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Macía M, Díaz-Encarnación M, Solans-Laqué R, Mallol EP, Castells AG, Escribano C, de Arellano AR. A projected cost-utility analysis of avacopan for the treatment of antineutrophil cytoplasmic antibody-associated vasculitis in Spain. Expert Rev Pharmacoecon Outcomes Res 2024; 24:227-235. [PMID: 38126738 DOI: 10.1080/14737167.2023.2297790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Antineutrophil cytoplasmic antibody-associated vasculitis (AAV) are rare autoimmune diseases characterized by inflammation of blood vessels. This study aimed to assess the cost-utility of avacopan in combination with rituximab (RTX) or cyclophosphamide (CYC) compared with glucocorticoids (GC) for the treatment of severe, active AAV in Spain. METHODS A 9-state Markov model was designed to reflect the induction of remission and sustained remission of AAV over a lifetime horizon. Clinical data and utility values were mainly obtained from the ADVOCATE trial, and costs (€ 2022) were sourced from national databases. Quality-adjusted life years (QALYs), and incremental cost-utility ratio (ICUR) were evaluated. An annual discount rate of 3% was applied. Sensitivity analyses were performed to examine the robustness of the results. RESULTS Avacopan yielded an increase in effectiveness (6.52 vs. 6.17 QALYs) and costs (€16,009) compared to GC, resulting in an ICUR of €45,638 per additional QALY gained. Avacopan was associated with a lower incidence of end-stage renal disease (ESRD), relapse and hospitalization-related adverse events. Sensitivity analyses suggested that the model outputs were robust and that the progression to ESRD was a driver of ICUR. CONCLUSIONS Avacopan is a cost-effective option for patients with severe, active AAV compared to GC in Spain.
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Affiliation(s)
- Manuel Macía
- Nephrology Service, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | | | - Roser Solans-Laqué
- Internal Medicine Department, Hospital Valle de Hebrón, Barcelona, Spain
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Bettiol A, Urban ML, Bello F, Fiori D, Mattioli I, Lopalco G, Iannone F, Egan A, Moroni L, Dagna L, Caminati M, Negrini S, Cameli P, Folci M, Toniati P, Padoan R, Flossmann O, Solans-Laqué R, Losappio L, Schroeder J, André M, Moi L, Parronchi P, Conti F, Sciascia S, Jayne D, Vaglio A, Emmi G. POS0246 SEQUENTIAL RITUXIMAB AND MEPOLIZUMAB IN EOSINOPHILIC GRANULOMATOSIS WITH POLYANGIITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4320] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundRituximab (RTX) is an effective remission-induction treatment in ANCA-associated vasculitides (AAVs). Some reports have suggested that it might be effective also in Eosinophilic Granulomatosis with Polyangiitis (EGPA), to induce and maintain remission of vasculitic manifestations [1,2]. However, its effects for preventing respiratory relapses seem to be poor. Mepolizumab (Mepo) (both 100 and 300mg/month) is effective in improving respiratory manifestations and lung function, while partially controlling also systemic activity [3,4]. Isolated case reports further indicate that the sequential therapy with RTX and Mepo might be effective [5-7].ObjectivesThe study aimed to investigate the efficacy and safety of a therapeutic regimen based on sequential RTX and Mepo for the control of EGPA.MethodsA multicenter, retrospective, cohort study was conducted on adult patients diagnosed with EGPA according to the ACR classification criteria [8] or MIRRA trial criteria [3]. Only patients who received induction therapy with RTX (any dosage), and subsequent treatment with Mepo (100-300 mg/4 weeks) within 12 months from last RTX administration were included. Patients receiving other induction therapies between RTX and Mepo were excluded. The effectiveness of sequential RTX and Mepo was assessed in terms of disease activity (by the Birmingham Vasculitis Activity Score, BVAS) and daily corticosteroid dosage. Safety data were also collected.ResultsThirty-four EGPA patients treated with sequential RTX and Mepo were included (59% females, median age of 51 years (IQR 40-58); 41% ANCA positive).In most cases (26/34; 76%), RTX was started at the dosage of 1g q2w, and all except two patients had active disease at time of RTX beginning [median BVAS of 9 (IQR 6-14)]. Specifically, most patients started RTX for the control of systemic manifestations (19/34; 56%), or of both systemic and respiratory symptoms (11/34; 32%). All except one patient were receiving oral corticosteroids, at a median dosage of 25 mg/day (10-38).Mepo was started after a median of 14 months (6-23) from RTX initiation and after a median of 5 months (IQR 3-11) from the last RTX administration. Mepo was used at the dosage of 100mg/4 weeks in 32/34 (94%), mostly for the control of respiratory manifestations (25/34, 74%). At the time of starting Mepo, the median BVAS was 4 (2-8), and median prednisolone dose 10 mg/day (7-15). After a median follow-up of 28 months (IQR 23-33) from starting Mepo, the median BVAS decreased to 1.5 (IQR 0-4) and the median corticosteroid dosage to 5 mg/day (2.5-5), with 7/34 (21%) patients being off steroids. At last follow-up, most patients were off-RTX (28/34), typically due to stable disease remission (20/34; 59%).Both RTX and Mepo were well-tolerated; 5 patients had adverse events on RTX (none serious), and 5 on Mepo (including one serious infection).ConclusionSequential use of RTX and Mepo seems to be effective for remission induction and maintenance in EGPA.References[1]Emmi, Ann Rheum Dis, 2018[2]Teixeira, RMD Open, 2019 3. Wechsler, NEJM, 2017[4]Bettiol, Arthritis Rheumatol, 2021[5]Shiroshita, Respir Med Case Rep, 2018[6]Higashitani, Mod Rheumatol Case Rep, 2021[7]Afiari, Cureus 2020[8]Masi, Arthritis Rheum, 1990Table 1.Effectiveness of sequential RTX and Mepo in the 34 patients included in the studyRTX beginningMepo beginningLast follow-upMedian time elapsed (IQR)-14 months (6-23) from RTX beginning28 months (23-33) from Mepo beginningDosage1g q2w (26/34);100mg/4 weeks (32/34)6 patients off Mepo; 28 patients off RTX375mg/m2 for 4 weeks (8/34)300mg/4 weeks (2/34)Reason for treatment beginning (manifestations)Systemic (19/34);Respiratory (25/34);-Systemic + respiratory (11/34);Systemic (4/34);Only respiratory (3/34);Remission maintenance (5/34)Other (1/34)BVAS (median, IQR)9 (6-14)4 (2-8)1.5 (0-4)Prednisolone dosage (median, IQR), mg/day25 (10-38)10 (7-15)5 (2.5-5)Disclosure of InterestsAlessandra Bettiol: None declared, Maria Letizia Urban: None declared, Federica Bello: None declared, Davide Fiori: None declared, Irene Mattioli: None declared, Giuseppe Lopalco: None declared, Florenzo Iannone: None declared, Allyson Egan: None declared, Luca Moroni: None declared, Lorenzo Dagna Consultant of: Consultation honoraria from GSK outside the current work, Marco Caminati: None declared, Simone Negrini: None declared, Paolo Cameli: None declared, Marco Folci: None declared, Paola Toniati: None declared, Roberto Padoan: None declared, Oliver Flossmann: None declared, Roser Solans-Laqué: None declared, Laura Losappio: None declared, Jan Schroeder Consultant of: Advisory Board fees from AstraZeneca and GSK, Marc André: None declared, Laura Moi: None declared, paola parronchi Consultant of: Consultation honoraria from GSK and Novartis, Fabrizio Conti: None declared, Savino Sciascia: None declared, David Jayne Consultant of: Consultant for Astra-Zeneca, Aurinia, BMS, Boehringer-Ingelheim, Chemocentryx, Chugai, CSL, GSK, Infla-RX, Janssen, Novartis, Roche/Genentech, Takeda and Vifor, Augusto Vaglio Consultant of: Consultation honoraria from GSK outside the current work, Giacomo Emmi Consultant of: Consultation honoraria from GSK outside the current work
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González-Nieto MI, Portella Alegre A, Planes-Conangla M, Bujan Rivas S, Serres-Créixams X, Solans-Laqué R. AB0464 ULTRASONOGRAPHIC FEATURES OF THE PAROTID AND SUBMANDIBULAR SALIVARY GLANDS IN SJÖGREN’S SYNDROME. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundPrimary Sjögren’s syndrome (pSS) is a systemic autoimmune disease characterized by the presence of “sicca syndrome”, secondary to the involvement of the exocrine glands. Different studies have been published and have shown that salivary gland ultrasound (SGUS) could be used as a tool for the diagnosis of pSS, especially the score of parenchymal inhomogeneity of salivary glands (SG) [1].ObjectivesTo identify relevant ultrasonographic features associated with glandular involvement in patients with pSS, such as size measurements, vascularization, and the characteristics of adjacent lymph nodes of parotid and submandibular SG, and their association with the score of parenchymal inhomogeneity.MethodsWe enrolled patients with pSS (n=53), based on the 2002 American–European Consensus Group (AECG) pSS classification criteria, and non-Sjögren’s sicca subjects (n=25), who exhibited sicca symptoms but did not fulfill the AECG pSS classification criteria. We considered SGUS score based on parenchymal homogeneity, presence of hypoechogenic areas, and clearness of posterior glandular border of SG. The score of the highest graded gland was considered and a score ≥2 was defined as a positive SGUS, according to OMERACT US-SG scoring [1]. The size measurements of the SG were the diameters in anterior-posterior, medio-lateral, and vertical directions during dental occlusion, and length and width of anterior prolongation of parotid glands. The vascularization was ranked according to the color doppler ultrasonography pattern without salivary stimulation. For the lymph nodes examination we considered the shape, number, and size of submandibular, superficial parotid (preauricular), and intraparotid lymph nodes, and the jugulodigastric lymph node, considering also that lymph nodes may not be detected. Categorical variables were compared using the Chi-square test and continuous variables were compared using Student’s t-test with Welch’s correction. p-values <0.05 were considered significant.ResultsSGUS was positive in a higher proportion of patients with pSS, in comparison to non-Sjögren’s sicca subjects (60% vs. 24%, p=0.003). The size measurements showed a smaller antero-posterior diameter of both the right (mean 31.3 mm vs. 35.4 mm, p=0.037) and left (mean 30.1 mm vs. 34.2 mm, p=0.004) submandibular glands in pSS patients. A smaller antero-posterior diameter of the left parotid gland was also observed (mean 30.2 mm vs. 34.2 mm, p=0.046) in pSS patients. The lymph nodes evaluation showed that superficial parotid lymph nodes were detected in a lower proportion in pSS patients (45% vs. 72%, p=0.027). No significant differences were found between pSS patients and non-Sjögren’s sicca subjects regarding the rest of the size measurements, the vascularization pattern, nor the shape, number, nor size of lymph nodes when they were detected. In addition, positive SGUS in pSS patients was also associated with smaller antero-posterior diameter of both the right (mean 29.9 mm vs. 35.4 mm, p=0.009) and left (mean 32.8 mm vs. 34.2 mm, p=0.008) submandibular glands, and a smaller antero-posterior diameter of the left parotid gland (mean 27.5 mm vs. 34.2 mm, p=0.044).ConclusionUltrasonographic features are a valuable resource for the evaluation of pSS. The score of parenchymal inhomogeneity is associated with clinical diagnosis, and other indices such as the antero-posterior diameter of the submandibular glands and a lower detection of the superficial parotid lymph nodes may be used to assist the evaluation. However, no other macrostructural features of the parotid and submandibular SG, and the adjacent lymph nodes, seem to be different between pSS patients and non-Sjögren’s sicca subjects.References[1]Jousse-Joulin S, Coiffier G. Current status of imaging of Sjogren’s syndrome. Best Pract Res Clin Rheumatol. 2020;34(6):101592.Disclosure of InterestsNone declared
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Solans-Laqué R, Portella Alegre A, Planes-Conangla M, Mestre-Torres J, Serres-Créixams X, González-Nieto MI. AB0467 COMPARISON OF 2002 AECG AND 2016 ACR/EULAR CLASSIFICATION CRITERIA AND ROLE OF SALIVARY GLAND ULTRASONOGRAPHY IN A SICCA COHORT. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundFor the last 20 years, different classification criteria have been used in clinical practice to improve the diagnosis of primary Sjögren’s syndrome (pSS) and for research purposes. Several recent studies have assessed major salivary gland ultrasonography (SGUS) as a tool for diagnosing pSS and its inclusion in the classification criteria sets. In addition, some research suggests that it may be important to distinguish between monospecific antibody assays to Ro60 or Ro52.ObjectivesTo compare the new 2016 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) criteria to the revised 2002 American–European Consensus Group (AECG) criteria in a cohort of subjects with sicca symptoms and to assess the diagnostic accuracy of SGUS. We include monospecific antibody determination to Ro60 or Ro52.MethodsPatients ≥ 18 years old with diagnosis of sicca syndrome without other associated collagen diseases were included. The initial cohort compromised 72 patients. We assessed features of salivary and lacrimal gland dysfunction and autoimmunity as defined by tests of both AECG and ACR/EULAR criteria. We included separate antiRo52 and antiRo60 antibodies determination, and considered only antiRo60 for the ACR/EULAR criteria as recommended [1]. All the patients underwent SGUS. Agreement between the criteria sets was assessed using Cohen’s κ coefficient, and categorical variables were compared using the Chi-square test.ResultsApplication of the AECG criteria resulted in the classification of 50 (69%) subjects with pSS, among whom 48 (67%) subjects also met ACR/EULAR criteria. All these patients received a physician diagnosis of pSS. No patients met ACR/EULAR only, and 22 (31%) subjects met neither criteria set. The concordance between AECG and ACR/EULAR criteria was almost perfect (κ = 0.94). The concordance group presented 8% antiRo60+, 4% antiRo52+, and 75% antiRo60+/antiRo52+, among whom 56% had antiRo60+/antiRo52+/antiLa+. No patients presented antiLa in the absence of both antiRo60 and antiRo52 antibodies. SGUS was abnormal in 63% of these patients. The 2 patients fulfilling only AECG criteria had antiRo52+, and SGUS was abnormal in one of them. SGUS was abnormal in 27% of the 22 patients fulfilling no criteria sets. Thus, SGUS was abnormal in a significantly higher proportion of patients with pSS, in comparison to non-Sjögren’s sicca subjects (62% vs. 27%, p=0.007). Including SGUS among the ACR/EULAR criteria would increase the concordance from κ = 0.94 to κ = 0.97 between the criteria set.ConclusionThe two sets of classification criteria yielded concordant results with an almost perfect agreement in our sicca cohort. The presence of both antiRo60 and antiRo52 antibodies was the most characteristic autoimmune pattern, with no detection of antiLa in the absence of them. SGUS was positive in a higher proportion of patients with pSS and may improve the classification criteria.References[1]Mariette X, Criswell LA. Primary Sjögren’s Syndrome. N Engl J Med. 2018;378(10):931-939. doi: 10.1056/NEJMcp1702514.Disclosure of InterestsNone declared
