secondary endpoints included individual components of the ACR index and Patient Global Assessment of Pain. Safety was assessed by physical exam and adverse experiences (AEs) occurrences. RESULTS Etoricoxib 90 mg was the only dose to reach a statistically significant difference from placebo (p < 0.001) on the primary endpoint; etoricoxib 60 mg approached significance (p = 0.057). Significant pain improvement vs. placebo was observed with etoricoxib 90 mg (p < 0.001), 60 mg (p = 0.018), and 30 mg (p = 0.017). Despite the use of background biologics and corticosteroids, a dose response was still apparent. A higher proportion of etoricoxib 60 and 90 mg patients had renovascular AEs (i.e., edema and hypertension) compared with placebo, although discontinuations for renovascular AEs were rare. Etoricoxib 90 mg had a higher incidence of serious AEs (n = 5; 1 was considered drug-related) versus placebo (n = 0). LIMITATIONS The present study was not powered to detect differences in cardiovascular or gastrointestinal safety by dose. Additionally, further research is needed to clarify the role of doses less than the etoricoxib 90 mg dose for pain management in RA patients. CONCLUSION Etoricoxib 90 mg demonstrated statistically superior efficacy (ACR20) compared with placebo and numerical superiority over the other doses of etoricoxib studied. Etoricoxib 30 and 60 mg demonstrated significant pain improvement versus placebo, suggesting utility for some patients.
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Affiliation(s)
- M Greenwald
- Desert Medical Advances, Palm Desert, CA, USA.
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Peloso PM, Gammaitoni A, Smugar SS, Wang H, Moore AR. Longitudinal numbers-needed-to-treat (NNT) for achieving various levels of analgesic response and improvement with etoricoxib, naproxen, and placebo in ankylosing spondylitis. BMC Musculoskelet Disord 2011; 12:165. [PMID: 21767407 PMCID: PMC3159143 DOI: 10.1186/1471-2474-12-165] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Accepted: 07/18/2011] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Clinical analgesic trials typically report response as group mean results. However, research has shown that few patients are average and most have responses at the extremes. Moreover, group mean results do not convey response levels and thus have limited value in representing the benefit-risk at an individual level. Responder analyses and numbers-needed-to-treat (NNT) are considered more relevant for evaluating treatment response. We evaluated levels of analgesic response and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score improvement and the associated NNTs. METHODS This was a post-hoc analysis of a 6-week, randomized, double-blind study (N = 387) comparing etoricoxib 90 mg, etoricoxib 120 mg, naproxen 1000 mg, and placebo in AS. Spine pain and BASDAI were measured on a 100-mm visual analog scale. The number and percentage of patients achieving ≥30% and ≥50% improvement in both BASDAI and spine pain were calculated and used to determine the corresponding NNTs. Patients who discontinued from the study for any reason were assigned zero improvement beyond 7 days of the time of discontinuation. RESULTS For etoricoxib 90 mg, etoricoxib 120 mg and naproxen 1000 mg, the NNTs at 6 weeks compared with placebo were 2.0, 2.0, and 2.7 respectively for BASDAI ≥30% improvement, and 3.2, 2.8, and 4.1 for ≥50% improvement. For spine pain, the NNTs were 1.9, 2.0, and 3.2, respectively, for ≥30% improvement, and 2.7, 2.5, and 3.7 for ≥50% improvement. The differences between etoricoxib and naproxen exceeded the limit of ±0.5 units described as a clinically meaningful difference for pain. Response rates and NNTs were generally similar and stable over 2, 4, and 6 weeks. CONCLUSIONS For every 2 patients treated with etoricoxib, 1 achieved a clinically meaningful (≥30%) improvement in spine pain and BASDAI beyond that expected from placebo, whereas the corresponding values were approximately 1 in every 3 patients treated with naproxen. Use of NNTs and responder analyses provide additional, complementary information beyond population mean responses when assessing efficacy compared to placebo and amongst active therapies.
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Affiliation(s)
- Paul M Peloso
- Clinical Research, Merck Sharp & Dohme Corp,, Whitehouse Station, NJ 08889, USA.