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Valls-Villalba À, Mestre J, Nuñez-Conde A, Bujan Rivas S, Solans-Laqué R. AB0566 CLINICAL AND SEROLOGICAL ASSOCIATION BETWEEN SJÖGREN SYNDROME AND VASCULITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.5034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundSjögren Syndrome (SS) is a systemic autoimmune systemic disease which mainly affects the exocrine glands, presenting mainly as persistent eye and mouth dryness as a result of a functional impairment of the lacrimal and saliva glands. Cutaneous vasculitis is one of the most characteristic extraglandular manifestations, especially in patients with anti-Ro antibodies. Although vasculitis may affect a wide range of organs and systems, the clinical characteristics and the diversity of vasculitis associated with SS have not been thoroughly studied.ObjectivesTo describe the clinical and analytical characteristics of patients with SS and cutaneous, or systemic vasculitis, as well as their outcome.MethodsRetrospective, descriptive study, of patients with primary SS and vasculitis attended at a Tertiary Hospital. Collected data were analysed using the SPSS statistical package. Quantitative data were expressed as a mean +/- 2SD and qualitative data as a proportion. A p-value 0.05 was considered significant.ResultsFrom a total of 395 patients with primary SS, 53 patients presented with both SS and vasculitis (51, 96.2%, women). The mean age at diagnosis was 56.12 (±2.17) years. Globally, 84.9% of patients met the 2002 classification criteria; 90.6% the 2012 criteria, and 83.0% the 2016 criteria. Thirty-two (60.4%) patients presented with cutaneous vasculitis (mainly purpura), and 7 (13.2%) with systemic vasculitis with renal, neurological and/or lung involvement. Extraglandular manifestations were frequent. Out of the 53 patients, twenty-five (47.2%) presented pulmonary involvement; 43(81.1%) articular involvement (19 [35.8%] arthritis); 21(39.6%) Raynaud phenomenon, and 15.1% peripheral neuropathy. Six (11.3%) patients developed a lymphoma. All patients presented positive ANA; 69.8% anti-Ro60, 52.8% anti-La, 75.5% RF; 62.3% polyclonal hypergammaglobulinemia; 33.9% cryoglobulins, 58.5% elevated beta2-microglobulin levels, and 12 (22.65%) hypocomplementemia (4 decreased C3, and 8 decreased C4). Biopsy specimens showed in 8 (15.9%) cases urticaria vasculitis; in 1 (1.9%) PAN; in 2 (3.8%) Cryoglobulinaemic vasculitis, in 5 (9.4%) ANCA associated vasculitis (4 PAM-MPO, and 1 GPA-PR3); and in 1 SNC vasculitis. 64.2% of patients received glucocorticoids and 37.7% hydroxychloroquine. 5 (9.4%) patients received Rituximab. Vasculitis were significantly more frequent in patients with anti-Ro60 (p=0.005, OR2.5 IC95% 1.33-4.74); anti-La (p=0.009, OR 2.39, IC95% 1.29-4.43); RF (p<0.000, OR 3.78, OR 3.72 IC95%1.90-7.26); C4 hypocomplementemia (p<0.00, OR 6.42, IC 95% 2.65-15.56); cryoglobulins (p=0.016, OR 2.29, IC95% 1.21-4.33); hypergammaglobulinemia (p=0.004, OR 2.53, IC95% 1.36-4.71), arthritis (p= 0.001, OR 3.26, IC95% 1.72-6.19), lung fibrosis (p=0.010, OR 2.92, IC95% 1.38-6.17) and lymphoma (p=0.011, OR 4.05, IC95% 1.5-10.94).ConclusionIn our series, most patients with SS presented repetitive flares of cutaneous vasculitis as previously reported. Nonetheless, our patients showed a greater proportion of lung and articular manifestations as well as anti-La positivity.Five patients presented with ANCA associated vasculitis, which represents and exceedingly rare and severe manifestation in this context.Patients with SS may present a wide range of vasculitis, ranging from the most common leucocytoclastic vasculitis to the more severe systemic vasculitis, such as: AAV and cryoglobulinaemic vasculitis.The association of SS with vasculitis is more common in patients with anti-Ro, anti-La and/or RF, hypocomplementemia, cryoglobulins and hypergammaglobulinemia.References[1]Ramos-Casals, M., Anaya, J., García-Carrasco, M., Rosas, J., Bové, A., Claver, G., Diaz, L., Herrero,[2]C. and Font, J., 2004. Cutaneous Vasculitis in Primary Sjögren Syndrome. Medicine, 83(2), pp.96-106.Disclosure of InterestsNone declared
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Mestre-Torres J, Escalante B, Fonseca E, Martinez-Zapico A, Monteagudo M, Abdilla M, Perez Conesa M, Gracia Tello B, Prieto-González S, Fraile G, Solans-Laqué R. POS0271 CLINICAL SYMPTOMS AT GIANT CELL ARTERITIS DIAGNOSIS AS PREDICTORS OF PERMANENT VISUAL LOSS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundGiant cell arteritis (GCA) is the most prevalent vasculitis in the elder. Nearly 20% of patients experience transient or permanent visual loss (PVL). It has been reported that erythrocyte sedimentation rate (ESR), haemoglobin (Hb), constitutional syndrome (CS) and fever are prognostic factors that predict PVL but models have shown poor diagnostic performance.ObjectivesTo evaluate if clinical signs, symptoms and blood tests can predict PVL at GCA diagnosis.MethodsWe retrospectively included patients from the Spanish Vasculitis Registry (REVAS) from 2005 to 2009. Clinical and blood tests data were obtained from medical records. We randomly split the cohort using shrinkage function to create a derivation and a validation cohort. In the derivation set we compared data and we built a multivariable logistic regression model to predict PVL. Internal validity was evaluated with 1000 bootstrap. External validity was evaluated using the validation set of data. Performance of the model was determined using the area under the curve (AUC) with 95% confidence interval. Calculations were done using StataBE 17.0.ResultsWe included 620 patients (derivation cohort: 397 patients). Clinical signs, symptoms and blood tests results according to the presence or absence of PVL (Table 1). Mean age at diagnosis was 76.3 years and PVL was present in 86 (21.7%) patients. Significant predictors at baseline were age (p=0.000), hypertension (p=0.04), fever (p=0.001), jaw claudication (0.000), transient visual loss (TVL, p=0.000) and decreased temporal artery (TA) pulse (p=0.004). Multivariable logistic regression showed that age older than 75 years (OR 2.7, p=0.000), jaw claudication (OR, 2.75; p=0.000) and TVL (OR 7.2, p=0.000) were risk factors for PVL. CS was the only protective factor (OR 0.57, p=0.017). Hypertension (OR 1.4, IC95%: 0.88 – 2.3) and diabetes (OR 1.63, IC95%: 0.94 – 2.8) were not statistically significant. Our model showed an AUC 0.8 (IC 95%: 0.75 – 0.84). A 1000 bootstrap analysis showed good internal validity (AUC 0.79, IC95%: 0.74 – 0.83). Validation cohort comprised 223 patients and the AUC of the model in this dataset showed an AUC 0.81. We compared our model to previously published models and we found that our model had a higher AUC (AUC 0.8, IC 95%: 0.75-0.84 vs. AUC 0.65, IC95%: 0.6 – 0.7; p < 0.0001).Table 1.Baseline date according to the presence or absence of permanent visual loss.Permanent Visual LossNo Permanent Visual LossVariableMean/ProportionSDMean/ProportionSDSignificanceFemale69.8%72.0%0.68Age >75 y.o.72.1%53.4%0.000Hypertension64.3%51.6%0.04Diabetes25.9%16.9%0.06Fever18.6%36.8%0.001Constitutional syndrome42.4%53.2%0.075Polymyalgia40.7%39.7%0.87Headache79.1%79.2%0.987Jaw claudication68.2%39.7%0.000Tenderness of the TA38.6%31.4%0.22Transient visual loss39.0%10.5%0.000Stroke3.5%3.9%0.86Transient ischaemic attack0.0%4.2%0.053Decreased TA pulse66.7%48.0%0.004TA enlargement55.1%50.9%0.51Haemoglobin11.11.211.41.40.37Erythrocyte sedimentation rate95.026.296.426.80.67C Reactive protein9.76.210.48.60.8SD: Standard deviation. TA: Temporal artery.ConclusionAge > 75 years, jaw claudication and TVL can predict PVL, being the CS a protective factor for this complication. Blood test data are not good PVL predictive factors.References[1]Nesher G. J Autoimm. 2014;48-49:73-75.[2]Cid MC et al. Arthritis Rheum. 1998;41:26-32.Acknowledgementson behalf of the Spanish Resgistry of Systemic Vascuitis (REVAS)Disclosure of InterestsNone declared
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González-Nieto MI, Portella Alegre A, García-Burillo A, Asadurova S, Mestre-Torres J, Serres-Créixams X, Solans-Laqué R. AB0468 COMPARISON OF THE DIAGNOSTIC PERFORMANCE OF SALIVARY GLAND SCINTIGRAPHY AND ULTRASOUND IN SJÖGREN’S SYNDROME. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundThe 2002 American-European Consensus Group (AECG) criteria included salivary gland scintigraphy (SGS) as one of the possible objective methods for assessing salivary gland involvement in primary Sjögren’s syndrome (pSS). However, this test as well as the sialography were not included in the 2016 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) criteria and considered obsolete. On the other hand, salivary gland ultrasound (SGUS) is a simple and non-invasive procedure that is readily available and provides important information on the major salivary glands. Several recent studies have assessed SGUS as a tool for diagnosing pSS.ObjectivesTo compare the diagnostic performance of SGS and SGUS for pSS patients.MethodsWe included 63 patients with sicca symptoms and suspected pSS. Diagnosis of pSS was established following the 2002 AECG criteria. The patients’ scintigraphic grade was determined according to Schall classification (I-IV scale) [1], establishing Schall grade ≥III (moderate functional impairment) as the cut-off. We considered SGUS score based on parenchymal homogeneity, presence of hypoechogenic areas, and clearness of posterior glandular border of salivary glands. The score of the highest graded gland was considered, and a score ≥2 was defined as a positive SGUS, according to OMERACT US-SG scoring [2]. The area under the receiver operating characteristic (ROC) curve was employed to evaluate the screening method’s performance.ResultspSS was diagnosed in 40 (63%) patients, and the remaining 23 sicca subjects (37%) constituted the control group. Abnormal SGS was established in 26/40 (65%) pSS patients and 10/23 (43%) controls. Positive SGUS was established in 24/40 (60%) pSS patients and 6/23 (26%) controls. Thus, the sensitivity and specificity of SGS were 65% and 57%, respectively, and 60% and 74% for SGUS, respectively. The area under the ROC curve (Figure 1) of scintigraphy was 0.73, while for the SGUS was 0.83.Figure 1.ROC curve comparison of SGS and SGUS for the diagnosis of pSS.ConclusionThe diagnostic accuracy of SGUS is not only comparable with scintigraphy in pSS patients but also results in a better performance. This result indicates that SGUS is a useful method for evaluating salivary gland involvement in pSS and could be an alternative tool to other diagnostic techniques, such as SGS.References[1]Schall GL, Anderson LG, Wolf RO, Herdt JR, Tarpley TM Jr, Cummings NA, et al. Xerostomia in Sjögren’s syndrome. Evaluation by sequential salivary scintigraphy. JAMA. 1971 28;216(13):2109-16.[2]Jousse-Joulin S, Coiffier G. Current status of imaging of Sjogren’s syndrome. Best Pract Res Clin Rheumatol. 2020;34(6):101592.Disclosure of InterestsNone declared
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González-Nieto MI, Portella Alegre A, Planes-Conangla M, Bujan Rivas S, Serres-Créixams X, Solans-Laqué R. POS0732 CLINICAL, HISTOLOGICAL, AND SEROLOGICAL FEATURES ASSOCIATED WITH SALIVARY GLAND ULTRASOUND IN PRIMARY SJÖGREN’S SYNDROME. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundSalivary gland ultrasound (SGUS) is a simple and non-invasive procedure that is readily available and supplies important information on the major salivary glands. Several recent studies have assessed SGUS as a tool for diagnosing primary Sjögren’s syndrome (pSS), and have reported its association with different features in pSS.ObjectivesTo investigate the association of SGUS findings with clinical, histological, and serologic features of pSS in our cohort. In addition, we include monospecific antibody determination to Ro60 or Ro52.MethodsPatients with pSS were determined according to the American-European Consensus Group (AECG) criteria for pSS. A total of 53 of these pSS patients underwent SGUS evaluation. We considered SGUS score based on parenchymal homogeneity, presence of hypoechogenic areas, and clearness of posterior glandular border of salivary glands. The score of the highest graded gland was considered and a score ≥2 was defined as a positive SGUS, according to OMERACT US-SG scoring [1]. Patients were classified into two groups according to positive vs. negative SGUS. Demographic, clinical, histopathological, and laboratorial data were collected and compared between the groups. Categorical variables were compared using the Chi-square test or Fisher’s exact test when the conditions for Chi-square test were not met, and continuous variables were compared using Student’s t-test with Welch’s correction. p-values <0.05 were considered significant.ResultsStudy participants were predominantly women (98%) and had a mean age of 60.2 years. SGUS was positive in 32 (63%) pSS patients, they were all women and had a mean age of 59 years. Positive SGUS was associated with objective evidence of ocular involvement (defined as a positive result for at least one of the ocular tests, p<0.001), time of evolution of xerophthalmia at diagnosis (mean 5.8 years vs. 2.2 years, p=0.037), pathological result of the labial salivary gland biopsy when it was performed (p<0.001), and the presence in the serum of both antiRo60 and antiRo52 antibodies (p=0.004), antiLa antibody (p=0.008) and ANA titer ≥1:320 (p<0.001). No significant differences were found between positive SGUS and negative SGUS patients regarding the presence of xerophthalmia nor xerostomia, time of evolution of xerostomia at diagnosis, episodes of parotid inflammation, abnormal salivary scintigraphy, nor the presence in the serum of monospecific antiRo52 nor antiRo60 in the absence of each other, nor positive rheumatoid factor.ConclusionPositive SGUS was associated in pSS patients with objective evidence of pathological ocular function, histopathology of minor salivary glands, and serology of pSS, specifically the presence of both antiRo52 and antiRo60 antibodies. In our cohort, no significant association was found regarding xerostomia, episodes of parotid inflammation, nor objective evidence of oral involvement. Thus, SGUS could be a useful tool to establish objective salivary gland involvement, independently of oral symptoms and other oral tests.References[1]Jousse-Joulin S, Coiffier G. Current status of imaging of Sjogren’s syndrome. Best Pract Res Clin Rheumatol. 2020;34(6):101592.Disclosure of InterestsNone declared
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Prieto-Peña D, Loricera J, Castañeda S, Moriano C, Bernabéu P, Vela-Casasempere P, Narváez J, Aldasoro V, Maíz O, Fernández-López C, Freire González M, Melero R, Villa-Blanco I, González-Alvarez B, Solans-Laqué R, Callejas-Rubio JL, Fernández-Díaz C, Rubio Romero E, García Morillo S, Minguez M, Fernández-Carballido C, De Miguel E, Sanchez-Martin J, Fernández E, Melchor S, Salgado-Pérez E, Bravo B, Romero-Yuste S, Galíndez-Agirregoikoa E, Sivera F, Ferraz-Amaro I, Hidalgo C, Romero-Gómez C, Galisteo C, Moya P, Alvarez-Rivas N, Mendizabal J, Nieto González JC, De Dios JR, Andreu JL, Pérez de Pedro I, Revenga M, Alonso Valdivieso JL, Rosa RM, De la Morena I, Fernández-Llanio N, Labrador E, Roman-Ivorra JA, Ortiz-Sanjuán F, García-Valle A, Gallego A, Iñiguez C, Garrido-Puñal N, De la Torre R, López-González R, Collado P, Raya E, Navarro F, Mas AJ, Ordás C, Boquet MD, Velloso Feijoo ML, Campos Fernández C, Rúa-Figueroa I, Conesa A, Manrique Arija S, González-Gay MA, Blanco R. POS0804 TOCILIZUMAB IN LARGE-VESSEL GIANT CELL ARTERITIS AND TAKAYASU ARTERITIS: MULTICENTRIC OBSERVATIONAL COMPARATIVE STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundTocilizumab (TCZ) has shown to be effective for large vessel vasculitis including giant cell arteritis (GCA) and Takayasu arteritis (TAK) (1-5). However, LVV-GCA and TAK show different demographic and clinical features that may influence on TCZ therapeutic response.ObjectivesTo compare the effectiveness of TCZ in patients with LVV-GCA and patients with TAK.MethodsObservational multicenter study of patients with LVV-GCA and TAK who received TCZ. Outcome variables were: a) proportion of patients who achieved complete clinical improvement along with normalization of laboratory markers (CRP ≤0.5mg/dL and/or ESR ≤ 20 mm/1st hour) at 12 months b) complete improvement in imaging techniques. A comparative study between patients with LVV-GCA and TAK was performed.ResultsWe evaluated 70 LVV-GCA and 57 TAK patients who received TCZ. Main clinical and demographic characteristic are described in Table 1. Patients with TAK were younger, had longer disease duration, had received more commonly previous biologic therapy and were receiving higher doses of prednisone at baseline. TCZ intravenous administration was more common in TAK patients (80.7% vs 48.6%; p<0.01). Follow-up time after TCZ onset was similar in both groups. At 12 months, about 75% of patients achieved complete clinical improvement and ESR/CRP normalization in both groups. A follow-up imaging technique was performed in 37 LVV-GCA patients after a mean time of 12.9±6.0 months and 38 TAK patients after 9.5±5.0 months. Complete improvement in imaging techniques was only observed in 18.9% and 21.1% of patients with LVV-GCA and TAK, respectively (Figure 1).Table 1.LVV-GCA (n=70)TAK (n=57)pGeneral featuresAge (years), mean ± SD67.2 ± 10.540.5 ± 16.3< 0.01Sex (female), n (%)51 (72.9)49 (86)0.07Disease evolution before TCZ onset (months), median [IQR]5 [2-15]12 [3-37]<0.01Baseline laboratory parametersESR (mm/1st hour), median [IQR]32 [12.5-54.7]31 [10-52]0.82CRP (mg/dL), median [IQR]1.4 [0.5-2.4]1.4 [0.5-3.5]0.41Baseline prednisone dose (mg/day), median [IQR]15 [10-20]30 [15-50]< 0.01Previous therapyConventional DMARDs, n(%)45 (64.3)44(77.2)0.51Biologic therapy, n (%)0(0)12 (21.1)<0.01TCZ therapyIntravenous, n (%)34 (48.6)46 (80.7)< 0.01Combined with MTX, n(%)24 (34.3)24 (42.1)0.37Follow-up time after TCZ onset, median [IQR]20 [10-36]18 [7-41]0.73Complete clinical improvement and ESR/CRP normalization at 12 months, n/N (%)35/47 (74.4)30/39 (76.9)0.79Complete improvement in imaging techniques, n/N(%)7/37 (18.9)8/38 (21.1)0.85CRP: C-reactive protein; DMARDs: Disease-modifying anti-rheumatic drugs ESR: erythrocyte sedimentation rate; GCA: giant cell arteritis; IQR: interquartile range; LVV: large vessel; MTX: methotrexate; n: Number of patients; N: total number of patients: TCZ: tocilizumab; TAK:takayasuFigure 1.ConclusionThe effectiveness of TCZ was similar in patients with LVV-GCA and TAK, despite a more refractory disease in TAK patients. A discordance between clinical and imaging activity improvement was observed in both LVV-GCA and TAK, as reported in previous studies (3).References[1]Calderón-Goercke M, et al. Semin Arthritis Rheum 2019; 49:126-35. https://doi.org/10.1016/j.semarthrit.2019.01.003[2]Prieto-Peña D et al. Ther Adv Musculoskelet Dis. 2021;13:175. PMID: 34211589.[3]Prieto Peña D et al. Clin Exp Rheumatol. 2021;39 Suppl 129:69-75. PMID: 33253103.[4]González-Gay MA, et al. Expert Opin Biol Ther. 2019;19:65-72. doi: 10.1080/14712598.2019.1556256.[5]Prieto-Peña D, et al. Semin Arthritis Rheum. 2019;48(4):720-727. doi: 10.1016/j.semarthrit.2018.05.007Disclosure of InterestsNone declared
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Mestre-Torres J, Martínez-Valle F, Gabaldón A, Simó-Perdigó M, Salcedo-Allende MT, Navales-Mateu I, Solans-Laqué R. Are Temporal Artery Biopsy Findings Related to PET/CT Findings in Giant Cell Arteritis? Clin Nucl Med 2022; 47:387-393. [PMID: 35234202 DOI: 10.1097/rlu.0000000000004097] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Two clinical subsets of giant cell arteritis have been identified with different histological and CT findings. However, PET/CT findings have not been compared with temporal artery biopsy (TAB). OBJECTIVE The aims of this study were to describe clinical and histological findings in patients with giant cell arteritis according to the presence or absence of aortitis in PET/CT at the disease diagnosis, and to identify independent factors related to aortic involvement. METHODS Patients were included and followed prospectively. Clinical symptoms and TAB findings were recorded. PET/CT was performed in the first 10 days of steroid therapy. Aortitis was defined if a grade 3 uptake on visual analysis was present on arterial wall. Clinical and histological variables were compared according to the presence or absence of aortitis on PET/CT. Multivariate analysis was performed to identify independent factors related to the presence of aortitis. RESULTS Twenty-seven patients (median age, 77.6 years) were included. PET/CT was performed with a median delay of 5.0 days. Aortitis was observed in 8 patients. Patients with aortitis were younger (69.9 vs 83.7 years, P = 0.04) and had less frequently ischemic manifestations (25.0% vs 84.2%, P = 0.006) than patients without aortitis. Giant multinucleated cells were more frequent on TAB from patients with aortitis (71.4% vs 16.7%), and its presence was an independent risk factor for the occurrence of aortic involvement on PET/CT (odds ratio, 12.2; P = 0.046). CONCLUSIONS Our study shows that giant cells on TAB are associated with the presence of aortitis on PET/CT. Patients with aortic involvement are younger and show less frequently ischemic manifestations.
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Affiliation(s)
| | | | | | - Marc Simó-Perdigó
- Nuclear Medicine Department, Hospital Vall d'Hebron, Barcelona, Spain
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Prieto-Peña D, Bernabeu P, Vela P, Narváez J, Fernández-López JC, Freire-González M, González-Álvarez B, Solans-Laqué R, Callejas Rubio JL, Ortego N, Fernández-Díaz C, Rubio E, García-Morillo S, Minguez M, Fernández-Carballido C, de Miguel E, Melchor S, Salgado E, Bravo B, Romero-Yuste S, Salvatierra J, Hidalgo C, Manrique S, Romero-Gómez C, Moya P, Álvarez-Rivas N, Mendizabal J, Ortiz-Sanjuán F, Pérez de Pedro I, Alonso-Valdivielso JL, Perez-Sanchez L, Roldán R, Fernandez-Llanio N, Gómez de la Torre R, Suarez S, Montesa Cabrera MJ, Delgado Sánchez M, Loricera J, Atienza-Mateo B, Castañeda S, González-Gay MA, Blanco R. Tocilizumab in refractory Caucasian Takayasu's arteritis: a multicenter study of 54 patients and literature review. Ther Adv Musculoskelet Dis 2021; 13:1759720X211020917. [PMID: 34211589 PMCID: PMC8216399 DOI: 10.1177/1759720x211020917] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 05/10/2021] [Indexed: 12/27/2022] Open
Abstract
Objective: To assess the efficacy and safety of tocilizumab (TCZ) in Caucasian patients with refractory Takayasu’s arteritis (TAK) in clinical practice. Methods: A multicenter study of Caucasian patients with refractory TAK who received TCZ. The outcome variables were remission, glucocorticoid-sparing effect, improvement in imaging techniques, and adverse events. A comparative study between patients who received TCZ as monotherapy (TCZMONO) and combined with conventional disease modifying anti-rheumatic drugs (cDMARDs) (TCZCOMBO) was performed. Results: The study comprised 54 patients (46 women/8 men) with a median [interquartile range (IQR)] age of 42.0 (32.5–50.5) years. TCZ was started after a median (IQR) of 12.0 (3.0–31.5) months since TAK diagnosis. Remission was achieved in 12/54 (22.2%), 19/49 (38.8%), 23/44 (52.3%), and 27/36 (75%) patients at 1, 3, 6, and 12 months, respectively. The prednisone dose was reduced from 30.0 mg/day (12.5–50.0) to 5.0 (0.0–5.6) mg/day at 12 months. An improvement in imaging findings was reported in 28 (73.7%) patients after a median (IQR) of 9.0 (6.0–14.0) months. Twenty-three (42.6%) patients were on TCZMONO and 31 (57.4%) on TCZCOMBO: MTX (n = 28), cyclosporine A (n = 2), azathioprine (n = 1). Patients on TCZCOMBO were younger [38.0 (27.0–46.0) versus 45.0 (38.0–57.0)] years; difference (diff) [95% confidence interval (CI) = -7.0 (-17.9, -0.56] with a trend to longer TAK duration [21.0 (6.0–38.0) versus 6.0 (1.0–23.0)] months; diff 95% CI = 15 (-8.9, 35.5), and higher c-reactive protein [2.4 (0.7–5.6) versus 1.3 (0.3–3.3)] mg/dl; diff 95% CI = 1.1 (-0.26, 2.99). Despite these differences, similar outcomes were observed in both groups (log rank p = 0.862). Relevant adverse events were reported in six (11.1%) patients, but only three developed severe events that required TCZ withdrawal. Conclusion: TCZ in monotherapy, or combined with cDMARDs, is effective and safe in patients with refractory TAK of Caucasian origin.
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Affiliation(s)
- Diana Prieto-Peña
- Department of Rheumatology, Research Group on Genetic Epidemiology and Atherosclerosis in Systemic Diseases and in Metabolic Bone Diseases of the Musculoskeletal System, IDIVAL, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Pilar Bernabeu
- Department of Rheumatology, Hospital General de Alicante, Alicante, Spain
| | - Paloma Vela
- Department of Rheumatology, Hospital General de Alicante, Alicante, Spain
| | - Javier Narváez
- Department of Rheumatology, Hospital de Bellvitge, Barcelona, Spain
| | | | | | | | - Roser Solans-Laqué
- Department of Internal Medicine, Hospital Vall d'Hebron, Barcelona, Spain
| | | | - Norberto Ortego
- Autoimmune Disease Unit, Hospital San Cecilio, Granada, Spain
| | - Carlos Fernández-Díaz
- Department of Rheumatology, H. Universitario de La Princesa, IIS-Princesa, Madrid, Spain
| | - Esteban Rubio
- Autoimmune Disease Unit, Hospital Virgen del Rocío, Sevilla, Spain
| | | | - Mauricio Minguez
- Department of Rheumatology, Hospital San Juan de Alicante, Alicante, Spain
| | | | - Eugenio de Miguel
- Department of Rheumatology, Hospital Universitario La Paz, Madrid, Spain
| | - Sheila Melchor
- Department of Rheumatology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Eva Salgado
- Department of Rheumatology, Complejo H. Universitario de Ourense, Ourense, Spain
| | - Beatriz Bravo
- Department of Rheumatology, Hospital Virgen de las Nieves, Granada, Spain
| | - Susana Romero-Yuste