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Krum H, Swergold G, Gammaitoni A, Peloso PM, Smugar SS, Curtis SP, Brater DC, Wang H, Kaur A, Laine L, Weir MR, Cannon CP. Blood Pressure and Cardiovascular Outcomes in Patients Taking Nonsteroidal Antiinflammatory Drugs. Cardiovasc Ther 2011; 30:342-50. [DOI: 10.1111/j.1755-5922.2011.00283.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Stauffer ME, Taylor SD, Watson DJ, Peloso PM, Morrison A. Definition of nonresponse to analgesic treatment of arthritic pain: an analytical literature review of the smallest detectable difference, the minimal detectable change, and the minimal clinically important difference on the pain visual analog scale. Int J Inflam 2011; 2011:231926. [PMID: 21755025 PMCID: PMC3132608 DOI: 10.4061/2011/231926] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [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: 01/25/2011] [Accepted: 03/08/2011] [Indexed: 01/22/2023] Open
Abstract
Our objective was to develop a working definition of nonresponse to analgesic treatment of arthritis, focusing on the measurement of pain on the 0–100 mm pain visual analog scale (VAS). We reviewed the literature to assess the smallest detectable difference (SDD), the minimal detectable change (MDC), and the minimal clinically important difference (MCID). The SDD for improvement reported in three studies of rheumatoid arthritis was 18.6, 19.0, and 20.0. The median MDC was 25.4 for 7 studies of osteoarthritis and 5 studies of rheumatoid arthritis (calculated for a reliability coefficient of 0.85). The MCID increased with increasing baseline pain score. For baseline VAS tertiles defined by scores of 30–49, 50–65, and >65, the MCID for improvement was, respectively, 7–11 units, 19–27 units, and 29–37 units. Nonresponse can thus be defined in terms of the MDC for low baseline pain scores and in terms of the MCID for high baseline scores.
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Bingham CO, Smugar SS, Wang H, Peloso PM, Gammaitoni A. Predictors of Response to Cyclo-Oxygenase-2 Inhibitors in Osteoarthritis: Pooled Results from Two Identical Trials Comparing Etoricoxib, Celecoxib, and Placebo. Pain Med 2011; 12:352-61. [DOI: 10.1111/j.1526-4637.2011.01060.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Langevin P, Lowcock J, Weber J, Nolan M, Gross AR, Peloso PM, Roberts J, Graham N, Goldsmith CH, Burnie SJ, Haines T. Botulinum toxin intramuscular injections for neck pain: a systematic review and metaanalysis. J Rheumatol 2010; 38:203-14. [PMID: 21123322 DOI: 10.3899/jrheum.100739] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the effect of intramuscular botulinum toxin type A (BoNT-A) injections on pain, function/disability, global perceived effect, and quality of life (QOL) in adults with neck pain (NP). METHODS We searched Central, Medline, and Embase databases up to June 2010. A minimum of 2 authors independently selected articles, abstracted data, and assessed risk of bias and clinical applicability. We estimated standard mean differences (SMD) with 95% CI, relative risks (RR), and performed metaanalyses (SMD(p)) using a random-effects model for nonheterogeneous data. The approach of the Grading of Recommendations Assessment, Development, and Evaluation working group summarizes the quality of evidence. RESULTS We selected 14 trials. High-quality evidence suggested BoNT-A was no better than saline at 4 weeks [4 trials/183 participants; SMD(p) -0.21 (95% CI -0.50 to 0.07)] and 6 months for chronic NP. Moderate-quality evidence showed a similar effect for subacute/chronic whiplash-associated disorder (WAD) on pain [4 trials/122 participants; SMD(p) -0.21 (95% CI -0.57 to 0.15)], disability, and QOL. Very low-quality evidence indicated BoNT-A combined with exercise and analgesics was not significant for chronic NP reduction at 4 weeks [3 trials/114 participants; SMD(p) -0.08 (95% CI -0.45 to 0.29)] but was at 6 months [2 trials/43 participants; SMD(p) -0.66 (95% CI -1.29 to -0.04)]. CONCLUSION Current evidence does not confirm a clinically or statistically significant benefit of BoNT-A used alone on chronic NP in the short term or on subacute/chronic WAD pain, disability, and QOL. Larger trials, subgroups, and predictors of responses defined a priori (to facilitate selection of patients most likely to benefit) and factorial designs to explore BoNT as an adjunct treatment to physiotherapeutic exercise and analgesics are needed.