- Department of Rheumatology, Complejo H. Universitario de Pontevedra, Pontevedra, Spain
| | | | - Cristina Hidalgo
- Department of Rheumatology, Complejo Universitario de Salamanca, Salamanca, Spain
| | - Sara Manrique
- Autoimmune Disease Unit, Hospital Regional de Málaga, Málaga, Spain
| | | | - Patricia Moya
- Department of Rheumatology, Hospital Sant Pau, Barcelona, Spain
| | | | - Javier Mendizabal
- Department of Rheumatology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | | | | | | | - Laura Perez-Sanchez
- Department of Rheumatology, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Rosa Roldán
- Department of Rheumatology, Hospital Universitario Reina Sofía, Córdoba, Spain
| | | | | | - Silvia Suarez
- Autoimmune Disease Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | | | - Javier Loricera
- Department of Rheumatology, Research Group on Genetic Epidemiology and Atherosclerosis in Systemic Diseases and in Metabolic Bone Diseases of the Musculoskeletal System, IDIVAL, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Belén Atienza-Mateo
- Department of Rheumatology, Research Group on Genetic Epidemiology and Atherosclerosis in Systemic Diseases and in Metabolic Bone Diseases of the Musculoskeletal System, IDIVAL, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Santos Castañeda
- Department of Rheumatology, H. Universitario de La Princesa, IIS-Princesa, Madrid, Spain
| | - Miguel A González-Gay
- Rheumatology Division, Research Group on Genetic Epidemiology and Atherosclerosis in Systemic Diseases and in Metabolic Bone Diseases of the Musculoskeletal System, IDIVAL, Hospital Universitario Marqués de Valdecilla, Avenida Valdecilla s/n, Santander, 39008, Spain
| | - Ricardo Blanco
- Department of Rheumatology, Research Group on Genetic Epidemiology and Atherosclerosis in Systemic Diseases and in Metabolic Bone Diseases of the Musculoskeletal System, IDIVAL, Hospital Universitario Marqués de Valdecilla, Santander, Spain
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Prieto-Peña D, Bernabéu P, Vela-Casasempere P, Narváez J, Fernández-López C, Freire González M, González-Alvarez B, Solans-Laqué R, Callejas-Rubio JL, Ortego N, Fernández-Díaz C, Rubio Romero E, García Morillo S, Minguez M, Fernández-Carballido C, De Miguel E, Melchor S, Salgado-Pérez E, Bravo B, Romero-Yuste S, Salvatierra J, Hidalgo C, Manrique Arija S, Romero-Gómez C, Moya P, Alvarez-Rivas N, Mendizabal J, Ortiz Sanjuan FM, Pérez de Pedro I, Alonso Valdivieso JL, Laura PS, Rosa RM, Fernández-Llanio N, Gómez de la Torre R, Suarez S, Montesa MJ, Delgado Sanchez M, Loricera J, Atienza-Mateo B, Castañeda S, González-Gay MA, Blanco R. AB0366 TOCILIZUMAB FOR TAKAYASU ARTERITIS: MULTICENTER STUDY OF 54 WHITE PATIENTS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Tocilizumab (TCZ) has shown to be effective for large vessel vasculitis including Takayasu arteritis (TAK) (1-3). Most evidence in TAK comes from Asian patients. However, white patients seem to have different clinical and prognostic features.Objectives:Our aims were to: a) assess the efficacy and safety of TCZ in white patients with refractory TAK, b) determine if clinical improvement correlates with imaging outcomes, c) compare TCZ in monotherapy (TCZMONO) vs combined with conventional immunosuppressive drugs (TCZCOMBO)Methods:Multicenter study of white patients with refractory TAK who received TCZ.Outcomes variables were remission, glucocorticoid-sparing effect, improvement in imaging techniques, and adverse events. A comparative study between patients who received TCZMONO and TCZCOMBO was performed.Results:54 patients (46 women/8 men; median age 42.0 [32.5-50.5] years). TCZ was started after 12.0 [3.0-31.5] months since TAK diagnosis. Remission was achieved in 12/54 (22.2%), 19/49 (38.8%), 23/44 (52.3%) and 27/36 (75%) at 1, 3, 6 and 12 months, respectively. Prednisone dose was reduced from 30.0 [12.5-50.0] to 5.0 [0.0-5.6] mg/day at 12 months (Table 1). 10 (26.3%) of the 38 patients in whom an imaging follow-up test was performed showed no radiographic improvement after a median of 9.0 [6.0-14.0] months. 4 of them were in clinical remission.23 (42.6%) patients were on TCZMONO and 31 (57.4%) on TCZCOMBO: MTX (n=28), cyclosporine A (n=2), azathioprine (n=1). Patients on TCZCOMBO were younger (38.0 [27.0-46.0] vs 45 [38.0-57.0] years; p= 0.048), with a trend to longer TAK duration (21.0 [6.0-38.0] vs 6.0 [1.0-23.0] months; p= 0.08) and higher C-reactive protein (2.4 [0.7-5.6] vs 1.3 [0.3-3.3] mg/dL; p=0.16). Despite these differences, similar outcomes were observed in both groups (log rank p=0.862) (Figure 1). Relevant adverse events were reported in 6 (11.1%) patients, but only 3 developed severe events that required TCZ withdrawal.Table 1.Baselinen=54Month 1N=54Month 3N=49Month 6N=44Month 12N=36Clinical remission, n (%)12 (22.2)19 (38.8)23 (52.3)27 (75.0)Laboratory improvementCRP (mg/dL), median [IQR]1.5 [0.5-3.5]0.2 [0.1-0.7]*0.2 [0.5-0.5]*0.2 [0.1-0.5]*0.1 [0.0-0.4]*ESR (mm/1sthour), median [IQR]30.5 [8.7-52.7]7.0 [3.0-14.0]*4.5 [2.0-8.0]*5.0[2.0-6.0]*4.0 [2.0-9.5]*Hemoglobin (g/dL), mean ± SD12.4 ±1.513.0 ±1.2*13.0 ±1.4*13.2 ±1.5*12.9 ±1.6*Prednisone dose, median [IQR]30.0 [12.5-50.0]20.0 [10.0-30.0]*10.0 [5.0-20.0]*5.0 [5.0-10.5]*5.0 [0.0-5.6]*CRP: C-Reactive Protein; ESR: Erythrocyte Sedimentation Rate; IQR: interquartile range; n: number. *p<0.01 vs baseline (Wilcoxon test).Conclusion:TCZ is effective and safe in white patients with refractory TAK. A discordance between clinical and imaging activity assessment may exist.References:[1]Prieto Peña D et al. Clin Exp Rheumatol 2020 Nov 27. PMID: 33253103.[2]Loricera J, et al. Clin Exp Rheumatol 2016; 34:S44-53. PMID: 27050507.[3]Calderón-Goercke M, et al. Semin Arthritis Rheum 2019; 49:126-35. PMID: 30655091Disclosure of Interests:Diana Prieto-Peña Grant/research support from: DP-P has received research support from UCB Pharma, Roche, Sanofi, Pfizer, AbbVie and Lilly., Pilar Bernabéu: None declared, Paloma Vela-Casasempere: None declared, J. Narváez: None declared, Carlos Fernández-López: None declared, Mercedes Freire González: None declared, Beatriz González-Alvarez: None declared, Roser Solans-Laqué: None declared, Jose Luis Callejas-Rubio: None declared, Norberto Ortego: None declared, Carlos Fernández-Díaz: None declared, Esteban Rubio Romero: None declared, SALVADOR GARCÍA MORILLO: None declared, Mauricio Minguez: None declared, Cristina Fernández-Carballido: None declared, Eugenio de Miguel: None declared, Sheila Melchor: None declared, Eva Salgado-Pérez: None declared, Beatriz Bravo: None declared, Susana Romero-Yuste: None declared, Juan Salvatierra: None declared, Cristina Hidalgo: None declared, Sara Manrique Arija: None declared, C. Romero-Gómez: None declared, Patricia Moya: None declared, Noelia Alvarez-Rivas: None declared, Javier Mendizabal: None declared, Francisco Miguel Ortiz Sanjuan: None declared, I. Pérez de Pedro: None declared, JOSE LUIS ALONSO VALDIVIESO: None declared, Pérez Sánchez Laura: None declared, Roldán Molina Rosa: None declared, Nagore Fernández-Llanio: None declared, Ricardo Gómez de la Torre: None declared, Silvia Suarez: None declared, María Jesús Montesa: None declared, Monica Delgado Sanchez: None declared, J. Loricera: None declared, Belén Atienza-Mateo: None declared, Santos Castañeda: None declared, Miguel A González-Gay Grant/research support from: MAG-G received grants/research supports from Abbvie, MSD, Jansen and Roche and had consultation fees/participation in company sponsored speaker´s bureau from Abbvie, Pfizer, Roche, Sanofi, Lilly, Celgene and MSD, Ricardo Blanco Grant/research support from: RB received grants/research supports from Abbvie, MSD and Roche, and had consultation fees/participation in company sponsored speaker´s bureau from Abbvie, Lilly, Pfizer, Roche, Bristol-Myers, Janssen, UCB Pharma and MSD.
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Loureiro-Amigo J, Palacio-García C, Martínez-Gallo M, Martínez-Valle F, Ramentol-Sintas M, Solans-Laqué R. Utility of lymphocyte phenotype profile to differentiate primary Sjögren syndrome from Sicca syndrome. Rheumatology (Oxford) 2021; 60:5647-5658. [PMID: 33620072 DOI: 10.1093/rheumatology/keab170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 02/07/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND blood B cell profile has been proposed to have diagnostic utility in primary Sjögren syndrome (pSS), but the potential utility of advanced lymphocyte profiling to differentiate between pSS and Sicca syndrome has not been fully investigated. METHODS distribution of peripheral lymphocyte subpopulations was analysed by flow cytometry in 68 patients with pSS, 26 patients with Sicca syndrome and 23 healthy controls. The ability to discriminate between pSS and Sicca syndrome was analysed using the area under the curve (AUC) of the receiver operating characteristic curve of the different lymphocyte subsets. RESULTS the ratio between naïve/memory B cell proportions showed an AUC of 0.742 to differentiate pSS and Sicca syndrome, with a sensitivity of 76.6% and a specificity of 72% for a cut-off value of 3.4. The ratio of non-switched memory B cells to activated CD4+ T cells percentage (BNSM/CD4ACT) presented the highest AUC (0.840) with a sensitivity of 83.3% and specificity of 81.7% for a cut-off value < 4.1. To differentiate seronegative pSS patients from Sicca patients the BNSM/CD4ACT ratio exhibited an AUC of 0.742 (sensitivity 75%, specificity 66.7%, cut-off value < 4.4), and the number of naïve CD4 T cells had an AUC of 0.821 (sensitivity 76.9%, specificity 88.9%, cut-off value < 312/mm3). CONCLUSION patients with pSS show a profound imbalance in the distribution of circulating T and B lymphocytes subsets. The ratio BNSM/CD4ACT is useful to discriminate between pSS and Sicca syndrome.
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Affiliation(s)
- Jose Loureiro-Amigo
- Autoimmune Systemic Diseases Unit. Internal Medicine Department. Hospital Universitari Vall d'Hebron. Barcelona. Spain.,Department of Medicine, Faculty of Medicine. Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Carlos Palacio-García
- Flow Cytometry Unit, Haematology Department. Hospital Universitari Vall d'Hebron. Barcelona. Spain
| | - Mónica Martínez-Gallo
- Immunology Department. Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Fernando Martínez-Valle
- Autoimmune Systemic Diseases Unit. Internal Medicine Department. Hospital Universitari Vall d'Hebron. Barcelona. Spain.,Department of Medicine, Faculty of Medicine. Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Marc Ramentol-Sintas
- Autoimmune Systemic Diseases Unit. Internal Medicine Department. Hospital Universitari Vall d'Hebron. Barcelona. Spain
| | - Roser Solans-Laqué
- Autoimmune Systemic Diseases Unit. Internal Medicine Department. Hospital Universitari Vall d'Hebron. Barcelona. Spain.,Department of Medicine, Faculty of Medicine. Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
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Solans-Laqué R, Rodriguez-Carballeira M, Rios-Blanco JJ, Fraile G, Sáez-Comet L, Martinez-Zapico A, Frutos B, Solanich X, Fonseca-Aizpuru E, Pasquau-Liaño F, Zamora M, Oristrell J, Fanlo P, Lopez-Dupla M, Abdilla M, García-Sánchez I, Sopeña B, Castillo MJ, Perales I, Callejas JL. Comparison of the Birmingham Vasculitis Activity Score and the Five-Factor Score to Assess Survival in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis: A Study of 550 Patients From Spain (REVAS Registry). Arthritis Care Res (Hoboken) 2020; 72:1001-1010. [PMID: 31033198 DOI: 10.1002/acr.23912] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 04/23/2019] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To compare the accuracy of the Birmingham Vasculitis Activity Score (BVAS), version 3, and the Five Factor Score (FFS), version 1996 and version 2009, to assess survival in antineutrophil cytoplasmic antibody-associated vasculitis (AAV). METHODS A total of 550 patients with AAV (41.1% with granulomatosis with polyangiitis, 37.3% with microscopic polyangiitis, and 21.6% with eosinophilic granulomatosis with polyangiitis), diagnosed between 1990 and 2016, were analyzed. Receiver operating characteristic (ROC) curves and multivariable Cox analysis were used to assess the relationships between the outcome and the different scores. RESULTS Overall mortality was 33.1%. The mean ± SD BVAS at diagnosis was 17.96 ± 7.82 and was significantly higher in nonsurvivors than in survivors (mean ± SD 20.0 ± 8.14 versus 16.95 ± 7.47, respectively; P < 0.001). The mean ± SD 1996 FFS and 2009 FFS were 0.81 ± 0.94 and 1.47 ± 1.16, respectively, and were significantly higher in nonsurvivors than in survivors (mean ± SD 1996 FFS 1.17 ± 1.07 versus 0.63 ± 0.81 [P < 0.001] and 2009 FFS 2.13 ± 1.09 versus 1.15 ± 1.05 [P < 0.001], respectively). Mortality rates increased according to the different 1996 FFS and 2009 FFS categories. In multivariate analysis, BVAS, 1996 FFS, and 2009 FFS were significantly related to death (P = 0.007, P = 0.020, P < 0.001, respectively), but the stronger predictor was the 2009 FFS (hazard ratio 2.9 [95% confidence interval 2.4-3.6]). When the accuracy of BVAS, 1996 FFS, and 2009 FFS to predict survival was compared in the global cohort, ROC analysis yielded area under the curve values of 0.60, 0.65, and 0.74, respectively, indicating that 2009 FFS had the best performance. Similar results were obtained when comparing these scores in patients diagnosed before and after 2001 and when assessing the 1-year, 5-year, and long-term mortality. Correlation among BVAS and 1996 FFS was modest (r = 0.49; P < 0.001) but higher than between BVAS and the 2009 FFS (r = 0.28; P < 0.001). CONCLUSION BVAS and FFS are useful to predict survival in AAV, but the 2009 FFS has the best prognostic accuracy at any point of the disease course.