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Affiliation(s)
- Pierre Langevin
- Cliniques Physio Interactive, 3520 rue de l'Hêtrière, Local 202, St-Augustin-de-Desmaures, Québec G3A 0B4, Canada.
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Moore RA, Moore OA, Derry S, Peloso PM, Gammaitoni AR, Wang H. Responder analysis for pain relief and numbers needed to treat in a meta-analysis of etoricoxib osteoarthritis trials: bridging a gap between clinical trials and clinical practice. Ann Rheum Dis 2010; 69:374-9. [PMID: 19364730 PMCID: PMC2800200 DOI: 10.1136/ard.2009.107805] [Citation(s) in RCA: 198] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2009] [Indexed: 01/06/2023]
Abstract
BACKGROUND Population mean changes from clinical trials are difficult to apply to individuals in clinical practice. Responder analysis may be better, but needs validating for level of response and treatment duration. METHODS The numbers of patients with pain relief over baseline (> or =15%, > or =30%, > or =50%, > or =70%) at 2, 4, 8 and 12 weeks of treatment were obtained using the WOMAC 100 mm visual analogue pain subscale score for each treatment group in seven randomised placebo-controlled trials of etoricoxib in osteoarthritis lasting > or =6 weeks. Dropouts were assigned 0% improvement from baseline from then on. The numbers needed to treat (NNTs) were calculated at each level of response and time point. RESULTS 3554 patients were treated with placebo, etoricoxib 30 mg and 60 mg, celecoxib 200 mg, naproxen 1000 mg or ibuprofen 2400 mg daily. Response rates fell with increasing pain relief: 60-80% experienced minimally important pain relief (> or =15%), 50-60% moderate pain relief (> or =30%), 40-50% substantial pain relief (> or =50%) and 20-30% extensive pain relief (> or =70%). NNTs for etoricoxib, celecoxib and naproxen were stable over 2-12 weeks. Ibuprofen showed lessening of effectiveness with time. CONCLUSION Responder rates and NNTs are reproducible for different levels of response over 12 weeks and have relevance for clinical practice at the individual patient level. An average 10 mm improvement in pain equates to almost one in two patients having substantial benefit.
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Affiliation(s)
- R A Moore
- Pain Research and Nuffield Department of Anaesthetics, University of Oxford, John Radcliffe Hospital, UK.
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Nordin M, Carragee EJ, Hogg-Johnson S, Weiner SS, Hurwitz EL, Peloso PM, Guzman J, van der Velde G, Carroll LJ, Holm LW, Côté P, Cassidy JD, Haldeman S. Assessment of neck pain and its associated disorders: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. J Manipulative Physiol Ther 2009; 32:S117-40. [PMID: 19251060 DOI: 10.1016/j.jmpt.2008.11.016] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Best evidence synthesis. OBJECTIVE To critically appraise and synthesize the literature on assessment of neck pain. SUMMARY OF BACKGROUND DATA The published literature on assessment of neck pain is large and of variable quality. There have been no prior systematic reviews of this literature. METHODS The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders conducted a critical review of the literature (published 1980-2006) on assessment tools and screening protocols for traumatic and nontraumatic neck pain. RESULTS We found 359 articles on assessment of neck pain. After critical review, 95 (35%) were judged scientifically admissible. Screening protocols have high predictive values to detect cervical spine fracture in alert, low-risk patients seeking emergency care after blunt neck trauma. Computerized tomography (CT) scans had better validity (in adults and elderly) than radiographs in assessing high-risk and/or multi-injured blunt trauma neck patients. In the absence of serious pathology, clinical physical examinations are more predictive at excluding than confirming structural lesions causing neurologic compression. One exception is the manual provocation test for cervical radiculopathy, which has high positive predictive value. There was no evidence that specific MRI findings are associated with neck pain, cervicogenic headache, or whiplash exposure. No evidence supports using cervical provocative discography, anesthetic facet, or medial branch blocks in evaluating neck pain. Reliable and valid self-report questionnaires are useful in assessing pain, function, disability, and psychosocial status in individuals with neck pain. CONCLUSION The scientific evidence supports screening protocols in emergency care for low-risk patients; and CT-scans for high-risk patients with blunt trauma to the neck. In nonemergency neck pain without radiculopathy, the validity of most commonly used objective tests is lacking. There is support for subjective self-report assessment in monitoring patients' course, response to treatment, and in clinical research.
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Affiliation(s)
- Margareta Nordin
- Department of Orthopaedics and Program of Ergonomics and Biomechanics, School of Medicine and Graduate School of Arts and Science, New York University, NY, USA.
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Côté P, van der Velde G, Cassidy JD, Carroll LJ, Hogg-Johnson S, Holm LW, Carragee EJ, Haldeman S, Nordin M, Hurwitz EL, Guzman J, Peloso PM. The burden and determinants of neck pain in workers: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. J Manipulative Physiol Ther 2009; 32:S70-86. [PMID: 19251078 DOI: 10.1016/j.jmpt.2008.11.012] [Citation(s) in RCA: 134] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
STUDY DESIGN Systematic review and best evidence synthesis. OBJECTIVES To describe the prevalence and incidence of neck pain and disability in workers; to identify risk factors for neck pain in workers; to propose an etiological diagram; and to make recommendations for future research. SUMMARY OF BACKGROUND DATA Previous reviews of the etiology of neck pain in workers relied on cross-sectional evidence. Recently published cohorts and randomized trials warrant a re-analysis of this body of research. METHODS We systematically searched Medline for literature published from 1980-2006. Retrieved articles were reviewed for relevance. Relevant articles were critically appraised. Articles judged to have adequate internal validity were included in our best evidence synthesis. RESULTS One hundred and nine papers on the burden and determinants of neck pain in workers were scientifically admissible. The annual prevalence of neck pain varied from 27.1% in Norway to 47.8% in Québec, Canada. Each year, between 11% and 14.1% of workers were limited in their activities because of neck pain. Risk factors associated with neck pain in workers include age, previous musculoskeletal pain, high quantitative job demands, low social support at work, job insecurity, low physical capacity, poor computer workstation design and work posture, sedentary work position, repetitive work and precision work. We found preliminary evidence that gender, occupation, headaches, emotional problems, smoking, poor job satisfaction, awkward work postures, poor physical work environment, and workers' ethnicity may be associated with neck pain. There is evidence that interventions aimed at modifying workstations and worker posture are not effective in reducing the incidence of neck pain in workers. CONCLUSION Neck disorders are a significant source of pain and activity limitations in workers. Most neck pain results from complex relationships between individual and workplace risk factors. No prevention strategies have been shown to reduce the incidence of neck pain in workers.
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Affiliation(s)
- Pierre Côté
- Centre of Research Expertise in Improved Disability Outcomes, University Health Network Rehabilitation Solutions, Toronto Western Hospital, Toronto, Canada.
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Carroll LJ, Hogg-Johnson S, Côté P, van der Velde G, Holm LW, Carragee EJ, Hurwitz EL, Peloso PM, Cassidy JD, Guzman J, Nordin M, Haldeman S. Course and Prognostic Factors for Neck Pain in Workers. J Manipulative Physiol Ther 2009; 32:S108-16. [DOI: 10.1016/j.jmpt.2008.11.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Carroll LJ, Hogg-Johnson S, van der Velde G, Haldeman S, Holm LW, Carragee EJ, Hurwitz EL, Côté P, Nordin M, Peloso PM, Guzman J, Cassidy JD. Course and Prognostic Factors for Neck Pain in the General Population. J Manipulative Physiol Ther 2009; 32:S87-96. [DOI: 10.1016/j.jmpt.2008.11.013] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Guzman J, Hurwitz EL, Carroll LJ, Haldeman S, Côté P, Carragee EJ, Peloso PM, van der Velde G, Holm LW, Hogg-Johnson S, Nordin M, Cassidy JD. A New Conceptual Model of Neck Pain. J Manipulative Physiol Ther 2009; 32:S17-28. [DOI: 10.1016/j.jmpt.2008.11.007] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Hurwitz EL, Carragee EJ, van der Velde G, Carroll LJ, Nordin M, Guzman J, Peloso PM, Holm LW, Côté P, Hogg-Johnson S, Cassidy JD, Haldeman S. Treatment of Neck Pain: Noninvasive Interventions. J Manipulative Physiol Ther 2009; 32:S141-75. [DOI: 10.1016/j.jmpt.2008.11.017] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Carroll LJ, Cassidy JD, Peloso PM, Giles-Smith L, Cheng CS, Greenhalgh SW, Haldeman S, van der Velde G, Hurwitz EL, Côté P, Nordin M, Hogg-Johnson S, Holm LW, Guzman J, Carragee EJ. Methods for the Best Evidence Synthesis on Neck Pain and Its Associated Disorders. J Manipulative Physiol Ther 2009; 32:S39-45. [DOI: 10.1016/j.jmpt.2008.11.