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Calderón-Goercke M, Prieto-Peña D, Castañeda S, Moriano C, Becerra-Fernández E, Revenga M, Alvarez-Rivas N, Galisteo C, Prior-Español Á, Galindez E, Hidalgo C, Manrique Arija S, De Miguel E, Salgado-Pérez E, Aldasoro V, Villa-Blanco I, Romero-Yuste S, Narváez J, Gomez-Arango C, Perez-Pampín E, Melero R, Sivera F, Fernández-Díaz C, Olive A, Álvarez del Buergo M, Marena Rojas L, Fernández-López C, Navarro F, Raya E, Arca B, Solans-Laqué R, Conesa A, Vázquez C, Román-Ivorra JA, Lluch P, Vela-Casasempere P, Torres-Martín C, Nieto JC, Ordas-Calvo C, Luna-Gomez C, Toyos Sáenz de Miera FJ, Fernández-Llanio N, García A, González-Vela C, García-Fernández J, Vicente-Gómez P, García-Manzanares Á, Ortego N, Ortiz-Sanjuán F, Corteguera M, Hernández JL, González-Gay MA, Blanco R. THU0297 SERIOUS INFECTIONS IN 134 PATIENTS WITH GIANT CELL ARTERITIS WITH TOCILIZUMAB IN CLINICAL PRACTICE. FREQUENCY, TYPE AND CLINICAL ASSOCIATIONS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Infections are the most common adverse event of Tocilizumab (TCZ) in Giant Cell Arteritis (GCA). In GiACTA study(1),serious infections were observed in 7% (9.6/100 patient-years) of patients who received TCZ weekly. Randomized clinical trials (RCTs) are conducted under highly standardized design excluding some real-world patients. Therefore, adverse events may be underestimated in RCTs. In our series of real-life, serious infections occurred in 11.9% (10.6/100 patient-years)(2).Objectives:In a wide series of GCA of clinical practice treated with TCZ, we assess the frequency, type and predisposing factors of serious infections.Methods:Multicenter study of 134 patients diagnosed with GCA, all of them refractory to conventional therapy, treated with TCZ. Serious infection was considered when a life-threatening infection, fatal, or requiring hospitalization occurred, intravenous antibiotics were required, or the infectious process led to persistent or significant disability.Results:16 of 134 (11.9%, 10.6/100 patient-years) patients developed serious infections during follow-up. The most frequent infections were pneumonia (n=4), urinary tract infection (n=4), and facial herpes zoster (n=2). At TCZ onset, serious infections were more frequent in older patients (74.3±9.6 vs 72.9±8.7 years), with a longer GCA evolution (20 [4.3-45.6] vs 13 [5-29.3] months), with visual manifestations (43.75% vs 17.8%) and a higher dose of prednisone at TCZ onset (30.4±15.5 vs 21.1±16.1 mg/day) (TABLE). Presence of comorbidities were similar in both groups. 13 of the 16 patients who had infections received a dose of prednisone greater than 15 mg/day (16.3/100 patient-years) compared to 3 patients under treatment with less than 15 mg/day of prednisone (4.2/100 patient-years).Conclusion:The age, GCA duration, ocular involvement and the dose of glucocorticoids, at TCZ onset, seem to be predisposing factors related to an increased risk of developing serious infections in GCA patients.References:[1]Stone JH, et al. N Engl J Med. 2017; 377:317-28.[2]Calderón-Goercke M et al. Semin Arthritis Rheum 2019 Aug;49(1): 126-135.TABLESERIOUS INFECTIONS(n=16)WITHOUT SERIOUS INFECTIONS(n=118)pBASAL FEATURES AT TCZ ONSETGENERAL FEATURES Age, years, mean± SD74.3±9.672.9±8.70.552 Sex, female/male n(%)13/388/300.760 Time from GCA diagnosis to TCZ onset (months), median [IQR]20[4.3-45.6]13[5-29.3]0.604COMORBIDITIES Hypertension, n(%)9(56)86(73)0.551 Diabetes, n(%)3(19)39(33)0.677 Chronic kidney disease, n(%)3(19)27(23)0.512CLINICAL FEATURES OF GCA PMR, n(%)9(56.25)64(54.2)0.879 Aortitis, n(%)5(31.25)53(45)0.301 Visual manifestations, n(%)7(43.75)21(17.8)0.017CORTICOSTEROIDS AT TCZ ONSET Prednisone dose mg/d, mean (SD)30.4±15.521.1±16.10.031Disclosure of Interests:Monica Calderón-Goercke: None declared, D. Prieto-Peña: None declared, Santos Castañeda: None declared, Clara Moriano: None declared, Elena Becerra-Fernández: None declared, Marcelino Revenga: None declared, Noelia Alvarez-Rivas: None declared, Carles Galisteo: None declared, Águeda Prior-Español: None declared, E. Galindez: None declared, Cristina Hidalgo: None declared, Sara Manrique Arija: None declared, Eugenio de Miguel Grant/research support from: Yes (Abbvie, Novartis, Pfizer), Consultant of: Yes (Abbvie, Novartis, Pfizer), Paid instructor for: yes (AbbVie, Novartis, Pfizer, MSD, BMS, UCB, Roche, Grunental, Janssen, Sanofi), Speakers bureau: yes (AbbVie, Novartis, Pfizer, MSD, BMS, UCB, Roche, Grunental, Janssen, Sanofi), Eva Salgado-Pérez: None declared, Vicente Aldasoro Speakers bureau: Roche, Abbvie, MSD, UCB, Pfizer, Menarini, Grunenthal, Gebro, Novartis, Janssen, Ignacio Villa-Blanco Consultant of: UCB, Speakers bureau: Novartis, MSD, Lilly, Susana Romero-Yuste: None declared, J. Narváez: None declared, Catalina Gomez-Arango: None declared, Eva Perez-Pampín: None declared, Rafael Melero: None declared, Francisca Sivera: None declared, Carlos Fernández-Díaz Speakers bureau: Brystol Meyers Squibb, Alejandro Olive: None declared, María Álvarez del Buergo: None declared, Luisa Marena Rojas: None declared, Carlos Fernández-López: None declared, Francisco Navarro: None declared, Enrique Raya: None declared, Beatriz Arca: None declared, Roser Solans-Laqué: None declared, Arantxa Conesa: None declared, Carlos Vázquez: None declared, Jose Andrés Román-Ivorra: None declared, Pau Lluch: None declared, Paloma Vela-Casasempere: None declared, Carmen Torres-Martín: None declared, Juan Carlos Nieto Speakers bureau: Pfizer, Abbvie, MSD, Novartis, Janssen, Lilly, Nordic Pharma, BMS, Gebro, FAES Farma, Roche, Sanofi, Carmen Ordas-Calvo: None declared, Cristina Luna-Gomez: None declared, Francisco J. Toyos Sáenz de Miera: None declared, Nagore Fernández-Llanio: None declared, Antonio García: None declared, Carmen González-Vela: None declared, Javier García-Fernández: None declared, Patricia Vicente-Gómez: None declared, Ángel García-Manzanares: None declared, Norberto Ortego: None declared, Francisco Ortiz-Sanjuán: None declared, Montserrat Corteguera: None declared, J. Luis Hernández: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD, Ricardo Blanco Grant/research support from: AbbVie, MSD, and Roche, Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, and MSD
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Prieto-Peña D, Calderón-Goercke M, Bernabéu P, Vela-Casasempere P, Narváez J, Fernández-López C, Freire González M, González-Alvarez B, Solans-Laqué R, Callejas-Rubio JL, Ortego N, Fernández-Díaz C, Rubio Romero E, García Morillo S, Minguez M, Fernández-Carballido C, De Miguel E, Melchor S, Salgado-Pérez E, Bravo B, Romero-Yuste S, Salvatierra J, Hidalgo C, Manrique Arija S, Romero-Gómez C, Moya P, Alvarez-Rivas N, Mendizabal J, Ortiz Sanjuan FM, Pérez de Pedro I, Loricera J, Castañeda S, González-Gay MA, Blanco R. SAT0270 TOCILIZUMAB IN REFRACTORY TAKAYASU ARTERITIS. OPEN-LABEL NATIONAL MULTICENTER STUDY OF 53 PATIENTS OF CLINICAL PRACTICE. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Tocilizumab (TCZ) was recently approved for Takayasu Arteritis (TAK) in Japan based on the results of the TAKT trial(1).However, data in clinical practice in Europe and America are scarce(2).Objectives:To assess efficacy and safety of TCZ in TAK of clinical practice in Spain.Methods:Observational, open-label multicentre study of 53 TAK patients treated with TCZ due to refractoriness or adverse events of previous therapy. Outcomes variables were improvement of clinical features, acute phase reactants and glucocorticoid-sparing effect.Results:53 patients (46w/7m); mean age, 40.6±14.6 years at TCZ onset. TCZ was started after a median of 12 [3.0-48.0] months from TAK diagnosis. In addition to systemic corticosteroids and before TCZ they received conventional immunosuppressant drugs (n=42) and biologic therapy (n=14). TCZ was prescribed as standard I.V. (n=42; 79.2%) or subcutaneous (n=11; 20.8%). The initial dose was 8 mg/kg/IV/4 weeks or 162 mg/SC/week, respectively. TCZ was used in monotherapy or combined with immunosuppressants (n=32; 60.4%): methotrexate (n=27), azathioprine (n=2), cyclosporine (n=3). Main clinical features at TCZ onset were: malaise (n=30),limb claudication (n=22), headache (n=18), fever (n=14), abdominal pain (n=10), and chest pain (n=9). Most of the patients experienced a rapid and maintained clinical, analytical improvement(TABLE).After a median follow-up of 18.0 [7.0-45.0] months, TCZ was discontinued in 20 patients due to: sustained remission (n=6), relapse (n=6), adverse event (n=5), gestation (n=3). Most relevant adverse side effects were serious infections: pneumonia (n=2), herpes zoster (n=1), abdominal sepsis (n=1).Table.Basal(N=53)Month 1(N=53)Month 3(N=46)Month 6(N=44)Month 12(N=34)Clinical improvement, n/N(%)Complete17/53 (32.1)19/46 (41.3)23/44 (52.3)26/34 (76.5)Partial30/53 (54.6)26/46 (56.5)18/44 (40.9)8/34 (23.5)No improvement6/53 (11.3)1/46 (2.2)3/44 (6.8)0/34 (0.0)Analytical markers,ESR (mm/1sth),median [IQR]35.0 [16.0-52.0]7.5 [3.0-14.0] *3.5 [2.0-8.0]*5.0[2.0-6.0]*5.0 [2.0-8.5]*CRP (mg/dL),median [IQR]1.7 [0.6 -3.5]0.21 [0.05-0.6]*0.14 [0.05-0.5]*0.14 [0.04-0.4]*0.10 [0.03-0.30]*Hb (g/dL),mean±SD12.3±1.512.8±1.2*12.9±1.3*12.9±1.4*12.9±1.4*Prednisone dose (mg/day),median [IQR]30.0 [15.0-50.0]20.0 [10.0-37.5]*10.0 [5.0-20.0]*5.0 [5.0-12.5]*5.0 [0.0-7.5]**Wilcoxon test p < 0.001.Conclusion:TCZ appears to be effective and safe in patients with refractory TAK in clinical practice.References:[1]Nakaoka Y et al. Ann Rheum Dis. 2018;77:348-354[2]Loricera J et al. Clin Exp Rheumatol. 2016; 34: S44-53.Disclosure of Interests:D. Prieto-Peña: None declared, Monica Calderón-Goercke: None declared, Pilar Bernabéu: None declared, Paloma Vela-Casasempere: None declared, J. Narváez: None declared, Carlos Fernández-López: None declared, Mercedes Freire González: None declared, Beatriz González-Alvarez: None declared, Roser Solans-Laqué: None declared, Jose Luis Callejas-Rubio: None declared, Norberto Ortego: None declared, Carlos Fernández-Díaz Speakers bureau: Brystol Meyers Squibb, Esteban Rubio Romero: None declared, SALVADOR GARCÍA MORILLO: None declared, Mauricio Minguez: None declared, Cristina Fernández-Carballido Consultant of: Yes, I have received fees for scientific advice (Abbvie, Celgene, Janssen, Lilly and Novartis), Speakers bureau: Yes, I have received fees as a speaker (Abbvie, Celgene, Janssen, Lilly, MSD, Novartis), Eugenio de Miguel Grant/research support from: Yes (Abbvie, Novartis, Pfizer), Consultant of: Yes (Abbvie, Novartis, Pfizer), Paid instructor for: yes (AbbVie, Novartis, Pfizer, MSD, BMS, UCB, Roche, Grunental, Janssen, Sanofi), Speakers bureau: yes (AbbVie, Novartis, Pfizer, MSD, BMS, UCB, Roche, Grunental, Janssen, Sanofi), Sheila Melchor: None declared, Eva Salgado-Pérez: None declared, Beatriz Bravo: None declared, Susana Romero-Yuste: None declared, J Salvatierra: None declared, Cristina Hidalgo: None declared, Sara Manrique Arija: None declared, C. Romero-Gómez: None declared, Patricia Moya: None declared, Noelia Alvarez-Rivas: None declared, Javier Mendizabal: None declared, Francisco Miguel Ortiz Sanjuan: None declared, I. Pérez de Pedro: None declared, Javier Loricera: None declared, Santos Castañeda: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD, Ricardo Blanco Grant/research support from: AbbVie, MSD, Roche, Consultant of: Abbvie, Eli Lilly, Pfizer, Roche, Bristol-Myers, Janssen, UCB Pharma and MSD, Speakers bureau: Abbvie, Eli Lilly, Pfizer, Roche, Bristol-Myers, Janssen, UCB Pharma. MSD
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Calderón-Goercke M, Prieto-Peña D, Castañeda S, Moriano C, Becerra-Fernández E, Revenga M, Alvarez-Rivas N, Galisteo C, Prior-Español Á, Galindez E, Hidalgo C, Manrique Arija S, De Miguel E, Salgado-Pérez E, Aldasoro V, Villa-Blanco I, Romero-Yuste S, Narváez J, Gomez-Arango C, Perez-Pampín E, Melero R, Sivera F, Olive A, Álvarez del Buergo M, Marena Rojas L, Fernández-López C, Navarro F, Raya E, Arca B, Solans-Laqué R, Conesa A, Vázquez C, Román-Ivorra JA, Lluch P, Vela-Casasempere P, Torres-Martín C, Nieto JC, Ordas-Calvo C, Luna-Gomez C, Toyos Sáenz de Miera FJ, Fernández-Llanio N, García A, Hernández JL, González-Gay MA, Blanco R. OP0033 OPTIMIZATION OF TOCILIZUMAB THERAPY IN GIANT CELL ARTERITIS. A MULTICENTER REAL-LIFE STUDY OF 134 PATIENTS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Tocilizumab (TCZ) is the only biological agent approved in Giant Cell Arteritis (GCA). There is general agreement on the initial and the standard maintenance dose of TCZ. However, information on duration and optimization of TCZ in GCA is scarce.Objectives:Our aim was to assess efficacy and safety of TCZ therapy optimization in an unselected wide series of GCA in clinical practice.Methods:Multicenter study, 134 patients with GCA who received TCZ due to inefficacy/adverse events of previous therapy. Once complete remission was reached and based on a shared decision between patient and physician TCZ was optimized in some cases. Optimization was done by decreasing the dose and/or prolonging the TCZ dosing interval progressively.Results:134 GCA patients treated with TCZ (101w/33m); mean age 73.0±8.8 years. TCZ was administered IV to 106 (79.1%) patients and SC to 28 (20.9%). TCZ was optimized in 43 (32.1%) patients. No demographic, clinical manifestations or laboratory data differences had been found at TCZ onset (TABLE). After a follow up of 12 [6-15.5] months, and a complete remission for 6 [3-12] months; the first TCZ optimization was performed. Median prednisone dose at first TCZ optimization was 2.5 [0-5] mg/day. TCZ IV was optimized from 8 to 4 mg/kg/4weeks in 12 of 106 (11.3%) and from 162 mg/SC/week to 162 mg/SC/2weeks in 9 of 28 (32.1%) cases. Five (11.6%) of the 43 optimized cases relapsed. In 4 cases, the relapses were treated increasing TCZ up to the pre-optimization dose, in 1 case the route of administration was change (4 mg/kg/4week to 162 mg/SC/week). In 8 of 43 optimized patients (18.6%), it was possible to withdraw TCZ after complete remission for 30 [16.25-45.75] months. Regarding adverse events and severe infections were similar in both groups. The mean TCZ treatment costs were lower in the optimized group.Conclusion:Once remission is reached in GCA patients under TCZ treatment, optimization of TCZ may be performed. Based on our experience it could be performed by reducing the dose with IV TCZ or by prolonging dosing interval with SC TCZ.References:[1]Calderón-Goercke M et al. Semin Arthritis Rheum 2019 Aug;49(1): 126-135.TABLE.OPTIMIZED-TCZ GROUP (n=43)NON-OPTIMIZED TCZ GROUP (n=91)pBASAL FEATURES AT TCZ ONSETGENERAL FEATURESAge, years, mean± SD68.9±8.771.4±8.50.125Sex, female/male n(%)32/1068/240.779Time from GCA diagnosis to TCZ onset (months), median [IQR]19.5[7.75-45]10.5[4 – 25]0.047SYSTEMIC MANIFESTATIONSFever, n(%)1(2.4)8(8.7)0.176Constitutional syndrome, n(%)11(26.2)19(20.7)0.476PMR, n(%)18(42.9)56(60.9)0.052ISCHEMIC MANIFESTATIONSVisual involvement, n(%)5(11.9)23(25)0.084Headache, n(%)26(61.9)42(45.7)0.081Jaw claudication, n(%)1(2.4)11(12)0.072CORTICOSTEROIDS AT TCZ ONSETPrednisone dose, mg/d mean (SD)15.1±11.125±17.40.001FOLLOW-UP ON TCZ THERAPY (MONTHS), MEDIAN [IQR]24[18-27]6 [3-18]0.000Relapses, n(%)5(11.6)5(5.5)0.207End follow-up remission, n(%)40(93)84(92)0.99Severe side efects, n(%)14(32.6)22(24.2)0.307Seriuos infections, n(%)6(14)10(11)0.878Cost, (mean) euros per yearIVSC7 538.47 329.011 726.411 726.4--Disclosure of Interests:Monica Calderón-Goercke: None declared, D. Prieto-Peña: None declared, Santos Castañeda: None declared, Clara Moriano: None declared, Elena Becerra-Fernández: None declared, Marcelino Revenga: None declared, Noelia Alvarez-Rivas: None declared, Carles Galisteo: None declared, Águeda Prior-Español: None declared, E. Galindez: None declared, Cristina Hidalgo: None declared, Sara Manrique Arija: None declared, Eugenio de Miguel Grant/research support from: Yes (Abbvie, Novartis, Pfizer), Consultant of: Yes (Abbvie, Novartis, Pfizer), Paid instructor for: yes (AbbVie, Novartis, Pfizer, MSD, BMS, UCB, Roche, Grunental, Janssen, Sanofi), Speakers bureau: yes (AbbVie, Novartis, Pfizer, MSD, BMS, UCB, Roche, Grunental, Janssen, Sanofi), Eva Salgado-Pérez: None declared, Vicente Aldasoro Speakers bureau: Roche, Abbvie, MSD, UCB, Pfizer, Menarini, Grunenthal, Gebro, Novartis, Janssen, Ignacio Villa-Blanco Consultant of: UCB, Speakers bureau: Novartis, MSD, Lilly, Susana Romero-Yuste: None declared, J. Narváez: None declared, Catalina Gomez-Arango: None declared, Eva Perez-Pampín: None declared, Rafael Melero: None declared, Francisca Sivera: None declared, Alejandro Olive: None declared, María Álvarez del Buergo: None declared, Luisa Marena Rojas: None declared, Carlos Fernández-López: None declared, Francisco Navarro: None declared, Enrique Raya: None declared, Beatriz Arca: None declared, Roser Solans-Laqué: None declared, Arantxa Conesa: None declared, Carlos Vázquez: None declared, Jose Andrés Román-Ivorra: None declared, Pau Lluch: None declared, Paloma Vela-Casasempere: None declared, Carmen Torres-Martín: None declared, Juan Carlos Nieto Speakers bureau: Pfizer, Abbvie, MSD, Novartis, Janssen, Lilly, Nordic Pharma, BMS, Gebro, FAES Farma, Roche, Sanofi, Carmen Ordas-Calvo: None declared, Cristina Luna-Gomez: None declared, Francisco J. Toyos Sáenz de Miera: None declared, Nagore Fernández-Llanio: None declared, Antonio García: None declared, J. Luis Hernández: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD, Ricardo Blanco Grant/research support from: AbbVie, MSD, and Roche, Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, and MSD
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Calderón-Goercke M, Castañeda S, Aldasoro V, Villa I, Prieto-Peña D, Atienza-Mateo B, Patiño E, Moriano C, Romero-Yuste S, Narváez J, Gómez-Arango C, Pérez-Pampín E, Melero R, Becerra-Fernández E, Revenga M, Álvarez-Rivas N, Galisteo C, Sivera F, Olivé-Marqués A, Álvarez Del Buergo M, Marena-Rojas L, Fernández-López C, Navarro F, Raya E, Galindez-Agirregoikoa E, Arca B, Solans-Laqué R, Conesa A, Hidalgo C, Vázquez C, Román-Ivorra JA, Loricera J, Lluch P, Manrique-Arija S, Vela P, De Miguel E, Torres-Martín C, Nieto JC, Ordas-Calvo C, Salgado-Pérez E, Luna-Gomez C, Toyos-Sáenz de Miera FJ, Fernández-Llanio N, García A, Larena C, González-Vela C, Corrales A, Varela-García M, Aurrecoechea E, Dos Santos R, García-Manzanares Á, Ortego N, Fernández S, Ortiz-Sanjuán F, Corteguera M, Hernández JL, González-Gay MÁ, Blanco R. Tocilizumab in giant cell arteritis: differences between the GiACTA trial and a multicentre series of patients from the clinical practice. Clin Exp Rheumatol 2020; 38 Suppl 124:112-119. [PMID: 32441643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 04/06/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES A potential point of concern among clinicians is whether results derived from the clinical trials can be reasonably applied or generalised to a definable group of patients seen in real world. It can be the case of the GiACTA study that is a phase III randomised controlled trial of tocilizumab (TCZ) in giant cell arteritis (GCA). To address this question, we compared the clinical features and the responses to TCZ from the GiACTA trial patients with those from a series of GCA seen in the daily clinical practice. METHODS Comparative study of clinical features between patients from the GiACTA trial (overall n=251) and those from a multicentre series of real-world GCA patients undergoing TCZ therapy (n=134). The diagnosis of GCA in the GiACTA trial was established by the ACR modified criteria whereas in the series of real-world patients it was made by using the ACR criteria, a positive biopsy of temporal artery or the presence of imaging techniques consistent with large-vessel vasculitis in individuals who presented cranial symptoms of GCA. GiACTA trial patients received subcutaneous TCZ (162 mg every 1 or 2 weeks) whereas those from the clinical practice series were treated using standard IV dose (8 mg/kg/month) or subcutaneous (162 mg/week). RESULTS Real-life patients undergoing TCZ were older with longer disease duration and higher values of ESR and had received conventional immunosuppressive therapy (mainly methotrexate) more commonly than those included in the GiACTA trial. Despite clinical differences, TCZ was equally effective in both GiACTA trial and clinical practice patients. However, serious infections were more commonly observed in GCA patients recruited from the clinical practice. CONCLUSIONS Despite clinical differences with patients recruited in clinical trials, data from real-life patients confirm the efficacy of TCZ in GCA.