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Busch AJ, Schachter CL, Overend TJ, Peloso PM, Barber KAR. Exercise for fibromyalgia: a systematic review. J Rheumatol 2008; 35:1130-1144. [PMID: 18464301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE Fibromyalgia (FM) is a syndrome expressed by chronic widespread pain often associated with reduced physical function. Exercise is a common recommendation in management of FM. We evaluated the effects of exercise training on global well-being, selected signs and symptoms, and physical function in individuals with FM. METHODS We searched Medline, Embase, CINAHL, SportDiscus, PubMed, PEDro, and the Cochrane Central Register for Controlled Trials to July 2005 and included randomized trials evaluating cardiorespiratory endurance, muscle strength, and flexibility. Methodological quality was assessed using the van Tulder and Jadad instruments. Training protocols were evaluated using American College of Sports Medicine (ACSM) guidelines. Clinical heterogeneity limited metaanalysis to 6 aerobic and 2 strength studies. RESULTS There were 2276 subjects across the 34 studies; 1264 subjects were assigned to exercise interventions. Metaanalysis of 6 studies provided moderate-quality evidence that aerobic-only exercise training at ACSM-recommended intensity levels has positive effects on global well-being (SMD 0.49, 95% CI 0.23-0.75) and physical function (SMD 0.66, 95% CI 0.41-0.92) and possibly on pain (SMD 0.65, 95% CI -0.09 to 1.39) and tender points (SMD 0.23, 95% CI -0.18 to 0.65). Strength and flexibility remain underevaluated; however, strength training may have a positive effect on FM symptoms. CONCLUSION Aerobic-only training has beneficial effects on physical function and some FM symptoms. Strength-only training may improve FM symptoms, but requires further study. Large, high-quality studies of exercise-only interventions that provide detailed information on exercise prescription and adherence are needed.
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Affiliation(s)
- Angela J Busch
- School of Physical Therapy, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
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Carroll LJ, Holm LW, Hogg-Johnson S, Côté P, Cassidy JD, Haldeman S, Nordin M, Hurwitz EL, Carragee EJ, van der Velde G, Peloso PM, Guzman J. Course and Prognostic Factors for Neck Pain in Whiplash-Associated Disorders (WAD). Eur Spine J 2008. [DOI: 10.1007/s00586-008-0628-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Côté P, van der Velde G, David Cassidy J, Carroll LJ, Hogg-Johnson S, Holm LW, Carragee EJ, Haldeman S, Nordin M, Hurwitz EL, Guzman J, Peloso PM. The Burden and Determinants of Neck Pain in Workers. Eur Spine J 2008. [DOI: 10.1007/s00586-008-0626-9] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Carroll LJ, Hogg-Johnson S, van der Velde G, Haldeman S, Holm LW, Carragee EJ, Hurwitz EL, Côté P, Nordin M, Peloso PM, Guzman J, Cassidy JD. Course and Prognostic Factors for Neck Pain in the General Population. Eur Spine J 2008. [DOI: 10.1007/s00586-008-0627-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Nordin M, Carragee EJ, Hogg-Johnson S, Weiner SS, Hurwitz EL, Peloso PM, Guzman J, van der Velde G, Carroll LJ, Holm LW, Côté P, Cassidy JD, Haldeman S. Assessment of Neck Pain and Its Associated Disorders. Eur Spine J 2008. [DOI: 10.1007/s00586-008-0630-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Forman-Hoffman VL, Peloso PM, Black DW, Woolson RF, Letuchy EM, Doebbeling BN. Chronic Widespread Pain in Veterans of the First Gulf War: Impact of Deployment Status and Associated Health Effects. The Journal of Pain 2007; 8:954-61. [PMID: 17704006 DOI: 10.1016/j.jpain.2007.07.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2007] [Revised: 06/28/2007] [Accepted: 07/02/2007] [Indexed: 11/20/2022]
Abstract
UNLABELLED Our study sought to 1) determine if deployment status is associated with chronic widespread pain (CWP), and 2) evaluate whether veterans with CWP have greater psychiatric comorbidity, higher health care utilization, and poorer health status than veterans without CWP. Five years after the conclusion of the first Gulf War (August 1990 to June 1991), we conducted a cross-sectional study of veterans who listed Iowa as the home of record using a stratified sampling design to determine their health status. We compared the prevalence of CWP between deployed and nondeployed veterans. Logistic and multiple linear regression models were constructed to test whether CWP was associated with comorbidities and health-related outcomes of interest. Five hundred ninety of 3695 veterans interviewed (16%) had CWP. Gulf deployment was associated with higher prevalence of CWP than deployment elsewhere (OR = 2.03, 95%CI = 1.60-2.58), after adjustment. Both deployed and nondeployed veterans with CWP reported more health care utilization and comorbidities and lower health-related quality of life scores than veterans without CWP. Deployed veterans were more likely to have CWP than nondeployed veterans, and CWP was associated with poor health outcomes. Military and medical personnel should be aware that efforts to prevent, identify, and treat CWP in veterans returning from the current war may be needed. PERSPECTIVE This article indicates that deployed veterans may have an increased risk for development of CWP, which is associated with greater healthcare utilization and comorbidity and lower quality of life. The risk of poor health outcomes suggests that veterans returning from the present conflict should be screened for CWP on their return.
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Affiliation(s)
- Valerie L Forman-Hoffman
- Center for Research in the Implementation of Innovative Strategies in Practice, Iowa City Veteran's Affairs Medical Center, Iowa City, Iowa 52242, USA.
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Abstract
STUDY DESIGN Systematic review. OBJECTIVE To assess the effects of massage on pain, function, patient satisfaction, cost of care, and adverse events in adults with neck pain. SUMMARY OF BACKGROUND DATA Neck pain is common, disabling, and costly. Massage is a commonly used modality for the treatment of neck pain. METHODS We searched several databases without language restriction from their inception to September 2004. We included randomized and quasirandomized trials. Two reviewers independently identified studies, abstracted data, and assessed quality. We calculated the relative risks and standardized mean differences on primary outcomes. Trials could not be statistically pooled because of heterogeneity in treatment and control groups. Therefore, a levels-of-evidence approach was used to synthesize results. RESULTS Overall, 19 trials were included, with 12/19 receiving low-quality scores. Descriptions of the massage intervention, massage professional's credentials, or experience were frequently missing. Six trials examined massage as a stand-alone treatment. The results were inconclusive. Results were also inconclusive in 14 trials that used massage as part of a multimodal intervention because none were designed such that the relative contribution of massage could be ascertained. CONCLUSIONS No recommendations for practice can be made at this time because the effectiveness of massage for neck pain remains uncertain. Pilot studies are needed to characterize massage treatment (frequency, duration, number of sessions, and massage technique) and establish the optimal treatment to be used in subsequent larger trials that examine the effect of massage as either a stand-alone treatment or part of a multimodal intervention. For multimodal interventions, factorial designs are needed to determine the relative contribution of massage. Future reports of trials should improve reporting of the concealment of allocation, blinding of outcome assessor, adverse events, and massage characteristics. Standards of reporting for massage interventions, similar to Consolidated Standards of Reporting Trials, are needed. Both short and long-term follow-up are needed.
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Abstract
BACKGROUND Mechanical neck disorders (MND) are common, disabling and costly. Massage is a commonly used modality for the treatment of neck pain. OBJECTIVES To assess the effects of massage on pain, function, patient satisfaction and cost of care in adults with neck pain. To document adverse effects of treatment. SEARCH STRATEGY Cochrane CENTRAL, MEDLINE, EMBASE, MANTIS, CINAHL, and ICL databases were electronically searched, without language restriction, from their inception to September 2004 SELECTION CRITERIA Studies using random or quasi-random assignment were included. DATA COLLECTION AND ANALYSIS Two reviewers independently conducted citation identification, study selection, data abstraction and methodological quality assessment. Using a random-effects model, we calculated the relative risk and standardized mean difference. MAIN RESULTS Nineteen trials met the inclusion criteria. Overall, the methodological quality was low, with 12/19 assessed as low-quality studies. Trials could not be statistically pooled because of heterogeneity in treatment and control groups. Therefore, a levels-of-evidence approach was used to synthesize results. Assessment of the clinical applicability of the trials showed that the participant characteristics were well reported, but neither the descriptions of the massage intervention nor the credentials or experience of the massage professionals were well reported. Six trials examined massage as a stand-alone treatment. The results were inconsistent. Of the 14 trials that used massage as part of a multimodal intervention, none were designed such that the relative contribution of massage could be ascertained. Therefore, the role of massage in multimodal treatments remains unclear. AUTHORS' CONCLUSIONS No recommendations for practice can be made at this time because the effectiveness of massage for neck pain remains uncertain. Pilot studies are needed to characterize massage treatment (frequency, duration, number of sessions, and massage technique) and establish the optimal treatment to be used in subsequent larger trials that examine the effect of massage as either a stand-alone treatment or part of a multimodal intervention. For multimodal interventions, factorial designs are needed to determine the relative contribution of massage. Future reports of trials should improve reporting of the concealment of allocation, blinding of outcome assessor, adverse events and massage characteristics. Standards of reporting for massage interventions, similar to CONSORT, are needed. Both short- and long-term follow-up are needed.