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Affiliation(s)
- Mónica Calderón-Goercke
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Santos Castañeda
- Department of Rheumatology, Hospital Universitario de La Princesa, IIS-Princesa, Madrid; Cátedra UAM-Roche, EPID-Future, Universidad Autónoma (UAM), Madrid, Spain
| | - Vicente Aldasoro
- Department of Rheumatology, Complejo Hospitalario de Navarra, Spain
| | - Ignacio Villa
- Department of Rheumatology, Hospital de Sierrallana, Torrelavega, Cantabria, Spain
| | - Diana Prieto-Peña
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Belén Atienza-Mateo
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Esther Patiño
- Department of Rheumatology, Hospital Universitario de La Princesa, IIS-Princesa, Madrid; Cátedra UAM-Roche, EPID-Future, Universidad Autónoma (UAM), Madrid, Spain
| | - Clara Moriano
- Department of Rheumatology, Complejo Asistencial Universitario de León, Spain
| | - Susana Romero-Yuste
- Department of Rheumatology, Complejo Hospitalario Universitario Pontevedra, Spain
| | - Javier Narváez
- Department of Rheumatology, Hospital de Bellvitge, Barcelona, Spain
| | | | - Eva Pérez-Pampín
- Department of Rheumatology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Rafael Melero
- Department of Rheumatology, Complexo Hospitalario Universitario de Vigo, Spain
| | | | | | | | - Carles Galisteo
- Department of Rheumatology, Hospital Parc Taulí, Barcelona, Spain
| | - Francisca Sivera
- Department of Rheumatology, Hospital Universitario de Elda, Alicante, Spain
| | | | | | - Luisa Marena-Rojas
- Department of Rheumatology, Hospital La Mancha Centro, Alcázar de San Juan, Spain
| | | | - Francisco Navarro
- Department of Rheumatology, Hospital General Universitario de Elche, Alicante, Spain
| | - Enrique Raya
- Department of Rheumatology and Internal Medicine, Hospital San Cecilio, Granada, Spain
| | | | - Beatriz Arca
- Department of Rheumatology, Hospital Universitario San Agustín, Avilés, Spain
| | - Roser Solans-Laqué
- Department of Internal Medicine, Hospital Valle de Hebrón, Barcelona, Spain
| | - Arantxa Conesa
- Department of Rheumatology, Hospital General Universitario de Castellón, Spain
| | - Cristina Hidalgo
- Department of Rheumatology, Complejo Asistencial Universitario de Salamanca, Spain
| | - Carlos Vázquez
- Department of Rheumatology, Hospital Miguel Servet, Zaragoza, Spain
| | | | - Javier Loricera
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Pau Lluch
- Department of Rheumatology, Hospital Mateu Orfila, Menorca, Spain
| | | | - Paloma Vela
- Department of Rheumatology, Hospital General Universitario de Alicante, Spain
| | | | | | - Juan Carlos Nieto
- Department of Rheumatology, Hospital Gregorio Marañón, Madrid, Spain
| | | | - Eva Salgado-Pérez
- Department of Rheumatology, Complejo Hospitalario Universitario de Ourense, Spain
| | - Cristina Luna-Gomez
- Department of Rheumatology, Hospital Universitario Nuestra Señora de la Candelaria, Tenerife, Spain
| | | | | | - Antonio García
- Department of Rheumatology, Hospital Virgen de las Nieves, Granada, Spain
| | - Carmen Larena
- Department of Rheumatology, Hospital Ramón y Cajal, Madrid, Spain
| | - Carmen González-Vela
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Alfonso Corrales
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - María Varela-García
- Department of Rheumatology, Hospital Universitario de La Princesa, IIS-Princesa, Madrid; Cátedra UAM-Roche, EPID-Future, Universidad Autónoma (UAM), Madrid, Spain
| | - Elena Aurrecoechea
- Department of Rheumatology, Hospital de Sierrallana, Torrelavega, Cantabria, Spain
| | - Raquel Dos Santos
- Department of Rheumatology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | | | - Norberto Ortego
- Department of Rheumatology and Internal Medicine, Hospital San Cecilio, Granada, Spain
| | - Sabela Fernández
- Department of Rheumatology, Hospital Universitario San Agustín, Avilés, Spain
| | | | | | - José L Hernández
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Miguel Á González-Gay
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain.
| | - Ricardo Blanco
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain.
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Calderón-Goercke M, Loricera J, Aldasoro V, Castañeda S, Villa I, Humbría A, Moriano C, Romero-Yuste S, Narváez J, Gómez-Arango C, Pérez-Pampín E, Melero R, Becerra-Fernández E, Revenga M, Álvarez-Rivas N, Galisteo C, Sivera F, Olivé-Marqués A, Álvarez Del Buergo M, Marena-Rojas L, Fernández-López C, Navarro F, Raya E, Galindez-Agirregoikoa E, Arca B, Solans-Laqué R, Conesa A, Hidalgo C, Vázquez C, Román-Ivorra JA, Lluch P, Manrique-Arija S, Vela P, De Miguel E, Torres-Martín C, Nieto JC, Ordas-Calvo C, Salgado-Pérez E, Luna-Gomez C, Toyos-Sáenz de Miera FJ, Fernández-Llanio N, García A, Larena C, Palmou-Fontana N, Calvo-Río V, Prieto-Peña D, González-Vela C, Corrales A, Varela-García M, Aurrecoechea E, Dos Santos R, García-Manzanares Á, Ortego N, Fernández S, Ortiz-Sanjuán F, Corteguera M, Hernández JL, González-Gay MÁ, Blanco R. Tocilizumab in giant cell arteritis. Observational, open-label multicenter study of 134 patients in clinical practice. Semin Arthritis Rheum 2019; 49:126-135. [PMID: 30655091 DOI: 10.1016/j.semarthrit.2019.01.003] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [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: 09/10/2018] [Revised: 12/14/2018] [Accepted: 01/02/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Tocilizumab (TCZ) has shown efficacy in clinical trials on giant cell arteritis (GCA). Real-world data are scarce. Our objective was to assess efficacy and safety of TCZ in unselected patients with GCA in clinical practice Methods: Observational, open-label multicenter study from 40 national referral centers of GCA patients treated with TCZ due to inefficacy or adverse events of previous therapy. Outcomes variables were improvement of clinical features, acute phase reactants, glucocorticoid-sparing effect, prolonged remission and relapses. A comparative study was performed: (a) TCZ route (SC vs. IV); (b) GCA duration (≤6 vs. >6 months); (c) serious infections (with or without); (d) ≤15 vs. >15 mg/day at TCZ onset. RESULTS 134 patients; mean age, 73.0 ± 8.8 years. TCZ was started after a median [IQR] time from GCA diagnosis of 13.5 [5.0-33.5] months. Ninety-eight (73.1%) patients had received immunosuppressive agents. After 1 month of TCZ 93.9% experienced clinical improvement. Reduction of CRP from 1.7 [0.4-3.2] to 0.11 [0.05-0.5] mg/dL (p < 0.0001), ESR from 33 [14.5-61] to 6 [2-12] mm/1st hour (p < 0.0001) and decrease in patients with anemia from 16.4% to 3.8% (p < 0.0001) were observed. Regardless of administration route or disease duration, clinical improvement leading to remission at 6, 12, 18, 24 months was observed in 55.5%, 70.4%, 69.2% and 90% of patients. Most relevant adverse side-effect was serious infections (10.6/100 patients-year), associated with higher doses of prednisone during the first three months of therapy. CONCLUSION In clinical practice, TCZ yields a rapid and maintained improvement of refractory GCA. Serious infections appear to be higher than in clinical trials.
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Affiliation(s)
- Mónica Calderón-Goercke
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Javier Loricera
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Vicente Aldasoro
- Department of Rheumatology, Complejo Hospitalario de Navarra, Navarra, Spain
| | - Santos Castañeda
- Department of Rheumatology, Hospital Universitario de La Princesa, IIS-Princesa, Madrid, Spain
| | - Ignacio Villa
- Department of Rheumatology, Hospital de Sierrallana, Torrelavega, Spain
| | - Alicia Humbría
- Department of Rheumatology, Hospital Universitario de La Princesa, IIS-Princesa, Madrid, Spain
| | - Clara Moriano
- Department of Rheumatology, Complejo Asistencial Universitario de León, León, Spain
| | - Susana Romero-Yuste
- Department of Rheumatology, Complejo Hospitalario Universitario Pontevedra, Spain
| | - Javier Narváez
- Department of Rheumatology, Hospital de Bellvitge, Barcelona, Spain
| | | | - Eva Pérez-Pampín
- Department of Rheumatology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Rafael Melero
- Department of Rheumatology, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | | | | | | | - Carles Galisteo
- Department of Rheumatology, Hospital Parc Taulí, Barcelona, Spain
| | - Francisca Sivera
- Department of Rheumatology, Hospital Universitario de Elda, Alicante, Spain
| | | | | | - Luisa Marena-Rojas
- Department of Rheumatology, Hospital La Mancha Centro, Alcázar de San Juan, Spain
| | | | - Francisco Navarro
- Department of Rheumatology, Hospital General Universitario de Elche, Alicante, Spain
| | - Enrique Raya
- Department of Rheumatology and Internal Medicine, Hospital San Cecilio, Granada, Spain
| | | | - Beatriz Arca
- Department of Rheumatology, Hospital Universitario San Agustín, Avilés, Spain
| | - Roser Solans-Laqué
- Department of Internal Medicine, Hospital Valle de Hebrón, Barcelona, Spain
| | - Arantxa Conesa
- Department of Rheumatology, Hospital General Universitario de Castellón, Spain
| | - Cristina Hidalgo
- Department of Rheumatology, Complejo Asistencial Universitario de Salamanca, Spain
| | - Carlos Vázquez
- Department of Rheumatology, Hospital Miguel Servet, Zaragoza, Spain
| | | | - Pau Lluch
- Department of Rheumatology, Hospital Mateu Orfila, Menorca, Spain
| | | | - Paloma Vela
- Department of Rheumatology, Hospital General Universitario de Alicante, Alicante, Spain
| | | | | | - Juan Carlos Nieto
- Department of Rheumatology, Hospital Gregorio Marañón, Madrid, Spain
| | | | - Eva Salgado-Pérez
- Department of Rheumatology, Complejo Hospitalario Universitario de Ourense, Ourense, Spain
| | - Cristina Luna-Gomez
- Department of Rheumatology, Hospital Universitario Nuestra Señora de la Candelaria, Tenerife, Spain
| | | | | | - Antonio García
- Department of Rheumatology, Hospital Virgen de las Nieves, Granada, Spain
| | - Carmen Larena
- Department of Rheumatology, Hospital Ramón y Cajal, Madrid, Spain
| | - Natalia Palmou-Fontana
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Vanesa Calvo-Río
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Diana Prieto-Peña
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Carmen González-Vela
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Alfonso Corrales
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - María Varela-García
- Department of Rheumatology, Complejo Hospitalario de Navarra, Navarra, Spain
| | | | - Raquel Dos Santos
- Department of Rheumatology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | | | - Norberto Ortego
- Department of Rheumatology and Internal Medicine, Hospital San Cecilio, Granada, Spain
| | - Sabela Fernández
- Department of Rheumatology, Hospital Universitario San Agustín, Avilés, Spain
| | | | | | - José L Hernández
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Miguel Á González-Gay
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain.
| | - Ricardo Blanco
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain.