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Affiliation(s)
- B G Haraldsson
- North Surrey Massage Therapy Clinic, 201-10366 136A Street, Surrey, BC, Canada V3T 5R3.
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Abstract
OBJECTIVE We sought to determine the predictors of incident chronic widespread pain (CWP), specifically, the effect of preexisting symptoms, stress, and psychosocial factors in the subsequent development of CWP among veterans from the first Gulf War (GW). METHODS We conducted a structured telephone survey (baseline) of military personnel originally from Iowa who were either eligible for or deployed to Operation Desert Shield/Desert Storm, approximately 5 years postconflict. We conducted a follow-up, clinical, in-person study of those who met a priori-defined outcomes of symptoms of cognitive dysfunction, depression, or CWP, and also a sample of those who did not meet any of the outcomes of interest. RESULTS A total of 370 of 602 evaluated GW veterans were free of CWP 5 years postconflict. At follow-up, 69 (19%) of these had developed CWP. A positive family history of medically unexplained persistent symptoms [odds ratio (OR)=4.8 (2.3, 13.2)] was strongly associated with CWP. At baseline, individuals who reported preexisting symptoms of bronchitis [OR=4.9 (1.9, 12.3)] and cognitive dysfunction [OR=2.1 (1.1, 4.2)] were more likely to develop CWP. Alcohol use [OR=0.2 (0.1, 0.7)] was protective against CWP. Rather than combat-related exposure per se, the perception of stress at the time of the GW [OR=1.6 (1.1, 2.3)] correlated with CWP. DISCUSSION Among the GW veterans evaluated longitudinally in this study, family history, predeployment symptoms, and the level of perceived stress during the GW were associated with subsequent development of CWP.
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Affiliation(s)
- Dennis C Ang
- Division of Rheumatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
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Peloso PM, Gross AR, Haines TA, Trinh K, Goldsmith CH, Aker P. Medicinal and injection therapies for mechanical neck disorders: a Cochrane systematic review. J Rheumatol 2006; 33:957-67. [PMID: 16652427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
OBJECTIVE To systematically review randomized trials on medicines and injections used to improve pain, function/disability, and patient satisfaction in adults with mechanical neck disorders (MND) with or without associated headache or radicular findings. METHODS We searched CENTRAL (Issue 4, 2002), and MEDLINE, EMBASE, MANTIS, CINHAL from their start to March 2003. Two authors independently selected articles, abstracted data, and assessed methodological quality using the Jadad criteria. When clinical heterogeneity was absent, we combined studies using random-effects metaanalysis models. RESULTS Thirty-two selected trials had an overall methodological quality of mean 3.2/5. For acute whiplash, administering intravenous methylprednisolone within 8 hours reduced pain at one week [SMD -0.90 (95% CI -1.57 to -0.24)], and sick leave but not pain at 6 months compared to placebo. For chronic MND at short-term followup, intramuscular injection of lidocaine was superior to placebo [SMD 1.36 (95% CI -1.93 to -0.80)]. In chronic MND with radicular findings, epidural methylprednisolone and lidocaine reduced neck pain [SMD -1.46 (95% CI -2.16 to -0.76)] and improved function at one-year followup compared to the intramuscular route. In subacute/chronic MND, we found conflicting evidence for oral psychotropic agents. In chronic MND with or without radicular findings or headache, there was moderate evidence from 5 high quality trials showing that botulinum toxin (Botox A) intramuscular injections were not better than saline in improving pain [SMD pooled -0.39 (95% CI -1.25 to 0.47)], disability, or global perceived effect. CONCLUSION Intramuscular injection of lidocaine for chronic MND and intravenous injection of methylprednisolone for acute whiplash were effective treatments. There was limited evidence of effectiveness of epidural injection of methylprednisolone and lidocaine for chronic MND with radicular findings. Muscle relaxants and nonsteroidal antiinflammatory drugs have unclear benefits. There was moderate evidence that Botox-A intramuscular injections for chronic MND were not better than saline.
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Bathon JM, Fleischmann RM, Van der Heijde D, Tesser JR, Peloso PM, Chon Y, White B. Safety and efficacy of etanercept treatment in elderly subjects with rheumatoid arthritis. J Rheumatol 2006; 33:234-43. [PMID: 16465653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
OBJECTIVE To evaluate safety and efficacy of etanercept treatment in elderly (age > or = 65 yrs) and younger adult subjects (age < 65 yrs) with rheumatoid arthritis (RA). METHODS Subset analyses were used to describe the safety and efficacy of etanercept in elderly and younger subjects treated for early and disease modifying antirheumatic drug-resistant or late-stage RA (ERA and LRA) in one of 4 randomized controlled clinical studies (N = 1353) or 2 longterm extensions (N = 1049). RESULTS Rates of serious adverse events tended to be higher in elderly than younger subjects; however, rates of safety events observed in elderly etanercept-treated subjects did not exceed rates in elderly placebo or methotrexate (MTX)-treated subjects. With regard to efficacy measures [American College of Rheumatology 20% response (ACR20), ACR50, and ACR70], elderly subjects tended to have somewhat less robust responses to treatment than younger subjects. However, for both age groups, treatment with etanercept resulted in improved efficacy and function compared with control treatment, and combination therapy with etanercept plus MTX resulted in greater efficacy than either etanercept or MTX used alone. Efficacy responses of elderly subjects were sustained for up to 6 years. Radiographic progression (measured using modified Sharp Score) after one year of treatment was lower in subjects treated with both etanercept and MTX compared with subjects treated with either agent used alone, and this pattern was similar in both age groups. CONCLUSION Consistent with responses in younger subjects, elderly subjects with RA treated with etanercept experienced significant improvement in disease activity and function without incurring additional safety concerns.
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Affiliation(s)
- Joan M Bathon
- Division of Rheumatology, Johns Hopkins University, Baltimore, MD 21224, USA.
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Forman-Hoffman VL, Carney CP, Sampson TR, Peloso PM, Woolson RF, Black DW, Doebbeling BN. Mental Health Comorbidity Patterns and Impact on Quality of Life Among Veterans Serving During the First Gulf War. Qual Life Res 2005; 14:2303-14. [PMID: 16328909 DOI: 10.1007/s11136-005-6540-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2004] [Indexed: 10/25/2022]
Abstract
PURPOSE To examine the patterns of coexisting (comorbid) mental disorders and whether comorbidity influences quality of life ratings in a sample of U.S. veterans. PATIENTS AND METHODS The Iowa Gulf War Study Case Validation study evaluated 602 military personnel, two-thirds of whom had symptoms of depression, cognitive dysfunction, or chronic widespread pain, who were activated or on active duty sometime during the first Gulf War (GW). Mental health disorders were defined using the SCID-IV, and the Health Utilities Index Mark 3 (HUI3) was used to measure health-related quality of life (HRQoL). Comorbidity was defined as having two or more mental disorders that spanned across at least two separate categories (e.g., depressive disorders and anxiety disorders). RESULTS Over 35% of veterans with a current mental disorder had at least one other comorbid mental disorder. Those with mental disorder comorbidity had lower HUI scores than veterans with only one or less mental disorders (mean 0.41 +/- 0.30 vs. 0.72 +/- 0.25, p < 0.0001). CONCLUSION The co-occurrence of mental disorders that span at least two mental disorder categories is associated with impaired HRQoL in this veteran population. Early identification of mental health comorbidity may lead to interventions to enhance HRQoL among military personnel.
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Affiliation(s)
- Valerie L Forman-Hoffman
- Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, 52242, USA.
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