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Fernández-Codina A, Simó M, Martínez-Valle F, Solans-Laqué R. Takayasu's arteritis relapse. Joint Bone Spine 2017; 85:119. [PMID: 28249725 DOI: 10.1016/j.jbspin.2017.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 02/01/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Andreu Fernández-Codina
- Systemic Autoimmune Diseases Unit, Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
| | - Marc Simó
- Nuclear Medicine Department, Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Fernando Martínez-Valle
- Systemic Autoimmune Diseases Unit, Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Roser Solans-Laqué
- Systemic Autoimmune Diseases Unit, Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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Solans-Laqué R, Fraile G, Rodriguez-Carballeira M, Caminal L, Castillo MJ, Martínez-Valle F, Sáez L, Rios JJ, Solanich X, Oristrell J, Pasquau F, Fonseca E, Zamora M, Callejas JL, Frutos B, Abdilla M, Fanlo P, García-Sánchez I, López-Dupla M, Sopeña B, Pérez-Iglesias A, Bosch JA. Clinical characteristics and outcome of Spanish patients with ANCA-associated vasculitides: Impact of the vasculitis type, ANCA specificity, and treatment on mortality and morbidity. Medicine (Baltimore) 2017; 96:e6083. [PMID: 28225490 PMCID: PMC5569416 DOI: 10.1097/md.0000000000006083] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The aim of this study was to describe the clinical characteristics of ANCA-associated vasculitides (AAV) at presentation, in a wide cohort of Spanish patients, and to analyze the impact of the vasculitis type, ANCA specificity, prognostic factors, and treatments administered at diagnosis, in the outcome.A total of 450 patients diagnosed between January 1990 and January 2014 in 20 Hospitals from Spain were included. Altogether, 40.9% had granulomatosis with polyangiitis (GPA), 37.1% microscopic polyangiitis (MPA), and 22% eosinophilic granulomatosis with polyangiitis (EGPA). The mean age at diagnosis was 55.6 ± 17.3 years, patients with MPA being significantly older (P < 0.001). Fever, arthralgia, weight loss, respiratory, and ear-nose-throat (ENT) symptoms, were the most common at disease onset. ANCAs tested positive in 86.4% of cases: 36.2% C-ANCA-PR3 and 50.2% P-ANCA-MPO. P-ANCA-MPO was significantly associated with an increased risk for renal disease (OR 2.6, P < 0.001) and alveolar hemorrhage (OR 2, P = 0.010), while C-ANCA-PR3 was significantly associated with an increased risk for ENT (OR 3.4, P < 0.001) and ocular involvement (OR 2.3, P = 0.002). All patients received corticosteroids (CS) and 74.9% cyclophosphamide (CYC). The median follow-up was 82 months (IQR 100.4). Over this period 39.9% of patients suffered bacterial infections and 14.6% opportunistic infections, both being most prevalent in patients with high-cumulated doses of CYC and CS (P < 0.001). Relapses were recorded in 36.4% of cases with a mean rate of 2.5 ± 2.3, and were more frequent in patients with C-ANCA-PR3 (P = 0.012). The initial disease severity was significantly associated with mortality but not with the occurrence of relapses. One hundred twenty-nine (28.7%) patients (74 MPA, 41 GPA, 14 EGPA) died. The mean survival was 58 months (IQR 105) and was significantly lower for patients with MPA (P < 0.001). Factors independently related to death were renal involvement (P = 0.010), cardiac failure (P = 0.029) and age over 65 years old (P < 0.001) at disease onset, and bacterial infections (P < 0.001). An improved outcome with significant decrease in mortality and treatment-related morbidity was observed in patients diagnosed after 2000, and was related to the implementation of less toxic regimens adapted to the disease activity and stage, and a drastic reduction in the cumulated CYC and CS dose.
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Solans-Laqué R, Fraile G, Escalante B, Fonseca E, Martinez-Zapico A, Perez-Conesa M, Abdilla M, Montegaudo M, Caminal L, Gracia B, Del Castillo M, Fanlo P, Ramentol M. SAT0365 Risk Factors for Visual Loss in Giant Cell Arteritis (GCA). Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.5355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Fernández-Codina A, Pinal-Fernández I, Orozco-Gálvez O, Solans-Laqué R, Bujan-Rivas S, Fonollosa-Plà V, Vilardell-Tarrés M, Martínez-Valle F. THU0570 Use of Disease-Modifying anti-Rheumatic Drugs in A Cohort of Patients with IGG4-Related Disease. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Solans-Laqué R, Rodriguez-Carballeira M, Rios J, Saez L, Fraile G, Solanich X, Pasquau F, Oristrell J, Fonseca E, Callejas J, Zamora M, del Castillo M, Frutos B, Caminal L, Abdilla M, Fanlo P, Garcia-Sanchez I, Sopeña B, Lopez-Dupla M, Perez-Iglesias A. FRI0388 Ussefulnes of Bvas and Ffs at Diagnosis To Predict Survival in Anca Associated Vasculitis (AAV). Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Loureiro-Amigo J, Pujol-Borrell R, Marín-Sánchez A, Solans-Laqué R, Mestre-Torres J. AB0549 Anca Testing in A Cohort of Patients from A Single Centre. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Rodriguez-Carballeira M, Fraile G, Martinez-valle F, Saez L, Rios J, Solanich X, Pasquau F, Fonseca E, Zamora M, Calleja J, Oristrell J, Frutos B, Abdilla M, Castillo M, Caminal L, Fanlo P, Garcia-Sanchez I, Sopeña B, Lopez-Dupla M, Perez A, Solans-Laqué R. FRI0362 Pronostic Factors of Survival in ANCA-Associated Vasculitis (AAV). Changes in The New Century. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Balada E, Selva-O'Callaghan A, Felip L, Ordi-Ros J, Simeón-Aznar CP, Solans-Laqué R, Vilardell-Tarrés M. Sequence analysis of TMEM173 exon 5 in patients with systemic autoimmune diseases. Autoimmunity 2015; 49:12-6. [PMID: 26593864 DOI: 10.3109/08916934.2015.1113404] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 12/22/2022]
Abstract
BACKGROUND Overactivation of the interferon pathways has been demonstrated in patients suffering from different systemic autoimmune diseases (SADs). Genetic associations have been described for many genes involved in these pathways. Gain-of-function mutations in the TMEM173 gene have recently been reported in patients with autoinflammatory diseases that share some clinical features with SADs. METHODS We aimed at detecting the reported three mutations of transmembrane protein 173 (TMEM173) exon 5 in 100 patients suffering from: systemic lupus erythematosus (SLE) (n = 22), primary antiphospholipid syndrome (PAPS) (n = 20), systemic sclerosis (SSc) (n = 20), dermatomyositis (DM) (n = 20), and vasculitis (n = 18). Samples from 19 healthy controls were also included. Sequence analyses were performed from the derived TMEM173 exon 5 PCR fragment amplified from DNA obtained from whole blood. RESULTS Neither mutations nor single nucleotide polymorphisms (SNPs) in the exon 5 of the TMEM173 gene were detected. Just the rs7380272 SNP, located in the intronic region upstream exon 5, was detected in some patients and controls. The allele frequency of this SNP, though, was not statistically different between the patients groups and the control group. CONCLUSIONS Our study demonstrates the lack of association between the presence of SADs and mutations in exon 5 of the TMEM173 gene. SADs are complex multifactorial diseases in which not just one but probably many different genetic alterations may coexist. Although we cannot rule out the possibility that other variations may exist in other regions of this gene, we think that studies must be directed towards the analysis of other genes which, as TMEM173, also code for nucleic acid sensors that activate the nucleic-acid induced type I IFN pathway.
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Affiliation(s)
- E Balada
- a Research Unit in Systemic Autoimmune Diseases, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona , Barcelona , Spain
| | - A Selva-O'Callaghan
- a Research Unit in Systemic Autoimmune Diseases, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona , Barcelona , Spain
| | - L Felip
- a Research Unit in Systemic Autoimmune Diseases, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona , Barcelona , Spain
| | - J Ordi-Ros
- a Research Unit in Systemic Autoimmune Diseases, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona , Barcelona , Spain
| | - C P Simeón-Aznar
- a Research Unit in Systemic Autoimmune Diseases, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona , Barcelona , Spain
| | - R Solans-Laqué
- a Research Unit in Systemic Autoimmune Diseases, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona , Barcelona , Spain
| | - M Vilardell-Tarrés
- a Research Unit in Systemic Autoimmune Diseases, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona , Barcelona , Spain
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Fernández-Codina A, Martínez-Valle F, Pinilla B, López C, DeTorres I, Solans-Laqué R, Fraile-Rodríguez G, Casanovas-Martínez A, López-Dupla M, Robles-Marhuenda Á, Barragán-González MJ, Cid MC, Prieto-González S, Brito-Zerón P, Cruces-Moreno MT, Fonseca-Aizpuru E, López-Torres M, Gil J, Núñez-Fernández MJ, Pardos-Gea J, Salvador-Cervelló G. IgG4-Related Disease: Results From a Multicenter Spanish Registry. Medicine (Baltimore) 2015; 94:e1275. [PMID: 26266361 PMCID: PMC4616706 DOI: 10.1097/md.0000000000001275] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IgG4-related disease (IgG4-RD) is a rare entity consisting of inflammation and fibrosis that has been described in multiple organs. Concrete diagnostic criteria have been established recently and there is a lack of large series of patients.To describe the clinical presentation, histopathological characteristics, treatment and evolution of a series of IgG4-RD Spanish patients.A retrospective multicenter study was performed. Twelve hospitals across Spain included patients meeting the current 2012 consensus criteria on IgG4-RD diagnosis.Fifty-five patients were included in the study, 38 of whom (69.1%) were male. Median age at diagnosis was 53 years. Thirty (54.5%) patients were included in the Histologically Highly Suggestive IgG4-RD group and 25 (45.5%) in the probable IgG4-RD group. Twenty-six (47.3%) patients had more than 1 organ affected at presentation. The most frequently affected organs were: retroperitoneum, orbital pseudotumor, pancreas, salivary and lachrymal glands, and maxillary sinuses.Corticosteroids were the mainstay of treatment (46 patients, 83.6%). Eighteen patients (32.7%) required additional immunosuppressive agents. Twenty-four (43.6%) patients achieved a complete response and 26 (43.7%) presented a partial response (<50% of regression) after 22 months of follow-up. No deaths were attributed directly to IgG4-RD and malignancy was infrequent.This is the largest IgG4-RD series reported in Europe. Patients were middle-aged males, with histologically probable IgG4-RD. The systemic form of the disease was frequent, involving mainly sites of the head and abdomen. Corticosteroids were an effective first line treatment, sometimes combined with immunosuppressive agents. Neither fatalities nor malignancies were attributed to IgG4-RD.
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Affiliation(s)
- Andreu Fernández-Codina
- From the Internal Medicine Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain (AF-C, FM-V, RS-L, JP-G); Hospital General Universitario Gregorio Marañón, Madrid, Spain (BP, CL); Pathology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain (IDT); Hospital Ramón y Caja, Madrid, Spain (GF-R); Consorci Sanitari Parc Taulí, Spain (AC-M); Hospital Universitari Joan XXIII, Tarragona, Spain (ML-D); Hospital La Paz, Madrid, Spain (AR-M); Hospital Valle del Nalón, Langreo, Spain (MJB-G); Hospital Clínic i Provincial, Barcelona, Spain (MCC, SP-G, PB-Z); Hospital Universitario San Cecilio, Granada, Spain (MTC-M); Hospital de Cabueñes, Gijón, Spain (EF-A); Hospital Universitario La Princesa, Madrid, Spain (ML-T); Hospital Universitario Río Hortega, Valladolid, Spain (JG); Complejo Hospitalario de Pontevedra, Pontevedra, Spain (MJN-F); and Hospital de Manises, Manises, Spain (GS-C)
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Solans-Laqué R, Rodriguez-Carballeira M, Fraile G, Castillo M, Rios J, Saez L, Solanich X, Caminal L, Oristrell J, Pasquau F, Fonseca E, Calleja J, Zamora M, Fanlo P, Abdilla M, Garcia I, Sopeña B, Lopez-Dupla M, Pérez A, Frutos B. FRI0275 Long-Term Survival and Baseline Prognostic Factors in a Wide Series of Patients with AAV from Spain. Usefulness of Prognostic Scores (Revas Study). Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.4229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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30
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Balada E, Ramentol M, Felip L, Ordi-Ros J, Selva-O’Callaghan A, Simeón-Aznar C, Solans-Laqué R, Vilardell-Tarrés M. Prevalence of HHV-8 in systemic autoimmune diseases. J Clin Virol 2015; 62:84-8. [DOI: 10.1016/j.jcv.2014.11.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 11/04/2014] [Accepted: 11/15/2014] [Indexed: 10/24/2022]
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Rodríguez-Carballeira M, Alba MA, Solans-Laqué R, Castillo MJ, Ríos-Fernández R, Larrañaga JR, Martínez-Berriotxoa A, Espinosa G. Registry of the Spanish network of Behçet's disease: a descriptive analysis of 496 patients. Clin Exp Rheumatol 2014; 32:S33-S39. [PMID: 24480539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Accepted: 11/07/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To describe the clinical features of a large cohort of 496 Spanish patients with Behçet's disease (BD) and to analyse if patient's sex influenced the initial and cumulated prevalence of disease manifestations. METHODS Retrospective and descriptive study of 496 patients recruited in sixteen centres on the frame of the Spanish Registry of Behçet Disease Project Group. Demographic and clinical data are presented in addition to treatments and their related adverse effects. Clinical features at disease onset and during follow-up were compared according to the sex of the patients. RESULTS On the whole series, female to male ratio was 1.2:1.0. Mean age at disease onset was 28.7±12.6 years (range 17-73). Oral ulcers were the most frequent initial manifestation presented in 52.0% of patients. During follow-up, eye inflammatory disease was recorded in 45.1% of patients; thrombosis in 19.7% and central nervous system involvement in 13.5%. Men had higher prevalence of ocular involvement and venous thrombosis (52.5% vs. 39.2%, p=0.004 and 26.3% vs. 9.6%, p<0.001, respectively). CONCLUSIONS Spanish patients with BD presented similar clinical characteristics as their counterpart in the same geographical area and other world regions. In addition, we confirmed that ocular and vascular involvements are more frequent in men than in women.
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Solans-Laqué R, Fraile G, Castillo M, Solanich X, Caminal L, Rodriguez M, Rios J, Zamora M, Calleja J, Fanlo P, Garcia I, Saez L, Oristrell J, Abdilla M, Pasquau F, Lopez-Dupla M, Perez A, Fonseca E, Sopeña B. SAT0288 Eosinophilic Granulomatosis with Poliangeitis (EGPA): Clinical Features and Outcome in A Large Serie of Spanish Patients. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.4714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Paija X, Bosch J, Pallisa E, Martinez-Valle F, Ramentol M, Bujan S, Solans-Laqué R. AB0548 Interstitial Lung Disease (ILD) in Primary SjÖGren Syndrome: Clinical, Immunological and Radiological Features and Outcome. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.3353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Martinez-Valle F, Ramentol-Sintes M, Perez-Bocanegra C, Bujan-Rivas S, Vilardell-Tarrés M, Solans-Laqué R. AB0449 Isolated aortitis as an atypical presentation of giant cell arteritis. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2013-eular.2771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Labrador-Horrillo M, Ramentol M, Martínez-Valle F, Solans-Laqué R, Bosch JA. AB0049 Eotaxin is overexpressed in churg-strauss syndrome compared to allergic asthma. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2013-eular.2372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Pinal-Fernandez I, Solans-Laqué R. The ‘Sparing Phenomenon' of Purpuric Rash over Tattooed Skin. Dermatology 2013; 228:27-30. [DOI: 10.1159/000356779] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 10/18/2013] [Indexed: 11/19/2022] Open
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Solans-Laqué R, Fraile G, Coto R, Saez L, Rios JJ, Rodriguez M, Pasquau F, Zamora M, Calleja JL, Castillo MJ. SAT0173 Alveolar Haemorrhage in Anca-Associated Vasculitides: Cliical Features and Prognosis. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Solans-Laqué R, Sellas A, Ramentol M, Rodriguez-Fernandez B, Martinez-Valle F, Barcelo M, Farietta S, Bosch J. AB0707 Arthritis prevalence and biological markers in primary sjÖgren’s syndrome:. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Solans-Laqué R, Caminal L, Saez L, Rios J, Zamora M, Solanich X, Rodriguez M, Lopez-Dupla M, Castillo M, Fonseca E, Calleja J, Fanlo P, Abdilla M. THU0226 Clinical features and mortality causes in a large cohort of spanish patients with anca associated vasculitides. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Solans-Laqué R, Fraile G, Monteagudo M, Caminal L, Abdilla M, Fanlo P. SAT0174 Clinical and Histological Features in Patients with Permanent Visual Los Due to Biopsy-Proven Giant Cell Arteritis. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Ramentol-Sintas M, Martínez-Valle F, Solans-Laqué R. Churg-Strauss Syndrome: an evolving paradigm. Autoimmun Rev 2012; 12:235-40. [PMID: 22796280 DOI: 10.1016/j.autrev.2012.07.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Accepted: 07/03/2012] [Indexed: 10/28/2022]
Abstract
The Churg-Strauss Syndrome is an ANCA-associated vasculitis, an inflammatory multisystem disease with preference to the respiratory tract. Peripheral and tissue eosinophilia are the pathological hallmarks of this condition. The etiopathogenesis is unknown but some cytokines appear to play a central role and could be targets for new therapies.
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Affiliation(s)
- Marc Ramentol-Sintas
- Research Unit in Systemic Autoimmune Diseases, Vall D'hebron Research Institute, Hospital Vall D'hebron, Barcelona, Spain
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Martínez-Valle F, Gironella-Mesa M, Solans-Laqué R. Avances en el tratamiento de la amiloidosis. Med Clin (Barc) 2012; 138:667-72. [DOI: 10.1016/j.medcli.2011.09.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2011] [Revised: 09/16/2011] [Accepted: 09/27/2011] [Indexed: 11/29/2022]
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Simeón-Aznar CP, Fonollosa-Plá V, Tolosa-Vilella C, Selva-O'Callaghan A, Solans-Laqué R, Vilardell-Tarrés M. Effect of mycophenolate sodium in scleroderma-related interstitial lung disease. Clin Rheumatol 2011; 30:1393-8. [PMID: 21881859 DOI: 10.1007/s10067-011-1823-1] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Revised: 05/17/2011] [Accepted: 07/22/2011] [Indexed: 11/29/2022]
Abstract
This study aims to determine the effectiveness of mycophenolate sodium (MS) in patients with scleroderma (SSc)-related interstitial lung disease (ILD). In a prospective observational study, we evaluated 14 consecutive SSc-ILD patients who were treated with MS for 12 months. The effect of MS on lung function was examined by using longitudinal data analytic methods. Wilcoxon rank-sum tests were used to examine the forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1) and diffusing capacity of the lung for carbon monoxide (DLCO) by pulmonary function testing. As a group, the median values for FVC, FEV1 and DLCO did not change significantly after 12 months of MS therapy and fulfilled the definition of stable disease by the American Thoracic Society. Individually, after 12 months of treatment, 6 out of 14 patients showed a pulmonary improvement defined as an increase of more than 10% in FVC, and 5 out of 14 patients remained stable. By contrast, the median FVC had declined a non-significant 7.2% from the previous 12 months before MS initiation. No significant drug adverse effects were registered. These prospective data suggest that MS is a safe and well-tolerated therapy for SSc-ILD patients, and it is capable of preventing functional pulmonary deterioration.
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Affiliation(s)
- Carmen Pilar Simeón-Aznar
- Internal Medicine Service, Hospital Universitario Vall d'Hebron, Passeig Vall d'Hebron 119-129, Barcelona, Spain.
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Solans-Laqué R, López-Hernandez A, Bosch-Gil JA, Palacios A, Campillo M, Vilardell-Tarres M. Risk, predictors, and clinical characteristics of lymphoma development in primary Sjögren's syndrome. Semin Arthritis Rheum 2011; 41:415-23. [PMID: 21665245 DOI: 10.1016/j.semarthrit.2011.04.006] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2010] [Revised: 03/21/2011] [Accepted: 04/03/2011] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To assess the risk and predictors of lymphoma development in a large cohort of patients with primary Sjögren's syndrome (pSS). METHODS Cox-regression analyses were used to study the predictive value of clinical and laboratory findings at pSS diagnosis, and Kaplan-Meier survival curves to compare survival probability between patients who developed lymphoma and the total cohort. Expected risk for lymphoma was calculated by comparison with the background population. RESULTS Eleven (4.5%) from 244 patients developed a non-Hodgkin lymphoma (NHL). Diffuse large B-cell and mucosa-associated lymphoid tissue lymphomas occurred at a similar frequency. Three (27.3%) patients died: 2 due to transformation from mucosa-associated lymphoid tissue to diffuse large B-cell. Purpura (HR 8.04, 95% confidence interval [CI] 2.33-27.67), parotidomegaly (HR 6.75, 95%CI 1.89-23.99), anemia (HR 3.43, 95%CI 1.04-11.35), leukopenia (HR 8.70, 95%CI 2.38-31.82), lymphocytopenia (HR 16.47, 95%CI 3.45-78.67), hypergammaglobulinemia (HR 4.06, 95%CI 1.06-15.58), low C3 (HR 36.65, 95%CI 10.65-126.18), and low C4 (HR 39.70, 95%CI 8.85-126.18) levels at pSS diagnosis were significant predictors of NHL development, but only hypocomplementemia and lymphocytopenia were independent risk factors. Hypocomplementemia was related to earlier development of NHL and higher mortality. The cumulative risk of developing lymphoma ranged from 3.4% in the first 5 years to 9.8% at 15 years. Standardized incidence ratio (95%CI) for NHL development was 15.6 (95%CI 8.7-28.2). CONCLUSIONS Patients with pSS have a 16-fold increased risk of developing lymphoma. This risk increases with time. Hypocomplementemia and lymphocytopenia at pSS diagnosis are the strongest predictors. Survival is clearly reduced in patients with hypocomplementemia. Indolent lymphomas tend to evolve over time toward a more aggressive histologic type.
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Affiliation(s)
- Roser Solans-Laqué
- Internal Medicine Department of Vall d'Hebron University Hospital, Barcelona, Spain.
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Solans-Laqué R, Bosch-Gil J, Canela M, Lorente J, Pallisa E, Vilardell-Tarrés M. Clinical features and therapeutic management of subglottic stenosis in patients with Wegener's granulomatosis. Lupus 2009; 17:832-6. [PMID: 18755865 DOI: 10.1177/0961203308089693] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [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
The objective of the study was to evaluate the clinical features, response to treatment, and long-term outcome of subglottic stenosis (SGS) in a series of patients diagnosed as having Wegener's granulomatosis (WG) at a single institution. Subglottic stenosis developed in 6 out of 51 (11.7%) patients, in four of them in the absence of other features of active disease, and was the symptom that leads to WG diagnosis in three cases. In two cases, SGS began while the patients were receiving systemic immunosuppressive therapy for disease activity involving other sites. PR3-ANCAs were positive in four cases. An urgent tracheostomy was needed in two patients. Four patients achieved SGS clinical remission on standard treatment with glucocorticoids and cyclophosphamide, but three of them experienced repeated local relapses and required additional immunosuppressive therapy and mechanical dilations. In one case, a local relapse was successfully managed with endotracheal dilation of the stenotic segment and intralesional injection of a long-acting corticosteroid plus mechanical dilation of the stenotic segment (ILCD) without adding supplemental immunosuppressant drugs. Two patients with isolated SGS were also successfully managed with ILCD alone and did not require the institution of systemic immunosuppressive therapy. One patient underwent open surgical repair when the disease was under control. Our data suggest that Subglottic stenosis often occurs or progresses independently of other features of active WG, and that ILCD may be a safe alternative to conventional immunosuppressive therapy in patients who develop SGS in the absence of other features of active disease, allowing reducing the treatment-related toxicity.
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Affiliation(s)
- R Solans-Laqué
- Department of Internal Medicine,Vall d'Hebron University Hospital, Barcelona, Spain.
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47
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Solans-Laqué R, Bosch-Gil JA, Molina-Catenario CA, Ortega-Aznar A, Alvarez-Sabin J, Vilardell-Tarres M. Stroke and multi-infarct dementia as presenting symptoms of giant cell arteritis: report of 7 cases and review of the literature. Medicine (Baltimore) 2008; 87:335-344. [PMID: 19011505 DOI: 10.1097/md.0b013e3181908e96] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [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: 11/25/2022] Open
Abstract
Cerebrovascular accidents (CVAs) and multi-infarct dementia have rarely been reported as presenting symptoms of giant cell arteritis (GCA), although 3%-4% of patients with GCA may present with CVAs during the course of the disease. We describe 7 patients with biopsy-proven GCA who presented with stroke or multi-infarct dementia. Most of them had other symptoms of GCA when the disease began that were misdiagnosed or not noticed. The internal carotid arteries were involved in 4 patients and the vertebrobasilar arteries in 3, with bilateral vertebral artery occlusion in 1. Small cerebral infarction foci on cranial computed tomography (CT) scan and magnetic resonance imaging (MRI) were found in 5 cases, and cerebellar infarction, in 2. MR angiography showed intracranial arteritis in 4 cases. Treatment with glucocorticoids and adjunctive antiplatelet or anticoagulant therapy was given in all cases, with neurologic improvement in 5. Two patients died. Necropsy demonstrated generalized GCA involving the medium and small cerebral vessels in 1 case. Central nervous system involvement is a rare complication in GCA but is important to recognize, as it can be reversible if diagnosed and treated promptly. Suspicion should arise in elderly patients suffering from strokes with a quickly progressing stepwise course and associated headache, fever, or inflammatory syndrome. In these cases, temporal artery biopsy should be performed without delay. Early diagnosis of GCA and immediate initiation of corticosteroid treatment may prevent progressive deterioration and death. Additional antiplatelet or anticoagulant therapy should be evaluated according to the individual risk and benefit to the patient under care.
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Affiliation(s)
- Roser Solans-Laqué
- From Internal Medicine Department (RS-L, JAB-G, MV-T), Neurovascular Unit of Neurology Department (CAM-C, JA-S), and Pathology Department (AO-A), Vall d'Hebron University General Hospital, Barcelona, Spain
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Simeón-Aznar CP, Fonollosa-Plá V, Tolosa-Vilella C, Selva-O Callaghan A, Solans-Laqué R, Palliza E, Muñoz X, Vilardell-Tarrés M. Intravenous cyclophosphamide pulse therapy in the treatment of systemic sclerosis-related interstitial lung disease: a long term study. Open Respir Med J 2008; 2:39-45. [PMID: 19340324 PMCID: PMC2606648 DOI: 10.2174/1874306400802010039] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2008] [Revised: 04/29/2008] [Accepted: 04/29/2008] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Interstitial lung disease (ILD) frequently complicates systemic sclerosis (SSc). Cyclophosphamide (CYC) is a promising immunosuppressive therapy for SSc-related ILD. Our objective was to investigate the effectiveness of an intravenous CYC (iv CYC) pulse regime in SSc-related ILD during treatment and thereafter. METHODS In a prospective observational study ten consecutive patients with SSc-related ILD were treated with iv CYC in a pulse regime lasting from 6 to 24 months. Clinical status, pulmonary functional testing (PFT) and high resolution computed tomography (HRCT) of the chest were evaluated at enrolment and 6, 12 and 24 months thereafter. After treatment withdrawal, patients were followed up every 6 months with PFT and chest HRCT to monitor lung disease. RESULTS Clinical improvement was apparent in 8 out of 10 patients. The median values of forced vital capacity (FVC), forced expiratory volume in the first second (FEV1) and diffusion lung capacity for carbon monoxide (DLCO) as well as ground-glass pattern on HRCT did not change significantly after 6, 12 and 24 months of therapy. The follow-up continued in 8 out of 10 patients after treatment withdrawal for a median of 26.5 months (range: 12-48 months). The final median FVC was 54.5% of predicted value (interquartile range, IQR= 31.6%-94%). Only one patient suffered a FVC deterioration greater than 10%, even though less than 160 ml. The final median DLCO was 68% of predicted value (IQR=38.3-83.6%). Only 2 patients who developed pulmonary arterial hypertension deteriorated their DLCO values of more than 15%. CONCLUSIONS An iv CYC pulse regimen over 24 months may stabilize pulmonary activity in patients with SSc-related ILD during the course of treatment and for a median of 26.5 months thereafter.
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Affiliation(s)
- C P Simeón-Aznar
- Internal Medicine Department, Vall d Hebron Hospital, Autonomous University of Barcelona, Bellaterra, Spain.
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Solans-Laqué R, Bosch-Gil JA, Pérez-Bocanegra C, Selva-O'Callaghan A, Simeón-Aznar CP, Vilardell-Tarres M. Paraneoplastic vasculitis in patients with solid tumors: report of 15 cases. J Rheumatol 2008; 35:294-304. [PMID: 18085729] [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: 05/25/2023]
Abstract
OBJECTIVE To review all cases of concurrent vasculitis and solid tumors diagnosed at our Department over a 15-year period and explore evidence that would support the notion of vasculitis being a true paraneoplastic syndrome. METHODS We reviewed the records of all patients diagnosed with vasculitis and solid tumors within 12 months of each other and prospectively followed until death or our report. We analyzed the main features and outcome of vasculitis in this setting. We also reviewed all cases published in the French-English literature. RESULTS Fifteen patients (9 men and 6 women) in whom both vasculitis and solid tumor occurred within the same 12 months were identified. Mean age was 72.5 years (range 58-84). In 7 cases the diagnosis of vasculitis antedated that of cancer, in 6 both processes were synchronously diagnosed, and in 2 vasculitis appeared after cancer diagnosis. The most common vasculitis was cutaneous leukocytoclastic vasculitis (n = 9). Other vasculitides included Henoch-Shönlein purpura (n = 2), polyarteritis nodosa (n = 1), and giant cell arteritis (n = 3). The commonest malignancies were carcinomas of urinary organs (40%), lung (26.7%), and gastrointestinal tract (26.7%). The median followup was 28.4 months (range 1-96). Thirteen of the 15 patients demonstrated concordance of disease activity and treatment response for both cancer and vasculitis. Vasculitis flared heralding tumor recurrence or progression in 7 (46.6%) cases. CONCLUSION In our patients, resolution of vasculitis following effective treatment of the putatively linked malignancy, and recurrence of vasculitis heralding tumor recurrence or progression, provide strong evidence for vasculitis being a true paraneoplastic syndrome. Chronic or persistent vasculitis with poor response to usually effective therapy, especially in elderly patients, should raise questions about underlying malignancy.
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Affiliation(s)
- Roser Solans-Laqué
- Department of Internal Medicine, Vall d'Hebrón University General Hospital, Barcelona, Spain.
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Affiliation(s)
- Roser Solans-Laqué
- Servicio de Medicina Interna-Enfermedades Sistémicas Autoinmunes, Hospital Vall d'Hebron, Barcelona, España.
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